Tag Archives: health

Glass, Wood, Animals, Books: The wonders of old pharmacies

Only a thin line separated alchemy from old pharmacies once. Apothecaries (who only later became the mystery-stripped ‘pharmacies’ or even worse ‘drug stores’) once contained wondrous collections of barrels, bottles, alembics, retorts, crucibles, pestles and mortars, animals whose bodies and bones were crushed and used in medicines. Of the medieval collections in Krakow’s Pharmacy Museum, the notes quote Shakespeare:

I do remember an apothecary—
And hereabouts he dwells—which late I noted
In tattered weeds, with overwhelming brows,
Culling of simples. Meager were his looks,
Sharp misery had worn him to the bones,
And in his needy shop a tortoise hung,
An alligator stuffed, and other skins
Of ill-shaped fishes; and about his shelves
A beggarly account of empty boxes,
Green earthen pots, bladders and musty seeds,
Remnants of packthread and old cakes of roses,
Were thinly scattered to make up a show.
–Romeo & Juliet, Act 5, Scene 1
This is Krakow’s museum in a nutshell. From the medieval section:

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Cabinets of poisons clearly marked to avoid accident:

Museum of Pharmacy, KrakowMuseum of Pharmacy, Krakow

Great vaulted cellars, full of more wondrous things, above all the medicinal wine, either steeped in herbs or to be later mixed with dried herbal powders:

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

We found this hidden round a corner. I don’t even know what this is.

Museum of Pharmacy, Krakow

Old water distillers, coloured glass vials, presses, alembics:

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

 

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

As time moved on, techniques became refined, the furniture in polished inlaid wood of the Baroque or the Biedermeier style, the glass neatly labelled:

Museum of Pharmacy, Krakow

Rows and rows of canisters in glass and porcelain sitting above wonderful drawers of uniform shape, all rescued from old apothecaries across the city and brought here:

Museum of Pharmacy, Krakow

Hirudines! Aka leeches. A collection of more mortars and pestles, pictures of leading pharmacists of Krakow and their documents now of historical relevance rather than professional necessity:

Museum of Pharmacy, Krakow

Enormous mortars and pestles. And oh, my love for bottles and small labelled drawers full of strange powders and herbs and medicines overfloweth:

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Old books are here also, with velveted covers:

Museum of Pharmacy, Krakow

Wooden boxes of superb craftsmanship filled with strange bottles and implements for the storing and mixing of musk:

Museum of Pharmacy, Krakow

Stoppered bottles of vibrant colour that make my heart beat faster:

Museum of Pharmacy, Krakow

Clear glass of strange shape and design:

Museum of Pharmacy, Krakow

Strange scissors of a shape perfectly crafted to an unknown task, old herbals, locked and keyed and made into beautiful works of art:

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

A map of plants and the ‘world’ as it was once believed to be:

Museum of Pharmacy, Krakow

Prescriptions

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Tiny glass vials and velveted boxes of syringes used and reused.

Museum of Pharmacy, Krakow

Cork-crushers and medicine makers

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Herbs and storage

All found in the attic, where warmer and dryer air might do their work:

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

Museum of Pharmacy, Krakow

This is one of my favourite places in this city, and I will be writing more because this only scratches the surface of the apothecarial wonder.

Also, please let us resurrect the term apothecary and use it more in everyday life.

I shall end with another quote from the museum, this from Gabriel Garcia Marquez, One Hundred Years of Solitude:

The rudimentary laboratory—in addition to a profusion of pots, funnels, retorts, filters, and sieves—was made up of a primitive water pipe, a glass beaker with a long, thin neck, a reproduction of the philosopher’s egg, and a still the gypsies themselves had built in accordance with modern descriptions of the three-armed alembic of Mary the Jew. Along with those items, Melquíades left samples of the seven metals that corresponded to the seven planets, the formulas of Moses and Zosimus for doubling the quantity of gold, and a set of notes and sketches concerning the processes of the Great Teaching that would permit those who could interpret them to undertake the manufacture of the philosopher’s stone. Seduced by the simplicity of the formulas to double the quantity of gold, José Arcadio Buendía paid court to Úrsula for several weeks so that she would let him dig up her colonial coins and increase them by as many times as it was possible to subdivide mercury. Úrsula gave in, as always, to her husband’s unyielding obstinacy. Then José Arcadio Buendía threw three doubloons into a pan and fused them with copper filings, orpiment, brimstone, and lead. He put it all to boil in a pot of castor oil until he got a thick and pestilential syrup which was more like common caramel than valuable gold. In risky and desperate processes of distillation, melted with the seven planetary metals, mixed with hermetic mercury and vitriol of Cyprus, and put back to cook in hog fat for lack of any radish oil, Úrsula’s precious inheritance was reduced to a large piece of burnt hog cracklings that was firmly stuck to the bottom of the pot.

