:: to the teeth ::    thoughts on social justice, medicine, race, hope and beats

"Another world is not only possible, she is on her way.
On a quiet day, I can hear her breathing." :: Arundhati Roy ::

"The most common way people give up their power is by thinking they don't have any." :: Alice Walker ::
Wednesday, December 29, 2004  

What if relief and reconstruction efforts aimed not just to save?

The tsunami disaster in South and South-East Asia has weighed heavily on me, even though I'm in safe territory in New Jersey. Why them? How am I sitting here unaffected while others have lost so many loved ones and are suffering so much? What can I do, other than donate $$? In a few months I'll be a physician, but i'm completely ill-equipped to handle a disaster like this. The aid agencies are responding to thousands of requests from volunteers around the world, stating that people trained in disaster relief are who are needed. As I've been thinking about all this, I've come across some blogs that I had not known about previously. The folks at ChiensSansFrontiers (sub headline: DesiMediaDogz without Borders) have been live blogging from the areas affected, and it's almost too much too take. An example:

(...) At the mass graves, we watched as bodies were lifted out of vans. No records of death. Only one Policeman on duty. No law. No order. Just people burying the dead. Body after body. Shovel after shovel. All along the Galle Road the destruction just made me numb. The media footage delivered by our FREE media brothers and sisters out there tell the truth. But they don't do the real carnage justice. No, not at all. You have to see with your own eyes bodies by the road. Unknown bodies. Stinking so much you feel the need to wretch. You have to see with your own eyes vans stuck on trees. Trawlers on the main road. Broken bridges. You have to see the power of your sea. And you have to be humbled.

And I've also just come across World Changing, an absolutely amazing weblog. Their premise is this:

WorldChanging.com works from a simple premise: that the tools, models and ideas for building a better future lie all around us. That plenty of people are working on tools for change, but the fields in which they work remain unconnected. That the motive, means and opportunity for profound positive change are already present. That another world is not just possible, it's here. We only need to put the pieces together.

Rock on. I'm hooked.

WorldChanging pointed me to this piece on Poynter Online -- where Jill Geisler asks some very important questions about the media coverage of this disaster (something I'm very interested in):
  • Will this story get as much coverage as the Scott Peterson case?
  • Will U.S. media invest its mighty resources into a story that is far from home, affects mostly people of other nations, and is relentlessly painful to witness?
  • Will media organizations ?- especially those that have cut back foreign bureaus -- redeploy staff to cover and stay with this story for more than its first days?
  • Will newsrooms that have adopted a "hyper-local" approach to news be willing to blow up that strategy in the face of a story that should transcend our parochial interests?
  • Will newsroom leaders see in this story the opportunities to bring readers and viewers closer to people, places, and issues they may never have known?
  • Will they reject the notion that Americans are interested in the story only in proportion to the number of U.S. citizens directly affected?
  • Will local television affiliates demand that their networks provide continuing and fresh pictures from overseas, so viewers won't see recycled images and assume the story is static, rather than dynamic?
  • Will networks send their top reporters, even anchors to the scene? What a powerful message that would send about the importance of this tragedy so far from our shores.

And Alex Steffen of WorldChanging just put together an absolutely wonderful piece that asks the question: What if relief and reconstruction efforts aimed not just to save, but to improve the lives of the victims of this week's disaster?

For one thing, history shows that the world tends to lose interest in disasters in developing world once people stop dying in large numbers. If we don't think now about our commitment to helping these communities recover and rebuild after the immediate crisis has passed, we never will.

...What if we looked at this relief and reconstruction effort as a chance to not only save lives (and of course that must come first) but to truly rebuild coastal Southeast Asia along more sustainably prosperous lines? What if we made the commitment to take what are now some of the most ravaged, destitute areas on Earth, and worked with the people there to reimagine and rebuild their communities to be the cutting edge of sustainable development?

Wow. Steffen then goes into a brilliant discussion of a few things that we could look at differently, including refugee housing, education for the kids, sustainable energy solutions, rural development, and a host of other solutions, all linked to other WorldChanging posts that expand these thoughts. I'm still absorbing all the information from the post and all its links, but this is the kind of material I absolutely love -- I'm going into the field of family medicine -- a field that looks at the health of the community and really tries to answer questions similar to Steffen's "What if relief and reconstruction efforts aimed not just to save, but to improve the lives of the victims of this week's disaster?" The question would be more like "what if medical efforts and dollars aimed not just to save (95% of our dollars going to health in this country are directed at treatment, only 5% are directed at prevention), but to improve the lives of the members of the community?".

