Pre-Colonial Health Systems

• Multiple systems operated simultaneously, each rooted in land, body, and community
  • Indigenous nations: ecologically grounded plant knowledge, ceremony, relational healing
  • West and Central African healing traditions: communal health, herbalism
  • Midwifery and neighborhood healers among immigrant communities
• All systems shared a core feature: accountability
  • Community councils, restorative practices, mutual obligation
  • Health was communal, not individual
• Biodiversity analogy: heterogeneous ecosystems flourish; monocultures collapse
  • Same principle applies to health systems

Epistemicide as Colonial Method

• Disease was a genocidal tool, but also carried an epistemological framework
  • Indigenous and African ways of knowing classified as inferior, pagan, or dangerous
  • Healers criminalized; midwives called witches
• Epistemicide was not a side effect of colonization: it was a method
  • Devaluation created a vacuum for Western institutions to fill
• Knowledge survived through individuals and elders passing it down
  • Still present in doula practice, ceremony, and individual reclamation work today

The 1913 Turning Point

• Early formal public health (mid-19th century) was bold and coalition-based
  • Physicians, housing reformers, poverty advocates, civil engineers
  • Focused on environment: housing, water quality, food, urban conditions
• Herbert Winslow Hill’s 1913 book argued the 19th-century approach was wrong
  • Central claim: infectious disease has one source, a germ in an infected person
  • Argued chasing “bad surroundings” was inefficient vs. finding and isolating the infected individual
• This shifted public health from treating the environment to treating the individual
  • The sick body was isolated from community, land, and ancestral knowledge
  • Built in a Euro-Western assumption: people stand apart from nature
• COVID as a modern echo: contact tracing prioritized over lived conditions

What Was Lost and Why It Matters

• Three things got “filed away” as irrelevant:
  • Communal and ancestral knowledge (labeled superstition)
  • The environment around the sick person
  • The community that knew and sustained the person
• Public health became reducible to individual behavior and individual choice
• Communities are not accessing or trusting health systems now
  • Rooted in this historical undermining
  • Current “community engagement” efforts often lack authentic co-creation with communities as experts

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The story we've been told is that professional health and justice systems arrived and improved on messy, informal community care. That story has cause and effect backwards. Before professionalization, communities in the US had sophisticated, relational, place-based systems for health and accountability. They were displaced deliberately, over roughly 150 years, because they threatened the financial and political interests of people building institutions around different values.

This episode introduces the term the series returns to in every era: epistemicide. The systematic destruction of community knowledge systems. It sets up the pattern the next five episodes will trace, era by era, and names the contradiction at the center of the present moment — institutions investing in "community engagement" while keeping community wisdom routed through their own gatekeepers.

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I sat down with Malka — educator, community herbalist, organizer, and co-founder of the DC Mutual Aid Apothecary — to talk about honoring endings, beginnings, in-between moments, mergers, sunsets. All the transitions that, when witnessed well, can turn into wisdom instead of just abrupt, unmarked closings.

Malka spent over a year researching the closure of Movement Ground Farm, a decade-long land-based nonprofit that attempted to shift into a worker-led model and eventually decided to sunset. She wove the story of that organization into a virtual interactive timeline, drawing on 20-plus interviews (some of them four hours long with former staff). Her research has become a case study for anyone moving toward collective land-based work, especially the people asking what we can learn from projects that have shut their doors.

We talk about why so many of us leave organizations carrying rage, distrust, and shame. Why the nonprofit form so often turns into a machine for sustaining itself. What happens when a founder can't let go of power, and what shifted for the Movement Ground Farm ED once he had a year of reflection and an outside witness to help him make sense of what happened. Malka also shares where she is right now with the DC Mutual Aid Apothecary, six years in, exploring what a soft ending can look like when a project has grown so entangled with its community that ending it isn't even fully in her hands anymore.

If you've ever left a project feeling like it went up in flames, or watched one dissolve without acknowledgment, this one's for you.

In this episode:

• Why unmarked endings get carried into the next role as rage, cynicism, or a quiet loss of faith
• What happens when the nonprofit's real job becomes sustaining the nonprofit
• Movement Ground Farm as a case study, and Malka's process of interviewing people from every side of a decade-long story
• The founder's paralysis, and what shifted when he could finally make sense of what happened
• Two very different kinds of endings: organizations imposed on a community versus ones that grew out of it
• Why some things can't fully be ended, because they no longer belong to their founders
• What a "soft ending" can look like (Plant Fest, and giving away thousands of seedlings, is a good example)
• The elements Malka names for holding a closure well: an outside witness, space for community to honor the work, not hoarding what you've built, and telling the story with nuance
• The offering an ending organization can make to the rest of us as a case study, mistakes on display, humbly

Resources mentioned:

• Movement Ground Farm — harvestingforseed.com
• The DC Mutual Aid Apothecary

Connect with Malka:

• LinkedIn: Malka Roth
• Instagram: @malkaeve
• Email: malkae.roth@gmail.com

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What Organizational Doula Work Is

