We must rewrite our stories to question assumptions about our own actions, intentions and values, and every taken for granted about others, particularly those with less power (patients, students, less dominant colleagues), and every unthought-through acceptance of the status quo, even that seemingly written in stone. And we must elicit and listen to the responses of peers. Listening critically to the stories of those peers also enables developmental learning from their experience. It is the exploration of experience, knowledge, values, identity that matters, rather than any attempt to arrive at a ‘true’ account (Doyle 2004).

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” Margaret Mead.

The woman who raised me
turned and said, don’t be scared
I’m your mother, I’m here, I won’t let them through.
My mama gave me conviction.
Women like her
Inherit tired eyes,
Bruised wrists and titanium plated spines.
The daughters of widows wearing the wings of amputees
Carry countries between their shoulder blades.

- Emtithal Mahmoud

Hakim

The wise. The learned.

Those who profess to favour freedom and yet depricate agitation are people who want crops without ploughing the ground, they want rain without thunder and lightning, they want the ocean without the roar of its many waters ... Power concedes nothing without a demand, it never has and it never will.
Frederick Douglass 

When spider webs unite, they can tie up a lion.

Ethiopian proverb 

A question of politics

Let us teach both ourselves and others that politics does not have to be the art of the possible...but that it also can be the art of the impossible, that is, the art of making both ourselves and the world better.

Vaclav Havel, President of Czechoslovakia,1990 

"Corn taught us Mayan people about community life and its diversity, because when one cultivates corn one realizes that there is a variety of crops such as herbs and medical plants depending on the corn plant as well. We see that in this coexistence the corn is not selfish, the corn shows us how to resist and how to relate with the surrounding world.”

Mayan community leader.

You Belong

Worn, wooden houses stand apart in space only the States could afford,

on their open porches fly flags waving majestically as if they were privy to your pending arrival.

Floorboards creek where forgotten footsteps rise to greet the expectant crowd,

the door blows open, and for a moment time stops-

rewinds, and adjusts while family members reacquaint.

You sink into the sofa kept warm in your absence and it becomes your throne for the night,

like a safety belt clicking into place, everything fits; there is a context to your madness.

Before long your humor crescendos feeding off the encouraging giggles of others,

jokes roll off your tongue as if comedy were your native language; you tease in a way only family can.

Next, dinner is served; no need for official welcomes – the food gleams with love,

home cooked meat is devoured and the bones are licked, sucked then polished clean in salutation.

Snippets of news are exchanged over the table then quickly forgotten,

instead stories are recounted; scenes brought to life as clear as your sister’s perfect pitch in song.

I watch you unwind in a home bubbling with memories, noise and laughter,

like sunshine reflecting off water, your family beams with pride to see who you have become.

They are as implicit in your success as you are in theirs,

And whether your stay is a handful of days or weeks that overspill into months, in this home you will always belong.

Honour your own struggles.

"Who are we - who am I to intervene in other people's lives when we know so little about any life, including our own?"

Rahnema

Sillage

The scent that lingers in the air, the trail left in water, the impression left in space after something or someone has been or gone; the trail of perfume.

Love Liberates

Two years de vuelta.



http://www.filmsforaction.org/watch/love-liberates/
Maya Angelou

"Walk as if you are kissing the Earth with your feet."  — Thích Nhất Hạnh

"Let gratitude be the pillow upon which you kneel to say your nightly prayer."  — Maya Angelou

Jamil "Oh my god, you're almost ready for America."

“You pierce my soul. I am half agony, half hope...I have loved none but you.”

Jane Austin

 "A little knowledge that acts is worth infinitely more than much knowledge that is idle."


Kahlil Gibran

“Every profession bears the responsibility to understand the circumstances that enable its existence.” 

― Robert Gutman

¿Por que Ahora?

Solo rodando por el mundo, 

con un dolor profundo 

y sin poder llorar. 

Luego la escarcha de los años, 

cubriendo como un paño 

mi angustia y mi penar. 

