World House Medicine

Health and well-being in Haiti

2012-01-18T19:11:00.000-05:00

"Early lessons in global health from Haiti" is my post on KevinMD regarding health and progress in rebuilding Haiti. I offer here a few additional notes on Haiti.

Hispaniola includes Haiti and the Dominican Republic

Watch this clip of Nou Bouke an Emmy Award winning documentary offering a close up view of Haiti with Edwidge Danticat narrating. Her latest book, Create Dangerously is on my reading list.

Nou Bouke: Two years later from The Miami Herald on Vimeo.

Nou Boke translates from Creole loosely into "I'm Tired" thanks to the translation in the documentary by Jacqueline Charles. This is a glimpse of the situation from the ground with voices and scenes from Haiti directed by Joe Cardona and photography director Jose Iglesias. The other clip is a about local schools raising funds to help rebuild Haitian school. The children raised $500K and classrooms are reopening.

A few tweets also offer updates on progress, health and well-being in Haiti:

In this video, you can see our new 120-bed hospital being built in #Haiti, where access to healthcare is still lacking. bit.ly/xWfPFd
— Doctors w/o Borders (@MSF_USA) January 20, 2012

Haiti Quake Efforts Were Hampered by Poor Information Sharing - bit.ly/zqvsxl
— PAHO/WHO (@pahowho) January 15, 2012

#Haiti2year Oxfam has reached +1.2M ppl w/water, sanitation, food & public health promotion: our 2 Yr Report oxf.am/oYU
— Oxfam International (@Oxfam) January 12, 2012

#Cholera is still affecting children in #Haiti. Read @thelancet ‘s article to find out more ow.ly/8qf8U #stopcholera
— UNICEF (@UNICEF) January 11, 2012

Learn more about the “Call to Eliminate Cholera in Hispaniola” from @CDCGlobal, @pahowho, & @UNICEF go.usa.gov/R9o
— CDC Global Health (@CDCGlobal) January 12, 2012

UNDP chat: Human Development Index and the Determinants of Health

2012-01-06T07:00:00.000-05:00

Chat with UNDP Administrator Helen Clark on the release of the 2011 Human Development Index and Report

"Sustainable human development is the expansion of the substantive freedoms of people today while making reasonable efforts to avoid seriously compromising those of future generations."

The 2011 Human Development Index (HDI) and Report is driven by indicators of life expectancy, education and gross national income data as a single statistic in both social and economic development.

The HDI includes187 countries.

A World Health Organization working-group, the Commission on Social Determinants of Health (CSDH) recognizes the visible role of health inequities found in social gradients around the world related to where people are born, grow, learn, work, play and age. Social and economic factors in everyday life influence health and well-being. CDSH has global reach and calls attention to root-causes of disease and illness including those factors beyond the health sectors. Here's a glimpse of the CSDH conceptual framework:

Health and equity are complementary for the well-being of society. The Human Development Index offers additional supporting data on the social determinants of health.

Reference:

Marmot M, Allen J, Bell R, Goldblatt P. Building of the global movement for health equity: from Santiago to Rio and beyond. The Lancet 2011,19 October 2011:10.1016/S0140-6736(11)61506-7

On A First Name Basis: What’s In A Name?

2011-12-30T10:33:00.002-05:00

I like the warm-up group exercise where individuals take a few minutes to write and then share in a gathering the story of their first name. How they came to have their first name? It’s a way to share something in a group that may not have been ever shared with others. It's an opportunity to reflect and hear stories of diversity with minimal risk. Storytelling and dialogue about self-identities, cultural/family traditions and relationships emerge for exploration and development. My first name is the same as my grandmother’s middle name. In my family, it was inappropriate to call adults by their first names. Like many families with southern roots, formal salutations (e.g. Mr., Mrs., Dr.) and last (family or sir) names were used when referring even to close family friends. It’s now more acceptable to use first names for informal settings even in the exchange between adults and children. In school, work and beyond you learn through others and norms, how to address those in leadership roles and where formality matters. In the profession of medicine, the Dr. title indicates creditionals, offers a distinctive meaning of respect, as well as privilege and power for allopathic and osteopathic physicians.

Nurses, pharmacists other professionals along with educators work side-by-side with physicians also have doctoral degrees. Are they not doctors? Is the M.D., Ph.D. a doctor, doctor? The New York Times article“When the Nurse Wants to Be Called ‘Doctor’” opened heated debate on this topic revealing the divides among physicians and other health professionals who are committed to collaborative approaches for high-quality, safe and compassionate patient care. Advanced degrees and specialty training incresease knowledge, compensation and leadership opportunity. Highly trained individuals charged with treating illlness, the relief of pain and suffering and wellbeing should be able to find acceptable nomenclature to define their roles and work.

In The New York Times Health blog Dr. Danielle Ofri laments the term “health care provider” as a definitivie title for her role as a physician. The increasing influence of other fields and professions collaborating in medicine is likely to continue the need for revision. For example, new retail clinics are new employing doctors. Imagine "Yes, we take walk-ins. Go to aisle 6 just past the toothpaste. The ________ will see you now." The New England Journal of Medicine essay by Dr. Pamela Hartzband and Dr. Jerome Groopman describes the rise of complexity within our health system pointing to another dimension of the struggle for identity and language. In the business world there’s a push to drop formality and consider first name exchanges to establish common ground. You have to examine carefully the norms and policy in your setting to understand appropriate strategies in addressing those around you. Furthermore, pay attention to what others indicate as preference and/or ask directly for the sake of clarity and to avoid offense. You should also make known your own personal and professional preferences known to others.

Do you use formality when addressing attendings, mentors and informality with colleagues? What’s your take on all this name calling? Have you ever been called out for inappropriately addressing someone?

Chat for heart health with storytelling

2011-12-18T16:00:00.000-05:00

Chat for heart health

2011-12-17T14:50:00.001-05:00

Dr. Tom Frieden, Director for the Centers for Disease Control and Prevention led a #CDCChat about cardiovascular disease and stroke. Here are a few of the tweets:

.@katellington Risk increases as you get older but healthy habits start in childhood. Never too soon or too late to be healthier.#CDCchat
— Dr. Tom Frieden (@DrFriedenCDC) December 13, 2011

.@TheHeartTruth As Nieca Goldberg writes, men and women have different hearts. Heart disease and stroke kill more women than men. #CDCchat
— Dr. Tom Frieden (@DrFriedenCDC) December 13, 2011

Heart attack signs differ 4 women. Shortness of breath, fatigue, abdominal pressure, nausea, heartburn, jaw/neck/back/shoulder pain #CDCchat
— Sister to Sister (@sisterhearts) December 13, 2011

Is there a link between hypertension (HTN), CVD, stroke and health?@MillionHeartsUS @CDCgov@DrFriedenCDC @MillionHeartsUS #CDCchat
— Katherine Ellington (@katellington) December 13, 2011

.@katellington Yes, hypertension is a leading reversible cause of heart disease and stroke. #CDCchat
— Million Hearts (@MillionHeartsUS) December 13, 2011

You can walk and talk for better health.Schedule a walking meeting. #CDCchat
— Katherine Ellington (@katellington) December 13, 2011

"The Art of the Walking Meeting" by @tedeytan bit.ly/s5xIIJ #CDCChat
— Katherine Ellington (@katellington) December 13, 2011

@katellington @arielleslam @fastfwdhealth thanks for continuing the #WalkWhileWorking revolution! Tweet me with your results :)
— Ted Eytan, MD (@tedeytan) December 13, 2011

What is the single best thing we can do for our health? Amazing answer via @docmikeevans youtu.be/aUaInS6HIGo
— Katherine Ellington (@katellington) December 15, 2011

Visible Hope: World AIDS Day

2011-12-01T23:30:00.000-05:00

My first experiences with HIV/AIDS came through personal encounters with relatives and friends who were diagnosed. More experiences came while I was volunteering in a community hospital Emergency Department where there were a few patient cases to learn about the opportunistic infections, treatment and survival. I also came to know more about the isolation, stigma, shame and emotional pain further complicating HIV/AIDS.

