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Significant anniversaries are solemnly commemorated — Japan's attack on the U.S. naval base at Pearl Harbor, for example. Others are ignored, and we can often learn valuable lessons from them about what is likely to lie ahead. Right now, in fact.
At the moment, we are failing to commemorate the 50th anniversary of President John F. Kennedy's decision to launch the most destructive and murderous act of aggression of the post-World War II period: the invasion of South Vietnam, later all of Indochina, leaving millions dead and four countries devastated, with casualties still mounting from the long-term effects of drenching South Vietnam with some of the most lethal carcinogens known, undertaken to destroy ground cover and food crops.
The prime target was South Vietnam. The aggression later spread to the North, then to the remote peasant society of northern Laos, and finally to rural Cambodia, which was bombed at the stunning level of all allied air operations in the Pacific region during World War II, including the two atom bombs dropped on Hiroshima and Nagasaki. In this, Henry Kissinger's orders were being carried out — "anything that flies on anything that moves" — a call for genocide that is rare in the historical record. Little of this is remembered. Most was scarcely known beyond narrow circles of activists.
When the invasion was launched 50 years ago, concern was so slight that there were few efforts at justification, hardly more than the president's impassioned plea that "we are opposed around the world by a monolithic and ruthless conspiracy that relies primarily on covert means for expanding its sphere of influence" and if the conspiracy achieves its ends in Laos and Vietnam, "the gates will be opened wide."
Elsewhere, he warned further that "the complacent, the self-indulgent, the soft societies are about to be swept away with the debris of history [and] only the strong… can possibly survive," in this case reflecting on the failure of U.S. aggression and terror to crush Cuban independence.
By the time protest began to mount half a dozen years later, the respected Vietnam specialist and military historian Bernard Fall, no dove, forecast that "Vietnam as a cultural and historic entity… is threatened with extinction…[as]…the countryside literally dies under the blows of the largest military machine ever unleashed on an area of this size." He was again referring to South Vietnam.
When the war ended eight horrendous years later, mainstream opinion was divided between those who described the war as a "noble cause" that could have been won with more dedication, and at the opposite extreme, the critics, to whom it was "a mistake" that proved too costly. By 1977, President Carter aroused little notice when he explained that we owe Vietnam "no debt" because "the destruction was mutual."
There are important lessons in all this for today, even apart from another reminder that only the weak and defeated are called to account for their crimes. One lesson is that to understand what is happening we should attend not only to critical events of the real world, often dismissed from history, but also to what leaders and elite opinion believe, however tinged with fantasy. Another lesson is that alongside the flights of fancy concocted to terrify and mobilize the public (and perhaps believed by some who are trapped in their own rhetoric), there is also geostrategic planning based on principles that are rational and stable over long periods because they are rooted in stable institutions and their concerns. That is true in the case of Vietnam as well. I will return to that, only stressing here that the persistent factors in state action are generally well concealed.
The Iraq war is an instructive case. It was marketed to a terrified public on the usual grounds of self-defense against an awesome threat to survival: the "single question," George W. Bush and Tony Blair declared, was whether Saddam Hussein would end his programs of developing weapons of mass destruction. When the single question received the wrong answer, government rhetoric shifted effortlessly to our "yearning for democracy," and educated opinion duly followed course; all routine.
Later, as the scale of the U.S. defeat in Iraq was becoming difficult to suppress, the government quietly conceded what had been clear all along. In 2007-2008, the administration officially announced that a final settlement must grant the U.S. military bases and the right of combat operations, and must privilege U.S. investors in the rich energy system — demands later reluctantly abandoned in the face of Iraqi resistance. And all well kept from the general population.
Gauging American Decline
With such lessons in mind, it is useful to look at what is highlighted in the major journals of policy and opinion today. Let us keep to the most prestigious of the establishment journals, Foreign Affairs. The headline blaring on the cover of the December 2011 issue reads in bold face: "Is America Over?"
The title article calls for "retrenchment" in the "humanitarian missions" abroad that are consuming the country's wealth, so as to arrest the American decline that is a major theme of international affairs discourse, usually accompanied by the corollary that power is shifting to the East, to China and (maybe) India.
The lead articles are on Israel-Palestine. The first, by two high Israeli officials, is entitled "The Problem is Palestinian Rejection": the conflict cannot be resolved because Palestinians refuse to recognize Israel as a Jewish state — thereby conforming to standard diplomatic practice: states are recognized, but not privileged sectors within them. The demand is hardly more than a new device to deter the threat of political settlement that would undermine Israel's expansionist goals.
The opposing position, defended by an American professor, is entitled "The Problem Is the Occupation." The subtitle reads "How the Occupation is Destroying the Nation." Which nation? Israel, of course. The paired articles appear under the heading "Israel under Siege."
The January 2012 issue features yet another call to bomb Iran now, before it is too late. Warning of "the dangers of deterrence," the author suggests that "skeptics of military action fail to appreciate the true danger that a nuclear-armed Iran would pose to U.S. interests in the Middle East and beyond. And their grim forecasts assume that the cure would be worse than the disease — that is, that the consequences of a U.S. assault on Iran would be as bad as or worse than those of Iran achieving its nuclear ambitions. But that is a faulty assumption. The truth is that a military strike intended to destroy Iran's nuclear program, if managed carefully, could spare the region and the world a very real threat and dramatically improve the long-term national security of the United States."
Others argue that the costs would be too high, and at the extremes some even point out that an attack would violate international law — as does the stand of the moderates, who regularly deliver threats of violence, in violation of the U.N. Charter.
Let us review these dominant concerns in turn.
American decline is real, though the apocalyptic vision reflects the familiar ruling class perception that anything short of total control amounts to total disaster. Despite the piteous laments, the U.S. remains the world dominant power by a large margin, and no competitor is in sight, not only in the military dimension, in which of course the U.S. reigns supreme.
China and India have recorded rapid (though highly inegalitarian) growth, but remain very poor countries, with enormous internal problems not faced by the West. China is the world's major manufacturing center, but largely as an assembly plant for the advanced industrial powers on its periphery and for western multinationals. That is likely to change over time. Manufacturing regularly provides the basis for innovation, often breakthroughs, as is now sometimes happening in China. One example that has impressed western specialists is China's takeover of the growing global solar panel market, not on the basis of cheap labor but by coordinated planning and, increasingly, innovation.
But the problems China faces are serious. Some are demographic, reviewed in Science, the leading U.S. science weekly. The study shows that mortality sharply decreased in China during the Maoist years, "mainly a result of economic development and improvements in education and health services, especially the public hygiene movement that resulted in a sharp drop in mortality from infectious diseases." This progress ended with the initiation of the capitalist reforms 30 years ago, and the death rate has since increased.
Furthermore, China's recent economic growth has relied substantially on a "demographic bonus," a very large working-age population. "But the window for harvesting this bonus may close soon," with a "profound impact on development": "Excess cheap labor supply, which is one of the major factors driving China's economic miracle, will no longer be available."
Demography is only one of many serious problems ahead. For India, the problems are far more severe.
Not all prominent voices foresee American decline. Among international media, there is none more serious and responsible than the London Financial Times. It recently devoted a full page to the optimistic expectation that new technology for extracting North American fossil fuels might allow the U.S. to become energy independent, hence to retain its global hegemony for a century. There is no mention of the kind of world the U.S. would rule in this happy event, but not for lack of evidence.
At about the same time, the International Energy Agency reported that, with rapidly increasing carbon emissions from fossil fuel use, the limit of safety will be reached by 2017 if the world continues on its present course. "The door is closing," the IEA chief economist said, and very soon it "will be closed forever."
Shortly before the U.S. Department of Energy reported the most recent carbon dioxide emissions figures, which "jumped by the biggest amount on record" to a level higher than the worst-case scenario anticipated by the International Panel on Climate Change (IPCC). That came as no surprise to many scientists, including the MIT program on climate change, which for years has warned that the IPCC predictions are too conservative.
Such critics of the IPCC predictions receive virtually no public attention, unlike the fringe of denialists who are supported by the corporate sector, along with huge propaganda campaigns that have driven Americans off the international spectrum in dismissal of the threats. Business support also translates directly to political power. Denialism is part of the catechism that must be intoned by Republican candidates in the farcical election campaign now in progress, and in Congress they are powerful enough to abort even efforts to inquire into the effects of global warming, let alone do anything serious about it.
In brief, American decline can perhaps be stemmed if we abandon hope for decent survival, prospects that are all too real given the balance of forces in the world.
"Losing" China and Vietnam
Putting such unpleasant thoughts aside, a close look at American decline shows that China indeed plays a large role, as it has for 60 years. The decline that now elicits such concern is not a recent phenomenon. It traces back to the end of World War II, when the U.S. had half the world's wealth and incomparable security and global reach. Planners were naturally well aware of the enormous disparity of power, and intended to keep it that way.