• Deep witnessing and accompaniment through transitions, not framework application
• Starts with assessment: what the organization already has, its history, cultural identity, strengths
• Builds emergent frameworks tailored to the specific team, broad enough to flex but tethered to history
• Psychological safety as a core pillar: enables trial-and-error culture and generative mistake-making
• Doula as “lantern holder”: outside perspective that makes sense of what teams can’t see from within
• Individual and collective work combined: leadership and team members addressed separately and together
• Tools are maps, not plans: flexible, multi-route, oriented toward a shared North star

Who It’s For and Key Use Cases

• Teams merging, experiencing leadership ruptures, or moving toward something new
• Organizations sunsetting or closing, including unexpected closures
• Coalitions forming across very different organizations (example: North Dakota anti-trafficking coalition bringing together law enforcement, nonprofits, faith groups, government)
• Teams in conflict: conflict held as generative, not something to squash
  • Ignored conflict snowballs, teams lose talent and the ability to dream together
  • Must be witnessed from outside by someone not in the conflict
• Conferences and gatherings: drop-in support, workshops, helping excited collaborators ground new ideas into actionable maps before they leave

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Alice Ely is one of my favorite people to talk with, and I’ve been wanting to have her on the podcast for a long time. She’s the executive director of the Public Health Council of the Upper Valley, celebrating twenty-five years of the organization she leads. She’s also the person who funded my BIPOC and queer healthcare storytelling work through the Vermont Community Health Equity Partnership a few years back, so this conversation was a real coming-full-circle moment for me.

We talk about what it took for the Public Health Council to hold the VTCHEP grant in a way that served the communities it was meant for. We talk about: word-of-mouth outreach through networks the state would never have thought to use; fiscal sponsorship for organizations without institutional infrastructure; money upfront when grantees needed it; and more.

We talk about qualitative data being treated as unreliable inside healthcare settings. We talk about what it means when N is too small to report. And we talk about the medicalization of public health, and what happens when community health workers never leave the institutional walls of the systems that employ them.

If you’re a funder, a public health leader, a community-led practitioner, or someone trying to change how your traditionally white-led organization shows up in this work, this one is for you.

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In 2019, Ethiopia's Federal Ministry of Health was doing something nobody else had done. They were building the first national Compassionate and Respectful Care initiative woven into a federal health transformation plan. And they were building it by listening.

In this episode, I sit down with three of my former colleagues from the Harvard Ministerial Leadership Program to talk about our work in Ethiopia, interviewing patients, providers, community health workers, ministry officials, NGO leaders, and professional associations across Addis Ababa, Oromia, and Amhara.

We talk about what we heard. That you cannot ask providers to be compassionate if the system isn't compassionate to them. That trainings alone don't hold unless leadership and culture hold them up. That compassion is subjective, which means measuring it without reducing it to a checklist requires a different kind of rigor. That the Ministry's incubation centers worked because facilities were given room to prototype in their specific contexts.

We also talk about what stayed with us and the impact of watching a federal body build strategy from the ground up.

This conversation is years overdue, and I'm so glad we finally had it.

Guests: Yuki Davis and Matt Hughsam

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Crows recognize individual faces. They remember who threatened them and who helped them, and they pass that knowledge to their young, to their flock, across generations. A crow you wronged once will tell crows who've never met you to watch out. A crow you consistently fed will bring you small gifts in return. They have community memory, just like the communities we serve as health and social justice organizations.

In this episode, we talk about listening fatigue, and why it's not apathy, it's the community's social intelligence functioning healthfully. We talk about what it looks like when an organization has already burned trust and what the slow road back requires. We make the case that reciprocity is earned through consistent behavior over time, not through better outreach materials or a flashier engagement strategy.

If your organization has ever wondered why the community won't engage anymore, this episode is the mirror.

IN THIS EPISODE

Why communities carry long memories and what that means for organizational reputation. Listening fatigue as rational community self-protection, not a communication problem to solve. How consistent follow-through earns the kind of trust and intelligence no survey can surface. What collective threat response looks like in coalition work. And the case for frameworks that read context rather than running the same playbook everywhere.

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We see the mushroom and think that's the whole organism. But the mushroom is just the visible fruiting body. The real organism is the mycelium, a vast underground network connecting root systems, sharing nutrients, sending chemical signals across the forest floor. Most of what keeps the forest alive is invisible.

In this episode, we talk about the work nobody puts on a slide deck and the gifts of decomposition as a precondition for growth.

And we talk about mycoremediation: fungi that break down toxins in contaminated soil. Because sometimes the ground has been poisoned by broken promises and extractive practices, and our work starts with cleaning the soil before we try to plant anything new.

IN THIS EPISODE

Why the most important organizational work is the work nobody sees, and what happens when you invest only in the visible outputs. Decomposition as a precondition for growth, not a sign of failure. How healthy organizations redistribute narrative capacity the way mycelial networks redistribute nutrients. And what it looks like when community engagement is genuinely symbiotic, not a one-way transaction dressed up as service.

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