The First Parish in Bedford Unitarian Universalist 75 The Great Road, Bedford, Massachusetts 01730 On the Common 781-275-7994

“Ignaz Semmelweis, Hand-Washing,
and States of Denial”

A sermon by Rev. John E. Gibbons

delivered on Sunday, October 15, 2006

at The First Parish in Bedford, Massachusetts

As those of you who were here last Sunday know, we heard two remarkable speakers – Fay White and Gail Hall – describe their experience as women whose actions, at another time in their lives, resulted in their incarceration.  And now, since Fay’s conviction was overturned and Kay has now served out her sentence, they also poignantly described their struggle to define their lives not simply as ex-cons but as human beings determined to reclaim their very souls which – both by their own destructive behaviors and by the kind of destructiveness that is our prison system – had deadened and denied. 

The reclamation of their souls required that they see themselves clearly and honestly in the harsh light of holding-tank truth:  Gail said that, when it came to lies and deception, she had become a master of deceit.  And seeing themselves and their situation clearly – after years of seeing themselves only through the distorted hazes of addiction and misery – Fay and Gail were able, heroically really, to turn their lives around. 

They wanted us to know, among other things, that their lives were not and are not so different than our lives.  Not so many of us have been to prison (some of us have), but when it comes to aspirations and temptations, accomplishments and frustrations, loyalties and betrayals, self-deceptions and self-redemptions – Fay and Gail are human beings, not them, not apart from but a part of us.

What those women said to us resonates with what I will say today, for I will address the topic of how people change and are able – or unable – to turn our lives – or our world – around.

Coming of age in the gloriously turbulent 60’s, I wanted to change the world.  And so I studied politics and became political.  In DuPage County, Illinois – at one time, the country’s most Republican county – for as long as I can remember, I licked envelopes and delivered leaflets door-to-door for candidates who never won.  And later I joined SDS and marched and protested and did a lot of political things; and when I went to college I studied political science.

Understanding the world in a political way – vital as that is – also came to feel incomplete to me and so I studied religion and received a double major in PoliSci and Religion; and promptly upon graduation I was pretty much unemployable…and, well, eventually I studied for the ministry. 

Somehow along the way, I realized that the political is personal and the personal is political, and that one cannot change the world without changing oneself.  “The trouble with changing your life” (you may have heard me say this before)… “The trouble with changing your life is that you have to change your life to do it.”  Another important point, and one that we sometimes forget in Unitarian Universalist churches, is that we’re here not just to change the world and other people (no matter how sorely they may be in need of improvement); we’re here because (and Sharon said this in her children’s story last Sunday about transformation) we want to become more generous, more courageous, more compassionate, more of that person we’ve always wanted to be.  Other people and the world are in desperate need of wholesale improvement, and so too are we.

This morning I want us to consider these issues by reflecting on the legacy of Ignaz Semmelweis.  Semmelweis was the Hungarian physician who in 1847 made what we think of as commonplace connection – but which was at the time a radical notion:  germs, Semmelweis learned, cause illness.

Semmelweis worked in a hospital in Vienna that had two maternity clinics.  Physicians delivered babies in one clinic and midwives delivered babies in the other.  The mortality rate in the doctors’ clinic was triple that of the midwives’.  Why?  Semmelweis observed that the doctors often came to their maternity ward straight from the autopsy ward where, with whatever germs their cadavers happened to carry, they promptly infected mother and child.

The mortality rate plummeted when Semmelweis had the doctors wash their hands with soap.

So far so good, but before we cheer the march of medical science, it turns out that knowledge does not automatically change behavior. 

Today – it is estimated that hospital personnel wash or disinfect their hands less than half as often as they should.  Doctors are the worst offenders, much worse than nurses or aides.  The Institute of Medicine, in its 2000 report titled “To Err is Human,” estimates that somewhere between 44,000 and 98,000 Americans die each year due to hospital error.  These are more deaths than are caused by motor vehicle accidents or breast cancer, and a leading cause is bacterial infection.

A September article in the New York Times Magazine documents the experience of the very good Cedars-Sinai Hospital in Los Angeles which realized that it – like most other hospitals – had a problem and so set out to change the behavior of its great but unwashed doctors.  I’ll tell you about the Cedars-Sinai example, and then we’ll see what this might mean for us.

The first question, of course, is why don’t doctors wash their hands?  And the first answer is, well, doctors are really very busy people.  And sinks are not always close at hand.  But it has been found that even when hospitals, like Cedars-Sinai, install wall-mounted Purell-type disinfectant dispensers, well, doctors still don’t always use them.