¿Por qué esperaste tanto tiempo para irte? 

¿Por qué dejaste que tu amor me corroyera? 

Pudiste hacerlo más humano 

y despedirte mas temprano 

y mi vida no muriera. 

Ahora te vas en Primavera, como si no supieras 

que para mí es mortal. Ahora ya es tarde y 

siento pena mi alma está muy llena de 

tí y de tu mal. 

Porque jurabas que me amabas sin sentirlo 

cuando enredabas mi cabello con cariño. 

Pudiste haber parado a tiempo con decirme, "Mira, Niño 

es un juego y nada mas." 

Ahora te vas en Primavera, 

como si no supieras 

que para mí es mortal. 

Ahora ya es tarde y siento pena 

mi alma está muy llena 

de tí y de tu mal. 

Porque jurabas que me amabas sin sentirlo 

cuando enredabas mi cabello con cariño. 

Pudiste haber parado a tiempo con decirme, "Mira, Niño 

es un juego y nada mas."

congruent

in agreement or harmony

The art of practice

“I believe that we learn by practice. Whether it means to learn to dance by practicing dancing or to learn to live by practicing living, the principles are the same. In each, it is the performance of a dedicated precise set of acts, physical or intellectual, from which comes shape of achievement, a sense of one's being, a satisfaction of spirit. Practice means to perform, over and over again in the face of all obstacles, some act of vision, of faith, of desire. Practice is a means of inviting the perfection desired."

- Martha Graham (world-famous choreographer and dancer)

The battle for compassion

"I believe this is our role in life, to take pleasure in one's own resistance and take responsibility to be an agent of positive change"

http://www.filmsforaction.org/watch/the-battle-for-compassion-2015/

"Electric communication will never be a substitute for the face of someone who with their soul encourages another person to be brave and true" - Charles Dickens

"es mejor saber nada que saber cosas que no son."

"The world doesn't change one person at a time. It changes as networks of relationships form among people who share a common cause and vision of what's possible."

Fernando Botero

Rather than creating works of art purely made to shock and provoke a certain reaction, Botero seeks to provide a sense of tranquillity and joy through much of his art – as the artist said himself, ‘art should be an oasis, a place of refuge from the hardness of life.’ 

‘an artist is never complete.’

"A riot is the language of the unheard."

 MLK Jr.'s "The Other America" 1968. 

"you were not wrong for leaving
you were wrong for coming back
and thinking
you could have me
when it was convenient
and leave when it was not"

rupi kaur

Dear George, 

Glad to see you're repairing all the church roofs in the UK, they can home all the homeless people and the food banks families are now attending since your party arrived in power. Thanks for all the tax cuts, can you ask your mates to give some of their savings to the people who longer can afford to eat? Really pleased to hear the supplementary charge on North Sea oil producers is being reduced, that will make such a difference to global warming and the every day family's living allowance. And your innovative 'internet of things', what an apt example of being able to control both our fridges in our two separate kitchens from one mobile phone, what genius! It's what people have been telling me they need in Catford all year. PS thanks for trying your utmost to protect the national health service, I know big businesses always have the public's best interests at heart and the massive disinvestment in our local services will do it the world of good. All the best for the next general election.

Your disheartened citizen,

Simone

¿Quién decide los limites de la libertad de expresión

La libertad parece un tema sencillo. La mayoría de la gente tendría que estar de acuerdo que todos merecemos la libertad. Sin embargo, cuando hablamos de la libertad de expresión hay más dudas que certezas; ¿qué exactamente es la libertad de expresión y que conlleva? Al contrario de tener respuestas, surgen muchas preguntas que uno tiene que considerar.

En primer lugar, ¿a quién otorgamos la libertad de expresión? ¿A quién debemos dar un espacio para hablar? ¿A todos? Eso significaría incluir a la gente racista, los fascistas, y los extremistas. Y si estamos de acuerdo que hay algunos grupos o temas que no debemos tocar, ¿quién decide cuáles son estos grupos y estos temas? ¿Quien sería aquel que controlaría o dictatorial a quién tiene libertad y quién no. ¿Quién decide que es la discriminación o es solamente una diferencia de opinión?