While working with projects in South Africa where people were shedding apartheid for reconciliation’s embrace there was also the emergence of HIV/AIDS. I remember times of powerful sharing and connection with women in communities of faith as well as in other settings. I listened to their stories.

A few years later. My very first academic writing accepted for publication was a narrative analysis of HIV/AIDS and Women motivated by a course in community health. In this chapter, I examined individual behaviors, political will and social inequalities contributing to HIV/AIDS risk among women in the United States, Caribbean, South East Asia and sub-Saharan Africa. Through reading, research and writing I came to understand more about biological, socioeconomic and political pathogens in fight against in HIV/AIDS.

In this fight leadership has made all the difference. From the United States to Uganda and throughout the world the global health community offers models for moving collaborative action in the fight against illness and disease.

The One and RED campaigns collaborate for the ONE & (RED)’s World AIDS Day event and the End of AIDS report show evidence of progress, on-going commitment and hope for the future. PEPFAR is working toward an AIDS free generation. The Foundation for AIDS Research (AMFAR) is focused on “getting to zero” with the NIH Center for AIDS research advancing science and medicine for new promising approaches in treatments and prevention including vaccine development. Treatment as prevention holds promise in reducing HIV transmission with antiretroviral treatment furthering the push to have everyone get tested, a challenge for primary care and public health.

We can all finds ways to work for the end of HIV/AIDS by employing our resources (time, expertise and/or donations) whether in your work, family, community or the world.

You should also tell your personal and/or professional story about HIV/AIDS the statistics indicate that the pandemic has touched most of our lives as patient, health professional, caregiver, family, friend or supporter. Current global and national statistics support the understanding that most us of have been touched by the HIV/AIDS pandemic, yet many remain silent. I’ve listened to doctors and nurses offer meaningful tellings of their encounters with HIV/AIDS from needle sticks to palliative care experiences.

Final note, Sheryl Lee Ralph’s “Sometimes I Cry” offers creativity in HIV/AIDS advocacy and Dr. Sharon Allison Ottey’s book All I Ever Did Was Love A Man is a compelling story for reading groups and/or community discussion on HIV/AIDS. Here’s a shortlist of other works to consider:

Ashe, Arthur and Rampersad, Arnold. Days of Grace: A Memoir. New York: Random House, 1994.
Bayer, Ronald. & Oppenheimer, Gerald M. 2000 AIDS Doctors: Voices from the Epidemic: An Oral History. New York: Oxford Univerisity Press, 2000.
Corea, Gena. The Story of Women and AIDS: The Invisible Epidemic. New York: HarperPerennial, 1993.
Klass, Perri. "Hers; Mothers With AIDS: A Love Story". New York Times. 1990.
Verghese, Abraham. My Own Country. New York: Vintage, 1994.
Young, Audrey. What Patients Taught Me: A Medical Student's Journey. Seattle: Sasquatch, 2007.

Reference

Ellington, Katherine. ‘Invisible Hope: HIV/AIDS and Women’ in ed. Grace Bantebya-Kyomuhendo. Women’s Health: African and Global Perspectives. Kampala: Women and Gender Studies, Makerere University, 2005.

From my twitter stream today:

You are welcome to leave your comments and stories, here.

A Broad Focus for Community: Occupy Health

2011-11-08T10:01:00.001-05:00

Personal pursuits make a difference for health. Individuals who take responsible steps whether it’s more physical activity, smoking cessation or medical adherence face complex environmental challenges where place matters. Some face forces more formidable than will power. The research provides evidence to shed light on influences for health. A recent study published in the New England Journal of Medicine demonstrates how place matters.[1] These results show better health outcomes for those who have an opportunity to relocate to better living conditions. A move out of high level poverty areas improves the potential for health. Access to healthy food, safe spaces for play and adequate living conditions works in the fight against childhood obesity and diabetes compelling the need to broaden our focus in designing community-level interventions. There are many factors that influence health, the Commission for a Healthier America offers a view:

Influence on Health: Broadening the Focus

"Behaviors, as well as receipt of medical care, are shaped by living and working conditions,

which in turn are shaped by economic and social opportunities and resources" [2]

Consider another striking example: the climb of out of poverty, educational achievement and economic prosperity doesn’t change the high risk of preterm births and maternal death for black women. Dr. Michael Lu an obstetrician and gynecologist believes "that for many women of color, racism over a life time, not just during the nine months of pregnancy, increases the risk of preterm delivery. To improve birth outcomes, Lu argues, we must address the conditions impacting women’s health not just when they become pregnant but from childhood, adolescence and into adulthood.” The video clip is telling as is the entire documentary series “Unnatural Causes.” [3]

There are social determinants of health. We should address issues beyond the doctor’s office that impact health. Where we live, work and play influences health, medical care and health care, our environment influences our personal efforts to achieve health. [4] Our national foreclosure crisis is making people sick, physically and mentally.[5] Yes, financial ruin is about personal responsibility. However, these situations are also tied to increasing rates of unemployment and economic downturn. It’s like thinking about how your personal spending impacts the nation’s economy without considering the roles of financial institutions and corporations. You make the mortgage payment every month, but the equity in your house diminishes. You go to work every day, but the same paycheck buys less of everything including healthy groceries so you grab fast, cheap food. Exercise routines may compromised when you have to work a second job to meet the bills. The stress of daily living over time may become chronic stress and put your health at risk.

The low hanging fruit to address personal behaviors may heal some, but doesn’t remedy the pervasive ills facing our society. My colleagues in community development, public health and health professions are dreamers, change agents, builders, innovators, leaders and champions for health and healthier living this makes me hopeful and willing to work for progress and the future.

References

Ludwig J, Sanbonmatsu L, et al. Neighborhoods, obesity, and diabetes–a randomized social experiment. N Engl J Med. 2011 Oct 20;365(16):1509-19.
Prepared for the Robert Wood Johnson Foundation by the Center on Social Disparities in Health at the University of California, San Francisco.
Courtesy of UNNATURAL CAUSES: Is Inequality Making Us Sick? Produced by California Newsreel with Vital Pictures. Presented by the National Minority Consortia. www.unnaturalcauses.org; www.newsreel.org
Robert Wood Johnson Foundation Vulnerable Populations brief A New Way to Talk about the Social Determinants of Health. July 2010
Robert Wood Johnson Foundation, Human Capital brief ”Foreclosure Process Takes Toll on Physical, Mental Health.” October 2011

N.B. This post was prompted in response to Dr. Jen Gunter's blog #OccupyHealthcare post and furthers my comments.

