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In 1968, Dr. Morris Schaefer, a Professor and Head of Department of Public Health at UNC, Chapel Hill wrote a striking paper about the current issues in delivering better health services. He presented it at the 95th annual meeting of the American Public Health Association and many of what he shared then resonates with the state of public health today. In it he shared ‘how our incapacity to appreciate the character of the problems we face, may render us helpless when we encounter future challenges. Our field is not only confronted by new challenges, but also an increased urgency attached to old problems, new responsibilities, new functions, all at an increasingly rapid rates. Also with each
new challenge, comes the need to respond to continuing changes, all while maintaining the stability necessary for effective Public Health Service.’

If only our field heeded his advice in 1968. That and the idea that Public Health for better or worse is deeply enmeshed in political activity, despite the fact than antipolitical ideology persists. The handling of the pandemic is a glaring example of this. One section though that I choose to keep today is his focus on how ‘the past is still present.’ He was so thorough with the significance of the past and why we all need to have a reorientation in our attitudes about public health that it only makes sense to render it in verse for the present.

Without no further ado, read my keep below inspired totally by Dr. Schaefer entitled the ‘keep knowing that the past is present in public health:’

Public health faces a new day. While a hangover still remains.

Unsolved longstanding problems remain. Unfamiliar areas of services too.

Shortage of personnel remain. Solutions for the future too.

Conditions of uncertainty remain. Clamor for demands too.

Varied programs and goals remain. Complicated disciplines too.

Target populations remain unknown. The public we serve too.

Useful but limited textbooks remain. Old, standard associations too.

Struggles between agencies remain. Tensions across disciplines too.

Uneasy frontiers for public health remain. Uneasy boundaries between agencies and governments too.

Delusions of a old and well-propagated myth of the non-political character of public health remains. The persistence of the non politics myth too.

Lost opportunities remain. Lack of clarity of vision too.

Unsolved current problems still remain. An extension and intensification of past problems too.

Social problems significantly remain. The hands of the past on the future too.

Discerning local interests remain. Harmonizing initiatives too.

The need for imaginative and highly capable actions remain. Increased competency with information technology too.

Enormous strains on coordination remains. Responsibilities and resources too.

Long standing tensions among professional groups remain. Equal status of groups too.

The need for greater visibility with public health remains. Shortening lines of communications too.

Loss of potentially fruitful research remains. Duplicating research and services too.

Existing fragmentation of agencies remain. Business as usual too.

The urgency of problems affecting particular groups remain. Disruptive and limited responses too.

Struggles for allocations remain. Visibility and authorizations of those allocations too.

And so the continuing problems of the past remain. In the midst of new problems too.

Limited understanding of the persistence of these problems remain. So too our inability to solve them still (whether in 1968 or 2021).

Dr. Morris Schaefer address on current problems and issues with public health.

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Go close to lions, even if afraid, at least you’ll be close to lions. Reach above the stars, even if you fall, at least you’ll land on stars. Run fast with wild deers. Even if you loose, at least you ran with deers. Fly high with eagles, even if you tire, at least you flew with eagles.

These are the life lessons i’m learning these days. A reminder to myself to always stay close to lions. Ooh yes that me, my early research days, being close to the king of the jungle himself.

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Maybe we should have talked more often. I should have asked more questions too. Not just hello, or how are you or Ke maka Di gi, or Chekwube? But have you checked your cervix lately? When was the last time you checked? Did you collect the sample by your self? What did the results say? Why are you still bleeding then? Fibroids will not cause you to bleed this long. Treatments are deficient, I know, but what did the doctor say? It’s a developing country and cancer is a death sentence. Maybe, just maybe if I had asked these questions always, all the time, then maybe Angie would still be here. We would have found out early. Angie, would still be calling me, my name, Osodieme. Check your cervix, for Angie. For me.

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Henrietta Lacks is like all of us to the scientific landscape. Nameless, faceless, voiceless, with no power to make decisions with how we are viewed to the field. She didn’t have a say with her own unique cells. No wonder people distrust a paradigm that continues to treat people as if they have no name, no face, no voice, not even power. Until now. The past week has been surreal.