As I'm running around the country right now interviewing for family medicine residency programs (the 3 years of training after medical school), I've been very excited about some of the family medicine departments' innovative approaches to addressing community health issues -- they're working with schools, gang members, religious leaders, and community health promotoras from the communities they serve, and thinking about proactive medicine and health, not just reactive (solely treatin' the disease). Oh yeah, and family med docs aren't the only docs doing creative things in the communities, also internal medicine docs and pediatricians and a host of other great docs. I'm not a territorial one-field-does-everything-creative kinda gal. But now I digress.

For now, I am so grateful that there are so many skilled disaster-relief folks in the tsunami hit areas (and traveling there) -- from physicians and other docs, to relief workers, to grave diggers, to volunteers in the surrounding areas, to survivors and friends who are putting aside their own shock and reflection on the disaster to help each other around the clock.

As I try to comprehend the tsunami disaster, I find myself navigating through all the above questions. In the coming days and months, I hope to keep donating money and figuring out other (non-financial) channels through which I can assist in this process. And I'll keep pushing myself to think about how I can work to improve the lives of folks there and here, in forward-thinking ways. But now I must sleep, as I have an interview at a VERY cool family medicine residency program tomorrow -- a program that pushes the envelope of how health care and health are looked at in a community.

posted by Unknown | 12/29/2004 10:19:00 PM | (0) comments |

Tuesday, December 28, 2004  

The public's mistrust and anxiety over painkillers

There's a fascinating piece in today's New York Times about the anxiety that patients feel about Celebrex, Bextra, Aleve, etc being deemed safe or not. Psychologists have broken it down nicely -- presenting the patient's perspective on this issue. Not surprisingly, mistrust in the FDA and physicians are important factors that contribute to the public's anxiety:

"Some doctors say they are concerned their patients may be overreacting, but psychologists who study how people evaluate risks say the widespread anxiety, raft of lawsuits and feelings of broken trust are neither surprising nor, necessarily, unwarranted.

"[Patients] hear that there was one study that didn't find an increase in heart attacks, but then they think, 'O.K., but how many studies have been suppressed?' " Dr. Loewenstein said. "There's a danger of a cataclysmic reduction or collapse of trust in physicians and in the government, and what we're seeing now could be a leading indicator of that." ...

"When it means that someone else is controlling whether or not I may be in danger, whether it's not letting me have the flu shot or not telling me about the potential risks of these medications, then people will react in ways that can seem out of proportion to the actual risk," Dr. Gray said...

So the fact that the warnings involved a drug that people took each morning thinking it would make them healthier is particularly troubling to the public, some experts say, as is the fact that health officials who were supposed to look out for them may have instead neglected to alert them about serious side effects...

"The degree of alarm and outrage is because something that's supposed to make people safe is really putting them at risk," Mr. Sunstein said.

posted by Unknown | 12/28/2004 08:01:00 PM | (0) comments |

Sunday, December 26, 2004  

Cannot quite grasp the tragedy

My mouth agape in horror, I watched people being swept away by the tsunamis in South and Southeast Asia, on television early this afternoon. Unfortunately the story was covered only for a minute on CNN. I was able to find all the known details on the internet, but I wondered how people who watch television for much of their news or don't have access to the internet, are able to grasp this story. That made me mad, but that's another topic for discussion.

I cannot comprehend the thousands of deaths that have already resulted from this tragedy. The Acorn and Vichaar have an updated list of organizations that are taking donations for the relief effort.

I recalled that only three months ago, my parents were at the southern tip of India, seeing for the first time the beautiful South Indian temples in that area. Matt Stoller of BOP posted a letter from a friend of a friend in India - some excerpts:

2 days ago, I was at the very tip of India, away out in the water visiting a temple, where you can admire the geographic glory of three bodies of water meeting and curving around the horn of India. Stunning. Millions of holiday travelers from all over India and the world. Impressive number of people...

Today, we got off the boat at about 10 am and got on a bus to Cochin at about 10:20. By the time we got to Cochin, 2 hours later, we began to get the inkling that something was very wrong.

The water in Cochin harbor was unbelievably strange and frothy, the beaches were unusually narrow and wet, and none of the fishing boats had returned. People were everywhere, lined up waiting for their loved ones and watching the strange surf. We heard then the news about the earthquake and tsunami. We heard that Alleppuzha and the backwaters are flooded. Kovalam is hard hit. Then we heard that the temple we had been on, just two days ago, is gone, along with all its many holiday travelers who come to marvel at the geography of India...