Community Immunity: Flu

2011-11-01T14:04:00.001-04:00

In response to low immunization rates in my community, I served on a task force to develop a community-based pilot to increase influenza vaccination. We worked in collaboration with the NYC Department of Health and Mental Hygiene, Department for Aging, Visiting Nurse Services of New York (VNSNY) and a local church health ministry. On a Sunday morning in late November (during the CDC's National Influenza Vaccine Week) nearly 100 African-Americans received their flu shots, we also held informational talks to dispel myths and fears, made time for physician-led Q&A and served healthy refreshments throughout the day, anyone was welcome to attend. A few doctors and nurses also received their flu shots to demonstrate leadership. We carried the message, “Flu shots are for the people you love. And for you. Flu shots save lives” with health alerts, announcements and relevant educational materials. Our success led to more expansive efforts.

A few years later when my community became the epicenter of the 2009 pandemic influenza A (H1N1) outbreak, I understood more clearly the significance of our unique efforts toward community immunity and health. In our neighborhood, there are many intergenerational families making vaccination important to protect those most vulnerable, the young and the elderly who often live in the same household. The outbreak began in nearby high school. The intensity of our local health department, leaders and communities working together is noteworthy. The outbreak took its natural, rapid and widespread course, but did not cause severe illness among those confirmed with 2009 H1N1 influenza or with influenza-like illness. While there were sharp increases in Emergency Department visits as well as overwhelming public concern local health care providers were able to manage the outbreak.

Seasonal influenza and H1N1 are different viruses -- the 2011Influenza Vaccine includes protection against H1N1 along other influenza strains. It seems that every neighborhood in New York City now has multiple options to a receive flu shot and the public health messages abound locally and nationally because it's important.

As a physician-in-training, I've learned valuable lessons from this experience about public health.

N.B. This post also appears on the RWJF Public Health blog in the "Share Your Public Health Story."

References:

Wake E, Geevarughese A, Zucker JR. Influenza prevention and control, 2010-2011. City Health Information. 2010;29(6):49-56.
Lessler J, Reich NG, Cummings DA, et al. Outbreak of 2009 pandemic influenza A (H1N1) at a New York City school. N Engl J Med 2009;361:2628-2636

Food and health

2011-10-24T13:13:00.003-04:00

Those who garden teach us how to work at the future.

A recent gift from a friend's garden.

I’m from a family of southerners who in moving to the city did not abandon their roots. I grew up with a small garden of tomatoes, peppers, and greens in the backyard, which cannot compare to the vast produce of warmer, well-cultivated countryside farms. Family and friends making visits to Georgia and South Carolina would return with tasty varieties of sweet potatoes, collards and other delights including my favorite chow chow, a vegetable relish of green tomatoes, cabbage, peppers and spices. Chow chow is a condiment that works well with greens and/or beans. I grew up loving vegetables on my plate with few exceptions. I’m getting back to these dishes including updates for favorite recipes see “the goodness of kale” at the end of this post. I also support food grown within reach from backyards to local farms.

Food provides the nutritional value that we need to be healthy. A great meal often involves tasty food, good company and time to share. Food Day provides an opportunity for reflection to change the way we eat and think about food. The grave health statistics for our nation include rising rates of childhood obesity, diabetes and cardiovascular disease all have some remedy with improving the access and availability of food so that healthier choices become easier (and tastier) choices.

National and local activities are taking place to build awareness and mobilize. We should be encouraged with opportunities to “eatreal” supporting healthy, affordable food with a real focus on local availability. Food Day principles for changes in food and health include:

1. Reduce diet-related disease by promoting safe, healthy foods.

2. Support sustainable farms & limit subsidies to big agribusiness

3. Expand access to food & alleviate hunger

4. Protect the environment and animals by reforming factory farms

5. Promote health by curbing junk-food marketing to kids

6. Support fair conditions for food and farm workers

There are many national and local events taking place, today. Learn more about Food Day at www.foodday.org.

The goodness of kale

Kale is a hearty leafy green loaded with vitamins and minerals. Kale is good food for you and tasty too. Here are a few of my recipe suggestions:

It takes about 2 lbs of cut (remove some of large stems) for 4 servings. Wash greens thoroughly in cold water.

Garlic and kale greens

Add 5 cloves of garlic to 2 tablespoons of olive oil in a large skillet. Heat on medium begin to add greens once garlic starts to cook. Add ½ cup of chicken stock, 1 teaspoon of hot pepper flakes and cover tightly. Let simmer for about 20 minutes. As greens wilt toss them a few times. Optional: Serve with warm corn bread. Add slices of cooked chicken-apple sausage or kielbasa.

Kale and white bean soup

Follow directions above and add an additional cup of chicken stock, one 16 oz. can of white beans and 1 cup of fresh sliced mushrooms. Let simmer for about 20-30 minutes in total.

Kale chips

Preheat oven to 350 degrees F. Spread cut and washed (pat dry) kale on a cookie sheet. Sprinkle lightly with coarse sale and drizzle with olive. Let cook 15-20 minutes until crisp. Serve warm or cold. Great crunchy snack or add flavor to a salad.

Olive oil in these recipes adds flavor and also aids digestive absorption of the many vitamins and minerals found in kale. There are lots of varieties of kale to choose from, curly green are most abundant. These dishes will take you through the winter as the frost and chill actually improves the taste of the dark green earthy goodness found in kale.

The Center for Science in the Public Interest is a non-profit watchdog and consumer advocacy group convening Food Day, a nationwide campaign with individual and organizational sponsors.

Occupy Health

2011-10-18T12:00:00.000-04:00

The occupy movement has reached more than 1,000 cities in the U.S and around the world. In her provocative blog post “What Think Tanks Owe the People in the Park,” Janice Nittoli asserts:

“It's never been the task of the people in the park to come up with the ideas. It's their job to call attention to injustice, to demand that the powerful be held accountable, to just plain get angry at massive inequity. It's the job of others to articulate an action plan for thinking progressives - and not just by repeating the same ideas that we had five, ten or even 15 years ago.”

High rates of unemployment, foreclosure crises, homelessness, looming national concern about the economy, children living in poverty, educational gaps leaving too many left behind is moving young people to the street, too. The sick and the aging are living longer lives with fears and realities of financial ruin more grim than the end of life. While health professionals and institutions are facing burnout and closing doors.

"Foreclosure is not just a metaphorical epidemic, but a bona fide public health crisis. When breadwinners become ill, they miss work, lose their jobs, face daunting medical bills — and have trouble making mortgage payments as a result."
—Pollack and Lynch, New York Times op-ed

Health is more than the absence of disease or cure. Health is about well-being and the quality of our lives. “Doctors for the 99% has become the name for an informal group of health activists who have set out to support the occupation.” A recent post by Dr. Matt Anderson offers a moving multimedia story about #occupy health professionals and organizations.

Last Saturday night, my commute was interrupted. The subway system rerouted trains, I had to get off and leave the station at Occupy Times Square (aka 42nd Street) to reconnect at another station located a few blocks away to reach my final destination. My short walk in the dazzle of Broadway’s flickering lights and bustling crowds included a brief occupy encounter, an experience that stirs my hope.

The twitter hashtag #OccupyHealth offers context to consider medicine, health, and health care. We should be inspired to imagine new possibilities for such a time as this. Huge drifts in differences have not always been offered with civility. Rising injustices leading a spirit of inequity should push us to listen, think, engage and act accordingly.