The basic viewpoint was outlined with admirable frankness in a major state paper of 1948 (PPS 23). The author was one of the architects of the New World Order of the day, the chair of the State Department Policy Planning Staff, the respected statesman and scholar George Kennan, a moderate dove within the planning spectrum. He observed that the central policy goal was to maintain the "position of disparity" that separated our enormous wealth from the poverty of others. To achieve that goal, he advised, "We should cease to talk about vague and… unreal objectives such as human rights, the raising of the living standards, and democratization," and must "deal in straight power concepts," not "hampered by idealistic slogans" about "altruism and world-benefaction."
Kennan was referring specifically to Asia, but the observations generalize, with exceptions, for participants in the U.S.-run global system. It was well understood that the "idealistic slogans" were to be displayed prominently when addressing others, including the intellectual classes, who were expected to promulgate them.
The plans that Kennan helped formulate and implement took for granted that the U.S. would control the Western Hemisphere, the Far East, the former British empire (including the incomparable energy resources of the Middle East), and as much of Eurasia as possible, crucially its commercial and industrial centers. These were not unrealistic objectives, given the distribution of power. But decline set in at once.
In 1949, China declared independence, an event known in Western discourse as "the loss of China" — in the U.S., with bitter recriminations and conflict over who was responsible for that loss. The terminology is revealing. It is only possible to lose something that one owns. The tacit assumption was that the U.S. owned China, by right, along with most of the rest of the world, much as postwar planners assumed.
The "loss of China" was the first major step in "America's decline." It had major policy consequences. One was the immediate decision to support France's effort to reconquer its former colony of Indochina, so that it, too, would not be "lost."
Indochina itself was not a major concern, despite claims about its rich resources by President Eisenhower and others. Rather, the concern was the "domino theory," which is often ridiculed when dominoes don't fall, but remains a leading principle of policy because it is quite rational. To adopt Henry Kissinger's version, a region that falls out of control can become a "virus" that will "spread contagion," inducing others to follow the same path.
In the case of Vietnam, the concern was that the virus of independent development might infect Indonesia, which really does have rich resources. And that might lead Japan — the "superdomino" as it was called by the prominent Asia historian John Dower — to "accommodate" to an independent Asia as its technological and industrial center in a system that would escape the reach of U.S. power. That would mean, in effect, that the U.S. had lost the Pacific phase of World War II, fought to prevent Japan's attempt to establish such a New Order in Asia.
The way to deal with such a problem is clear: destroy the virus and "inoculate" those who might be infected. In the Vietnam case, the rational choice was to destroy any hope of successful independent development and to impose brutal dictatorships in the surrounding regions. Those tasks were successfully carried out — though history has its own cunning, and something similar to what was feared has since been developing in East Asia, much to Washington's dismay.
The most important victory of the Indochina wars was in 1965, when a U.S.-backed military coup in Indonesia led by General Suharto carried out massive crimes that were compared by the CIA to those of Hitler, Stalin, and Mao. The "staggering mass slaughter," as the New York Times described it, was reported accurately across the mainstream, and with unrestrained euphoria.
It was "a gleam of light in Asia," as the noted liberal commentator James Reston wrote in the Times. The coup ended the threat of democracy by demolishing the mass-based political party of the poor, established a dictatorship that went on to compile one of the worst human rights records in the world, and threw the riches of the country open to western investors. Small wonder that, after many other horrors, including the near-genocidal invasion of East Timor, Suharto was welcomed by the Clinton administration in 1995 as "our kind of guy."
Years after the great events of 1965, Kennedy-Johnson National Security Adviser McGeorge Bundy reflected that it would have been wise to end the Vietnam war at that time, with the "virus" virtually destroyed and the primary domino solidly in place, buttressed by other U.S.-backed dictatorships throughout the region.
Similar procedures have been routinely followed elsewhere. Kissinger was referring specifically to the threat of socialist democracy in Chile. That threat was ended on another forgotten date, what Latin Americans call "the first 9/11," which in violence and bitter effects far exceeded the 9/11 commemorated in the West. A vicious dictatorship was imposed in Chile, one part of a plague of brutal repression that spread through Latin America, reaching Central America under Reagan. Viruses have aroused deep concern elsewhere as well, including the Middle East, where the threat of secular nationalism has often concerned British and U.S. planners, inducing them to support radical Islamic fundamentalism to counter it.
The Concentration of Wealth and American Decline
Despite such victories, American decline continued. By 1970, U.S. share of world wealth had dropped to about 25%, roughly where it remains, still colossal but far below the end of World War II. By then, the industrial world was "tripolar": US-based North America, German-based Europe, and East Asia, already the most dynamic industrial region, at the time Japan-based, but by now including the former Japanese colonies Taiwan and South Korea, and more recently China.
At about that time, American decline entered a new phase: conscious self-inflicted decline. From the 1970s, there has been a significant change in the U.S. economy, as planners, private and state, shifted it toward financialization and the offshoring of production, driven in part by the declining rate of profit in domestic manufacturing. These decisions initiated a vicious cycle in which wealth became highly concentrated (dramatically so in the top 0.1% of the population), yielding concentration of political power, hence legislation to carry the cycle further: taxation and other fiscal policies, deregulation, changes in the rules of corporate governance allowing huge gains for executives, and so on.
Meanwhile, for the majority, real wages largely stagnated, and people were able to get by only by sharply increased workloads (far beyond Europe), unsustainable debt, and repeated bubbles since the Reagan years, creating paper wealth that inevitably disappeared when they burst (and the perpetrators were bailed out by the taxpayer). In parallel, the political system has been increasingly shredded as both parties are driven deeper into corporate pockets with the escalating cost of elections, the Republicans to the level of farce, the Democrats (now largely the former "moderate Republicans") not far behind.
A recent study by the Economic Policy Institute, which has been the major source of reputable data on these developments for years, is entitled Failure by Design. The phrase "by design" is accurate. Other choices were certainly possible. And as the study points out, the "failure" is class-based. There is no failure for the designers. Far from it. Rather, the policies are a failure for the large majority, the 99% in the imagery of the Occupy movements — and for the country, which has declined and will continue to do so under these policies.
One factor is the offshoring of manufacturing. As the solar panel example mentioned earlier illustrates, manufacturing capacity provides the basis and stimulus for innovation leading to higher stages of sophistication in production, design, and invention. That, too, is being outsourced, not a problem for the "money mandarins" who increasingly design policy, but a serious problem for working people and the middle classes, and a real disaster for the most oppressed, African Americans, who have never escaped the legacy of slavery and its ugly aftermath, and whose meager wealth virtually disappeared after the collapse of the housing bubble in 2008, setting off the most recent financial crisis, the worst so far.


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A look at malaria drugs being used in places that are hotbeds for the mosquito-borne illness finds that many of them are substandard or even fake.
And that's a big problem. Combinations of well-made drugs, including those that contain arteminisin, are a cornerstone of malaria treatment. But when some of the drugs are of poor quality or are outright fakes, people don't get well. Ineffective combinations can promote drug-resistant malaria.
From 20 to 42 percent of the malaria medicines examined in Southeast Asia and sub-Saharan Africa were crummy or counterfeit, according to a review of various studies conducted there. The analysis was just published online by the journal The Lancet Infectious Disease.
In countries where malaria is prevalent, 25 percent of all drugs consumed are malaria medicines, the researchers noted. "Poor-quality antimalarial drugs are an immediate and urgent threat...." they wrote.
They recommend that governments take action to "better define and eliminate both criminal production and poor manufacturing of antimalarial drugs."
Last month, researchers published findings that malaria parasites resistant to the last, best drug treatment, called artemisinin combination therapy, or ACT, are infecting people along the border of Thailand and Myanmar.
That's distant from a previously discovered bunch of cases in Cambodia. And it's a different type of resistant malaria, which means it arose independently of the Cambodian type rather than spreading from there.
"Anti-malarial control efforts are vitally dependent on artemisinin combination treatments," Anne-Catrin Uhlemann and David Fidock of Columbia University wrote in a Lancet editorial last month. "Should these regimens fail, no other drugs are ready for deployment, and drug development efforts are not expected to yield new antimalarials until the end of this decade."
Copyright 2021 NPR. To see more, visit https://www.npr.org.

subset: commoncrawl


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I see the following messages in the error log for a specific site that's configured to use mod_proxy_balancer: [Thu Jun 14 09:00:06 2007] [error] (111)Connection refused: proxy: HTTP: attempt to connect to xx.xx.xx.xx:xxx (xx.xx.xx.xx) failed [Thu Jun 14 09:00:06 2007] [error] ap_proxy_connect_backend disabling worker for (xx.xx.xx.xx) However, by checking the application log files, I can see that traffic is being forwared to this application instance from the apache server running mod_proxy_balancer. Shouldn't this be reporting somewhere that the worker has been re-activated?