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Root Shock pt 2 — Struggle and the Aesthetics of Equity

Root Shock - Mindy Thompson FullilovePsychiatrist Mindy Fullilove’s Root Shock doesn’t just explore the costs of displacement to the consciousness of the individual and the collective, but also looks at struggle on multiple levels. First, though, lets just revisit her framing of the issue:

When all the fancy rhetoric about “blight” is stripped away, American urban renewal was a response to the question, “The poor are always with us, but do we have to see them every day?” The problem the planners tackled was not how to undo poverty, but how to hide the poor. Urban renewal was designed to segment the city that barriers of highways and monumental buildings protected the rich from the sight of the poor, and enclosed the wealthy center away from the poor margin.(197)

I also like this fundamental insight:

In the peculiar calculus of American racism…white people must occupy whole parts, like a whole row of bus seats or a whole neighborhood. As soon as any black people enter, the whole is spoiled, and the white people must either eject the black people…or move away themselves. (225)

The most basic means of struggle against such a calculus is that as an individual or group, in the form of political direct action. She talks about what fighting back means to people, quotes testimony from trials:

Gladys Moore on the Montgomery Bus Boycott: “Well, after so many things happened. Wasn’t no man started it. We all started it overnight. (emphasis added) (40)

Jo Ann Robinson, in her memoirs: “The one day of protest against the white man’s traditional policy of white supremacy had created a new person in the Negro. The new spirit, the new feeling did something to the blacks individually and collectively, and each liked the feeling. There was no turning back! There was only one way out–the buses must be changed!” (41)

She also talks about the healing process that occurs through collective struggle, which is nice to hear from a medical professional:

As a public health psychiatrist, I believe that healing a group’s psyche occurs through a collective process that requires organizing ways in which people come together to learn facts, share ideas, raise questions, and search for solutions. (180)

Near the end of the book she lays out a series of workshops done with community members. The first used an idea she called ‘The Community burn Index’, used to measure the damage to the neighbourhood lot by lot, charted through a community mapping exercise where small groups walked street by street telling stories and really seeing their streets and homes. I quite loved what this revealed:

I learned something about the difference between interiority and exteriority when it comes to what we see. People who are insiders to a place stop seeing it. It is a hand part of human consciousness that many things–including the scenery we look at every day–slip our of awareness in to the vast pool of rote activities and knowledge.

People who are outsiders to a place see it as a landscape. they are inhibited from seeing what they’re really seeing, but in their case it’s not because it’s new. Rather, we have another handy mental device for decoding places we’ve never been to before, and that is stereotyping… Oddly enough, neither the inside nor the outsider has the foggiest idea what he is look at. (185)

It is coming together to really look, to see things in the moment as they are, to tell stories, to talk to each other, that they helped each other really see what was there, what was no longer there.

That’s powerful, no?

They repeated this exercise with people from all over Pittsburgh, trying to build connections not just between residents and their built environment, but between people from other neighbourhoods and this particular neighbourhood so long cut off from the city. Through the eyes of a French planner and architect, they realise that this is a neighbourhood that once had multiple entries and exits and paths down the hill to the river, and all of them had gone, sealing them off from the rest of the city.

It is through discussions with this same architect, Michel Cantal-Dupart, that Fullilove proposes a new framework for analysing and resolving issues created by development. She calls it the aesthetics of equity, and it holds some interesting ideas I think. In summary:

Principle One: Respect the Common Life the Way you Would an Individual Life (199)

There is always a common life, whether or not you can see it right away. My own aside — people in power never see it.

Principle Two: Treasure the Buildings History Has Given Us (199)

If only planners had ever done that…instead we work with what they have left us, and I think this is key:

The solution to the “many centers” problem lies in improving the connections among them. The passerby must be able to figure out how to move among the jumble of squares. We need images that compel transition, promote flow, and permit movement from one place to another. We need a permeable city, safe not because of its walls, but because of the engagement of its citizens, each and every one a guardian of the public piece/peace. (204)

Here Fullilove edges towards all the wonderful literature studying how buildings and planning create environments that foster and build community.

Principle Three: Break the Cycle of Disinvestment (204)

I suppose here is where my study of political economy makes me a little skeptical that this could happen without one hell of a fight that is more transformative than anything we’ve seen before. But I write too much about that elsewhere. Still, it is fundamental to these dynamics, and needs to be understood just as much as everything else here.

Principle Four: Freedom of Movement (205)

Hell yes. This has never really existed in the U.S. for non-whites. But there’s a funny section here on the massive gardens of André Le Nôtre built for French aristocrats and the Sun King himself. I feel strongly about such gardens that use perspective to show power and wealth and the subjection of nature, so it’s interesting to be challenged here with a sentence that says 

Perspective creates both the intimacy of “here” and the wonder of “there”. It allows rest and dwelling, but it also encourgaes exploration and travel… Perspective is, at heart, a democratic tool, because it is a linking tool. (208)

I think Gordon Cullen explores this quite beautifully in the townscape in ways that show just how much about power and wealth those damn gardens really are. But point taken in the abstract. I think Cantal has some odd views being passed along here, as Haussman is praised a little further along for his vistas and opening up of the city, and that just makes me a little sad without acknowledging the massive displacement, the purpose of making the poor easier to control and send them to the peripheries.

Still, I quite like these four principles. Just as I do the idea that people should be able to take city spaces and make it their own.

I also like the thought she ends with:

We are somewhere on the dwelling/journey spiral. We have all been forced from home but non of us has yet reached safety. We might choose to continue to proceed in blindness. But we might also recognize that we can use the journey to create the arrival of our dreams in the community of all of us.

Let us listen to the bell; it tolls for us. It’s time to go home. (239)

 

 

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Root Shock pt 1 — Urban Renewal and Public Health

Root Shock - Mindy Thompson FulliloveThis is one of the few books that really tries to come to grips with the deep psychological trauma caused by mass displacement — what it calls Root Shock. It does so through the prism of urban renewal and reminds us of the scale of it. The program ran  from 1949 to 1973, and during this time the U.S. government bulldozed 2,500 neighborhoods in 993 cities, dispossessing an estimated million people. They were supposed to be slum clearances, they were supposed to create space for new housing. Few of these clearances did, and we are still coming to grips with what was lost. But there is a bitter truth behind the switch from ‘urban’ to ‘Negro’ removal — it is the Black community that lost the most and that continues to be most impacted by it all.

