Persistence may be defined as the quality that allows someone to continue doing something or trying to do something even though it is difficult or opposed by other people, or firm or obstinate continuation of advocacy despite difficulty.1 The first definition implies a long-term commitment to a program. It also implies seeing a project through and seeking opportunities to connect others when the time is right. The term “stickiness factor” from Malcom Gladwell’s book, The Tipping Point: How Little Things Can Make a Big Difference, has been brought into the global health discussion by Danielle Laraque-Arena, MD, FAAP, in her presidential speech at the 50th anniversary of the Academic Pediatric Association.2,3 The stickiness factor describes a desire to see programs through to sustainability with a more positive, fanciful lightness, not dogged determination like a bulldozer. As children and youth are given the tools to take ownership of their future with persistence and confidence, there may be no turning back.
The fierce determination of community health professionals to ensure adequate, reliable, culturally appropriate, and sustainable programs and policies has come, in part, in the United States from the growth of support for such programs from the American Academy of Pediatrics (AAP).
This chapter will briefly follow through the evolving trends and many key concepts as they helped to frame and guide the work of pediatricians and other health care professionals working with communities in the United States and overseas.
Several key concepts that helped to support this effort were taken up by the AAP, including the Convention on the Rights of the Child, child-friendly places, concepts of equity and social justice, the Community Access to Child Health program, asset-based community development, the Anne E. Dyson Child Advocacy Award, and the Community Pediatrics Training Initiative, along with the requirement that residents have experiences and opportunities outside the hospital to work with community-based organizations and to learn principals of public health and service learning. The need for persistence will be shown throughout. All these concepts translate easily to overseas work, as we will show with 4 examples. The shared vision of seeking educational successes for all children who can grow up with knowledge of their own languages and stories is taking root across all borders. We are seeing in various countries the importance of spending time with a parent, teacher, or mentor starting at birth surrounded with love and words. The emphasis on the home language spoken freely around the newborn may perhaps mitigate a world fraught with violence, prejudice, and addiction, both in the family and community and in the world at large.
Cases of Implementing Service-Learning into Engineering Education in the United States