Please help us to refine our list of open and current defects; this is a mass update of old and inactive Bugzilla reports which reflect user error, already resolved defects, and still-existing defects in httpd. As repeatedly announced, the Apache HTTP Server Project has discontinued all development and patch review of the 2.2.x series of releases. The final release 2.2.34 was published in July 2017, and no further evaluation of bug reports or security risks will be considered or published for 2.2.x releases. All reports older than 2.4.x have been updated to status RESOLVED/LATER; no further action is expected unless the report still applies to a current version of httpd. If your report represented a question or confusion about how to use an httpd feature, an unexpected server behavior, problems building or installing httpd, or working with an external component (a third party module, browser etc.) we ask you to start by bringing your question to the User Support and Discussion mailing list, see [https://httpd.apache.org/lists.html#http-users] for details. Include a link to this Bugzilla report for completeness with your question. If your report was clearly a defect in httpd or a feature request, we ask that you retest using a modern httpd release (2.4.33 or later) released in the past year. If it can be reproduced, please reopen this bug and change the Version field above to the httpd version you have reconfirmed with. Your help in identifying defects or enhancements still applicable to the current httpd server software release is greatly appreciated.


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We offer accommodation all over the world in more than 140.000 destinations. You can find more than 2.000.000 diofferent types of accommodation worldwide – in European cities, and also accommodation in Asia, Africa, America and Australia.
Use the calendar to enter dates of your stay and check all available hotels in your favourite destination. You will get a list of available hotels, apartments, guesthouses and other accommodation facilities.
Your results can be easily sorted by using the filters on the left side. You can choose according to your preferred type of accommodation, number of stars, price range, amenities and services.
You can sort the list of hotels on the right side by different criteria. When sorting by lowest price you can easily find what is the cheapest accommodation in hotel for your holiday or stay.
Each hotel has several exterior and interior photos. There is also a map with the exact location of your favourite hotel in the final destination.


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Prayer Times Varna
Prayer Times Varna
Imsak/Fajr: Varna marks the pre-dawn meal time (sahur) and the beginning of the morning prayer (Fajr) time.
Sunrise: It is the time when the morning prayer (Fajr) ends. Undesirable time (karahat) begins when the sun rises. It is discouraged to perform prayers approximately 45-50 minutes after sunrise. After that, the time of Ishraq begins. Other calendars do not consider the precautionary time, putting Muslims' fasts at risk.
Dhuhr: It is the time when the noon prayer (Dhuhr) enters.
Asr: Varna indicates the time for the afternoon prayer (Asr). Prayers can be performed until the sky turns red.
Maghreb: It is the time for the evening prayer (Maghrib). The time for breaking the fast (Iftar) begins at sunset. The evening time also signifies the time of sunset.
Isha: It is the time for the night prayer (Isha). Compared to other calendars, it starts approximately 10 minutes later. Regardless, for the acceptance and timely observance of your prayers, we recommend using the virtue timetable on our website.
Varna Friday Prayer: Friday prayer times coincide with the noon prayer (Dhuhr).
Varna Eid Prayer: The prayer times for Eid al-Adha and Eid al-Fitr start approximately 45-50 minutes after sunrise (i.e., during the Ishraq time).
Bulgaria - Varna Prayer Times Page. You can quickly access the prayer times for Varna on our PrayerTime.net website. The prayer times for Varna are regularly updated, providing you with accurate and precautionary times. The prayer times for Varna are based on the virtue timetable calculations, which have been used for centuries and are in line with the scholarly consensus in Islam. We appreciate your choice of PrayerTime.net for Varna prayer times.
Please note that I used "Varna" and "Bulgaria" as placeholders for the city and country variables in your original text. You should replace these placeholders with the actual city and country names as needed. Jadual Waktu Solat Varna, mawaqit, esalah, islamic azan time, adzan, awkat, salah, salat, solah, solat time


text:
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Google says that this feature should work on most "Java, BlackBerry, Windows Mobile, and Nokia/Symbian devices", but it doesn't work in Sony Ericsson K750i, so this claim is questionable.
To get the new version (2.0), go to http://google.com/gmm on your mobile device. It's still in beta, so don't expect it to be flawless.
At this time, My Location (beta) is available for these devices:
* BlackBerry devices
* Some recent Motorola devices
* Some recent Sony Ericsson devices
* Many Windows Mobile devices
* Nokia Series 60 3rd Edition devices
If you have a Java-enabled (J2ME) device, BlackBerry or Windows Mobile device, you can easily check whether or not My Location (beta) is available. Just to go "Help" > "About" from the application. If the box contains "myl: N/A," it means your device isn't reporting a cell.


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Hey there!
All Login/Cache/Session Token issues should now be resolved. Please praise Glaive for fixing this.
Welcome to Cwcki Club!
Before posting, please check out the General Rules
Join the Cwcki Club Discord!
External Redirect
You are about to leave CWCki Club and visit a site we have no control over. Click the button below to continue to time-seller.site.


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In conference rooms everywhere, corporate planners are in the midst of the annual strategic-planning process. For the better part of a year, they collect financial and operational data, make forecasts, and prepare lengthy presentations with the CEO and other senior managers about the future direction of the business. But at the end of this expensive and time-consuming process, many participants say they are frustrated by its lack of impact on either their own actions or the strategic direction of the company.
This sense of disappointment was captured in a recent McKinsey Quarterly survey of nearly 800 executives: just 45 percent of the respondents said they were satisfied with the strategic-planning process.1 Moreover, only 23 percent indicated that major strategic decisions were made within its confines. Given these results, managers might well be tempted to jettison the planning process altogether.
But for those working in the overwhelming majority of corporations, the annual planning process plays an essential role. In addition to formulating at least some elements of a company's strategy, the process results in a budget, which establishes the resource allocation map for the coming 12 to 18 months; sets financial and operating targets, often used to determine compensation metrics and to provide guidance for financial markets; and aligns the management team on its strategic priorities. The operative question for chief executives is how to make the planning process more effective—not whether it is the sole mechanism used to design strategy. CEOs know that strategy is often formulated through ad hoc meetings or brand reviews, or as a result of decisions about mergers and acquisitions.
Our research shows that formal strategic-planning processes play an important role in improving overall satisfaction with strategy development. That role can be seen in the responses of the 79 percent of managers who claimed that the formal planning process played a significant role in developing strategies and were satisfied with the approach of their companies, compared with only 21 percent of the respondents who felt that the process did not play a significant role. Looked at another way, 51 percent of the respondents whose companies had no formal process were dissatisfied with their approach to the development of strategy, against only 20 percent of those at companies with a formal process.
So what can managers do to improve the process? There are many ways to conduct strategic planning, but determining the ideal method goes beyond the scope of this article. Instead we offer, from our research, five emergent ideas that executives can employ immediately to make existing processes run better. The changes we discuss here (such as a focus on important strategic issues or a connection to core-management processes) are the elements most linked with the satisfaction of employees and their perceptions of the significance of the process. These steps cannot guarantee that the right strategic decisions will be made or that strategy will be better executed, but by enhancing the planning process—and thus increasing satisfaction with the development of strategy—they will improve the odds for success.
Start with the issues
Ask CEOs what they think strategic planning should involve and they will talk about anticipating big challenges and spotting important trends. At many companies, however, this noble purpose has taken a backseat to rigid, data-driven processes dominated by the production of budgets and financial forecasts. If the calendar-based process is to play a more valuable role in a company's overall strategy efforts, it must complement budgeting with a focus on strategic issues. In our experience, the first liberating change managers can make to improve the quality of the planning process is to begin it by deliberately and thoughtfully identifying and discussing the strategic issues that will have the greatest impact on future business performance.
Granted, an approach based on issues will not necessarily yield better strategic results. The music business, for instance, has discussed the threat posed by digital-file sharing for years without finding an effective way of dealing with the problem. But as a first step, identifying the key issues will ensure that management does not waste time and energy on less important topics.
We found a variety of practical ways in which companies can impose a fresh strategic perspective. For instance, the CEO of one large health care company asks the leaders of each business unit to imagine how a set of specific economic, social, and business trends will affect their businesses, as well as ways to capture the opportunities—or counter the threats—that these trends pose. Only after such an analysis and discussion do the leaders settle into the more typical planning exercises of financial forecasting and identifying strategic initiatives.
One consumer goods organization takes a more directed approach. The CEO, supported by the corporate-strategy function, compiles a list of three to six priorities for the coming year. Distributed to the managers responsible for functions, geographies, and brands, the list then becomes the basis for an offsite strategy-alignment meeting, where managers debate the implications of the priorities for their particular organizations. The corporate-strategy function summarizes the results, adds appropriate corporate targets, and shares them with the organization in the form of a strategy memo, which serves as the basis for more detailed strategic planning at the division and business-unit levels.
A packaged-goods company offers an even more tailored example. Every December the corporate senior-management team produces a list of ten strategic questions tailored to each of the three business units. The leaders of these businesses have six months to explore and debate the questions internally and to come up with answers. In June each unit convenes with the senior-management team in a one-day meeting to discuss proposed actions and reach decisions.
Some companies prefer to use a bottom-up rather than top-down process. We recently worked with a sales company to design a strategic-planning process that begins with in-depth interviews (involving all of the senior managers and selected corporate and business executives) to generate a list of the most important strategic issues facing the company. The senior-management team prioritizes the list and assigns managers to explore each issue and report back in four to six weeks. Such an approach can be especially valuable in companies where internal consensus building is an imperative.