What was it, then, that was lost?

…the collective loss. It was the loss of a massive web of connections–a way of being–that had been destroyed by urban renewal; it was as if thousands of people who seemed to be with me in sunlight, were at some deeper level of their being wandering lost in a dense fog, unable to find one another for the rest of their lives. It was a chorus of voices that rose in my head, with the cry, “We have lost one another.” (4)

I like this understanding of it. I also quite love that despite a clinician trying to deepen our understanding of the psychological impacts, she maintains a larger understanding of just what is happening.

This process taught me a new respect for the story of upheaval. It is hard to hear, because it is a story filled with a  large, multivoiced pain. it is not a pain that should be pigeonholed in a diagnostic category, but rather understood as a communication about human endurance in the face of bitter defeat. (5)

And you know I love the spatial awareness that has to be part of this, because it is a physical loss of building, home, neighbourhood, as much as a loss of connection.

Buildings and neighborhoods and nations are insinuated into us by life; we are not, as we like to think, independent of them. (10-11)

So how does Fullilove define Root Shock?

Root shock is the traumatic stress reaction to the destruction of all or part of one’s emotional ecosystem. It has important parallels to the physiological shock experience by a person who, as a result of injury, suddenly loses massive amounts of fluids. Such a blow threatens the whole body’s ability to function…. Just as the body has a system to maintain its internal balance, so, too, the individual has a way to maintain the external balance between himself and the world. This way of moving in the environment…. (11)

It is not something that is experienced right away and then disappears.

The experience of root shock–like the aftermath of a severe burn–does not end with emergency treatment, but will stay with the individual for a lifetime. In fact, the injury from root shock may be even more enduring than a burn, as it can affect generations and generations of people.

Root shock, at the level of the individual, is a profound emotional upheaval that destroys the working model of the world that had existed in the individual’s head. (14)

This book is interladen with quotes and stories from people Fullilove worked with, she cares like I do to let people speak for themselves about their experience. She quotes Carlos Peterson, on the bulldozing of his neighbourhood:

‘My impression was that we were like a bunch of nomads always fleeing, that was the feeling I had.” (13)

There is Sala Uddin, who remembered urban renewal first with approval — the new homes they were getting, then:

Critiquing his own earlier enthusiasm, he pointed out to me, “We didn’t know what impact the amputation of the lower half of our body would have on the rest of our body until you look back twenty years later, and the rest of your body is really ill because of that amputation.

The sense of fragmentation is a new experience that we can now sense, that we didn’t sense then. We were all in the same location before. Now we are scattered literally to the four corners of the city, and we are not only politically weak, we are not a political entity. We are also culturally weak. And I think that has something to do with the easiness of hurting each other. How easy it is to hurt each other, because we are not that close anymore. We are not family anymore. (175)

Because she is able to listen, she is able to describe the ways that people are connected both to buildings, but also to each other. I love how from multiple angles, the human connections to the earth, to the built environment and to each other always emerge as key to lives well-lived, whether looking at permaculture or public space or psychology:

This lesson of interconnectedness is as hard to learn as differential calculus or quantum mechanics. the principle is simple: we–that is to say, all people–live in an emotional ecosystem that attaches us yo the environment, not just as our individual selves, but as being caught in a single, universal net of consciousness anchored in small niches we call neighborhoods or hamlets or villages. Because of the interconnectedness of the net, if your place is destroyed today, I will feel it hereafter. (17)

This brings a new look at Jane Jacob‘s street ballet, where

you are observing the degree to which people can adapt to different settings, and not just adapt, but attach, connect. They are connecting not to the negatives or even the positives of the setting, but to their own mastery of the local players and their play. (19)

I am quite intrigued by this idea:

Instead, the geography created by dispersal-in-segregation created a group of islands of black life. “Archipelago” is the official geographic term for a group of islands. Black America is an archipelago state, a many-island nation within the American nation. The Creation of the archipelago nation had two consequences for African Americans. The first is that the ghettos became centers of black life; the second is that the walls of the ghetto, like other symbols of segregation, became objects of hatred. In this ambivalent, love/hate relationship, it was impossible to chose to dwell. Yet people did choose to make life as vibrant and happy as they possibly could. (27)

This feels particularly true of earlier periods when the colour lines were hard and fast and patrolled by white mobs and white gangs and the use of violence. When green books were necessary when travelling to know where to stay, what to eat safe from the oceans of white hatred (too far? Not in terms of the hatred, but maybe in terms of metaphor…) When the ghetto walls were high and strong and each brick legally protected, which is part of the story and the trauma of urban renewal’s root shock. For so long people faced the choice: to fight to improve the ghetto or the fight to leave it. Regardless, she captures something of what the ghetto cost the city as a whole:

Segregation in a city inhibits the free interaction among citizens and invariably leads to a brutality and inequality, which themselves are antithetical to urbanity. When segregation disappears, freedom of movement becomes possible. that does not necessarily mean that people will want to leave the place where they have lived. The ghetto ceases to be a ghetto, it is true, but it does not stop being a neighborhood of history. Postsegregation, the African-American ghetto would have been a sight for imaginative re-creation , much like the ghetto in Rome. (45)

She writes later on:

The divided city is a subjugated city. (164)

The tragedy always was this inisght, again from Jane Jacobs  (as summarised by Fullilove):

