Love with Grit

Transforming Safety in Any Organization Through Street Medicine Philosophy

In our pursuit of creating safety at work, we often overlook the profound impact of philosophy on our practice. Recently, while conducting research for a client project, I stumbled upon a brilliant webinar titled "Promoting Safety in Street Outreach," on the National Health Care for the Homeless Council’s website and the insights it offered were too compelling not to share.

Led by Brett J. Feldman, Director of the Division of Street Medicine and Assistant Professor of Family Medicine at Keck School of Medicine, the webinar enlightens us on a philosophical framework that provides the foundation of how his team works. Feldman's street-care team, serving unsheltered homeless individuals, demonstrate how a philosophy centered on love and solidarity fosters not only physical but psychological safety. These centred values manifest in action with practical application. Before you dismiss this article as not being relevant because your organization doesn’t deal with homeless, please stay with me as I believe that the philosophy provided can benefit any organization. If you serve people, lead people, or relate with people, this article is for you. I was shocked that after two decades of working across multiple industries, and in healthcare for over a decade and attending many violence prevention courses and conferences, I had not reached the depth of understanding offered by Feldman.

Although policies and procedures are important, Feldman's approach is made solid through social teaching and a deep understanding of the streets, offering a unique perspective applicable to any organization facing a risk of violence. The Street Medicine Social Teaching foundational values taught are:

• Love with grit; and

• Authentic solidarity.

These foundational values are the antidote to reducing medicine to a science or allowing patients to be reduced to a disease, metric, or possession.

At this point in the presentation my attention was fully captured but, I was curious, what is love with grit? Luckily, Feldman explains. Love with grit is not that fuzzy emotional feeling but an act of will; it is small, daily acts of sacrifice and suffering; which, leads to a freedom to serve because the decision to love has already been made; “we don’t have to decide how to feel, we’ve already decided to love.”

Authentic Solidarity

Love with grit, Feldman continues, helps us to resist the temptation to flee. In medicine (and I would add in many professions) it is not professional to love your patients (clients). It is dangerous. There is no hugging, no crying with them as it is believed to cloud judgement, ultimately becoming responsible for their demise. When encountering suffering, it is a choice to either engage or retreat in an act of self-preservation. If you retreat, you isolate the person you were attempting to serve but also isolate yourself.

Authentic solidarity, as Feldman explains, involves sharing suffering with love and grit. It transcends the boundaries of professional detachment, challenging us to engage authentically with those we serve. It's not just charity from above but a collaborative effort where the served and the server work together, eradicating traditional power dynamics. Feldman explains that coming to the realization that you abandoned the people you have dedicated your life to serving is difficult to live with. It changes how you go out to them, and they know that you are not willing to go that far with them either, which changes how they will interact with you.

Charity vs. Solidarity

Authentic solidarity: the sharing of suffering; therefore, not only promotes safety but it promotes liberation for both the served and the server. To illustrate this, Feldman walks us through two separate stickman drawings created by his 11-year-old daughter. One illustrating charity. The other, solidarity. Under the heading charity, a person-serving is reaching down into a hole, arms stretched trying to grasp and pull the person-served, who also has outstretched arms, out of the hole. In this model, all the tools and services are available once the person-served is out of the hole and although it is good, it doesn’t change the power dynamic. In contrast, under the heading solidarity is a person-serving who has jumped down into the hole bringing all their tools and services with them, is laying down on the ground of the hole, propped up on their elbows, legs in the air with the person-served being able to stand on their outstretched legs, foot to foot being hoisted up out of the hole. Feldman explains that you get into the hole, even lower than them, they will even get out before you but that’s okay because you have more resources and will get out too.

Feldman explains that unlike RV medicine, street medicine doesn’t require the homeless to suspend their reality (by stepping into an RV). It is the provider whose reality is suspended as they meet their patients where they are at on the street or, for example, under a bridge. For this level of service to be safe for the server, Feldman explains that there needs to be a strong foundation in social teaching and knowledge of the streets. For any organization that has a risk of violence, I agree that social teaching is foundational, and I would translate knowledge of the streets to needing to have a solid violence risk assessment that dives deep into understanding the risk faced by the population served as well as serving staff.

When Feldman had finished outlining this base philosophy, I was struck to question if I truly understood love and if I could improve in practising love not just for those that I serve but also in my interpersonal relationships. Was I, through an act of will, practising love with grit in my daily moments of suffering and sacrifice? I challenge you to ponder that question yourself.

In my work, I've come to believe that safety procedures crafted with love are not only possible but essential. This article serves as an invitation to reconsider the roots of our safety practices, infusing them with the transformative power of genuine care and solidarity.

In our next exploration, I will delve into the critical elements that erode solidarity, as outlined by Feldman. Thank you for joining me on this transformative journey. Your time and attention are valued, and I'm thrilled to be in your company.