To give a quick background and this is from Yasmin Amer for NPR news: ‘In 1951, a Black woman named Henrietta Lacks walked into Johns Hopkins Hospital in agonizing pain. Doctors diagnosed her with cervical cancer. She died just months later. But what this mother of five never knew was that her cells would outlive her and be used to develop new drugs and vaccines…Her cells were the first known immortal cells. Whereas other cells died in the lab, hers thrived. They multiplied. They gave doctors the ability to do new, innovative research. Names and fortunes were built on them, nicknamed HeLa cells for Henrietta Lacks.’

Watching the Lacks family do their part to put a name, a face, a voice to cells used without permission is soul gratifying. To see the highest health organization in the world, the World Health Organization acknowledge that some injustice occurred in a field that preys on people for what what just is and not for their overall being, is also soul gratifying. Henrietta Lacks is no longer nameless, or faceless or even without voice because some voices, came together to say in harmony together, enough is enough. Enough is enough with treating people as if they were commodities in science. Treating them as if they were indispensable. Enough is enough with being faceless in science too. Enough is also enough with being voices with science. She matters just as everyone else matters as well. Science can no longer pretend as if it’s not in the business of people who have names or faces or voice. They do.

Every single person that interacts with the field has power even beyond science. We in the field are not the only ones that get to decide what has impact or who counts. They public had a critical say to advancing the field. They have a critical say with dictating how we best use our tools to serve them. And if and when we deviate from what is permissible, the public has a say with putting us right back in order. That is what Henrietta Lacks Family did for her this past couple of days. She may be long gone, but forever and ever we will say her name, see her face and know her voice. She was powerful beyond her wildest dreams and will remain so for as long as time permits.

The immortal Henrietta Lacks

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Love is the closest thing to heaven on earth. It’s the closet thing to what we all deserve, what we all dream to have. To love, be loved, and die loved. It’s the light we all need when surrounded by so much darkness. To light, be lit, and die with light. To let our light flow as we want it before we become dust to dust, ashes to ashes, keeps me focused on love. And this love will break all we know. Our hope, our beliefs, even our faith that tomorrow will be so much better than today. Love knows all things. Surpasses all things too. But love, breaks all things. It hard to write too because to love and be loved is like a willingness to break and be broken. I am thinking particularly of my children. I know they say there will be tough days but the past two months of caring for them fully have broken me down. Tears have rolled down my eyes and I too have asked myself whatever possessed me to have so many of them. Love remains the answer. Dreaming too.

Then there is work. My fourth love that seeks to be first. It constantly breaks my heart with every twists and turns, every attempts from others to dim my light for fear it may outshine theirs. In these moments I’m realizing that even love with work is only as great as the dreams that can be realized. The more beautiful the dreams, the greater the love. We focus too much on work as defined by others that we forget to dream. Rather than waste time with those who choose to dim the dreams, dim your light, it’s best to surround yourself with those who prefer to help you realize them, help you dream. We need more dreamers at work. For what we value for work, can only flourish and shine when it’s built on love, when it’s built on dreams.

I have been dreaming lately of a new kind of work, dreaming of raising the possibilities of work built on love. Not just one that reflects what I currently do, but one willing and committed to transforming work beyond what I do, even if it breaks me down. I have also surrounded myself with dreamers, a rare group of people willing to transform all we know about the work we do. We are in love, this group and I. I expect one day that our love too will break us. Yet we choose to dream. For that is the hallmark of what it takes to love, be loved and die loved. Also what it takes to light, be lit and die lighting our paths, our own way. We choose to dream so our love, our destiny can unfold. For we know that even with this work, even with the willingness to be broken, there are fragments of paradise, fragments of light pushing through that refuse to be hidden. We are pushing through these dreams knowing we are loved. Knowing too that we maybe broken. Yet we keep dreaming. Keep dreaming with those who choose love.

P.s this keep was inspired by Ben Okri’s A Time for New Dreams, my muse these dreaming days.