Bajo la ley de La Igualdad de 2010, en Inglaterra, se protege nueve características de grupos de personas contra la discriminación. Los características incluyen: genero, orientación sexual, religión, raza, la maternidad y reasignación de genero. ¿Cual es el significado de esta ley para la moralidad y la libertad de expresión, están relacionadas el uno con el otro? ¿Impediría la libertad de expresión si no podríamos hablar mal de estos grupos?

Hay algunos casos recientes que reflejan las cuestiones morales y filosóficas que surgen de todas de estas preguntas importantes.

Le Pen del partido extremo derecha de Francia vino a Inglaterra el año pasado para participar en un debate en la universidad de Oxford. Este evento fue cancelado a ultima hora porque había muchas manifestaciones contra este debate. Le Pen regreso a su país y según algunos con un argumento mas valido, que el estado y la sociedad están matando la libertad de expresión. ¿Que hubiera pasado si este evento se hubiera llevado acabo? Aparentemente impidiendo su participación no significaría que hemos influido en sus creencias; lo apuesto, ahora hemos dado mas leña al fuego. Si hubiéramos escuchado su punto de vista, tal vez habríamos aprendido mas sobre su forma de pensar, sus razones de pensar así y de esta forma buscar estrategias para evitar el crecimiento de esta ideología en Inglaterra. De esta forma, nosotros hubiéramos conseguido mas aceptación y no este grupo político.

Mi gran pregunta (entre muchas pequeñas preguntas) sería ¿quién pone los límites de la libertad de expresión? ¿Quien decide quién tiene la razón o no, a quién dejamos hablar y a quién no?

Aunque yo creo tener certeza sobre los principios fundamentales de justicia en este mundo, a la vez reconozco que todos tenemos diferentes experiencias, diferentes formas de pensar y creencias. Lo que no ofende a uno ofende a otro. Según esta forma de pensar ¿cómo se podría manejar la libertad de expresión en nuestra sociedad tan diversa como la que es hoy? Si protegemos algunos grupos ¿por qué no podríamos proteger las religiones y sus profetas? Si los símbolos nacionales son sujetos de protección por qué no los partidos políticos?

Creo que una buena base para marcar los parámetros seria los derechos humanos. Si damos por cierto que todos debemos respectar los derechos humanos, por el entendido que son principios globales adoptados por los Naciones Unidas,  entonces debemos limitar a aquellos que hablan en contra de los derechos humanos o atentar contra ellos. Los derechos humanos junto con la ley de La Igualad formarían una buena base y una matriz legal para delimitar la libertad de expresión.

En conclusión, como aparentemente tenemos una base común sobre cuales son los limites la libertad de expresión, ahora la discusión tendría que ser entorno  a la pregunta: ¿hasta donde llega estos limites?  Entonces les pregunto de nuevo, ¿cuáles son los límites de la libertad de expresión?

Simone

La mujer del viento

Here is a poem I wrote for Anne Marie’s Birthday last year to try and express what an impact our friendship had on me, and on my experience of Guatemala. Anne Marie, our fortuitous crossing may have been ephemeral but your influence continues to enrich my life back in the UK, as I’m sure you are enriching the lives of others wherever you are.

La mujer del viento.

Mujer del viento, viniste del norte con una brisa fresca, trayendo el sol al sur.

En el momento que yo lo más necesitaba, llegaste a Guatemala para llenar mi vida con luz y amor. 

Nos deleitábamos con música, comida y baile, disfrutando de todo lo bonito, olvidando momentáneamente lo que es difícil y duro en este país.

Yo había encontrado una cómplice para compartir la vida acá, estos días eran inolvidables.

Cuando te fuiste de Guatemala el invierno llegó, la lluvia ahogó mi corazón con una tristeza pesada porque no estabas cerca. La primavera eterna se había ido en el viento contigo.