A slum would endure if residents left as quickly as they could. A neighborhood could transform itself, if people wanted to stay. It was the investment of time, money  and love that would make the difference. (44)

That was almost never allowed to happen. Instead neighbourhoods were bulldozed — and again there is the comparison to rubble left by war, similar to Dybek, to Gbadamosi:

Indeed, in looking at American urban renewal projects I am reminded more of wide-area bombing–the largely abandoned World War II tactic of bombing major parts of cities as we did in Wurzeburg, Germany and Hiroshima, Japan–than of elegant city design. (70)

It was done in the most destructive way possible:

Even though the basis for compensation was gradually extended, the payments continued to be linked to individual property rights. Collective assets — the social capital created by a long-standing  community–were not considered in the assessment of property values. (79)

There is not enough on why I think, which limits the section thinking through what we can do to stop it. But there is this quote from Reginal Shereef, who studies the effects of urban renewal on African Americans in Roanoke:

“But the reality of urban renewal was that cities wanted to improve their tax base. And that is my interest. I have always looked at the intersections between public policy and economics. And what happened in Roanoke was neighborhoods was torn down so that commercial developers could develop prperties and sell it to private interests…” (98)

Part 2 looks at some of the positive ways to think of community, ways that we can work to preserve and improve our neighourhoods. But I’ll end this with one of the lovelier expressions of what home means to people, this from resident Dolores Rubillo:

“People know, you know where you are–” and, leaning in to me added, “you are safe in the dark.” (127)

 

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Memories from Beryl Knotts: Meals on Wheels begins and more

[My interview with Beryl Knotts inspired me immensely, especially after so much reading on the East End and writing about Fr John Groser and his work there, so I thought I would repost this blog I did for St Katharine’s]

Beryl Knotts first interviewed for a position at the Royal Foundation of St Katharine in November of 1953. It all happened quite by accident too — having left school at sixteen to take care of her mother, Beryl first trained and worked for three years as a secretary in two posts in London and Woking. For her third job, she went to inquire at the Tavistock Appointments Bureau, but unwittingly went into the “graduate” section by mistake! Although she had no degree, the woman behind the desk took the time to help her anyway, and recommended she apply for a secretarial job at the national office of the Training and Personnel Department of the YWCA in Baker Street. Thus she began a lifetime committed to social work, as, in due course, the YWCA staff recommended her to move to the work of the Stepney Old People’s Welfare Association then developing at St Katharine’s to get hands-on experience in community work.

20150714_153339She had never been to the East End before, and remembers the fog and the Dickensian feeling of the place, with St Katharine’s an oasis of warmth and light in the middle of a bombed out city. Cable Street was narrow and grimy then, taking a different route past St Katharine’s than it does now. I’ve found an old map from Fr. John Groser’s history of St Katharine’s distributed at the time. It shows the old buildings that once stood here, and also marks the memory of our local train station as Stepney East.

Beryl worked for the most part with Dorothy Halsall, one of the two sisters living and working here as part of the St Katharine’s community. The other was Ethel Upton. There were also two brothers at the time, Brother Bernard from the ministry in Peckham, and Brother De Jong, a layman. Jean Denford was Fr. John Groser’s Secretary, and also an assistant to Dorothy Halsall.

Apart from the main buildings there was a big yard, and alongside it a cottage where for a while Tom lived, a Canadian worker-priest who had committed his life to serving his vocation through work in the factories. He married Sherry and they lived there together, Sherry becoming a model of generosity for Beryl (and now for myself, this is an ideal I love but hard to reach in this day and age I think). Sherry would always begin cooking the evening meal for say four, but as people dropped by they were always invited to stay until it often became eight or more. No matter how many came they would manage to provide them a meal, though the soup might be a bit watery. What food there was would always be stretched to include everyone.

After commuting from Woking for six months, Beryl moved to Bethnal Green — in those days, the wonderful St Margaret’s Settlement provided not just community services but also rooms for 25 young people, half of them students and half of them working in the East End. As part of their life there, they had to do some social work in the local area. Beryl had the most delightful story of the first time she was sent to visit an elderly lady in a second floor flat. Beryl Knotts knocked and this lady (who had clearly met several social researchers in the area before!) answered with ‘Come in love, and I’ll answer all yer questions’ (even though Beryl was just a ‘visitor’!). This lady always gave her great big mugs of very strong hot tea, and her generous but practiced and humorous answer showed perhaps something of how it was to be in an over-researched area of social deprivation as the East End tended to be in those post-war years.

Even so, both the deep commitment to the work and the warm fellowship that arose between the young people living at St Margaret’s and serving the community emerged clearly through our conversation. So much so that I felt its loss deeply, and wish I might have been part of something like that. Beryl has still kept the sparkling sense of fun.

So the Stepney Old People’s Welfare Association. After the war, the housing in this area that hadn’t been bombed flat was often dangerously weakened, and had been in very poor condition even before the bombing started. For this reason, most of the young families were moved out further east towards Dagenham, leaving a disproportionately large proportion of the older age group suddenly alone and in bad housing, bereft of both the useful roles they might once have held in taking care of children or helping with the home, as well as the support and companionship of their families.

She remembers them very poor, very tough, and very strong. Above all her stories are humorous ones, life made better with laughter rather than tears, and hard times always lightened with a joke.