Even here, all around the horn of India far from the line of force from the earthquake, the water was able to turn back the very strong river that flows out to meet the sea. There finally came the moment when a cry was raised and we saw it, a dark line way off on the horizon, and as it came closer you could see a wall of water. Sure, wall of water, but it was only about a metre high, we thought. No problem. So no-one moved from where we were watching (about 15 metres up on a rocky outcrop, gotta be safe, right?) and there were people and touts offering their wares on the beach. But when it hit… the beaches were completely underwater, all of the people on the beach had to run away fast, we on the rocky outcrop got soaked, the touts’ carts were swept away, and the children were in hysterics. No-one was hurt, but we all treated the wall afterwall after wall of water that came, all afternoon and evening, and even now continues as I write, with a great deal more respect.

And if it could be this strange and threatening in Cochin, imagine the east coast and Sri Lanka...

posted by Unknown | 12/26/2004 06:32:00 PM | (0) comments |

Tuesday, December 14, 2004  

Only girlie-men listen to nurses who doth protest

Governor Schwarzenegger of California thinks he's tough shit. Yup, he put some nurses in their place, as they were protesting at a women and families conference that big ol' gov was speaking at:

"Pay no attention to those voices," the muscleman governor told the audience at the conference. "Those are special interests. They're just angry because I kick their butts everyday."

Who was he talking about? Nurses from the California Nurses Association, who were protesting his executive order against important nurse-to-patient ratios in the hospital. A law was passsed in California in 1999 requiring that nurses have a regulated maximum number of patients to care for simultaneously in the hospital. Those of us who work in the hospitals know that nurses have the absolute TOUGHEST jobs, and that fewer patients per nurse translates often into better patient care and healthier patients. California's hospitals have had 5 years to translate this law into action, and Gov Schwarzenneger recently signed an executive order (caving into lobbing from BIGGER special interests -- the hospital associations) to block this law from going into effect.

Rose Ann DeMoro, executive director of the California Nurses Association has a fire quote: "We expect more from the state's top officer than just pre-pubescent comments and blatant pandering to corporate donors."

The California Healthcare Association (a special interest which represents hospitals) has even put together an ad commending the Gov on his executive order.

Check out the California Nurses Association's website for information on actions you can take, and share the site with your friends in california!

Russell Mokhibir and Robert Weissman have more on this issue in their article on the Gov. and special interests. This is a patient issue, and nurses and docs as well as patients can speak our minds to the tough guy gov. And we've got to start breaking down this double-edge that many conservatives have -- looking like they're not for special interests while pandering to the anti-patient ones every day.

posted by Unknown | 12/14/2004 01:27:00 PM | (0) comments |


That Wicked Wickard thing

Supporters of states' rights have always blamed Wickard, and a few other cases of the same era, for paving the way for strong federal action on workplace safety, civil rights and the environment. Although they are unlikely to reverse Wickard soon, states' rights conservatives are making progress in their drive to restore the narrow view of federal power that predated the New Deal - and render Congress too weak to protect Americans on many fronts...

In pre-1937 America, workers were exploited, factories were free to pollute, and old people were generally poor when they retired. This is not an agenda the public would be likely to sign onto today if it were debated in an election. But conservatives, who like to complain about activist liberal judges, could achieve their anti-New Deal agenda through judicial activism on the right. Judges could use the so-called Constitution-in-Exile to declare laws on workplace safety, environmental protection and civil rights unconstitutional.

Wow. Today's the first time I've heard the name Wickard. In addition to the above info, there are probably implications for health care and other things that are in the way of the far right's pockets. There's more in this piece in the NYT about the growing campaign (happening under our noses) to undo the New Deal. It's an alarm to watch the legal system a bit more closely.

posted by Unknown | 12/14/2004 01:15:00 PM | (0) comments |

Monday, December 13, 2004  

The psychic energy of the poor, and organizing communities

David Glenn has a fascinating piece in Dissent Magazine, reviewing Jason De Parle's book "An American Dream: Three Women, Ten Kids, and a Nation's Drive to End Welfare". Supposedly, in the book (which I haven't read yet), De Parle focuses much more on the personal, intimate stories of these women and their kids than the broader issues of economic justice and labor laws and how they affect these families. David Glenn embraces this personal approach and enters an analysis of how leftists should reflect more on the social crisis, as this book shows that the crisis is in many ways "independent of the immediate economic environment".