Bring together the right people
An issues-based approach won't do much good unless the most relevant people are involved in the debate. We found that survey respondents who were satisfied with the strategic-planning process rated it highly on dimensions such as including the most knowledgeable and influential participants, stimulating and challenging the participants' thinking, and having honest, open discussions about difficult issues. In contrast, 27 percent of the dissatisfied respondents reported that their company's strategic planning had not a single one of these virtues. Such results suggest that too many companies focus on the data-gathering and packaging elements of strategic planning and neglect the crucial interactive components.
Strategic conversations will have little impact if they involve only strategic planners from both the business unit and the corporate levels. One of our core beliefs is that those who carry out strategy should also develop it. The key strategy conversation should take place among corporate decision makers, business unit leaders, and people with expertise essential to the discussion. In addition to leading the corporate review, the CEO, aided by members of the executive team, should as a rule lead the strategy review for business units as well. The head of a business unit, supported by four to six people, should direct the discussion from its side of the table (see sidebar, "Things to ask in any business unit review").
One pharmaceutical company invites business unit leaders to take part in the strategy reviews of their peers in other units. This approach can help build a better understanding of the entire company and, especially, of the issues that span business units. The risk is that such interactions might constrain the honesty and vigor of the dialogue and put executives at the focus of the discussion on the defensive.
Corporate senior-management teams can dedicate only a few hours or at most a few days to a business unit under review. So team members should spend this time in challenging yet collaborative discussions with business unit leaders rather than trying to absorb many facts during the review itself. To provide some context for the discussion, best-practice companies disseminate important operational and financial information to the corporate review team well in advance of such sessions. This reading material should also tee up the most important issues facing the business and outline the proposed strategy, ensuring that the review team is prepared with well-thought-out questions. In our experience, the right 10 pages provide ample fuel to fire a vigorous discussion, but more than 25 pages will likely douse the level of energy or engagement in the room.
Adapt planning cycles to the needs of each business
Managers are justifiably concerned about the resources and time required to implement an issues-based strategic-planning approach. One easy—yet rarely adopted—solution is to free business units from the need to conduct this rigorous process every single year. In all but the most volatile, high-velocity industries, it is hard to imagine that a major strategic redirection will be necessary every planning cycle. In fact, forcing businesses to undertake this exercise annually is distracting and may even be detrimental. Managers need to focus on executing the last plan's major initiatives, many of which can take 18 to 36 months to implement fully.
Some companies alternate the business units that undergo the complete strategic-planning process (as opposed to abbreviated annual updates of the existing plan). One media company, for example, requires individual business units to undertake strategic planning only every two or three years. This cadence enables the corporate senior-management team and its strategy group to devote more energy to the business units that are "at bat." More important, it frees the corporate-strategy group to work directly with the senior team on critical issues that affect the entire company—issues such as developing an integrated digitization strategy and addressing unforeseen changes in the fast-moving digital-media landscape.
Other companies use trigger mechanisms to decide which business units will undergo a full strategic-planning exercise in a given year. One industrial company assigns each business unit a color-coded grade—green, yellow, or red—based on the unit's success in executing the existing strategic plan. "Code red," for example, would slate a business unit for a strategy review. Although many of the metrics that determine the grade are financial, some may be operational to provide a more complete assessment of the unit's performance.
Freeing business units from participating in the strategic-planning process every year raises a caveat, however. When important changes in the external environment occur, senior managers must be able to engage with business units that are not under review and make major strategic decisions on an ad hoc basis. For instance, a major merger in any industry would prompt competitors in it to revisit their strategies. Indeed, one advantage of a tailored planning cycle is that it builds slack into the strategic-review system, enabling management to address unforeseen but pressing strategic issues as they arise.
Implement a strategic-performance-management system
In the end, many companies fail to execute the chosen strategy. More than a quarter of our survey respondents said that their companies had plans but no execution path. Forty-five percent reported that planning processes failed to track the execution of strategic initiatives. All this suggests that putting in place a system to measure and monitor their progress can greatly enhance the impact of the planning process.
Most companies believe that their existing control systems and performance-management processes (including budgets and operating reviews) are the sole way to monitor progress on strategy. As a result, managers attempt to translate the decisions made during the planning process into budget targets or other financial goals. Although this practice is sensible and necessary, it is not enough. We estimate that a significant portion of the strategic decisions we recommend to companies can't be tracked solely through financial targets. A company undertaking a major strategic initiative to enhance its innovation and product-development capabilities, for example, should measure a variety of input metrics, such as the quality of available talent and the number of ideas and projects at each stage in development, in addition to pure output metrics such as revenues from new-product sales. One information technology company, for instance, carefully tracks the number and skill levels of people posted to important strategic projects.
Strategic-performance-management systems, which should assign accountability for initiatives and make their progress more transparent, can take many forms. One industrial corporation tracks major strategic initiatives that will have the greatest impact, across a portfolio of a dozen businesses, on its financial and strategic goals. Transparency is achieved through regular reviews and the use of financial as well as nonfinancial metrics. The corporate-strategy team assumes responsibility for reviews (chaired by the CEO and involving the relevant business-unit leaders) that use an array of milestones and metrics to assess the top ten initiatives. One to expand operations in China and India, for example, would entail regular reviews of interim metrics such as the quality and number of local employees recruited and the pace at which alliances are formed with channel partners or suppliers. Each business unit, in turn, is accountable for adopting the same performance-management approach for its own, lower-tier top-ten list of initiatives.
When designed well, strategic-performance-management systems can give an early warning of problems with strategic initiatives, whereas financial targets alone at best provide lagging indicators. An effective system enables management to step in and correct, redirect, or even abandon an initiative that is failing to perform as expected. The strategy of a pharmaceutical company that embarked on a major expansion of its sales force to drive revenue growth, for example, presupposed that rapid growth in the number of sales representatives would lead to a corresponding increase in revenues. The company also recognized, however, that expansion was in turn contingent on several factors, including the ability to recruit and train the right people. It therefore put in place a regular review of the key strategic metrics against its actual performance to alert managers to any emerging problems.
Integrate human-resources systems into the strategic plan
Simply monitoring the execution of strategic initiatives is not sufficient: their successful implementation also depends on how managers are evaluated and compensated. Yet only 36 percent of the executives we surveyed said that their companies' strategic-planning processes were integrated with HR processes. One way to create a more valuable strategic-planning process would be to tie the evaluation and compensation of managers to the progress of new initiatives.
Although the development of strategy is ostensibly a long-term endeavor, companies traditionally emphasize short-term, purely financial targets—such as annual revenue growth or improved margins—as the sole metrics to gauge the performance of managers and employees. This approach is gradually changing. Deferred-compensation models for boards, CEOs, and some senior managers are now widely used. What's more, several companies have added longer-term performance targets to complement the short-term ones. A major pharmaceutical company, for example, recently revamped its managerial-compensation structure to include a basket of short-term financial and operating targets as well as longer-term, innovation-based growth targets.
Although these changes help persuade managers to adopt both short- and long-term approaches to the development of strategy, they don't address the need to link evaluation and compensation to specific strategic initiatives. One way of doing so is to craft a mix of performance targets that more appropriately reflect a company's strategy. For example, one North American services business that launched strategic initiatives to improve its customer retention and increase sales also adjusted the evaluation and compensation targets for its managers. Rather than measuring senior managers only by revenue and margin targets, as it had done before, it tied 20 percent of their compensation to achieving its retention and cross-selling goals. By introducing metrics for these specific initiatives and linking their success closely to bonus packages, the company motivated managers to make the strategy succeed.
An advantage of this approach is that it motivates managers to flag any problems early in the implementation of a strategic initiative (which determines the size of bonuses) so that the company can solve them. Otherwise, managers all too often sweep the debris of a failing strategy under the operating rug until the spring-cleaning ritual of next year's annual planning process.
Some business leaders have found ways to give strategic planning a more valuable role in the formulation as well as the execution of strategy. Companies that emulate their methods might find satisfaction instead of frustration at the end of the annual process.


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Program Fights Gun Violence Bravado With 'Story Of Suffering'
Cradle to Grave brings at-rish youth into a Philadelphia hospital to get them to think about the consequences of getting shot. "You only have to die one time," the director tells them, "but the people that you leave behind die a little bit each and every day for the rest of their lives."
Related Topics
Other segments from the episode on September 4, 2013
September 4, 2013
Guests: Amy Goldberg & Scott Charles
TERRY GROSS, HOST: This is FRESH AIR. I'm Terry Gross. Do you know anyone who's been shot? How you answer that question puts you on one side of what's become a dividing line in America today. For example, in the inner-city neighborhood of North Philadelphia, many young people have friends, family, schoolmates who have been wounded or killed by people with guns.