Across the span of sixty years some of these memories ring very clear. There was Alfie, an old docker whom she met in her very first week at St Katharine’s. His wife had just died, and he didn’t know what to do. Dorothy Halsall helped arrange a pubic health funeral for her, and in those days even such funerals involved a carriage and horses and plumes, the procession that stopped in every location that had been important to the person whose life was being celebrated and death being mourned. Alfie had wanted to buy her some flowers and found an old purse in which his wife had hidden away some £5 worth of savings.

He used all of it to buy daffodils, her favourites. The carriage was absolutely filled with daffodils when it stopped at the Hall at St Katharine’s, where she had found so much enjoyment.

The next week Alfie came in and asked them, ‘do you know a woman who would come and live with me?’

The old hall that once stood here sounds absolutely wonderful. They ran lots of clubs from it as well as elsewhere in the borough, including lunch clubs. Beryl remembered every Monday afternoon it was opened up for the elderly to come and play cards or dominoes, and have their tea and biscuits.

We have too few pictures in the archives, but I have found a couple proofs from the Old People’s Welfare Association Christmas Party of 1957. Although Beryl had left St Katharine’s by the end of 1956, most of the people would have been the same:

OPWSxmasparty1957web

Old People's Welfare Society Christmas 1957

Meals on wheels also got its start here at St Katharine’s, believed to be the first one in the country. They had a specially fitted van that would pick up food from a restaurant in Limehouse and deliver it through a rota of staff and volunteers to the elderly who were housebound Monday through Friday for which they paid three shillings and four pence a week (ten pence a day). These were always hot and fresh meals, meat and veg and lots of gravy, plus a pudding, on china plates that were returned the next day.

They came to realise that there were also a smaller number of Jewish elderly who needed the same services, but of course offered a special challenge because of requiring kosher meals and kosher service. Dorothy contacted the LCC for help, and they put her in touch with the Women’s Royal Voluntary Service. Somewhat to the amusement of the St Katharine’s staff, they sent an ex-service lady to discuss the programme. Beryl remembers her as someone who, although out of uniform, gave the decided impression that she was still wearing it! She linked them up with Jewish Board of Guardians, who were able to provide a rota of Jewish volunteers with private cars who would fetch the meals from a kosher restaurant in the area, and then deliver them each day to probably around twelve to fifteen homes.

Miraculously, Beryl didn’t think there had ever been any accidents with those meals, though the food was not nearly so secure as in the van they had for the main delivery. There was only one day where they didn’t have a Jewish volunteer able to come. She rang up the taxi rank at Whitechapel to find a Jewish driver, and with his help they were still able to provide the meals.

Beryl would also often take people’s pensions to them when they could not go for themselves to collect them, and Jean Denford would visit the housebound regularly who were referred (perhaps from the Clubs or local agencies) as having special needs. Beryl remembers the older people were always so very happy to see Jean, and just how dreadfully they missed their families.

It seems a very hard thing to have separated them from their families, hard on both sides and a great lesson to be learned there about how important those ties are to people’s wellbeing. This is especially poignant as we face much the same situation again for very different reasons, as the housing crisis is pushing younger families further and further away into London’s outskirts, leaving their elderly parents lonely and isolated in older neighbourhoods like Stepney, Wapping, Shadwell and Limehouse.

Another big issue they provided for here at St Katharine’s was the care of elderly people’s feet. In this very poor and ageing community people often couldn’t manage to take care of their own feet. Most of the people living here, and in the East End more broadly, had always worn second-hand shoes, had seldom had proper nutrition or medical care, and thus had multiple issues with their feet that often threatened their independence and mobility.

Once a week then, St Katharine’s brought in a chiropodist to provide free services — the only requirement for his patients was that everyone first went to the public baths just across the street.

Only last week I was in a meeting of health workers and local champions in Stepney, discussing the realities that with decreased funding available, older people are once again finding it impossible to access care for their feet such as supportive shoes, massage, nail-cutting services and the other things they need to help them stay independent and walk comfortably. Once more, charities serving the elderly as St Katharine’s once did are being asked to find ways to subsidise chiropody services.

Of all the ways that St Katharine’s could honor and revive all that it has done in that past, it is disappointing that we should have to consider anew providing such a service.

There are also, however, collective and the creative ways we could take as inspiration for moving forward that do not invoke a past many hoped we would have left long behind.

Father Groser quite loved acting, so they would put on plays — Beryl remembers once they hosted a performance of ‘Much Ado About Nothing’ in the open air garden. And of course his son Michael was a wonderful sculptor, another son, Tony, was an actor, and his daughter Gillian very musical, so life here had a very creative feel.

Like many people in our community, Beryl remembers the garden parties held here, and the old people’s parties (though you’d never call them that nowadays, she noted). The elderly often put together musical entertainments in the big hall, with sing-along numbers. There was even someone who would dance the can-can in union jack knickers. Mr Donovan was the M.C. with only one eye and no teeth. He was a proud member of the Queen’s Bays (the 2nd Dragoon Guards) and always wore the badge on his lapel. During the Queen Mother’s visit in November of 1955 (she wore a lovely pale mauve velvet coat, pearls and hat) — as the Bays’ Colonel-in-Chief she quickly recognized the badge and Mr. Donovan was absolutely over the moon, and told the tale for weeks afterwards!

St Katharine’s also followed many of the same patterns from year to year, a massive clean every March/April, where absolutely everything would be taken down, shaken out, and thoroughly cleaned — down to all the curtains taken down and washed and rehung even the great old curtains from the stage in the hall. St Katharine’s day on 25th November was also a very big event, with a service and a special meal cooked by Mrs. Pomfret — old Pom as everyone who worked there used to call her. The kitchen and dining rooms today are of course completely different different to what they once were, though more or less in the same place.