Making House Calls: A Story for Primary Care

2011-10-14T01:49:00.000-04:00

A community doctor allowed me the privilege of bearing witness to his private practice by providing a training ground for early lessons in the practice and art of medicine.

Hypertension, diabetes, glaucoma, diverticulitis, gout, cardiovascular disease, lung and breast cancers were among the most frequent of memorable cases that I recall from months that I spent one day a week observing patient care and providing administrative support — a premedical student’s dream. Office hours began in the afternoons and continued late into the evenings with overwhelming demand peaking during the winter months when cold and flu were on the rise. The office was open late because most of the patients worked full-time, but were often underemployed and/or underinsured and needed evening hour appointments. The small waiting area was always crowded, but most endured the wait with resolve because they respected for his commitment to care. Patients knew that he would take the time to listen when it was there time. This came through when they called for appointments and checked-in at the desk.

Patients usually lived within a five mile radius of the office, which was on the lower level of the doctor’s modest home, a few blocks away from my grandparents’ house. He was their neighbor and physician, too. There were significant numbers of couples and intergenerational families in this patient population. I’d learn that most had been patients for many years. There was also an increasing number of new patients, who were always offered appointments near the end of office hours to accommodate more time as were the patients with complicated situations.

When illness loomed beyond his reach, the doctor helped his patients navigate a world of specialists and the hospital experience by managing expectations, explaining procedures and calming their fears while acknowledging the uncertainty. He held regard for and equipped caregivers, too.

A few times a week, the doctor made house calls to a few select patients with urgent care needs. I remember when he visited my grandmother when she had too much leg pain to get out of bed. He diagnosed her sciatica, gave instructions about rest, wrote a prescription and a note for work. Many years later he’d return to our home to see my grandfather for respiratory distress, the house call focused on helping our family come to terms with the pressing need for his hospitalization as well as to come to grips with the gravity of his condition.

Physician house calls give a glimpse of the patient’s environment, lifestyle and dynamics that can go untold during history-taking. A vegetable garden growing on the side of the house may confirm some commitment to nutrition. Indoor odors with a hint of bleach may offer notes on cleanliness. On the other hand, the smell of alcohol or tobacco may match symptoms visible in the chart. House calls offer a glimpse of the patient en vivo informing diagnosis, treatment and decision-making.

In this primary care practice setting, I gained a profound sense of the trust and respect necessary in the relationship between doctor and patient as well as the connection between community and doctor.

I learned others lessons that I look forward to sharing in forthcoming posts.

N.B. Doctors providing primary care services deliver “definitive care to the undifferentiated patient at the point of first contact and [taking] continuing responsibility for providing the patient's care...Primary care physicians devote the majority of their practice to providing primary care services to a defined population of patients. The style of primary care practice is such that the personal primary care physician serves as the entry point for substantially all of the patient's medical and health care needs - not limited by problem origin, organ system, or diagnosis. Primary care physicians are advocates for the patient in coordinating the use of the entire health care system to benefit the patient.”

—American Academy of Family Physicians

In Memoria: Do Justice

2011-10-01T10:56:00.001-04:00

Last month, my beloved great Aunt passed away after battling illness with the same kind of spirit she took on to address the challenges in her life applying tenacity, courage and a good sense of humor. I had the honor and privilege of writing her obituary. It was a time of healing, reflection and contemplation. Memories, pictures and inquiries with family and friends helped me move through a century of American history to offer a vibrant narrative on her struggle and strength in living out a meaningful life.

Remarkably, my Aunt was a leader in our family and community. She was a critical thinker, agitator, strategist and organizer who kept a close view of the world and hand in our lives encouraging resiliency, progress and love.

As a young woman, she and my maternal family escaped the threat of harm by moving from a small South Carolina town on the boarder of Georgia to New York City. During the 1940s many black families were making the same travel plans because Jim Crow left many realizing that flight was a better response to their fears than a fight because so much blood had already been spilled. I believe as her eulogist suggested that untold horrific stories of her encounters with discrimination and racism moved my Aunt to work after work and family responsibilities in the civil rights movement. She taught me lessons about what it means “walk humbly, love mercy and do justice” in a world that doesn’t seem to favor the empowerment of people of color. In her eyes doing justice involved working actively in the community and beyond for the sake of humanity.

While the legislation of the Civil Rights Act of 1964 outlawed discrimination against blacks and women, including racial segregation there was still work to be done for progress. For example, prior to 1964 it was illegal for people of color to go to a hospital to receive medical care anywhere in the United States, very few places had colored hospitals. Many organizations continue the push for justice in education, employment, housing, health care as well take on the criminal justice system for the well-being of our society. Since 1909, the National Association of Colored People (NAACP) has been pivotal in leading the way by addressing injustice. Today, the aim is to bring an end to the death penalty in the United States, you can join this cause at http://action.naacp.org/EndTheDP

“When in Gregg v. Georgia the Supreme Court gave its seal of approval to capital punishment, this endorsement was premised on the promise that capital punishment would be administered with fairness and justice. Instead, the promise has become a cruel and empty mockery. If not remedied, the scandalous state of our present system of capital punishment will cast a pall of shame over our society for years to come. We cannot let it continue.”

—United States Supreme Court Justice Thurgood Marshall, 1990

I’ve come to understand professionally that lethal injections are not good medicine. According to the Innocence Project, “seventeen people have been proven innocent and exonerated by DNA testing in the United States after serving time on death row.” I agree with the National Urban League statement “disparities and problems cast a long shadow of doubt over our criminal justice system.”

The state of Georgia shamefully executed Troy Davis on September 21, 2011 despite serious doubts about his guilt. But our fight to abolish the death penalty lives on.”

—Amnesty International

In fifteen minutes, execution by lethal injection ended the life of Troy Davis with too much doubt.

Lethal Injections Are Not Good Medicine

2011-09-27T13:36:00.000-04:00

Recently, two executions by lethal injections were carried out in America. One ended the life of Troy Davis in Georgia, the other with too much hate Lawrence Russell Brewer in Texas. Death and dying offer complexity and complications in the profession medicine bound by policies, mandates and laws driven by internal (e.g. professional associations, medical boards) and external (e.g. federal, state, medical center) forces.

Lethal injections involve delivering a fatal dose of drugs resulting in unconsciousness, paralysis, cardiac arrest then within minutes, death. Dr. Marc Siegel’s recent commentary on “Doctors and Death Penalty Cases” notes that “… physicians helped design the lethal injection protocol. We provide the intravenous access, monitor the patients, administer the injections, and declare death. — That’s not at all what I thought I was signing up for when I enrolled in medical school.”

Bioethics helps us question our beliefs and values as they unfold in the treatment and care of patients. We should consider, first do no harm.

Since 1980 the American Medical Association code of Medical Ethics has opined against physician participation in capital punishment including lethal injections. As of 2010 the American Board of Anesthesiologists (ABA) will revoke the certification of members who participate in execution by lethal injection. ABA board member, Dr. Mark Rockoff makes a salient remark, “if lethal injections are medicalized, it could make it look like operating rooms are like death chambers, that anesthesiology drugs are death drugs and anesthesiologists are executioners. That would all undermine public confidence in the medical profession.” These decisions are not based on the appropriateness of the death penalty.

