Upstream or downstream, that is the question


I recently attended a talk about the latest research in fetal alcohol spectrum disorder (FASD).

Initially I was intrigued by the physical and behavioural manifestations of the disorder, but quickly began to feel overwhelmed by the complexity of the diagnostic and management approach. Part way through the talk I was struck with this idea: The real problem isn’t FASD. The real problem is drinking in pregnancy, unintended pregnancies and the lackadaisical attitude about drinking in our culture. Why aren’t we talking about that? 

Why are we putting so much attention and effort into managing problems that shouldn’t happen?

That is the question.

There are a lot of us who believe our job is to work downstream, to help the sick and injured.

There are only some of us who believe it’s our job to work upstream. To see and prevent problems before they happen, to do what isn’t being done, to make connections, to teach, to lead, and to help people see risks and change what they can.

It’s scary to work upstream, against the current and venture into un-chartered waters. Guidelines are rare and the journey is fraught with uncertainty, vulnerability and risk for failure. I can’t think of a better way to work.

All I know is that I’m far more interested in changing the culture and preventing problems and unnecessary hardship than trusting in the belief that my job is to be constantly surrounded by suffering.

The reality is that trusting in nothing but downstream work is exhausting and dangerous. When we choose to work downstream, we’re essentially building our careers on a physical and emotional battlefield.

If that’s not how you want to live your life, or you’re tired of drowning, it’s possible to turn around and make your way upstream. Try seeing the real problems underlying the problems you’re faced with every day.

That’s the work that needs to be done.

It’s up to you.