Beryl had found her old diaries, they sat in front of us small and worn, and she had noted down some of the many entries she had made so long ago to jog her memory about all that once happened here. It was marvelous of her to prepare so. There were a number of outings: one was to see the Queen’s homecoming at Westminster Pier after her world tour, there were others to Beaconsfield, Ramsgate, Knebworth Gardens, Southend for jellied eels. They sang all the way home from that one.

One summer evening they had what they called a ‘frail party’, with special transportation arranged by Jean Denford and volunteers from the Soroptimists Club (to which Dorothy Halsall belonged) to help a group of housebound elderly escape their own four walls for an evening. They had parties for the mum’s club, St Katharine’s club, a film night where they showed Isle of Summers.

They had an evening lecture called ‘The Social Consequences of the Present Housing Policy’ given by Arthur Blenkinsop, MP from Hull. Fr John Groser sometimes invited public school boys to debate with the dockers and the point of it was for the boys to hear about life from the dockers’ point of view.

We had a most wonderful session of reminiscing, Beryl and I, on a sofa at Friend’s Meeting House beside Euston Station, as she was only down for the day from Oxford. She only briefly let fall how in 1956 she went on to get her social work qualifications at Edinburgh University and LSE — inspired by, and perhaps also with some gentle pushing from Dorothy Halsall. She would have been quite happy, she said, to continue longer in the East End. With so much discussion of how St Katharine’s used to be, we had little time to talk more about her time in Brazil, and all she did upon her return to England and her work around the world, but I hope that we will meet again to talk more about that.

It was an inspiration to speak with her. It always is to meet people who embody a wonderful curiosity about the world alongside generosity and compassion. Especially those who have devoted their lives to making this world a better place. It is only as I was typing up my copious notes that I thought to look for her online, and found a short bio which she has forgiven me for including:

Beryl KnottsBeryl was brought up in a Congregational family and had early experience with the Surrey Congregational Youth Council. She trained and worked as a social worker in the UK and from 1966 to 1969 served as a UNA volunteer in Brazil. This led to 10 years international social work experience in Peru, Nigeria, South Sudan and Geneva, followed by 11 years with Oxfam, latterly in international human resources, until retirement in 1991. She was a URC Racial Justice Advocate, an avowed ecumenist and was a local Church Secretary from 1997 until 2011.

I had a lovely and inspiring time hearing all of her stories, and hope to hear more…

 

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Full Society, Healthy Lives: Thoughts on the Marmot Review

fair-society-healthy-lives-full-report-1In my mind there are two quotes that really encapsulate what the Marmot Review is. The first is the epigraph, and for me it was breathtaking to find it here:

Rise up with me against the organisation of misery.
–Pablo Neruda

The second? A clear outline of where exactly the researchers began:

The starting point for this Review is that health inequalities that are preventable by reasonable means are unfair. Putting them right is a matter of social justice. A debate about how to close the health gap has to be a debate about what sort of society people want.

Surely it is time we started there and moved forward. It does note (and I chuckled at this, I’m not sure why):

It is sometimes difficult for many people to accept that serious and persistent health inequalities exist in England.

By ‘many people’ I assume they mean the happy middle and upper classes with reasonable health. But on the other side of the class (and race and nationality and gender and sexuality) lines, it is no real surprise that the WHO (World Health Organisation) Commission on Social Determinants of Health should have ‘surveyed the world scene and concluded that “social injustice is killing on a grand scale.”‘ Is that the kind of world we support?

Most would answer no. I also think most would agree with this:

Economic growth is not the most important measure of our country’s success. The fair distribution of health, well-being and
sustainability are important social goals. Tackling social inequalities in health and tackling climate change must go together.

I like too this call to the health profession to begin to engage with the fact that our socioeceonomic position is more determinative of our health than any prescription or therapy that they can give  — as well as to policymakers and politicians to lower our NHS bills by increasing equality and opportunity in our society:

People with higher socioeconomic position in society have a greater array of life chances and more opportunities to lead a flourishing life. They also have better health. The two are linked: the more favoured people are, socially and economically, the better their health. This link between social conditions and health is not a footnote to the ‘real’ concerns with health – health care and unhealthy behaviours – it should become the main focus.

The two main policy goals they propose are these:

  • To create an enabling society that maximises individual and community potential

  • To ensure social justice, health and sustainability are at the heart of all policies.

Wouldn’t that be great? These break down into 6 more concrete policy suggestions (and these are made more and more concrete for implementation at the end of the report):

  • Give every child the best start in life

  • Enable all children young people and adults to maximise their capabilities and have control over their lives

  • Create fair employment and good work for all

  • Ensure healthy standard of living for all

  • Create and develop healthy and sustainable places and communities

  • Strengthen the role and impact of ill health prevention

The evidence they marshal in support of these positions is so impressive, beginning with the weight of these first two graphs as shown below. The first represents over ten years difference between the wealthiest and the poorest in how long they may statistically expect to live. Over ten years. More sobering, perhaps, is the number of years available to us to live  in fullness of life and health, without disability. For the very poorest, they can expect age and ill-health related disabilities in their early fifties — it breaks my heart.

For the heartless, imagine the fucking economic cost of that.

Direct NHS healthcare costs in England associated with treating the consequences of inequality amount to £5.5 billion per year for treating acute illness and mental illness and prescriptions.228 These activities represent approximately one third of the NHS budget. In consequence, it is likely that the full impact of health inequalities on direct healthcare costs is considerably greater than this.