And so there seem to be a couple of psychological reasons for this non-compliance, the first of which can be called “perception-deficit.”  There is one study of Australian doctors who self-reported that 73% washed their hands, but their actual rate was 9%.  (I suspect that this sermon may significantly improve the health of our community, or perhaps it will only reduce the number of you who make use of doctors or hospitals!) 

And so the second psychological reason that doctors fail to wash their hands is – in a word – arrogance.  Hey!  It can’t be me carrying the bad bugs…it must be, once again, the cause of so many social ills, those troublesome other people! 

There’s an economic angle to this too.  One of the motivating factors that encouraged Cedars-Sinai to embark on a campaign to improve their hand-washing record was that they were up for an accreditation inspection.  However, most of the doctors there are free agents who work for themselves, not for the hospital.  Thus, the upcoming inspection was a nuisance to them and had no direct impact.  The doctors’ well-being, in other words, was not interconnected with that of the hospital.  The article in the Times said, “Their incentives…were not quite aligned with the hospital’s.”

So what did Cedars-Sinai do about this?  First of all, the hospital cajoled their doctors – sent them gentle reminders, email, faxes, posters.  No effect. Nada.  Nincs.

Then they started to hand out small bottles of Purell at the doctors’ entrance to the parking lot…and they started to get somewhere.  They formed a Hand Hygiene Safety Posse (a group of nurses who spied on doctors), but they also sought opportunities to reward doctors caught in the act of actually washing their hands.  They gave away $10 Starbucks gift cards.  That the behavior of the hospital’s highest-earning personnel could be bought by $10 bucks may seem surprising, but “none of them turned down the card.”  

Now the spies reported back that compliance was rising: it started at 65% and rose to 80% – but this wasn’t going to be enough for the accreditation inspectors who required 90%.  (I can tell these numbers may still give you pause.  Can you imagine an ad campaign: “9 out of 10 of our doctors wash their hands!”)

So the hospital administration was discouraged.  What would they do?  The head epidemiologist – a woman named Rekha Murthy – reported this bad news to the Chief of Staff Advisory Committee over lunch.  They were still at only 80% compliance.  After lunch, however, she handed each of the committee members an agar plate – you know, from science class, a sterile Petri dish filled with spongy gelatinous agar.  “I would love to culture your hand,” she told each of the committee members.  And so they pressed their palms into the plates which were then sent to the lab to be cultured and photographed.  This resulted in photos that were, she said, “disgusting and striking, with gobs of colonies of bacteria.”

And what, you ask, does one do with the most winningly disgusting photograph?  At Cedars-Sinai, they turned it into a screen saver that “haunted” every computer in the hospital.

“Hand hygiene compliance,” this report concludes, “shot up to nearly 100% and…has pretty much remained there ever since.”

It took getting what was grotesquely under their skin into the doctors’ faces for change to happen.

We say, in the mission statement of this First Parish in Bedford, that we exist “to change ourselves and the world.”  OK, so how exactly will we do this?  Well, we might begin by noting some of the reasons we don’t do this or, at least, don’t do this nearly as well or as effectively as we might want:

We don’t do this, in part, because – well – we’re really quite busy.  We’re very busy people.  And change is not terribly convenient – but, of course, things might be different if only we had some easily-accessible change machines.  Or not.

And, then again, we don’t change ourselves or our world nearly as much as we might because of what might be called a “perception-deficit.”  We perceive (we think, our image of ourselves) is that we do a whole lot o’ changin’ when, maybe – just maybe – the actual fact is that we really don’t. 

Could it be that we secretly (or even openly) believe that the world could be significantly improved if only other people did most of the changing?  I’m not going to estimate our rate of non-compliance with our mission but could it be that arrogance has something to do with whatever gap might exist?

Could it be that we see ourselves, really, as individualistic free spirits, free agents unbound by artificial conventions like mission statements; and could it be that our personal incentives, in other words, are not quite aligned with that of the church?

Should we employ gentle reminders, emails, faxes, posters?  More effective, though, might be 10 dollar – be still my heart – giftcards from Starbucks?  

Probably – all satire aside – we really should seek out some carrots, some positive incentives and acknowledgments for those among us who do make changes in their lives and in our world.

And maybe we should make use of spies?

I guess where I want to go with this is that change does not really happen – our compliance rate will remain low – until the need for change is somehow visible to us and in our face, until we see ourselves as others see us.

This is starting to get biblical!  How, for example, might we start to take the Golden Rule seriously – and treat others as we ourselves would wish to be treated?  How could we refrain from complaint against the mote in another’s eye until we see the log in our own?

What would it be like if we had screen savers of children from Darfur?  Or every day, on booting up our computers, we saw a photo of Bedford’s young men killed in Iraq, John Hart or Travis Desiato? 