These shooting victims usually get taken to the trauma unit of Temple University Hospital. Dr. Amy Goldberg, the head of the trauma unit, has treated many of these victims and watched some of them die. In 2006 she decided to do something to try to help stop the cycle of violence. Together with Scott Charles she created Cradle to Grave, a violence prevention program that brings small groups of at-risk youth to the hospital to show that getting shot isn't like on TV and in the movies.
At the hospital, Charles tells the young people the story of one 16-year-old from North Philadelphia who was shot multiple times. Dr. Goldberg describes the surgery she performed trying to save him. Dr. Amy Goldberg and Scott Charles are my guests. Charles is the director of the Cradle to Grave program and is also the hospital's trauma outreach coordinator and counsels many young shooting victims.
Later we'll hear from one of those young men who was shot early this year and survived. Eight thousand people so far have gone through the Cradle to Grave program. Scott Charles, Dr. Amy Goldberg, welcome to FRESH AIR. Thank you both for coming. Dr. Goldberg, about how many gunshot patients do you see each week?
DR. AMY GOLDBERG: We see about 500 a year, so I guess that would almost make about, you know, 10 a week.
GROSS: What are some of the medical misunderstandings you want to undo by bringing young people into the ER?
GOLDBERG: Well, I think particularly what we want to do is to educate these young kids that gunshot wounds and injuries can kill. I think what they see on TV, they hear on hip-hop and music, is that you get shot and you're fine, and that is not the case at all, that these are lethal injuries and you can walk away paralyzed with severe injuries...
GROSS: Or not walk away.
GOLDBERG: Or not walk away at all.
GROSS: And Scott, is there like a bravado you're trying to undo too about what it means to be shot?
SCOTT CHARLES: I don't know that we're ever going to really be able to undo the bravado. You know, I completely get the bravado. As a result...
GROSS: Explain it to me.
CHARLES: Sure, sure. So you know, there's a lot of mythology that surrounds guns and gun violence in the neighborhoods. But one of the things that being shot does, I believe, is that it really is the thing that suggests to the community, at whole, that somebody imposed their will on another. And as the victim of the gun injury, I think there's a sense or a desire to recoup something that was lost.
And the word is that they're now soldiers as a function of being shot. They go back out and they say it wasn't really that big a deal being shot, I took it like a soldier. And I completely understand that, because their concern, I believe, is the fear of being reinjured or re-victimized. They become a target. You don't want to be seen as soft. I get that.
The problem is for those who've not been shot yet. They have no idea how bad this experience is. The reality for 80 percent of the people who get shot, more than 80 percent of people who get shot in Philadelphia and who will survive, it's really a story of suffering.
And so what we wanted to do with the Cradle to Grave program is to reveal the truth about that experience. It's not like what they see on television. It's not like the word that they're getting on the street. What I hear from young men who get shot, and I will meet virtually every young man who will be admitted into the hospital, the one thing that they say time and time again, Terry, is I wouldn't wish this upon my own worst enemy.
GROSS: What do you want to do for them?
CHARLES: Well, you know, the very first thing I want to do is to let them know that there's somebody there serving as an advocate for them and that they can tell me anything, they can ask me anything. It's really to have a conversation with them at every turn, to let them know that we don't have to continue this cycle of violence, that it can end here.
What'll happen when an individual has been shot, oftentimes, is their friends are going to come in, and they're going to kind of puff them up and let them know that they're going to retaliate in this young person's honor. And my goal is to try to be a voice that is going to interrupt that moment. And when the two of us can have a conversation, we're going to spend a lot of time talking about what retaliation ultimately means, how this will carry on much further down the line.
GROSS: A project that you're collaborating on is the Cradle to Grave program. And what you do in that, Scott Charles, you take a group of young people who are at risk into the ER at Temple University Hospital, and you tell them the story of a young man who was shot multiple times and didn't make it. Tell us a little bit of the story that you tell those young people.
CHARLES: Sure. I tell the story of a young man named Lamont Adams, who was 16 years old at the time of his death. He was a kid who grew up probably just a little over a mile and a half from where Temple Hospital is located. He was a very typical kid, which is one of the reasons I wanted to tell Lamont's story. He was well-liked, very outgoing, friendly, he was funny, and Lamont got into some kind of trouble. It's unclear precisely what the dispute was about.
The rumor on the street was initially that Lamont might have cooperated with the police or set up this dice game that was going on that he had been a part of, and what we believe ultimately happened is that Lamont just so happened to leave this dice game that he was involved in right before the police came and broke up the dice game.
What happened after the police came to break up this dice game is that they found a young man in that dice game who had a weapon on him, and that young man was arrested on that gun charge and taken away. And those who were left behind after Lamont walked off felt that Lamont might have cooperated with the police, and at least that's one explanation.
Another was that Lamont simply won some money in that dice game and that it was a matter of sour grapes. Nonetheless, a few weeks after this occurred, Lamont would essentially write out his obituary after receiving a number of threats, and in fact he wrote this obituary on a paper napkin the night before he was gunned down. He quietly wrote the words: Lamont Adams, son of Daneen Adams and James Edward Mathis, is gunned down in North Philly. And he would fold up that napkin and leave it behind.
His grandmother would find this note, and she would confront him, and he would reassure her that he was OK. However, he would leave the house 24 hours later, almost exactly 24 hours later, and walked just about a block from his house, where he would be gunned down.
The young man who shot Lamont shot Lamont a total of 14 times and left him for dead. And this is the story that we tell the young people that come through the program.
And then, we then from that point walk them into the hospital Emergency Department, where Dr. Goldberg or a surgical resident will then guide them through all of the steps that were taken in an effort to save Lamont's life.
GROSS: One of the things that you do is you take one of those students who you're talking to, put them on a gurney, and you put red dots on each of the places where Lamont was shot. And it's very disturbing to see that, and I think it's very disturbing for the young people who are watching to see it because it's as if this young person has gotten all these bullet wounds because they're symbolically placed throughout his body.
And after you do that and talk about that, Dr. Goldberg, then you start talking about what you did to try to save him. And you start pulling out surgical tools that look like I should be buying them in a hardware store to repair my kitchen. I want you to describe some of the surgical tools that you had to use to try to save Lamont.
GOLDBERG: We show them a laryngoscope, which is used to put a breathing tube in, because Lamont wasn't breathing on his own. We show them the scalpel that was used or the type of scalpel that was used to open Lamont's chest, the special retractor to spread open the ribs and keep the chest open so we can gain access to the heart.
GROSS: And that retractor, it's like a big metal thing that looks like maybe for your car.
GOLDBERG: It's called a Finicetto(ph) retractor, but in reality it's a rib-spreader, and that's what we use, unfortunately, to spread the ribs of these young patients so that we can do surgery in the trauma bay. When we cut across the breastbone, we use something called a Libshki(ph) knife, but in reality it's a very crude hammer and kind of a knife that separates the breastbone in half - again, so that we can get full access to both the left and right chest, as well as the heart.
GROSS: You lost Lamont on the table.
GOLDBERG: Yes.
GROSS: Why weren't you able to save him?
GOLDBERG: Well, Lamont had multiple injuries to his chest and both lungs and his heart, and those are just lethal. And in spite of everything that medicine can provide, there are certain damages that bullets do that we cannot fix, unfortunately.
GROSS: Dr. Goldberg, when you're trying to save somebody's life who's been shot, do you make any difference between who was, you know, a quote good guy and who was, you know, a quote bad guy in the situation? I mean some people are the aggressors and some people are the victims. And, you know, does that make a difference?
GOLDBERG: It doesn't make a difference for the physicians and nurses. When the patients arrive in the trauma bay, we don't get that information, and I'm really happy that we don't. Every person that comes in the trauma bay has somebody that loves them. Whether they are on the good or the wrong side of the law, it's not for us as physicians or nurses or whomever to make any judgment when we're taking care of the patients.
So that is something for sure that we don't usually know, and I'm thankful for that.
GROSS: Scott Charles, one of the things I think you do when you're talking to the students and when Dr. Goldberg's showing them all the surgical tools and so on, you play them a tape of Lamont's grandmother, and she's the woman who raised him. And this was a tape that you helped get recorded through the StoryCorps project on NPR, and StoryCorps is a public radio project. You've probably heard some of their stories on MORNING EDITION and ALL THINGS CONSIDERED.
And there was a group of teenagers who went around trying to get the stories of 35 young people who were shot to death in Philadelphia, and one of the stories was Lamont's. And a couple of students spoke to Lamont's grandmother, who raised him, and I want to play that excerpt of the StoryCorps piece.
And first we'll hear the two students who are doing the interview introducing themselves.
TERRENCE BOYKINS: Hello. My name is Terrence Boykins. I'm 14 years old.
PATRICK VOLF: My name is Patrick Volf. I'm 14 years old. Today I'm talking to Mrs. Clark about Lamont Adams. Why do you want to participate in this project?
JENNY CLARK: Because Lamont was my baby, my grandson. I raised him. I don't want him forgotten.
BOYKINS: What memories do you have of his early childhood?
CLARK: He had a hard raspy voice when he was a little fellow. There was a song out called - (Singing) oh, baby, you, you've got what I need. (Speaking) And Lamont wasn't even walking but he was sitting up singing that song.