The review also notes:

As further illustration, we have drawn on Figure1 a line at 68 years – the pensionable age to which England is moving. With the levels of disability shown, more than three-quarters of the population do not have disability-free life expectancy as far as the age of 68. If society wishes to have a healthy population, working until 68 years, it is essential to take action to both raise the general level of health and flatten the social gradient.

Ah, to be 68 and working for the bosses while disabled, I can’t wait.

fair-society-healthy-lives-full-report-18

The power of the second graph is the difference in mortality between regions. This also breaks my heart. Surely the point of a nation and a national government is to aim for some level of parity in opportunity and life.

The graphic below is  crazy too, it shows the effect of wealth and environment on intelligence (or at least, the ability to show intelligence through testing). This is about class and education, which of course intersects with health but also with our ability to become the person we want to be, live the lives we are capable of living. The review explains:

As Figure 6 shows, children who have low cognitive scores at 22 months of age but who grow up in families of high socioeconomic position improve their relative scores as they approach the age of 10. The relative position of children with high scores at 22 months, but who grow up in families of low socioeconomic position, worsens as they approach age 10.

fair-society-healthy-lives-full-report-24Are you ready to change the world yet?

From education you move into work — and poor people’s work is killing them. Worse, though, is that the lack of work is also killing them.

Getting people into work is therefore of critical importance for reducing health inequalities. However, jobs need to be sustainable and offer a minimum level of quality, to include not only a decent living wage, but also opportunities for in-work development, the flexibility to enable people to balance work and family life, and protection from adverse working conditions that can damage health.

Another graphic to blow your mind — the direct link between employment and mortality:

The dramatic increase in unemployment in the United Kingdom during the early 1980s stimulated research on the link between unemployment and health. Figure 8 shows the social gradient in the subsequent mortality of those that experienced unemployment in the early 1980s. For each occupational class, the unemployed have higher mortality than the employed.

fair-society-healthy-lives-full-report-28

It’s community that I’m most interested in, perhaps because I think it is a way to mitigate all of these things while we fight to make the world more fair, and because everything goes to show that the closer and more supportive a community is, the healthier its members are. Building that kind of community where I live and work feels like something I can actually do to make a difference (that and join a union). But thinking geographically, the physical neighbourhood we live in also has a huge impact on our lives, both in terms of quality and length:

In the poorest neighbourhoods of England, life expectancy is 67, similar to the national average in Egypt or Thailand, and lower than the average in Ecuador, China and Belize, all countries that have a lower Gross Domestic Product and do not have a national health service.

Now ain’t that something? Here’s another set of bullet points on environment and health:

  • The conditions in which people are born, grow, live, work, and age are responsible for health inequalities.

  • Early childhood, in particular, impacts on health and disadvantage throughout life.

  • The cumulative effects of hazards and disadvantage through life produce a finely graded social patterning of disease and ill health.

  • Negative health outcomes are linked to the stress people experience and the levels of control people have over their lives and this stress and control is socially graded.

  • Mental well-being has a profound role in shaping physical health and contributing to life chances, as well as being important to individuals and as a societal measure.

This evokes the complexities shaping these things a little better:

the distribution of health and well-being needs to be understood in relation to a range of factors that interact in complex ways. These factors include: material circumstances, for example whether you live in a decent house with enough money to live healthily; social cohesion, for example whether you live in a safe neighbourhood without fear of crime; psychosocial factors, for example whether you have good support from family and friends; behaviours, for example whether you smoke, eat healthily or take exercise; and biological factors, for example whether you have a history of particular illnesses in your family. In turn, these factors are influenced by social position, itself shaped by education, occupation, income, gender, ethnicity and race. All these influences are affected by the socio-political and cultural and social context in which they sit.

These are many of the things that determine where we live, and the kinds of support we can expect. Once our place of residence is decided, the other health issues kick in. So much of this is really about the physical hazards that exist in poorer neighbourhoods (and there is more work on this than is shown here), but also the mental hazards of poverty, and the lack of power and control that comes with it. The lack therefore, of even the possibility of true wellness.

There is substantial evidence of a social gradient in the quality of neighbourhoods. Poorer people are more likely to live in more deprived neighbourhoods. The more deprived the neighbourhood, the more likely it is to have social and environmental characteristics presenting risks to health. These include poor housing, higher rates of crime, poorer air quality, a lack of green spaces and places for children to play and more risks to safety from traffic. In the 30 years between 1970 and 2000 Britain saw a substantial increase in the geographical concentration and segregation of poverty and wealth. Since 2000 there seems to have been little progress in reducing this. Urban clustering of poverty has increased…wealthy households have become concentrated on the outskirts and areas surrounding major cities. During the same period, major restructuring of the British economy has led to the loss of manufacturing and traditional industries, with high levels of economic inactivity becoming concentrated in particular localities and neighbourhoods.

It is this segregation of poverty and wealth that is also the problem, a writing off of estate and neighbourhoods and what looks like the whole Northeast of the country.

Since reading Appleyard’s Liveable Streets, I’ve also been thinking a lot about how community is destroyed by streets and cars and traffic, and it is the poorest that suffer most — this graph really brings it home:

fair-society-healthy-lives-full-report-82

I do like the fact that they point out that these are not just issues for the poor, however, although they clearly suffer most and resources should be targeted accordingly. They write

…everyone beneath the very best-off experiences some effect of
health inequalities. If the focus were only on those most in need and social action were successful in improving their plight, what about those just above the bottom or at the median, who have worse health than those above them? All must be included in actions to create a fairer society.