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First day blues. Today was the first day since I last taught a class, a little over a year ago. It’s seems like a long time ago. My mindset begins blues. My mind was set on new ways to cultivate this course, elevate this class too. We are heavy on Sinek. Start with why, my forever muse. It’s a grant writing class. So finding why, is what I forever choose. The golden circle my forever mood. Behind the scenes, though, three children were sick with cold. Something viral in the air with all the back to school blues. I caught it too. Still we proceeded with today, nervous as ever, for every start of a new semester, a new set of blues, new set of rules and tools, for weary souls. There is still a pandemic too. Yet we begin, as if my world has not been turned upside down since August, as if these blues have not depressed my mind. We moved with ease too. Seeing new faces, new minds to cultivate, bring joy for this call to elevate. Never want to get to the top without minds we elevate. So I settled down to reach each one, as best as I could, with stories that would help shift minds as best as it could. We don’t teach here. We reach minds. There were talks of failure as an opportunity. My stories through academia are ripe with failures. Lavish ones to boast of. Of ways to fail eloquently, yet rise still eloquent, for the call to elevate minds is a movement, a moment so full of eloquence. There were peaks and valleys or stories of moments of joy, moments of despair through this process of cultivating minds. They loved it. This isn’t a grant writing class I said. It’s one where we throw all rules out the door. For to be the best at this, to truly work to cultivate minds, you will need to elevate minds to think outside the box, outside all they have stocked in neat piles about grant writing. I don’t do piles. I don’t teach either. Just stories. Every grant is a storytelling tell to me. So we begin there, with your why story. They smiled. I smiled too. We are hooked. First day blues keep me smiling all day too. Day 1 down, 12 more to go. Keep first day blues with new classes.

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Yesterday I listened to a conversation with black youth that changed my life. I have lived but not with intent and purpose until this past year. Not even with an unwavering commitment to becoming anti-racist in my work until recently. Granted the pandemic and the George Floyd killing and protests played a role, but connecting with people, some new, some old, some unexpected has made me into a woman with vision, conviction too of what to do to bring radical healing to all black youth. I am prepared to work with anyone interested in creating a space for black youth to reimagine a better way for their health. I am prepared to support them so they can act on whatever vision they want for their health.

Prior to the start of the summer, I was part of a group that wrote a radical proposal to bring healing and transformation to a generation in desperate need for their voices to be heard. This call for radical healing is part of what Dr. Shawn Ginwright advocates in his book Black Youth Rising. He calls for the use of unconventional strategies that inspire youth to act towards personal restoration for their health and wellness and demands institutional change and justice for all black youths. Moreover when communities come together, when we do so with the sole objective to thrive and not merely survive, Dr Ginwright suggested that these new approaches will not only rebuild hope, but will also foster healing from years of oppressive social, economic, educational conditions. We were sold and wrote our proposal with his emancipatory vision in mind. The grant reviewers thought otherwise and didn’t even discuss our grant. To them what we proposed, that black youth may have the audacity to rise and act to resist social marginalization while confronting inequities with their health wasn’t transformational enough. We respectfully disagree. Yesterday proved we are on to something.

Though we were not successful, one thing we did not do ourselves was listen to black youth themselves beyond the articles we read and reviewed. We did so yesterday. I am forever in awe and totally grateful for the insight 6 black youth shared with us yesterday. They were open. Nothing out of the ordinary, but with their unique voices and perspectives with life often not represented in our public health field. They felt heard and seen. Felt loved too and protected. They dreamed of dreams they felt could be achieved and healing they desperately want to achieve. We listened under the guidance of Alexis, our extraordinary tour guide, as they shared parts of themselves they felt society fails to recognize exists. By the time our one hour meeting was over, I was ready to scream, shout too, with an eloquent rage. Enough is enough. Black youth, all youth need anti-racist response to their health. Not the response that is tokenism, or a space filler, or even top down and carried out by so-called experts, myself and those in my field included, but the one they control. They would do it for free too if we let them. We are prepared to do so. The details are still murky, but our vision is clear. There is a need for black youth to rise. A black youth rising movement too with health. We are ready to start the journey with them. Join us if you may. Or watch as we finally create a platform where all black youth, all youth can arise. Either way, we are prepared to ensure they arise.