Overwhelming schedules, research demands and high volume patient case loads should not push us away from this challenging dialogue and/or opportunity for advocacy. The debate here is personal, political and inter-professional one that should not be avoided by health care professionals.

This post also appears at www.KevinMD.com

I've joined NAACP #toomuchdoubt campaign, Amnesty International and others in the move to end the death penalty in the United States and around the world.

A common cold

2011-09-20T13:42:00.002-04:00

If you are from North America a most frequent health concern is the common cold. It turns out that most of us will suffer from the common cold or upper respiratory related-illness, but recover quickly. You can take sensible measures to help us avoid infection. I'm from a family with deep southern roots and a tradition where my grandmother had hand in my early childhood upbringing. Her sense of health and well-being includes home remedies, she believes in the power of chicken soup to help the healing process.

Here's a note to prevention post for self-care:

• Practice healthy habits.
• Eat a balanced diet.
• Get enough sleep.
• Exercise.
• Do your best to keep stress in check.
• Wash your hands.

Home remedies abound including talk about andrographs, echinecea, vitamin C, zinc lozenges. What do you suggest for the common cold or flu?

References:

Ackerman, J. Ah-Choo! The Uncommon Life of Your Common Cold. New York: Hachette Book Group, 2010

Are you prepared for disaster? My notes on storm survival

2011-08-23T08:12:00.014-04:00

If you’ve seen the news recently, you know that emergencies can happen unexpectedly in communities just like yours, to people like you. We’ve seen tornado outbreaks, river floods and flash floods, historic earthquakes, tsunamis, and even water main breaks and power outages in U.S. cities affecting millions of people for days at a time and now Hurricane Irene is coming. Health care professionals need to be prepared for unexpected weather and emergencies.

I was never concerned about weather patterns beyond the four seasons of the New York City atmosphere. It’s worth noting that my grandmother was born just off the Savannah River in the night of a storm, she's lived in New York for over 75 years, but continues to pay close attention when joint pain and a distinct stiffness combine with an inner sense telling her body that a storm is coming soon. I remember her strict commands that all electrical appliances should be shut off and no one should talk on the phone. We’d sit quietly and still, far away from windows with shutters closed. When the clap of loud thunderstorms came, she’d say "hush now God's talking" eventually there would be storytelling about dark nights, lightening strikes, flooding, other disasters and lives lost in the her South Carolina homeland. We’d also listen to radio reports.

The changing temperatures and severity of recent natural disasters around the world now have me following weather patterns and my storytelling prompt is the memory of Hurricane Ivan. My reflective essay is published in The New Physician magazine conveys early reflections on the traumatic experience of Ivan. While many years have passed, a residue of emotions and feelings still surface under the right conditions. The sudden approach of certain hues of grey in the sky, the hint of a sweet smell of moisture in the air, winds whistling gently stirring trees refresh my memory. It was a warm, clear, blue sky day filled with sunshine when the forecast of Hurricane Ivan was announced. In the early hours looking at the dopplers on CNN, we thought the storm might pass despite technological and sensory intelligence to the contrary. Within moments, the daylight disappeared, darkness emerged and the power failed soon thereafter. The results:

“Catastrophic damage to Grenada and heavy damage to Jamaica, Grand Cayman, and the western tip of Cuba. After peaking in strength, the hurricane moved north-northwest across the Gulf of Mexico to strike Gulf Shores, Alabama as a strong Category 3 storm, causing significant damage. Ivan dropped heavy rains on the Southeastern United States as it progressed northeast and east through the eastern United States, becoming an extratropical cyclone.”

Ear-popping pressure systems created by the wind should not be under-estimated, you can be blown away, physically. The effect of continual downpours with rising tides can trigger a real threat to life when water is everywhere. Storm surges, high winds, tornadoes, and flooding are the hallmarks of hurricane hazards.

Are you prepared for disaster? “ Preparing for the Unexpected” is the course that I taught for the American Red Cross course, I continue to serve on a volunteer medical reserve corps and have Advanced Disaster Life Support certification. National Preparedness Month is in September, here's a foretaste using the resources and tools provided.

"Individuals and families are the most important members of the nation's emergency management team.” Craig Fugate, FEMA Administrator

Here are my notes on family disaster plans:

Discuss the type of hazards that could affect your family. Know your home's vulnerability to storm surge, flooding and wind.

Locate a safe room or the safest areas in your home for each hurricane hazard. In certain circumstances the safest areas may not be your home but within your community.

Determine escape routes from your home and places to meet. These should be measured in tens of miles rather than hundreds of miles.

Have an out-of-state friend as a family contact, so all your family members have a single point of contact.

Make a plan now for what to do with your pets if you need to evacuate.

Post emergency telephone numbers by your phones and make sure your children know how and when to call 911.

Check your insurance coverage - flood damage is not usually covered by homeowners insurance.

Stock non-perishable emergency supplies and a Disaster Supply Kit.

Use a NOAA weather radio. Remember to replace its battery every 6 months, as you do with your smoke detectors.

Take First Aid, CPR and disaster preparedness classes.

Visit http://www.ready.gov for additional details follow these three steps.

1. Get a Kit: Keep enough emergency supplies on hand for you and those in your care – water, non-perishable food, first aid, prescriptions, flashlight, battery-powered radio – for a checklist of supplies visit Ready.gov.

2. Make a Plan: Discuss, agree on, and document an emergency plan with those in your care. Work together with neighbors, colleagues and others to build community resilience.

3. Be Informed: Free information is available to assist you from federal, state, local, tribal, and territorial resources. You can find preparedness information by: Accessing Ready.gov to learn what to do before, during, and after an emergency.

Police, fire and rescue may not always be able to reach you quickly, such as if trees and power lines are down or if they're overwhelmed by demand from an emergency. The most important step you can take in helping your local responders is being able to take care of yourself and those in your care; the more people who are prepared, the quicker the community will recover.

On the Rise: Women in Leadership

2011-08-13T10:59:00.001-04:00

We are living a new era where the progress for the civil rights of women is undeniable, yet Facebook COO Sheryl Sandberg points out in her compelling TED presentation:

“We still live in a world where some women don’t have [civil rights]. But all that aside, we still have … a real problem … women are not making it to the top of any profession anywhere in the world.

The fault line is in the family and life balancing act women must do to survive in the workplace. To be clear this is true for men too. Women are more likely to face challenges when long work hours, travel and the business of professional networking keep them away from families.

Furthermore, the profession of medicine requires a commitment to patient care, education and research, but the climb to the top has additional milestones. While many put in extra time and sweat their persistence still places them outside the closed doors of hospital board rooms, department chair offers, academic medicine positions or physician-leader roles. Data and research are scant on measures for progress. I always look at the pictures on the walls in medical center hallways and conference rooms, it’s rare to see anyone who resembles me in those pictures. I do see women moving through up the ranks who are awesome role models.

For the last 10 years medical school classes have held equal portions of men and women, but those who teach medical students and lead institutions are predominately men. Recent research published by Dr. Borges and others indicate that “women physicians choose their careers because of the perceived quality of life, earnings potential, and organizational reward. They are less likely than men to identify role models for professional–personal balance.”

Women do need to seek out role models early in their careers, but it’s not enough. More significant is the understanding that if there’s no institutional, top-down approach to addressing the complexity of these issues, meritocracy alone will not break down barriers nor will change occur.