This also means health providers and community workers actually working together closely in taking on some of these problems.

Community engagement on a systematic basis is an essential element in partnership working for addressing health inequalities. Without this, reducing health inequalities will not be possible.

This approach requires mapping community assets, identifying barriers to participation and influencing and building community capacity through systematic and sustained community development.

They look at different ways this could happen. One is through focusing on building stronger social support networks to fight the high levels of stress, isolation and depression found in communities facing high level of deprivation, which can lead to ‘increased risk of premature death’. They note the effectiveness both of social networks and participation in improving mental health generally, but also the importance of including communities and individuals in the design of interventions.

They give some recommendations on how to go about things, which in the end lead to local individuals and communities being able to have power over their health, their lives, and the neighbourhoods they live in.

    1. First, identifying population needs better quality information from communities. In theory this can lead to health improvements and reduced health inequalities through an increased uptake of more effective services, particularly preventative services, and/or more effective interventions.

    2. Second, improving governance and guardianship and promoting and supporting communities to participate in directing and controlling local services and/or interventions. This will help to improve the appropriateness and accessibility of services and interventions, increase uptake and effectiveness and influence health outcomes.

    3. A third way to reduce social isolation is to develop social capital by enhancing community empowerment. This helps to develop relationships of trust, reciprocity and exchange within communities, strengthening social capital.

    4. Lastly, increasing control and community empowerment may result in communities acting to change their social, material and political environments.

       

Somethings about what not to do (but what gets done all the damn time), because the point is empowering people which in itself creates better health:

To achieve this goal community engagement practices need to move beyond what are often routine, brief consultations, to involving individuals in partnerships to define problems and develop local solutions to address those problems.

Which involves

Building active and sustainable communities based on principles of social justice. This is about changing power structures to remove barriers that prevent people from participating in the issues that affect their lives.

Promoting this approach sets a new task for political, civic and public service leadership in creating the conditions which enable individuals and communities to take control of their own lives, and in developing and sustaining a wider range of capabilities across the life course.

I like this idea of the life course, it is not one of the ways in which community organisers or planners tend to think, but makes perfect sense when looking at how negative impacts — in health and everything else — accumulate over our lifetimes and those of our children. I’ve also run into a few people, women for the most part, really trying to think about this in architecture and planning, how people age through housing and community, how their needs and desires change.

I also like how this review ties health in to climate change. They never say out right that all of this is academic in the face of massive environmental catastrophe, but it was in my mind at least. They do relate community and social health to increased green spaces, more walking, healthier work, more use of public transport  and etc which all contribute to making everything more sustainable.

I had a few quibbles of course. Any review of this kind, looking at the big picture, will have the problem I think of speaking in big categories, lumping categories of people in together as though they are all one thing. Sometimes I was a bit troubled as it threw around generalisations — such as the study of kids receiving free meals at schools and how terrible their outcomes were by whether they were irish, black, gypsy/ traveller/ roma children. That shit bothers me. I was one of those kids. Every now and then the language starts to shut our potential off, to overcome, to think bigger, to improve our lives and others like us. To set poor kids apart as if they can’t have a hand in changing this.

That might just be me on my high horse, some of this came a little close to home. It’s always a fine balance though, between recognising the power of structural injustices and constraints, and respecting the abilities of those who most suffer under them.

Even as it did make some of the distinctions above, and never forgot to mention the complexities of race and class in this picture, it also failed to look at them in any real way. Gender too is absent. It does, however, provide a good foundation for exploring these equity and justice issues further.

There’s also some technical language that highlights the bureaucratisation of the field. I quote you as an example ‘middle-level Super Output Areas (MSOAs)’ which I suppose are required for policy discussions to change public health practices as they are existing realities, yet they make you want to hit the person who coined them.

And for those in the non-profit world (and increasingly other areas) always in search of how to stay funded, there are a couple of nice passages on some things I wish all funders and policy makers could understand. Principally that things take time, projects need to grow organically and be tailored to different people and institutions in different areas, relationships and trust only come after years, not days or weeks.

Reviews often look for new interventions, particular policies that may help turn the corner or make significant impact in improving service quality. However, a stream of new initiatives may not achieve as much as consistent and concerted action across a range of policy areas. A social determinants approach to health inequalities highlights how it is the intersection between different domains that is critical – health and work, health and housing and planning, health and early years education. Success is more likely to come from the cumulative impact from a range of complementary programmes than from any one individual programme and through more effective, coherent delivery systems and accountability mechanisms….. achieving reductions in health inequalities requires coherent, concerted, long-term, cross-cutting policies, backed by sufficient investment.

There are also some practical points on how funding is killing smaller organisations, despite the fact that they are highly committed, flexible and most integrated into the communities they serve, making them most likely to be the most effective.

There is increasing concern that the current commissioning environment disadvantages the third sector generally and may even threaten the survival of smaller voluntary organisations. The range of factors includes:

  • The inability of smaller organisations to marshal the resources, including the time, skills and knowledge, to effectively compete for tenders

  • Commissioning practices favouring larger organisations and the statutory sector, for example, clustering services to be put out to tender in a single contract can lead to smaller and niche providers being squeezed out

  • Short-term contracts with insufficient time for development and consequences for staff recruitment and retention

  • The growing requirement for contracts to be delivered on tighter funding, leaving little scope for developmental work and innovation.

Recipe for disaster really, and the unhelpful bureaucratization of exactly the kind of community work that bureaucratization strangles dead and can never on its own get right.

Anyway, this report is mostly wonderful. You can download it here.