And for those of us leftists interested in organizing communities, this paragraph from Glenn's piece is good take-home advice:
The second reason why leftists should reflect on the social crisis is that it occupies so much of the psychic energy of the poor themselves. When I reported on a campaign to unionize home-health-care workers in Milwaukee in 2001, accompanying workers as they knocked on one another's doors, I noticed how quickly conversations would move from anxiety about wages to anxiety about crime. One woman spent several minutes pointing out a hole in her back door; burglars had bashed through it a few days earlier and menaced her elderly grandmother. Another woman, one of the lead organizers, heard the gunshot when a man sitting in a car next door to her was murdered that summer. In earlier reporting among ex-welfare recipients in Milwaukee, I often heard it said that political activism is a good way to get yourself killed: look at what happened to Harold Washington. (There is a widespread belief that Washington, Chicago's first black mayor, who died of a heart attack in 1987, was somehow murdered by Chicago's white establishment.) Organizing campaigns among the urban poor today have to fight uphill against a tremendous amount of alienation, isolation, and fear. (By contrast, most of the great upsurges of the American left, from Flint to Montgomery, grew from communities in which there were denser social networks and higher levels of everyday trust.)

posted by Unknown | 12/13/2004 07:21:00 PM | (0) comments |

Saturday, December 11, 2004  

Where's the Playground?

In the morning fog and rain, I followed the directions to the Columbia Family Practice Clinic, where I and a few other interviewees would be meeting with the program director of Columbia University's Family Medicine Residency Program (one of 10-15 places I'm looking at to train in the fine art of family medicine for three years after graduating from medical school this May). The clinic is up in the Inwood/Washington Heights area of Manhattan, an area that is mostly populated by people of Dominican Republic heritage -- those who have lived here for generations and those who have recently immigrated to the United States.

I lived in the Washington Heights area of Manhattan for over a year, about twenty blocks down from this clinic, when I was attending Columbia's school of public health. While taking walks in the summer evenings and nights, I'd see whole families of kids, parents, grandparents, dogs, babies, and friends lounging and having fun outside their apartments. For me, the word "community" remains defined with this image and its positive associations.

Yesterday morning though, in the fog and rain, I experienced a different feeling as I tried to find the "playground" landmark on the directions to finding the parking garage near the clinic. I couldn't find it. Finally, upon observing the entrance to the underground parking garage, I looked opposite the street for the playground that the directions mentioned. I saw an asphalt basketball court, surrounded by fence. Children were even playing basketball at this early hour, but for some reason I hadn't made the connection that this was the "playground". I was thrown off balance.

Something about the congestion of these streets and the lack of ability to have grass on a playground or something more than two basketball poles took me by surprise. Just a few years ago, when I was going to school there, I would have recognized the basketball court as a playground. I've been outside of Manhattan for the past few years -- I've been going to medical school and living in or near Newark, New Jersey -- but Newark is by no means a suburban big-playground type of town, so I found my reaction a bit shocking.

Next to the basketball court was an apartment building (or was it a school?) that also had a playground, with some playground toys and equipment, but it was on the roof of the apartment building, about five or six floors up from the ground and again grassless. All around were stores and apartment buildings, and a few steps down I found myself at the entrance of the Columbia family practice clinic. I'm considering this residency program for my next three years of training, and as a place where I can serve a wonderful, vibrant and hardworking community. At the same time, I'm processing my feelings of a palpable sense of congestion and squeeze on the people, the resources, and the breathing space (the playgrounds and fun spaces) of the northern areas of Manhattan. And I'm grappling with what I want in a residency program -- do I want to be in an underserved area of northern Manhattan? Or do I want to be in an underserved area in central Albuquerque? Two very different terrains, of course. Questions, questions. I found myself more at ease upon discovering the existence of some nice parks in the Washington Heights area.

posted by Unknown | 12/11/2004 11:33:00 AM | (0) comments |

Friday, December 10, 2004  

Blog enhancement and sperm reduction?

At Inside the Mind of Madness, Abhi reflects:

Sometimes we just get so caught up in our lives that a certain selfishness takes over. I never meant to hurt them. It is important that you, my compassionate readers, believe me. You think that you are doing the right thing by blogging, by bringing your ramblings to a willing audience while you are still relevant in this mad world. You protect your friends and family by not revealing any personal information about them and by not putting them in the position to have to admit they know you. Then all of a sudden you realize that all the time you've been blogging you have been hurting those closest to you. The injustice of it all. You women out there just won't understand. How could you? Some things men must face alone. I don't know really know many I've hurt. Years from now I might find out.

What's all this about? Well, he's lamenting the possible loss of sperm from using a laptop. For those of the Abhi (male) variety, it seems that the heat generated from sitting with legs together and from the heat of a laptop on your lap can increase your scrotal temperature, from which it could be inferred could reduce the viability of some of the little sperm (obviously further studies would have to be conducted to see if there is significant reduction of sperm, etc). But for the soon-to-be-docs out there, a new screening question (and preventive counseling) has been devised (to add to the gazillion others):

"In the questionnaires that I give to my patients before I see them, I ask if they use hot baths or a sauna, and I tell them that they should stop it if they are trying to conceive," [Dr. Sheynkin] said. "I am now going to start asking if they use laptop computers."

posted by Unknown | 12/10/2004 08:23:00 PM | (0) comments |

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