Dr. Karen Sibert’s recent op-ed in the New York Times inspires my blog post along with other offline discussions, including the talk with Michele Martin on NPR’s Tell Me More, which aimed to further the conversation about part-time career choices women are making in the face of doctor shortages, decreasing health care budgets and a moral obligation. Dr. Sibert and others make it clear about the sacrifices for both men and women when it comes with a commitment to patient care, but Dr. Au and others make the case for our right to choose, wisely and carefully.

I follow the career paths by reading the literature as well as over the years books written by women in medicine, here are just a few from my bookshelf:

Treatment Kind and Fair: Letters to a Young Doctor by Perri Klass

Zenzele: A Letter for My Daughter by J. Nozipo Maraire

Final Exam: A Surgeon’s Reflections on Mortality by Pauline Chen

Another Day in the Frontal Lobe: A Brain Surgeon Exposes Life on the Inside by Katrina S. Firlik

Medicine in Translation: Journeys with My Patients by Danielle Ofri

Almost Home: Stories of Hope and the Human Spirit in the Neonatal ICU by Christine Gleason

The Country Doctor Revisited: A Twenty-First Century Reader edited by Therese Zink

Stories of Illness and Healing: Women Write Their Bodies edited by Marsha Hurst and Sayantani DasGupta

On a historical note Dr. Virginia Apgar’s story is endearing as she was set on becoming a surgeon, but gender discrimination led her to a career in anesthesiology after training she went on to head a new division of anesthesiology where she developed the Apgar score. As the medical school’s first female division head, she built a residency program and, in 1949, became the first woman appointed to a full professorship at the Columbia University College of Physician & Surgeons. No, I’m not interested in a career anesthesiology, I am looking for opportunities where innovative ideas are supported regardless of gender, race or ethnicity.

A few pointers, I’ve heard from those listed above and elsewhere:

Relationships and family matter, try to avoid undermining your anchors to move ahead, you may find short-term success and long-term misery with the loss of your family and friends and a more demanding job.
Don’t turn your head or look way when you see real harm done to women especially if it’s you in the hot seat, choose battles worth fighting.
Read and review the policy handbook at your institution. Knowledge is power.
Honor and respect women physician-leaders in their roles and get to know their stories.
Tell your own stories so that others might know of your success and/or be warned of your pitfalls.
“Lift as you climb” so that you enable collective success in the profession.
The road is long so make good friends for the distance.

U.S. Surgeon General Regina Benjamin, Secretary of Health and Human Services, Gov. Kathleen Sebelius and First Lady Michelle Obama are at the helm efforts to improve health and health care in America and these women are all phenomenal. We should continue our look up stream and push for policies and practices that allow for a more balanced profession for men and women, which in my view enables better patient care and improves quality of life for both patient and physician. There should debate, divergent points of view as well as common ground to stay focused on more progress.

7/12/2011 blog cross-post on KevinMD.com

Lessons for Independence

2011-07-03T17:19:00.007-04:00

Professor Melissa Harris Perry teaches political science, I have never pursued such coursework. I heard her give a high-spirited and compelling plenary presentation at a conference, "Assuring Equity through Health and Health Reform" and have since followed her tweets, read her book and listened to some of her other talks. I was intrigued by her proclamation that the Declaration of Independence was her very favorite lesson in the curriculum to offer students. As a document of liberation bound with theological context and political agendas it stands against time with a historical significance worth studying beyond it’s most famous statement:

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness.”

I’m moved by the passionate debate that produced the Declaration as well as the fortitude it gave the abolitionist movement to fight against slavery. The 4th of July offers a history lesson for America that should take place with celebration. The reading enables lessons for freedom and independence. It's a teachable moment.

"The Declaration of Independence: A History". Charters of Freedom. National Archives and Records Administration. Retrieved July 3, 2011

Saturday Palpitations

2011-06-30T13:15:00.000-04:00

Heart impulses represented in the cardiac cycle.

It was early Saturday morning, I was making my plans for the day, crossing-off a few items that seemed unreasonable with others that had been accomplished. As I moved toward the kitchen, a voice from the living room bellowed “the coffee is ready” turning my head I could see bright rays of sunshine making a visible path through the open front door. My morning greeting followed with “did you have breakfast?” she answered, “yes” so I grabbed a cup of yogurt, found a banana in the fruit basket and sat down with cinnamon coffee in my favorite cup.

She came to the table, pulled up a chair up close and said with half-hearted laughter, “I keep having these fluttering feelings” and I asked, “what have you been up to this morning?” She said, “well, I ate cereal for breakfast, took my medication then I rode my bike to the bank. Now I’m getting ready to go grocery shopping, choir rehearsal and then to get my hair done, but I keep feeling these flutters.” Her schedule made me uncomfortable, she had other unmentioned responsibilities like caring for my grandmother and cooking dinner but I wasn’t ready to stir up an argument. My response, “well, it’s been a busy morning so why don’t you go back to the sofa and rest for awhile” from the other room we talked about a co-worker who’d died suddenly a few days ago. She took pause to admit her feelings of anguish.

My summertime stay made for an opportunity to talk about anxiety, stress and triggers. Learning to listen attentively and offering the power of presence to her narrative, I began to see her rage with the world of injustice, her strength to overcome, but more clearly, a shield entrapping her emotions as described in Paul Lawrence Dunbar’s poem “We Wear The Mask.”

“What Shapes Health?” a series of webinars held by Robert Wood Johnson Foundation with leading national experts presenting their research on the relationship between stress and health. My talks with mom don’t afford the opportunity for statistics and analysis, but the current evidence does compel my passion to carry on with our dialogue. She’s interested the simple facts. In response to the New York City Health Department’s no trans-fat public awareness campaign, her question “What’s the big deal?” As I grinned through a a medical student biochemistry lesson on lipid metabolism she became irritated and puzzled. I made more progress when I went told story about french fries and the hidden calories in partially-hydrogenated oils leading to weight gain, rising cholesterol levels, which may increase the risk of heart disease. She got it, began reading food labels more carefully and switched out the oils in the pantry with healthier choices. Yet, our conversation about the relationship between stress and health continues to be challenging as her perceptions are not mine. I'm asking the upstream policy questions about the conditions in our lives that can help alleviate stress and make for healthier living. Mom's web of healthy choices are obvious from the breakfast table to the bike path, but there's also chronic stress embedded in tough daily decisions and the quest for life balance.

By late Saturday evening, I was sitting in front of the computer with the banter of young people outside my front bedroom window and a hint of barbeque in the air keeping me alert enough to move through the night’s reading. I heard rushing foots steps coming down the stairs, she knocked on my door. In a shaky voice she said “What did you tell me to do about these palpitations?” My alarm-filled response, “have these continued from early this morning?” She nodded, exclaiming “I’m too uncomfortable to lie down or sleep like this.” My response, “you have to go the hospital” reaching for the phone I dialed 911. She lamented that she didn’t think her situation was that serious. I did. She urged me to take her blood pressure. I did not.

The prevalence of heart disease among black women is twice as high as for others.

