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Day 12 of the Australian Journey

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Today I was more accepting of my lack of status as a pedestrian while I took my morning run.   To show the difference in perception, I mentioned to my Australian hosts that the law of the sea gives the right of way to the slowest vessel.   They were aghast.   How could that be possible?!?   The right of way should go to the fastest vessel, and that's how they drive on land also.

Today we did another inipi ceremony (a.k.a., sweat lodge) for our Mission Australia hosts.   Two locals joined us who had spent substantial time on the Pine Ridge Agency in South Dakota and knew many songs.   They tended fire for us and carried stones, and the lodge sat on land they leased to be able to run regular ceremonies.   We really appreciated their help and to know about the Lakota-Sydney connection in which Lakota elders regularly came to teach in Sydney and Sydney-ites went to visit the elders in South Dakota.

Another thought came to me today -- culture exchange is different from cultural tourism.   In cultural exchange, each culture has something to offer the other.   In our coming here to do culture exchange, we gave as much as we received.   The local aboriginal people enjoyed participating in our culture as much as we enjoyed participating in theirs.   To my surprise, now, I know more about local aboriginal practices that many Australian I meet.   Like people in the States, they look for the exotic (our current spirituality du jour is Peruvian and ayahuasca) and ignore the richness of practice happening all around them.

The remainder of the day focused on Mission Australia with a fitting ending of listening to our host, Phil, play a mean lead guitar at open mike night at a local restaurant/bar in Manly.   The humor began when we heard it referred to as a Manly gig. Therefore what I want to discuss next is what I learned about the excellent work that they do.

First we heard about the Catalyst-Clemente program, which offers a model of how university education can become accessible to disadvantaged people.   It uses higher education in the humanities, delivered in a community setting, to engage with people who are disadvantaged and would not otherwise receive this education.   It involves a partnership between a university, community organizations, and a range of external supporters.   The subjects taught are fully accredited by the university and are in areas such as history, literature, ethics, and art.   The basic requirements for participants are a willingness to learn, a willingness to commit to a 12 week program, a literacy level that is sufficient to read a newspaper, and some stability in their lives.

To my surprise the origins of this program lie in the USA where New York journalist and social commentator, Earl Shorris, began the Clemente program in 1997.   Its philosophy is that tertiary-level education in the humanities can assist socially disadvantaged/marginalized people to think about and reflect upon the world in which they live.   In turn, this intellectual engagement can promote a broader re-engagement with society, activity with other people at every level, and assist them to exit from the cycle of poverty.   (See Earl Shorris, Riches for the Poor: the Clemente Course in the Humanities, published in 2000 by W.W. Norton and Co. in New York City).   "Students learn to view themselves in terms of their intellectual and personal capacities, to see themselves not as victims, but as agents.   Mission Australia is running this program in conjunction with Australia Catholic University.   I thought, this is something my institution, Union Institute & University, could consider doing in partnership with other community agencies.