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For trees, storms are a matter of life and death. Peter Wohlleben, the New York Times author of the book ‘The Hidden Life of Trees’ briefly stated why in his beautiful book. Winds blowing 60 miles an hour can uproot a tree, pummeling mature trunks to nothingness with forces equivalent to 220 tons. Trees that are unprepared fall. The pressure is enormous. Forest floors sink to nothing too within minutes. But some trees, like deciduous trees, withstand the pressure. They do so as a community, helping each individual tree swing back and forth depending on the direction of the moving winds. While some trees are straightening themselves after the first gust of wind, others may have sprung back quickly, absorbing and distributing the strong gust of wind throughout the tree. The result is that each tree gets help, depending on the way the wind blows and despite the storms. So too is death of a loved one.

Some of us are still struggling, barely a week later. I am one of them. I can’t seem to think straight these days without wishing that this is a terrible dream and waking up is just around the corner. It isn’t and the idea of never speaking again to Angie just keeps me in awe of life. Others are still asking questions, revisiting how we got here, how we didn’t know, how she never let on about the pain she was in. And she was in pain. Imagine, everything, all your vital organs giving away, and you have no single pain medication to cope with the onslaught your body must be going through. She was rather a tough woman and a fighter till the end, always saying she felt better, thus making it seem we had time. It wasn’t until she saw her mother, that I knew we were really at the end. I will never forget how she called her and called her and she never answered or how Angie cried when she finally saw her mother by her bedside. For sure, I am in the struggling camp. I am also in the camp prevention and camp advocacy now. I never really paid attention to cervical cancer until now. I am ready for the battle. Like trees, I am prepared for the storm ahead too with prevention in a country where many people still have no idea that HPV vaccines exist or that you should be checking your cervix once you turn 30 years old. We have lots of work to do. And as a community, we will bend whatever way the wind blows as a community and individually so no other woman or girl gets cervical cancer. Until then, keep swinging back and forth like trees on a windy day, to end cervical cancer.

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Last week the U.S Surgeon General issued an advisory that declared ‘misinformation as a public health threat.’ In a blue document with massive bold letters in white, he argued that we need to begin the process of confronting misinformation by ‘building a healthy information environment.’ I was intrigued and kept scrolling down the document to understand for myself what he meant by the terms ‘a healthy information environment.’

I also welcomed the invitation to ‘limit the spread of health information as a moral and civic imperative that will require a whole-of society effort.’ His words. The table of contents seemed easy to follow with suggestions on the ‘what’ people can do whether as individuals or educators or journalists or even funders and of course the government. There was even a ‘where do we go from here’ section that increased my curiosity with the report. But from the first page, the background, the report lost me and I am sure the public. None of this centered the ‘public’ in public health.

There is a reason why health misinformation is so rampart these days and it has nothing to do with long backgrounds, even those focused on correct health information. We fail and continue to fail the ‘public’ if the words we use to speak to ‘public’ doesn’t include language or even tools that makes sense to the ‘public.’ I wanted to root for this document because of the seriousness of the topic, because this is literally a life and death matter and people, black and brown lives are dying everyday because of health misinformation.

Then it dawned on me, if I took a camera and walked down the streets of Harlem or Newark, or Augusta, or Pittsburgh, or even went to stores like Sam’s Club or Costco, would people be able to tell me what if anything they remembered from the Surgeon General’s advisory. Would they even know it exists?

There in lies the dilemma with health misinformation. While the public health experts are so focused on what it is or what it is not, the ‘public’ is focused on the why in the forms of stories they pass on to each other, through words and languages and other mediums that make sense to the ‘public.’ There is a reason why social media is widespread and content is viewed as powerful. People are expecting from public health, serious comments about their lives using tools and language that make sense to the ‘public,’ that speak to the ‘why.’ They are not expecting the ‘what.’ They are expecting connections, truths, even art and spoken words that say things important to help them with life, their health. The sooner we understand the ‘why’ of health information, the quicker we can begin to center the ‘public’ in public health. This is what is meant by public health to me these days, a deliberate focus on the public’s health, not by us the experts but by the public first.

We spend too much time focused on the ‘what’ of health that we forget the ‘why’ in public. There is a reason why stories live on long after the storyteller has ended the story. We can start there by bringing back stories to public health. Poetry too. As a tool, whether spoken or listened too, poetry can humanize us, make us whole, both emotionally and intellectually. Art can do the same. Art for and by the public can be intentional and life-sustaining with centering the public in public health. While letters to the public, like a ‘Dear Public Health’ can help the public confront the worst so as to be free to experience the best that is unshakable in public health, the ‘public.’