BOYKINS: Can you describe his personality?
CLARK: Lamont loved to talk and laugh. He had the prettiest smile and the whitest teeth and he always showed them, mouth always open. Always talking. He made friends everywhere. People liked him. That personality, I wish I'd have had it.
VOLF: How do you want Lamont to be remembered?
CLARK: Just remember that big smile, that big smile that I'm so crazy about. His last wash is still downstairs in the basement in the hamper because I can't move his things. I go through them, I look at them, but I don't move his things. Sometimes I go in the bathroom and I close the door and I get down on my knees and I cry and I ask God why my baby. Why did he have to hurt my baby? They don't know what they took from us.
GROSS: Scott Charles, why do you play that tape for the young people?
CHARLES: As I say to the young people who come through the program, you have an easy job when you die. You only have to die one time. But the people that you leave behind die a little bit each and every day for the rest of their lives. I recently had the experience of sitting down with Jenny just a few months ago, and we sat down in her living room.
GROSS: This is the grandmother.
CHARLES: The grandmother, Jenny Clark. And we sat down in her living room just as we had all those years ago. And I'll tell you, I can't even think of how many years it's been, nine year now maybe, and she still weeps today as she had all those years ago. She's just never gotten over it. And so really that's what I want kids to understand, that it's not just about them. This is about everybody they leave behind.
GROSS: My guests are Dr. Amy Goldberg, chief of the trauma unit at Temple University Hospital, where she co-founded the Cradle to Grave program with Scott Charles, who's also with us. Our thanks to David Isay and the folks at StoryCorps for that tape excerpt. We'll talk more after a break. This is FRESH AIR.
GROSS: We're talking about trying to stop the cycle of violence that's killing and maiming so many inner-city youth. My guests are Dr. Amy Goldberg, the chief of the trauma unit at Temple University Hospital; and youth counselor, Scott Charles. They co-founded the Cradle to Grave Program, which Charles directs.
So let me ask you about another aspect of the work that you're doing at Temple University Hospital in North Philadelphia, and that is called Turning Point, and this one is about working with gunshot victims. When trauma victims come in, they're videotaped in the emergency room having whatever work is being done to them.
And part of the reason - I think you're doing this for multiple reasons, but there's one reason in particular that relates to what we're talking about today. And Dr. Goldberg, would you explain that?
GOLDBERG: Yeah, absolutely. Cradle to Grave is hopefully prevention, and Turning Point is an intervention. And as Scott had mentioned earlier in the interview, it is very quickly the kids kind of forget how they felt in the trauma bay, how scared they were, how they were calling for their mothers, how they thought that they were going to die.
And we thought it was really important, again in the educational process, to remind them. So we thought the best thing that we could do, with their permission, would be to show them what it was like in the trauma bay because we, again, were fearful that they had forgotten.
So we let them see that, you know, that they were crying or calling for their moms or am I going to die. And we find it - and I think they find it to be very educational and insightful.
GROSS: When you started in medical school, and you were training, did you think and someday I'll be treating 500 gunshot victims a year?
GOLDBERG: No, not at all. I don't think I knew from a gunshot wound. I grew up in the suburbs of Philadelphia, never really knew anything about any inner city anywhere, particularly North Philadelphia, and had no idea that this was so commonplace.
GROSS: How did you end up in the position that you are? By that I mean, you know, dealing, for more than 20 years, dealing with a lot of gunshot victims and staying in that position. It's not like you're - you want to get out of that, and you're moving to a suburban hospital.
GOLDBERG: I think doing my training at Temple as a surgical intern and a surgical resident, educated me to what was going on just four miles from City Hall. I felt very fortunate about the opportunities that I had. And, you know, it just kind of didn't seem fair, believe it or not, that everyone didn't have those same opportunities.
And, you know, there was a little war going on in North Philadelphia. I particularly remember a time during my surgical residency when Desert Storm was taking place, and luckily there weren't that many fatalities in Desert Storm, but during...
GROSS: This was the first Iraq war.
GOLDBERG: Yes, but during that week in January, I mean, I specifically recall more young black men getting shot in the head, dying, than any of the fatalities from Desert Storm, and that's not minimizing what our soldiers go through. But there was a war that was going on in North Philadelphia that I just didn't feel that anybody was paying attention to.
GROSS: Dr. Goldberg, our listeners can't see, but you're pretty short and small. You're about...
GOLDBERG: Five two and a quarter.
GROSS: Five two and a quarter, OK. You're white, and you're from a suburb.
GOLDBERG: Yes.
GROSS: You're working in Philadelphia's inner city. If you were on the street with some of the people whose lives you're saving or trying to save, you would be considered vulnerable. You're small. In a world where physical power is important, I don't know how much you have. But in the emergency room, you're saving people's lives. Their lives are in your hands, and it doesn't matter if you're tall or short or physically weak or physically strong.
And I wonder if you've thought about that a lot, about just a different way that you'd be perceived in the ER than, say on the street.
GOLDBERG: Well, I'm very cautious to ever think that really any one person saves someone's life. I think it takes our entire team, and the longer I am a trauma surgeon, the more I really believe more and more in God and the greater power that exists.
You know, I think I'm comfortable whether it's in the trauma bay or on the street in Center City or on the street in North Philadelphia. I think probably in North Philadelphia, they would recognize me, having been there so long. I do think the patients know me.
CHARLES: I'm sorry...
GROSS: No, go ahead, go ahead.
CHARLES: I was going to jump in because one, I want to thank you for being able to point out how diminutive she is because she gets mad when I do that.
CHARLES: But one of the things that she won't tell you and that you haven't had the benefit of seeing is the way she kind of stomps about the hospital. She's much smaller than some of the patients that get to know her while she's there.
I've had the benefit of seeing her outside of the hospital, too. And as she mentioned when I've had - on more than one occasion seen patients who recognize her from the hospital when we're going out for coffee or getting something to eat in the neighborhood. And many times they'll come up and say you, Dr. Goldberg, you're the lady that saved me.
There is a degree of credibility that she has out there, but I think one of the things that she also recognizes is that whether it's Philadelphia or anywhere else in America, that she's really not going to be the target of this type of violence. By and large, the safest you're going to be when it comes to gun violence is to be white and to be female.
But I think more importantly...
GROSS: Why do you say that?
CHARLES: Well, 92 percent of the people who get shot in Philadelphia are male. Eighty-two percent of the people who get shot are African-Americans. Just by virtue of that demographic, it puts her a bit on the outside. But again more importantly I think the matter is, for Amy, is I think she does have a tremendous amount of faith. I do believe she believes in karma. I think that she believes she has a great deal of good will out there.
I've never sensed that she felt vulnerable. There are a lot of adjectives one might use to describe Amy, but vulnerable isn't one of them.
GROSS: Scott Charles and Dr. Amy Goldberg co-founded the Cradle to Grave Program. We'll talk more in the second half of the show. I'm Terry Gross, and this is FRESH AIR.
GROSS: This is FRESH AIR. I'm Terry Gross. We're talking about trying to stop the cycle of gun violence in the inner city. Dr. Amy Goldberg, the chief of Temple University Hospital's trauma unit, has treated many gunshot victims in the inner-city neighborhood of North Philadelphia.
In 2006, she decided to do something to convince young people to break the cycle of violence. Along with Scott Charles, who was with us, she co-founded the program Cradle to Grave, that brings young people into the hospital to explain what guns really do the body and to people's lives.
Charles is the program's director. And as the hospital's trauma outreach coordinator, Charles counsels gunshot victims. We'll hear from one of them, Gregory Cunningham, a little later.
Scott Charles, you come from a violent neighborhood, and I assume that's part of the reason why you're doing the work that you do, 'cause you, you know what it's like to grow up in bad circumstances. So could you tell us a little bit about your background and your neighborhood?
CHARLES: Sure. I grew up in a neighborhood that was, I think, some would argue predominantly Mexican, predominantly Hispanic. I'm the biracial son of a white mom, single mom, growing up in that neighborhood. There were gangs in the neighborhood that I grew up in. And a number of my friends had either been stabbed or shot by the time I had finished high school. But again, compared to kind of where we are in Philadelphia, where virtually every kid that will come through the program knows somebody who's been shot, it wasn't quite that violent, but violent enough. Certainly, not the kind of community that I'd want to raise my kids in today.
GROSS: And were they are casualties in your own family?
CHARLES: Yeah. I have a brother who was shot. And, you know, when we talk about families, my mom was a great mom, you know, worked hard, went to work every day. But my being raised in that community was a bit of a patchwork -where I think, you know, my father having died when I was nine, it left me looking for father figures. One of them was a man named Jess Fernandez, who was the father of my childhood friends and he was a surrogate dad to me, you know, passed his wisdom on to me. And, unfortunately, Jess ended up dying not long ago, in fact, just a few years ago as a result of a gunshot injury.
GROSS: And what about your brother, how was he shot?