This program is being researched around the world.   Mission Australia conducted a pilot student into the impact of the program on re-engaging homeless people in inner city Sydney.   Results were positive, showing increased student self-esteem and autonomy (Yashin-Shaw, I., Howard, P., & Butcher, J. (2005).   Educating disaffected adult learners: Re-engaging the homeless through tertiary level humanities studies in Vocational Learning: Transitions, interrelationships, partners, and sustainable futures. Proceedings of the 13th Annual International Conference on Post-Compulsory Education and Training, Brisbane, Australian Academic Press).   Following this pilot study, Mission Australia, the St. Vincent de Paul Society, and the Australian Catholic University (ACU National) carried out a second phase of research into the benefits of this program.   They ran three Catalyst-Clemente courses (as they named them) simultaneously in Sydney and in Brisbane.   An art history course was taught at Mission Australia Centre including a visit to the New South Wales Art Gallery and a couple walking tours of the city.   A practical art class was taught in Brisbane including an exhibition with other ACU National students of the artwork created during the course.   A literature and drama course was taught at Vincentian Villege in Sydney, including students performing a play and attending a production of Shakespear's The Tempest at the Sydney Opera House with other ACU National students.   Over half of the students successfully completed the courses, which was extraordinary given their disadvantaged backgrounds.   The students' descriptions of how the course changed their lives are moving and can be found on the Mission Australia website at and in their publication, Enhancing participation: New possibilities for disadvantaged Australians.   The work was especially interesting to us in relation to a small pilot project we did of teaching homeless people with HIV/AIDS (and mental health issues and substance use problems) in New York City how to give Reiki energy healing treatments to one another.   The effect was one of empowerment and building a sense of agency -- pride that they had something to offer other people.   Even staff members at the facility where we encountered them would ask some of them for a Reiki session.   We published this study in the Permanente Journal in 2011.   Encountering this program at Mission Australia has given me more ideas for how to empower our population in Vermont, some of whom are homeless, and many of whom suffer chronically from any number of problems.   (I've noticed that people who have psychological suffering invariably have "physical" suffering.   The division of psychology and body is artificial and for academic purposes but perhaps compromises care.   Almost all of our patients with what we call "complicated minds", because they like the term and don't feel it is pejorative, also have chronic back pain, chronic neck pain, neuropathic pain.   Some have diabetes.   Many have asthma.   Some have chronic obstructive pulmonary disease.   Almost all have difficulty sleeping, and many have arthritis, hypertension, heart disease, and more.   The list is endless.   Because we do both medicine and psychiatry, we are addressing the whole person and that's a lot to handle.   I thought how wonderful it would be if our population had a Catalyst-Clemente Program.   Currently they can't access the courses offered through Community College of Vermont because the tuition is beyond their means (about $500 per three credit course).   Also, paralleling the findings of Mission Australia, going to CCV is not necessarily friendly for them.   They're not familiar or comfortable with a school environment.   Classes are often larger than 8 to 15 people.   They don't necessarily have a case manager who can support their non-educational needs to whom learning partners and the course instructors can turn for support.   They don't have IT support or access to computers or knowledge about how to use computers.   Mission Australia provided all this in an integrated, delivery environment in which the students felt comfortable.   This is what I do not see us doing in Vermont, at least, not yet.

The other project about which we heard much was "The Michael Project", conducted by Mission Australia in collaboration with Murdoch University.   "The Michael Project combines homeless and accommodation services, assertive case management, and eleven specialist allied health and support services."   I is a three year, private donor funded project, working with homeless men in the Sydney area.   It provides homeless/accommodation services, ranging from mobile, street-based outreach, through to emergency, short-term, and medium-term accommodation.   Case management involved frequent contact and integrated support.   The specialists involved included dentist, podiatrist, psychologist, drug and alcohol counselor, recreation therapist, barber, occupational therapist, reading and math teacher, computer consultant, and two street-based aboriginal health outreach workers.    The Michael Project reduced the percent of "rough sleepers" (no shelter) from 27.4% to 3.3%.   The percent of people accommodated rose from 27.8% to 93.9%.   The percent in temporary shelter (caravan, boarding house, etc.) felt from 20.7% to 0.8%.   The percent in hospital or prison fell from 15.2% to 0.8%.   This had to be cost-effective!   They are well on their way to publishing their Wave 2 results, which I hope to receive soon.

As part of the Michael Project, homeless people were surveyed to learn more about their situation and how they came to be that way.   The researchers found that sleeping rough is common with the mean length ranging from 1.5 years to 4 years.   The prevalence of mental health conditions and substance use was at least 20 times higher than those of the overall Australian male population.   To their surprise, half of the people had held a full-time job in the last 2 years.   Of course, poverty was overwhelming.   A majority had children, but lacked supportive family members and friends, which contributed to their social isolation, as did their lack of paid work, money, access to transportation, and poor health.   Quality of life was low compared to overall Australians, particularly in terms of social relationships and living environment.   High levels of health service use and contact with the criminal justice system were found.   Ninety-five percent of the participants had experienced one or more traumatic events, which is not surprising considering that people who are diagnosed with psychosis are about 50 times more likely to have experienced traumatic events than the general population (see my blog about the Hearing Voices conference on Day 3 and 4).   I'll also be very interested to read about the cost-effectiveness study that is being conducted.

That completed our day.   Tomorrow we will interact with Child and Youth Initiative (CYI workers) about how increasing narrative competence can improve their work with youth.   Particularly, I believe almost every adolescent male in today's culture is looking for some type of heroic role to perform.   Everyone wants to be heroic and to be seen as a hero.   But, how?   Sometimes anti-heroes are easier to perform than socially acceptable heroes.   And, sometimes, adolescents notion of hero does not match that of adults.   More about that tomorrow.

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Lewis Mehl-Madrona graduated from Stanford University School of Medicine and completed residencies in family medicine and in psychiatry at the University of Vermont. He is the author of Coyote Medicine, Coyote Healing, Coyote Wisdom, and (more...)
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