It is always about the ‘public’ after all. Our future depends on listening, seeing, feeling, daring even to center the ‘public’ in public health. We are all amplified when we center the ‘public’ in public health. That should have been the main crux of the advisory, a foundation through which to dismantle the public health threat that is health misinformation. We have miles to go but if we want to end this war, as it’s a war to, with casualties increasing everyday, the ongoing pandemic being a clear example, then we have got to bring back the ‘public’ in public health.

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My life is not my own. So I give myself away so you can use me. This song by William McDowell is my keep as I start this week. This is the week where I learn whether it’s time or not for God’s plans to be fulfilled in his child. So if God then is for me, who can be against me, is the song I sing. If God is with me, whom shall I fear when everything is by his design. Also the fact I could never make this on my own. So I literally give myself away.

When I look back over all I have done the past few months, I realize with each passing day that I never could have made it without God. So giving myself to him is easy. He has always been before me. Psalm 139 reminds me that he knew this week, this day would come when I was still being formed in the womb. That’s the part that keeps me in awe, win or lose. Everything is according to his design. There is no one like him. Who can ever stop us when our God is greater, stronger, higher than anything even awesome in power. It has always been about him after all. It’s his plans, it’s his work, it’s his words, all written through me, but for his glory.

I am stronger because he allowed me to use the gifts he gave to me for his glory. I am wiser because I would do it again whether I fail or even win. I know how to still win even when I fail. That part keeps me grounded. Failure is always an option with God on your side. It’s all for his glory still and I am just a vessel that he uses to bless his children, uses to light a path, blaze a road through a vast forest of nothingness. I could not do any of this without him ordering every single step. So win or lose, being discussed or not, is all a reminder that if he is for me, who can be against me. If he is for me, whom shall I fear. And if no one knows me, he still adores me and I will do my part to remain his light. For a city built on a hill cannot be hidden. I cannot be hidden. Keep giving yourself away to God.

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I remember the day we met. I was summoned to a meeting at a faculty office by the Director of Health for Student Services. He was a close friend to my family. I say summoned because I tried to excuse myself from it. My excuses too were valid as I was on maternity leave. I just had my second child a month ago. I knew he meant well when he said it was for a student and she needed help. I arrived at his office promptly. Something about helping out a student in need keeps me standing always. Upon my arrival, I met the student and her uncle. They explained her situation and asked if I would take her on as a mentor for her masters degree. I felt I had no choice seeing that I was summoned and reluctantly said yes. I had no clue as well where to begin, as I would be on maternity leave while she navigated being a student. That was nearly seven years ago.

Today, that student, boarded a plane to begin her tenure-track career as an Assistant Professor at Wake Forest University. Our relationship has now come full circle. We worked together extremely well in ways that make me even wonder how I would fare as she leaves. I remember the beginning days of writing with her. She has always been a writer but need a little bit of finesse. It took time, with revisions, and discussions, all from a place of wanting to bring out the best in her. She listened, revised, listened some more and wrote and wrote.

These days, all I do is give a sense of the topic, and she is off soaring. I don’t even have to discuss much, let alone revise. It’s perfect. That’s what I mean by full circle. That as mentors, those we guide, will do better than us, greater than us even, and beyond our wildest reach, our deepest depths. I have come across mentors who prefer you remain a mentee. Some are also willing to stifle your drive because you dared to thrive. Possibly without them too. Yet, they too forget, that the greatest gift they can give to those they guide is the circle. Once it’s complete, mentees should become ready to soar, even if they stumble along the way. Still rise on eagle’s wind and soar.

That’s my keep for you today. That as you start this new journey at Wake Forest, as you close one chapter of your life and open another, that as you complete this circle and begin another, that you will always rise like an eagle and soar to new heights. Reach to for what is highest within your capacity and quietly make your name known. You may be overlooked, even underestimated but the future belongs to those who dare fly. Fly Dr. Ucheoma Nwaozuru. It’s your future.