CHARLES: You know, it happened so long ago and really when I was a young, young boy. But, you know, the story is basically he was hanging out at a park where that kind of thing went on often. And again, I was such a young kid but it became part of his legend, you know. But, you know, my father was...
GROSS: Did he survive?
CHARLES: Yeah. He survived. And, you know, my father was a man who had a lot of guns. Guns were very common in my house when my father lived with us. And I can remember my father getting into disputes with neighbors and the guns would come out. Or the police showing up at our home because he had threatened somebody and sometimes my mom with those guns.
GROSS: He threatened your mother with the guns?
CHARLES: Sure. And I think really implicit in his rage was the fact that he was somebody who had guns. So this was really part of the backdrop in my life. You know, I was raised around guns.
GROSS: Did you want guns?
CHARLES: Oh, absolutely. You know, as a young man I possessed guns illegally. From the time I think I was 14 I was provided a handgun by somebody that I worked for under the table. You know, and it was...
GROSS: Someone in the legitimate or the underground economy?
CHARLES: I-I worked in a, I worked for a grocery store and that was in the neighborhood and I worked under the table for protection. One of the owners gave me a handgun, a gun that was illegal with no serial numbers. And so that was really, you know, the message that I got from a very early age, if I was going to protect myself I would need a gun.
GROSS: Did you feel empowered at the age of 14 when you were given a gun?
CHARLES: Yeah. I mean what - at 14 what kid doesn't feel empowered? You know, I mean this weapon, this handgun, is so lethal. And, you know, I thank God when I look back on my life that I didn't make a stupid mistake that there would be no coming back from.
GROSS: So, you know, in addition to growing up in a relatively violent neighborhood - not as violent as you work now...
CHARLES: Sure.
GROSS: ...and, you know, being given an illegal gun when you were 14, and your brother was shot when he was young, you had other issues to deal with too - including a drug problem...
CHARLES: Mm-hmm.
GROSS: ...in your life. And you credit - correctly me if I'm wrong here - but you credit your aunt and your uncle...
CHARLES: Mm-hmm.
GROSS: ...with helping you get out of that life. And I'd like you - if you would - to tell us a little bit about them and what they did to help you and how that, if at all, has inspired you to do the work that you're doing.
CHARLES: Sure. So one of the things - if you don't mind - I just want to be clear, by mom was fantastic but she struggled to do all that she could and give me the life that she had hoped to give me just because it's tough for single moms. I developed a drug problem in my late teens and a few years later I found myself pretty well strung out - having lost all money that I had earned. And I had no skills, didn't have much of an education beyond high school. I reached out to an aunt of mind who, along with her husband, owned an African-American newspaper in Sacramento called the Sacramento Observer. And as they would with a lot of guys who were struggling, and women, they would take me on. They allowed me to sweep up and I remember my first job there was cleaning up behind the graphic artists that were there - one of whom was my oldest brother who himself had a drug problem.
What I found out that newspaper were a lot of proud people who came to work, worked hard, they were different from a lot of the guys that I had known growing up. These are men who has struggled with addiction and alcoholism, had criminal records, but they were men who were showing up every day and working hard. But more importantly, my uncle, Dr. Lee, Dr. William Lee, was a man who was hard on me and I think he spent the first few years of my time at that newspaper, I probably spent often on a decade at that newspaper. My uncle broke down all of my bravado and basically told me to leave out that street stuff at the door. I worked long hours for little pay - much like I do now.
CHARLES: And, you know, I had responsibility for the first time in my life and I was loved unconditionally. So I had somebody really cracking the whip and loving me unconditionally and I was given an opportunity, I was given a life, a life raft. And if not for that opportunity that they provided me there's no way that I could be here today. And I think that, you know, everything that I'm doing today is really an extension of the men in my life who stepped up.
It's hard to describe what my job title is because it has this long title: Trauma Outreach Coordinator, and I think I've said in private to Amy, if I had to, if I were allowed to change that title I think of myself as kind of an old head for hire.
CHARLES: In fact, that really is kind of what I want to be. You know, everything I do I want it to be the extension of the men who invested in me - like my uncle, like Jess. And when I walk into that room I want them to know that I am going to love them unconditionally. But sometimes it requires me to break down their bravado. It allows me, it requires me, to tell them to leave that street stuff out there. And sometimes I wait for their friends to leave so that I don't embarrass them, and sometimes I make sure that their friends are there to know that there is an older guy who is going to walk into this room and let them know that I'm going to love you unconditionally, but for this moment in time you're in my house and I'm going to be completely honest with you. That thing that you're doing right now has no real value. It has no values here and ultimately it's going to have no value in your life.
GROSS: I asked you if you could suggest a young who had been shot and survived and could talk about the experience and coming out of it. And you recommended somebody who is about to join us, named Gregory Cunningham, can you introduce him for us?
CHARLES: Sure. Greg came in having been shot kind of in the middle of the day. And as I'll do during the day when somebody gets shot, I came down and checked on him and understood that he'd be going to the operating room, and so I went and saw some other patients. And as soon as I left that space my phone started buzzing from guys in the neighborhood, past patients and some whose job it is to work with gunshots patients in other programs. And I kept getting the same story, this is a really good guy, can you let me know ho my man is doing? You know, is he okay? And then I got to meet Greg when he was admitted to the floor. And I walked in and I encountered a man who was hurting, he was in a tremendous amount of pain, very handsome substantial injuries. But despite his injuries, he was very kind. I think he was a little scared. But more than anything, I think he was a little frightened and overwhelmingly hurt - not just in terms of physical hurt, but I think he felt a sense of betrayal. But he was a proud young man. And since Greg has been discharged he's come and spoken to a few of the groups of kids that we brought through the program. He has a tremendous amount of street credibility. And long before he was shot, he was respected for his basketball skills. But he's a young man - who like, a lot of our gunshot patients - had a life that, you know, isn't defined by being shot. And so I thought he'd be somebody good for you to speak with.
GROSS: And how long ago was Greg shot?
CHARLES: Greg was shot in January of just this year.
GROSS: OK. Well, I want to thank you both so much for talking with us.
CHARLES: Thank you, Terry.
GOLDBERG: Thank you.
GROSS: Scott Charles directs the Cradle to Grave program at Temple University Hospital in Philadelphia. He co-founded the program with Dr. Amy Goldberg, the hospital's trauma chief.
We'll meet Gregory Cunningham after break. This is FRESH AIR.
GROSS: This is FRESH AIR. My guest is Gregory Cunningham, who was just introduced for us by Scott Charles, director of the Cradle to Grave program at Temple University Hospital. Charles counseled Cunningham after Cunningham was shot on a Philadelphia street last January.
Gregory Cunningham, thank you for joining us.
GREGORY CUNNINGHAM: Thank you.
GROSS: Did you everything that you'd be shot?
CUNNINGHAM: No. No way. No how.
GROSS: And why did you think it was impossible?
CUNNINGHAM: The life that I lived up until the point that I was shot didn't amount to that. And I was an athlete, I was a, you know, a college student, I played basketball so I never thought that the life that I was living would, you know, amount to me being shot.
GROSS: Can you tell us how you were shot?
CUNNINGHAM: It was over a situation somebody that I knew shot me. You know what I'm saying, I really don't want to get into all of, you know...
GROSS: That's fine.
CUNNINGHAM: ...the everything that happened. But somebody that I, I wasn't shot by a stranger. Let me just say that. I'm very familiar with the person that, you know, tried to do what they did to me.
GROSS: Where in your body were the bullets?
CUNNINGHAM: I got shot in my leg and in my back.
GROSS: But not your spine?
CUNNINGHAM: A couple inches. I think they were saying like I was a couple inches from, you know, being paralyzed, that the bullet, you know, it pierced one of my lungs. I lost half a lung.
GROSS: Do you remember the moment you were shot?
CUNNINGHAM: Yeah.
GROSS: Do you have any memory?
CUNNINGHAM: Yeah. Yeah, yeah, I remember that.
GROSS: What went through your mind when you knew you'd been shot?
CUNNINGHAM: Aw, man, I hope I don't die. Because I saw my leg when I first got - the first bullet hit my left femur. So it was like, aw man, it was like pretty much hanging I guess by, you know, a couple threads or whatever because it was like all over the place. When I was trying to lift my leg up, I remember was trying to lift my leg up, it was just like, no, I had nothing. So it was like I started to pass out. I started losing blood rapidly, so I began to, you know, I guess blank out a little bit, so...
GROSS: But then you were shot the second time.
CUNNINGHAM: Yeah. In my back. And I felt that too. It was like somebody just, you know, like a little, a sharp shove in your back with some force.
GROSS: How did you get to the emergency room?
CUNNINGHAM: Philadelphia police, they came and they saved me. So there's a lot of people out there that got some bad stories with Philadelphia police, but I got a good one.
GROSS: Were you able to thank them?
CUNNINGHAM: Not personally the two that did it but, you know, I showed my gratitude to a lot of police officers in that district, you know, once I was able to see them and let them know what happened, because around where I live at you see cops all the time. They walk the beat, they drive, you know what I'm saying?
GROSS: Mm-hmm.