The ambulance came in less than ten minutes. Her pulse was rapid, blood pressure was abnormally high and the portable heart monitor gave a picture of irregularities. She was rushed to the hospital while I stayed behind with my grandmother who was now awake, upset by the ordeal and demanding answers by asking the same few questions repeatedly. “Why did they have to take your mother to the hospital? What’s wrong with her heart? How did that happen? She’s too young to have heart trouble? They took your mother to the hospital? For what?” It was a long night.

After an hour in the emergency room, mom was admitted to the hospital. Her pulse, blood pressure and rhythms returned to normal with medication. Further test results, proved puzzling to the doctors, but she was released from the hospital after a few days with instructions to follow up with her primary care physician and with a referral to see a cardiologist.

That summer, I also finished my first reading of our cardiovascular physiology packet with a more profound interest in the advances of science and medicine as well as the research related to health disparities.

Cross-posted at www.KevinMD.com

Matters of the heart

2011-06-23T09:55:00.002-04:00

My sketch of the human heart during first year anatomy.

She whispered to me with bulging eyes of urgency, “something is not right, I’ve been in pain all night.” Her chief complaint was chest pain. She had a routine work-up and some care with little relief. The news came that all of her test results were normal. Her body appeared tense, she looked panicked and afraid. At bedside, the attending suggested endoscopy offering that her pain may be related to a gastrointestinal condition. I introduced myself immediately as a medical student and quickly advocated for a cardiologist consultation. I mentioned that a few months prior she had been rushed to this hospital by ambulance with what had been determined as idiopathic ventricular fibrillation. The attending shook his head, he started moving toward the nurse’s station and I followed behind. He reviewed her case with me again and then he shouted, “endoscopy” then I said “cardiology consult.” I left quickly without waiting for a response because I was trembling with fear.

As I sat outside trying to figure what my next steps would be, my phone rang and it was the nurse, she said that the attending had agreed to the cardiology consult. I returned to our house to care for my grandmother, in the absence of my mom she had no caregiver. In the afternoon the cardiologist called me to express his concern with mom’s condition. He recommended, pending insurance approval that she be transferred to another hospital (the one that I had told her to go in the first place) for more tests and further observation. This hospital did not have a full cardiology service and would be closing for good within next 72 hours.

Mom was transferred that night, additional test results showed significantly block coronary arteries. Early the next morning she had cardiac catheterization to open her blocked blood vessels. After a short hospital stay in she returned home.

For a medical student learning to observe in clinical settings is a skill that comes with practice, time as well as teaching. Furthermore, bearing witness involves seeing the whole patient taking aim at focus beyond the chart to examine the situation. The recently released book by Dr. Augustus White, Seeing Patients: Unconscious Bias in Health Care (Harvard University Press, 2011) offers the following:

“...the race and sex of patients [influences] physicians’ decisions about whether to refer patients for catheterization...If you were black, the report (Schulman et.al) concluded, you were less likely to be referred. If you were a woman, you were also less likely to be referred. And if you were a black woman, you were especially less likely to be referred.”

While some have criticized Dr. Schulman’s research as “exaggerating the disparities” inequalities in treatment and care are demonstrated in his efforts providing evidence for the need to improve health care as discussed in the report Unequal Treatment Confronting Racial and Ethnic Disparities in Healthcare by Brian Smedley et. al. As an African American woman who is a physician-in-training, I’m glad to witness good medicine as well as mom’s progress.

Cross-posted at KevinMD.com

A beautiful story for all of us

2011-06-18T10:02:00.004-04:00

I could not believe my eyes when a recent online Psychology Today blog post made claims about beauty and Black women. As I moved through the article, the charts and read on, skewed “data” to malign in the name of science and research was clear. I could not bear the sight of this without reaching out to a few friends and colleagues. We agreed that this was egregious and something had to me done. A few hours after the actual blog post there was so much internet traffic the article web page was shut down due to technical difficulties, then it was removed completely. Outrage and responses continued on other blogs, FB and Twitter.

The story grew beyond the article into a pursuit of justice as young black women scholars organized with thecolorofchange.org petition to challenge the racist and sexist assertions regarding Black women. Over 100,000 people responded from across around the globe. The result: Professor Satoshi Kanazawa of The London School of Economics is no longer a contributing blogger for Psychology Today! Furthermore, the publication is revising their editorial process for reviewing blog posts. The Color of Change group also urges editors "to take more proactive and transparent steps in exploring the role of racism and sexism in scientific research and analysis."

Dr. Thema Bryant, psychologist, professor and President of the Society for the Psychology of Women states, “the media and television in particular has the ability to promote stereotypes or shatter them. Negative stereotypes are often used to justify discrimination. Stereotypes of African American women are rooted in the intersection of racial and gender oppression."

Notes to consider

The leadership of a few can galvanize the support of many others who see injustice
Web 2.0 and social media empower “the people formerly known as the audience” to read and respond
Moves against wrong can be swift because of the work already done and the progress made, this effort has been just a few weeks in the making
Research and data offer powerful tools for storytelling

Together, we can make a difference.

"Our lives begin to end the day we become silent about things that matter." Martin Luther King, Jr.

For Compassion

2011-05-26T17:48:00.003-04:00

What did you do last weekend? Were you waiting. The world is still a place we call home, for now. The smell of fear is in the air across America and also around the globe with Icelandic ash halting travel and increasing concerns about climate change and the environment. Streams of pictures moving across the news about Joplin along with more tornado watches and grim forecasts are disheartening.

It’s time for relief efforts. It’s time for compassion. It’s time to come together.

You see the devastation and despair. While we’re carrying on with our lives trying to find peace of mind with routines, schedules and more to-do lists, we miss the opportunity to reckon. We overlook the ruin of others’ lives thinking that there are no consequences. The gravity of the physical destruction, the significant loss of lives has its effects. Our response or lack thereof will have an impact. Consider the call for compassion

“ the ability to ‘feel with’ the other, is now essential—not only for the integrity of the religious enterprise, but for a healthy economy and the survival of our species”

—Karen Armstrong, The Charter for Compassion

Compassion should be our response for the relief of pain and suffering.

The turn of the economy and high rates of unemployment are having an impact on many low- and moderate- income families are seeking unprecedented support from federal and state programs like Medicaid. Kaiser Family Foundation just released the results of an independent survey revealing 60% Americans want to sustain Medicaid with funding and policies in place to guarantee coverage as well as set guidelines for benefits and eligibility, perhaps a sign of compassion.

We're all vulnerable especially during times of illness even with insurance some individuals require Medicaid to meet gaps in coverage. Dr. Atul Gawande tweets about these results with some surprise. I know that the sicker (and the poorer) you are the more likely you are to need Medicaid. The high cost of treatment and specialists make Medicaid all the more relevant for access to health care.

Kaiser results indicate that "Americans have a strong attachment to Medicaid" with about half self-reporting that someone in their lives if not themselves has received Medicaid benefit -- 69 million people will be covered by Medicaid this year. Most Americans see Medicaid as a resource they would use if needed.

This weekend we’ll remember loved ones and honorable lives. Families will come together. Stories and sermons of hope and faith will be told to bring us closer. Plan to offer and/or accept the invitation for healing and love.

Need help? Click here to download the Charter for Compassion.

Our world and families in the days ahead

2011-05-16T09:48:00.000-04:00

Today in America you have a 50% chance of living beyond 100 years. Those who are aging and living well make this mark with survival stories of resiliency by allowing the power of hopefulness to help them with setbacks in life, they overcome stress with success. Another key is having a network of care and love from families, friends and supportive communities. We need our families and beloved communities for long and healthy lives.