Pero en aquellos meses y los años que seguían aprendí mucho de ti. Aprendí apreciar la tranquilidad, el arte, la poesía, la pintura, la fotografía y la escritura. Aprendí a escuchar a la madre tierra y a mi propia voz.

Anne Marie tu espíritu brilla desde el fondo de tu alma e iluminas todo  lo que tocas.

Ahora has encontrado una pareja para compartir tu hermoso camino y no hay mayor satisfacción que ver a una amiga encontrar su media naranja.

Ahora habrán dos llamas brillando juntos en el viento.

Simone

The Hermit

Even though we are often surrounded by other, we always must follow our own paths.

today's thought.

Today I visited a day centre for adults with disabilities while offering invaluable respite for their carers. I spoke to people who had felt suicidal before they started attending the day centre. People who were isolated at home with no way of leaving the house and noone who could support their complex needs. At the day centre they spend time together, learn new skills and enjoy themselves for a few hours despite facing many difficulties. Soon they will no longer be able to go, the latest of many closures due to government budget cuts. Our local council has been forced to reduce their budget by 90 million, and as ever it's the most vulnerable that suffer. Day centres for the disabled, physically and mentally, breast feeding groups, Sure Start centres, older people's homes, mental health support services for young people and adults, dial a ride transport, it's all suffering. Why? Four years ago we voted for a government that doesn't believe we have a responsibility to look after our most vulnerable, we voted for a party who preferred to save us all a few pounds by taxing us a little less. We all need help at some point in our lives; as children, as parents, for our parents, for our grandparents. We can change things, vote for party who is willing to invest in health, education, social care, community. I URGE YOU TO REGISTER AND VOTE. YOUR VOTE COUNTS. 

Someone of the same race, the same birth, the same, society, but who doesn't know what nature requires of him. But I do. And so I'll treat them as the law that binds us-the law of nature-requires. With kindess and with justice.

Book Threee Meditations

Don't waste the rest of your time here worrying about other people- unless it affects the common good. It will keep you from doing anything useful. You'll be too preoccupied with what so-and-so is doing, and why, and what they're saying, and what they're thinking, and what they're up to, and all the other things that throw you off and keep you from focusing on your own mind.

Book Three Meditations

Remember how long you've been putting this off, how many extensions the gods gave you, and you didn't use them. At some put you have to recognise what world it is that you belong to, what power rules it and from what source you spring; that there is a limit to the time assigned you, and if you don't use it to free yourself it will be gone and will never return.

Book Two: Marcus Aurelius

Health for All in Primary Healthcare esay

Our course lecturer for Health for All, Henry Perry said, “the term primary health care means many things to many different people”. According to this premise we must acknowledge that Health for All through primary health care will need to be approached and implemented differently depending on the local context.

I currently work in an urban setting in southeast London as a community engagement officer in the health and community sector. Before this I worked in rural Guatemala supporting an indigenous women’s organisation that operated a small-scale rural healthcare programme. These are two very different realities yet both have relatively poor health outcomes for their local populations. I hope to use the knowledge gained from this course to improve health outcomes for local communities, here in the UK and abroad in Guatemala. In this essay I will consider three actions that I want to take as a result of having taken this course. I will also discuss some of the barriers and challenges that I might encounter while suggesting possible solutions to overcome these challenges.

 Actions

I will take action to increase the awareness of the reality of access to primary healthcare for the majority of the developing world while promoting the effectiveness of the Health For All approach to primary care to my wider network here in the UK and abroad. 