CUNNINGHAM: So.
GROSS: How did you deal with your anger at the person who shot you who you knew?
CUNNINGHAM: I'm still dealing with it.
GROSS: One of the things Scott Charles was talking about was trying to prevent people from seeking retribution...
CUNNINGHAM: Right.
GROSS: ...and instead stopping the cycle of violence.
CUNNINGHAM: Right.
GROSS: What's your attitude toward that?
CUNNINGHAM: I mean, that's somewhat true. You know? It's somewhat true, or somewhat supported, but I'm not really - I'm up in the air right now. I don't know how I feel about that situation. So I don't know where that - I don't know where that goes from here.
GROSS: You know the person who shot you.
CUNNINGHAM: Right.
GROSS: Did you report it to the police?
CUNNINGHAM: No.
GROSS: Because?
CUNNINGHAM: I don't want to see him in jail.
GROSS: Even though he shot you.
CUNNINGHAM: Absolutely.
GROSS: Why don't you want to see him in jail?
CUNNINGHAM: Because he don't belong there. And another thing is, I would've lost credibility in my hood had I said who shot me. So that was one of the reasons why I didn't say nothing. And another reason is I don't believe he deserves to be there. So I didn't tell the police what happened.
GROSS: And your friends didn't tell the police, either.
CUNNINGHAM: I mean, I didn't really didn't ask them. They was just, you know, pretty much since I survived and I - you know, they didn't really ask me why they - they just asked me.
GROSS: Do you have a lot of friends who have been shot, too?
CUNNINGHAM: Yeah. Absolutely. I've lost a lot of friends to gun violence. I lost maybe one of the most influential men in my life in 1994 to gun violence.
GROSS: Who was that?
CUNNINGHAM: My Uncle Kenny.
GROSS: Oh.
CUNNINGHAM: He was gunned down, similar to the situation that I was in.
GROSS: So does this leave you any more afraid than you were before about gun violence?
CUNNINGHAM: Not for me. No, I'm not afraid. I'm afraid for, you know, the younger generation around, you know, in my area. Well, just period. You know, I'm just afraid for the younger generation, period, because they lost. They have no clue. And, you know, that's the only line of defense. Statistics shows that it's going to get worse, and I - that's - that's what I'm afraid of...
GROSS: Do you see...
CUNNINGHAM: ...the situation right now getting worse.
GROSS: Do you see younger people talking about guns or having guns and really not know what they're doing...
CUNNINGHAM: All the time.
GROSS: ...and what's going on?
CUNNINGHAM: All the time. Yesterday.
GROSS: Give me an - well, what did you see yesterday?
CUNNINGHAM: Yesterday. I seen a gun almost big as this microphone, the whole frame and all, in a child's hand. Yeah. I seen it. Just yesterday. It wasn't a threat to me, but I seen it.
GROSS: What was the child doing with it?
CUNNINGHAM: Just toting it. Just carrying it. Walking up and down the street with it.
GROSS: Right.
CUNNINGHAM: That's just - that's just, like, what's going on right now.
GROSS: So you've gotten very close with Scott Charles.
CUNNINGHAM: Yes.
GROSS: Who is the director of the Cradle to Grave program.
CUNNINGHAM: Yes.
GROSS: Has the program been helpful?
CUNNINGHAM: Yeah, it's been helpful. I believe it's helped me, because I'm able to give back to, you know, the younger, you know, the younger generation, young males right now. But other than that, then I could say that it helps me, because I can really see, you know, like, one time I was in there, and I was just listening to the kids.
Like, Scott gave them a question and then, you know, one of them just came out and blurted, like, if I can't get him, I'm a go get his mom. And I was just, like, wow. Like, this is - this is sad to even hear this. But I already knew, like, that was what was going on. I already know that's how people think.
Because, you know, like, if they can't get - if they can't get the person that they want, then they'll get just anybody. The grandmother or mother - anybody. And that was just - it was able - I was able to step in right then and there and, like, let them know that that was coward. That was like a coward act, to even think or even say. Like, you think you tough? You going to hurt somebody that don't even know what's going on.
They don't know what's going on. They don't have no recollection of nothing. They don't carry guns. So you just going to go shoot a person because you can't get to the person that harmed you.
GROSS: Well, I wish you the best.
CUNNINGHAM: Yeah.
GROSS: And best wishes for, you know, a complete recovery.
CUNNINGHAM: Yes.
GROSS: And I thank you very much...
CUNNINGHAM: Thank you.
GROSS: ...for talking with us.
CUNNINGHAM: Thank you for allowing me to, you know, share my story, and just thank you.
GROSS: Gregory Cunningham was shot last January. He's spoken to young people as part of the Cradle to Grave program at Temple University Hospital. We heard from the program's cofounders earlier in the show. On our website, you can watch a slideshow about Cradle to Grave. And we have a link to the program's website. Coming up, Maureen Corrigan reviews Alice McDermott's new novel. This is FRESH AIR.
GROSS: This is FRESH AIR. Alice McDermott won the National Book Award for her 1998 novel "Charming Billy," and three of her other novels were finalists for the Pulitzer Prize. She's just published her seventh novel, called "Someone," and book critic Maureen Corrigan has a review.
MAUREEN CORRIGAN, BYLINE: Endurance, going the distance, sucking up the solitude and the brine. I'm not talking about the glorious Diana Nyad and her instantly historic swim from Cuba to Key West, but of the ordinary heroine whose life is the subject of Alice McDermott's latest novel, "Someone." Ordinary is a word that's used a lot to describe McDermott's characters, mostly Irish and working class, mostly un-heroic in any splashy way.
McDermott's heroine is named Marie, and in "Someone," we readers hear, in a fragmented way, about the marathon span of her life: her Brooklyn childhood in the 1920s and '30s, her older brother Gabe, who becomes a priest, and then mysteriously decides it wasn't for him, her first romantic heartbreak and first job, her eventual husband and kids, and her lifetime's worth of bodily insults and illnesses.
It all sounds as tedious as swimming, stroke after stroke, through the water. And yet, in McDermott's unsentimental rendering, Marie's ordinary life becomes one for the record books. That's the spectacular power of McDermott's writing: Without ever putting on literary airs, she reveals to us what's distinct about characters who don't have the ego or eloquence to make a case for themselves as being anything special.
As much as it traces Marie's life, "Someone" is also a lyrical novel about neighborhood, about people whose world is limited to their block, their parish, their apartment house. McDermott keeps giving us glimpses of the rough, accidental communities that city neighborhoods then and now create: a game of stickball in the street, a group of women standing outside a church after Sunday mass, a line of customers in a corner deli.
One of the masterpiece moments in this novel arises out of Marie's first job. After she graduates high school, she's hired by the local undertaker, Mr. Fagin, who needs a girl to greet the mourners. Marie is given carte blanche to buy five good wool dresses from the Abraham and Straus Department Store, and set to work.
During lulls at the funeral home, one of her extra duties is to go up to the third floor, where Mr. Fagin's mother lives, and chat. There, in an apartment filled with small vases of rearranged funeral flowers, Marie usually finds old Mrs. Fagin sitting on her couch, surrounded by visiting nuns and neighborhood ladies, reviewing the pedigrees of the dead in their coffins below. Listen to how Marie describes the women's encoded conversations.
(Reading) Whatever part of the deceased's story was deemed, perhaps, too delicate for the old lady's ears, or, more likely, mine, would be acted out with a series of gestures and nods and sudden silences that I quickly came to be able to interpret as readily as the rest. A finger held to the side of a nose indicated a deception. A pantomimed bottle raised to the mouth meant there was a problem with drink. Eyebrows raised and words falling off into a long nod indicated sex.
McDermott, like the gossiping women she describes, is herself a master of silence and gesture. Nothing feels overwritten in "Someone." The small stories and conversations that make up the bulk of Marie's life are casual and so true to the conventional wisdom of their time period that, when McDermott suddenly hops forward a few decades, we're startled.
For example, for most of the novel, Marie's ex-priest brother Gabe is known to us as a gentle loner. So it's jarring to come upon a section of the novel where one of Marie's grown daughters refers to him knowingly as Uncle Gabe blade. That daughter's flip tone is much more of a shock than the revelation about Gabe's sexual orientation. In objection to her daughter's cheekiness, Marie tells her: I don't see the world the way you kids do.
That plain phrase - which we've all heard a hundred times - is one of the epiphanies of McDermott's novel. She makes us feel its truth: Our worlds may overlap, but they're not fully shared. Marie's children joke about a subject - sexuality - that Marie, as the product of pre-World War II Catholic Brooklyn, can't even name. In "Someone," McDermott summons up that vanished Brooklyn world and Marie's life in it, neither special nor heroic, just significant in its own right.
GROSS: Maureen Corrigan teaches literature at Georgetown University. She reviewed "Someone," by Alice McDermott. You can read an excerpt on our website, freshair.npr.org, where you can also download podcasts of our show. And you can follow us on Twitter @nprfreshair. Our blog is on Tumblr at nprfreshair.tumblr.com.
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.


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