The United Nations set May 15, 2011 for the observance of the International Day of Families with a theme of "Confronting Family Poverty and Social Exclusion." It’s a call to recognize that families around the world are vulnerable especially given the persistence of violence, poverty and the uprising of natural disasters in an already unstable and unbalanced climate. From my view convening a global or national dialogue on family requires a look beyond strategies of war, approaches to economic market stability or business as usual in search of policies and practices that mobilize resources to value, connect, unify and empower communities and families who are interconnected by blood lines across generations and living together, in close proximity through relationships and/or sharing physical location. What’s the challenge?

“Social exclusion is often at the root of the problem. Discrimination and unequal access to social services deprive families of the opportunity to plan a better future for their children. Certain types of families are at particular risk, including large families, single-parent families, families where the main breadwinners are unemployed or suffer from illness or disability, families with members who suffer discrimination based on sexual orientation, and families living in urban slums or rural areas. Indigenous and migrant families, as well as those living through conflict or unrest, are also on the front lines of marginalization and deprivation.”

Secretary-General's Message for 2011

The aftermath of earthquakes in Haiti and Japan show people struggling to find their children and other family members. In Haiti the rising levels of cholera puts families and communities at risk for illness that without access to clean drinking water, nutrition and health care increases preventable deaths. In a technology meets volunteerism equals innovation, crisis mapping has helped bring response teams with resources to critical areas of the world. A website and portal www.Ushahidi.com helps users “call for help” using mobile devices via email, sms and tweets to map locations of distress based. Many countries like Hait don't have a 911 response system. Volunteers around the world have helped to develop the sophisticated system using Facebook, Twitter and Google maps with people on the ground to reconnect some children and families when geography seemed to be an impossible barrier. A vivid example showing the power and possibility of connection, for families around the world.

The recent devastation of tornadoes and floods in southern and midwestern parts of the United States have left many families homeless, disconnected and grieving the loss of loved ones. Who will help them heal? In her book, The Warmth of Other Suns” author Isabell Wilkerson tells the migration stories and now more so the return of African American families to their southern roots, which perhaps still remains tied to the search for relief from discrimination and racism. Yet, remarkable and significant progress has led to stunning diversity in America visible in neighborhoods, schools and the workplace, but also shows clear evidence of inequity at the cost of lives, comprising health and society. Here we have to continue the dialogue to realize for better outcomes for the future.

What can we do to strengthen our families? We can take on acts of empathy, compassion and love without delay.

A matter of healing and health: our segregation dilemma

2011-05-06T17:02:00.001-04:00

After withstanding the longest filibuster in history, the Civil Rights Act was signed into law on May 6, 1960 paving the way for much stronger legislation includig the 1964 Civil Rights Act and the Voting Rights Act of 1965. You can see here progress as an iterative process requiring time and tenacity. Justice is slow, but steady. The 1964 civil rights laws declared hospital segregation illegal.

Yet, the persistence of racial residential segregation continues to drive disparities in health.[1] Social factors in local settings result in variations of population health across communities. [2,3] The segregation dilemma among African Americans is distinctive because other minority groups have not lived within the historical context of the African American population, our closet kin are Native Americans. The landscape of America is changing rapidly with increasing Latin and Asian populations revealing a new story of complexity.

In growing numbers, people of different cultures and ethnic backgrounds are coexisting in communities, workplace settings, schools, playgrounds. While religious and faith centers remain some of the most segregated places in America. A few weeks ago a provocative talk considering “Race and Racism in America: Are We A Color Blind Society?” hosted by the W.K. Kellogg Foundation offered some insight into the practice of engaging into this challenging dialogue. For example, while 50% of African Americans have dated across racial lines, 98% of African Americans have experienced have first-hand experiences with discrimination. Discussions about bias, stereotyping and discriminatory practices do help to improve attitudes as well as behaviors. Silence may perpetuate pain and suffering. Race is an illusion discounted by the the science of human biology and modern genetics, but race is a social reality. A Joint Center for Political and Economic Studies report indicates racial inequalities in health care access and quality added more than $50 billion a year to direct U.S health care costs from 2003 to 2006. In Seeing Patients: Unconscious Bias in Health Care physician-educator Augustus White offers that the Unequal Treatment report “shocked the medical world into recognition of what was going on with racial and other prejudices.” [4,5] Deeply rooted health care disparities are entangled in the larger story in our society.

“Housing policy is health policy. Educational policy is health policy. Antiviolence policy is health policy. Neighborhood improvement policies are health policies. Everything that we can do to improve the quality of life of individuals in our society has an impact on their health and is a health policy.”

—David R. Williams, UNNATURAL CAUSES

The public conversation continues next week with a meeting offered via webcast on “America Healing” including Florence & Laura Norman Professor of Public Health, Harvard University sociologist David R. Williams. These professional meetings push beyond anecdotes so that the evidence of disparities can be seen and addressed. In considering "What determines health?" and the social factors related to healthier lives, Robert Wood Johnson Foundation will also host a webinar on “Place and Health: Why Conditions Where We Live, Learn, Work and Play Matter” and the chat continues via Twitter hashtag #healthissocial with an expert panel.[6] These are open-door meetings, offering virtual presence attendance. We all need to consider new possibilities for healing and health in our lives. Join the conversation.

References

Kramer MR, Hogue CR. Is segregation bad for your health? Epidemiol Rev 2009;31(1):178 –94.
Miller DM, Pollack CE, Williams DR. Healthy homes and communities: putting the pieces together. Am J Prev Med 2011;40(1S1):S48–S57.
Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep 2001;116(5): 404 –16.
White AA, Chanoff D. Seeing Patients: Unconscious Bias in Health Care. Cambridge, MA: Harvard University Press, 2011.
Smedley B, Stith A, Nelson A, eds., Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington,DC: Institute of Medicine, The National Academies Press, 2003.
Lavizzo-Mourey R, Williams DR. Strong medicine for a healthier America: introduction. Am J Prev Med 2011;40(1S1):S1–S3.

The day our world changed

2011-05-02T21:51:00.001-04:00

It’s a day when many Americans have gone back in time to revisit September 11, 2011, some are recounting the loss of loved ones, more are connecting their memories and feelings then to this day, emotions are soaring all across America. There’s a sense of relief, victory, applaud for success in leadership by President Obama.

Last night, Al Qaeda’s Osama bin Laden was killed in an act for justice to restore hope, security and the promise of our future.

Let there be healing.

Real Stories: Black Women Live On

2010-11-08T20:02:00.001-05:00

Former Secretary of State Condoleeza Rice has a new memoir Extraordinary Ordinary about the segregated South and the force of family love on her life. Her memories are America's too as she grew up in Birmingham, Alabama when bombing bloodshed propelled the civil rights movement when survival demanded perseverance, resistance and equanimiity. Condi notes that while there has been remakable progress since those days, challenges do persist as many are trapped in zip codes by poverty and race hindering their educational opportunity, employment possibilities as well as living standards.

Professor Rice notes that she prefers the term 'black American' because "African-American mocks the immigrant narrative" saying that her ancestors were enslaved to come to this country and are a significant part of America's beginning and founding population. Condi's story is American history with lessons about race, gender and the generational legacy of being extraordinary.