One specific activity will be to advocate taking this course, and the principles that I have learnt with two international students currently working with my organisation who are from Sierre Leon and Nigeria studying a Masters in Hospital Administration in London. They were placed with Healthwatch to better understand the importance of valuing the patient experience, and what can be achieved through working with and empowering the patient. The students have expressed that there is a organisational culture in their countries to implement top down approaches to healthcare dominated by international donors’ objectives while the local community’s needs are overlooked or dismissed. Dr. Abhay Bang from Last Mile Doctors and Carl Taylor’s approach, one of the founders of Health for All is to ‘begin with the people’.  I will use examples of success from this course such as Brazil and Bangladesh to illustrate the importance of working with local communities. I will also provide examples of the impact patient and community involvement have on improving health outcomes in primary care and the wider health system through my own experience working in Healthwatch. These two students will then take this learning back to their universities and prospective countries to achieve Health for All through primary health care. 

I intend to use the approaches and successes in projects like Jamakhed and BRAC to help develop a new project within my role at Healthwatch on a new project called ‘Breathing Well”. As part of the project we have to train volunteer ‘champions’ to promote healthy living lifestyles, identify people who have breathing difficulties and signpost them to the appropriate service or health facility. This model reflects that of Dr. Abhay Bang from Last Mile Doctors said ‘go where there are problems rather than where the facilities are’. This is a key principle in Health For All for primary healthcare. We intend to train local volunteers who are active members of the diverse communities of the borough. They will  provide signposting to primary healthcare services, identification of illness, and promote healthy living lifestyles in a way that is easy to understand to their own community members. Although we are not short of health facilities in the UK in comparison to countries like India or China, there are issues around access for those living in deprivation or for those who have English as a second language. It is hoped that by using community champions, which have a similar role to the Community Health Workers in projects like Jamkhed, will improve health outcomes and reduce health inequalities in the borough.

The champion role is very similar to the role of Community Health Workers which feature as a key player in health for all. We will train local actors to take on the role of health promoters to reach the most marginalised communities. In particular for those communities who have considerable barriers to access healthcare, for example for people who do not speak English as a first language. Seeing the success of BRAC in Bangladesh, I am hopeful that this new way of working will bring success for our Breathing Well project.

 I plan to return to work with AMA (the indigenous women’s organization in Guatemala) as part of my Masters programme in Participation, Power and Social Change. AMA already applies many of the approaches that Henry Penry highlights in our course: full community involvement, addressing the health priorities as identified by the community, intersectional work, and training local actors to provide care in the community to name a few. They also promote the use of traditional Mayan health practices where appropriate, such as the Mayan sweat baths and the use of herbs to assist in childbirth. Utilising and building on local knowledge is something Carl Taylor advocates in his lecture of the history of primary healthcare for all in week two. With the knowledge from this course, I can assess where if at all the health programme can improve. Retention of volunteers is often a challenge for the organisation which we learnt from examples in the course can be overcome by using financial incentives, providing regular training, and holding weekly meetings. I will also promote the concepts of Health For All to other projects based in Guatemala with whom I come into contact. All too often foreign NGOs use top down approaches relying on outside aid and foreign staff capacity. This model is not sustainable and does not adequately involve the agency of local communities.

 Challenges/obstacles

Volunteer retention is a challenge for most projects, I envision this being a difficulty in the Breathing Well Project. Volunteers who are easier to find for ‘champion’ roles such as this one tend to be involved in many different projects and therefore have limited time for an additional role or ‘burn out' from too many commitments. In BRAC Community Health Workers are required to have 10 years experience and be over 25 years old to qualify. As an organisation we need to be selective in terms of who we choose although the restrictions might differ to BRACs to adapt to the local context. We need to consider using community leaders who have strong links to their communities so that they are unlikely to leave the area while having a personal investment in making the project a success. We could also consider financial incentives as a tool to improve volunteer retention.

 As we saw through the lectures in the course, funding is always an issue. Funding programmes under primary healthcare is a challenge because there are less ‘quick wins’ like some of the top down disease-orientated models where outcomes are clearly visible relatively quickly. AMA has historically struggled to fund their Mayan Health programme over projects like the ‘smokeless cook stoves’ because they are more tangible and therefore more appealing to donors. Another personal action will be writing a paper to promote the benefits of using the concepts of health for all primary care in Guatemala. The paper can be shared with donors and I will highlight successes in countries like Brazil and Bangladesh drawn from the course’s resources.