We’re talking about changing our world and ourselves.  There’s a parishioner here who decided to limit his drinking – and ultimately stopped drinking – based on the number of bottles seen each week he put out at the curb in his recycling bin.  His behavior was made visible:  to his neighbors, maybe, but more importantly to himself.  He had eyes to see and he saw that there were too many bottles in his gray recycling bin.  Perhaps our recycling bins might become our screen savers?

The question is, how do we make ourselves visible to…us?

On Friday, the Nobel Peace Prize was awarded to Muhammad Yunus of Bangladesh, the proponent of Grameen Bank-style micro-credit loans that make a huge difference in the alleviation of poverty.  Yunus, for example, loaned a very small amount of money - $30, perhaps – to Bangladeshi women in remote villages who then bought telephones and, in turn, sold phone calls to their other village women who had never before spoken on the telephone.  These villagers never knew life existed outside their village.  But with a telephone in hand, one observer said, “Now her world is the real world.” 

What would it take for us – we who are technologically-affluent but who remain incredibly isolated and parochial – what would it take for us to discover the real world that is our world?  Is there a screen-saver or some other way to place the rest of the world’s face where it belongs - that is, under our skin and in our face?

Last week I attended an academic forum at Harvard about the 1956 Hungarian Revolution.  It’s a long story but a major part of that story is that the United States goaded Hungarians to revolt against their government – we lauded freedom and liberty and democracy – when the reality was that we had no intention whatsoever of supporting anyone who might actually act upon our idealistic words.  The Hungarians, you know, revolted against their government.  Based on our rhetoric, they anticipated US aid, but we did nothing.  And thus the Hungarian revolution was crushed by Soviet tanks.  For domestic political consumption, we blathered idealism – not expecting anyone here in the United States to take our rhetoric seriously, but in fact the Hungarian people thought we were telling the truth, which we were not. 

And so, here again, is a situation of perception-deficit wherein we fail to see ourselves as others see us.  And so, just how is it that we justify our troops in Iraq and effusively praise democracy and freedom when in fact a large majority of the Iraqi people say that our presence exacerbates their troubles and they want us to leave?

Leslie Gelb, President Emeritus of the Council on Foreign Relations and former foreign-affairs columnist at the New York Times says, “We’re forever spouting bullshit in foreign policy for domestic political reasons at great costs to people abroad, who take the bullshit seriously.”

I’m trying to talk about changing our selves and changing our world, and the way to do this – I believe – is by seeing ourselves as we are and by cutting the bull.  How do we develop some way of seeing ourselves as we are, some way of witnessing to our own behavior?

I described this sermon-theme to our staff last week, and it was Brad who said that, yes, this is a regular theme of the fundamentalists and the evangelicals.  They’re the ones who say that, when you die and before you’re assigned a place for eternity, you’ll first be shown a movie of your life.  Now, I cannot bear to watch a video of this service (or any other service I’ve participated in, or listen to a recording of my voice) – let alone watch a documentary of my life.  And, however absurd I may find this concept, I also think that somehow – before we die – we need, if not a documentary, at least a screen-saver with – I just don’t know – some visual representation of our behaviors that are disgustingly abhorrent.

Some may wonder if a compellingly attractive image might be motivating but, truth be told, I doubt that at Cedars-Sinai a screen-saver of clean hands would have been nearly so effective as that of hands that are filthy.

I think I’ve told you enough and I’ll let you write the remainder of this sermon in your own hearts and souls. Here: these are the words of our former poet laureate, recently deceased, Stanley Kunitz:

I have walked through many lives,
some of them my own,
and I am not who I was,
though some principle of being
abides, from which I struggle
not to stray.
When I look behind,
as I am compelled to look
before I can gather strength
to proceed on my journey,
I see the milestones dwindling
toward the horizon
and the slow fires trailing
from the abandoned camp-sites,
over which scavenger angels
wheel on heavy wings.
Oh, I have made myself a tribe
out of my true affections,
and my tribe is scattered!
How shall the heart be reconciled
to its feast of losses?
In a rising wind
the manic dust of my friends,
those who fell along the way,
bitterly stings my face.
Yet I turn, I turn,
exulting somewhat,
with my will intact to go
wherever I need to go,
and every stone on the road
precious to me.
In my darkest night,
when the moon was covered
and I roamed through wreckage,
a nimbus-clouded voice
directed me:
“Live in the layers,
not on the litter.”
Though I lack the art
to decipher it,
no doubt the next chapter
in my book of transformations
is already written.
I am not done with my changes.

I hope and believe this to be true:   We are not done with our changes.