Lastly, I foresee a challenge in trying to implement my learning within AMA because of my identity as a foreigner, and the fact that I am not medically trained. AMA’s methodology, quite rightly applies the principles of community development: local actors are the agents of change in their own communities. Therefore it would not be appropriate for me to attempt to implement lessons learned from this course, that is the job of the locally trained community facilitators. However, persuading donors of the importance of funding approaches like Health For All is appropriate and extremely useful. This will be another action I can take forward thanks to this course.

To conclude, I have identified three if not more actions to take forward as a result of this course, I have analysed the potential challenges involved in applying these actions, and I have suggested how these challenges can be overcome. As I discussed at the beginning of this essay, “the term primary health care means many things to many different people”. Therefore our role as advocates and leaders in Health For All must to be to share the principles of Alma ATA and this course with local partners, while empowering them to adapt and apply the principles to the local context in an appropriate, effective, and sustainable way.

I don't wanna bore you with it but...

https://www.youtube.com/watch?v=UwSuPXMHhaE

The woods are lovely, dark and deep.
But I have promises to keep,
And miles to go before I sleep,
And miles to go before I sleep. 

Robert Frost, whose words resonate more than ever at the moment.

" There is no universal solution, but there is a universal process to find appropriate local solutions."

Carl Taylor

Sometimes novels are considered 'important' in the way medicine is - they taste terrible and are difficult to get down, but are good for you. The best novels are those that are important without being like medicine; they have something to say, are intelligent but never forget to be entertaining and to have character and emotion at their centre. Harper Lee's triumph is one of those.

Chimamanda Ngozi Adichie

https://www.youtube.com/watch?v=fQrBbY7hhS4


Where did you go? I don't know
Nick Hakim

Slow me down, Lord

Slow me down, Lord. 
     Ease the pounding of my heart by the quieting of my mind. 
     Steady my hurried pace. 
     Give me, amidst the day's confusion 
     the calmness of the everlasting hills. 

     Break the tension of my nerves and muscles 
     with the soothing music of singing streams 
     that live in my memory. 

     Help me to know the magical, restoring power of sleep. 
     Teach me the art of taking minute vacations.... 
     slowing down to look at a flower, 
     to chat with a friend, 
     to read a few lines from a good book. 

     Remind me 
     of the fable of the hare and the tortoise; 
     that the race is not always to the swift; 
     that there is more to life than measuring its speed. 
     Let me look up at the branches of the towering oak 
     and know that ... it grew slowly ... and well. 

     Inspire me 
     to send my own roots down deep... 
     into the soil of life's endearing values... 

     That I may grow toward the stars of my greater destiny. 

     Slow me down, Lord.

From Killnarney Catherdal, Ireland

¨Siempre es relativamente siniestro volver a lugares que han sido testigo de uninstante de perfeccion¨

Ernesto Sabato por medio de Heidi. Que palabras mas astuto para ayudarme comprender y acostumbrar que mis veintes y la epoca chapina se ha pasado.

'How do you know what to do? How do you ever know?'

'You don't. I don't, said Muiris, coming forward. 'You ask for prompts, I suppose, don't get any and then just pick one thing or the other. Anything can happen. It's all chance.'

Four letters of love.

He would be fine, she told him and opened her mouth wide in the hope of freeing the balloon of guilt caught in her midriff.

Four letters of love

“Nothing great was ever achieved without enthusiasm”

Ralph Waldo Emerson

Ethereal

Extremely delicate and light in a way that seems not to be of this world.

"her ethereal beauty"

synonyms: delicate, exquisite, dainty, elegant, graceful, beautiful, lovely

Ursula craved solitude but she hated loneliness, a conundrum that she couldn't even begin to solve.

Life After Life

"Become such as you are, having learned what that is." Having found this beautiful quote by Pindar at the end of my novel, 'Life After Life' I think this is the perfect affirmation with which to end 2014, the year of many transitions, and to begin the New Year in 2015.