My friend Jaenia tells a poignant story about going to a doctor’s appointment not too long ago. A couple of things about Jaenia – she is a strong woman. She loves her people well and bears the burdens of others, always offering hope. What some don’t know is that all of this comes at a personal cost.
At the time of the visit, she was going through some difficult things in her personal life. Just prior to arriving, tears were streaming down her cheeks. She pulled herself together long enough to sign in, but the minute she got into the exam room and saw the doctor, she choked up again.
“What’s going on?” said her doctor. And with that, the tears began to fall again. The doctor reached for a box of Kleenex and handed it to her. Jaenia did what most of us do during these situations. She began to apologize. The provider stopped her and said “It matters. All of this matters.” And then she allowed her to cry.
“It matters. All of this matters” This is wholistic care at its best.
Sometimes we think we have to have all the right words, that if we don’t we dishonor the one who is in front of us with their tears flowing. But sometimes, all we need to do is give kleenex and wait. Our waiting is a nonverbal affirmation that the person in our midst matters, their pain is acknowledged through patient waiting and kleenex.
This is part of what it is to bear witness to stories, whether they be stories of pain or of joy. I often talk about the ingredients to active listening and bearing witness being about the head, the heart, and the body. We listen with our heads, our intellect, the brain we’ve been gifted, the knowledge we have; we listen with our hearts, the pain and joy of our own experiences moving out of self absorption and into an empathy for the one in front of us; and we listen with our physcial selves, our bodies tuned in to the story that we are now honored to hear.
Kleenex, patient waiting, bearing witness with our heads, hearts, and bodies – it all matters. It’s what makes fractured hearts heal, one person at a time.
It was 10 years ago today that my sister-in-law and I arrived in Pakistan to participate in a 2-week medical relief trip.
At the end of the summer of 2010, Pakistan had been overwhelmed by floods with millions displaced. Camps for those who had lost their homes were set up across the country and aid was coming in from many countries around the world. Anytime there is a disaster like these floods, there is a domino effect of problems. Malaria, severe malnutrition, dysentery from poor water supplies, and skin diseases that happen when you have thousands of people living in close proximity to each other.
As my childhood home and love, Pakistan has a special place in my heart and to go back in this capacity was a gift. I returned with far more than I gave. What I didn’t know at the time is that it would change the trajectory of my life, for it was during and soon after that trip that I began to write.
I began writing about childhood memories and belonging, about the trip to Pakistan and what it meant to me. I wrote about saudade and identity, about faith and being an adult third culture kid. I wrote and I wrote and I wrote. Soon after, I began a blog. The blog propelled me into writing a book, and then another book that I had begun several years earlier. Writing was my therapy, my way to make sense of so much that had happened long ago.
At the end of my trip, I wrote an essay called “Holy Moments from an Unholy Disaster.” It was later published in my first book, but as I remember the anniverary of that return, I wanted to post it here.
To you who have read my words, who have encouraged me in my writing journey, who have stuck with me through mixed metaphors and my sometimes grammatically dubious sentence structure – I am beyond grateful. You have made my words live by reading them and posting them, by emailing or messaging me to say that my words resonate. I am so thankful.
On this 10 year anniversary of my return, here is the essay “Holy Moments from an Unholy Disaster.”
Given the choice of a five-star hotel or camping, I will pick a five-star hotel every time. I tell friends that anyone who grew up in the developing world with a commode for a toilet and one bath a week would appreciate my love of luxury. So it was with some surprise that I found myself eager to return to Pakistan on a medical flood relief team.
When I first heard news of the floods, I felt a sadness that was somewhat distant and removed. Pakistan was my childhood love and home, but as an adult I have been more connected to the Middle East through work and travel. My connections with Pakistan had been reduced to occasional emails from friends and to moments on the subway when, eyes closed, the rhythmic movement transports me back to the Pakistani trains of my childhood. That changed when I saw a picture in the New York Times of the city of Jacobabad under floodwaters.
Jacobabad, in the Sindh province, was home to my family when I was a little girl. I broke my leg there. My mother’s artificial flowers were stolen in Jacobabad. Mom had planted them around our house to add color to clay that would never grow anything. They provided a source of joy for a few hours and then they were gone. The New York Times photograph hit my heart in a way I had not anticipated, and through what could only be a work of God, an opportunity came about for me to participate as a nurse on a medical relief trip to care for internally displaced people in northern Sindh.
I never imagined that my life for a short time would resemble a National Geographic feature story. Although I grew up in Pakistan, raised my family in Islamabad, and lived for seven years in Cairo, my current reality is downtown Boston, where I drink a Starbucks coffee daily. I shop at Ann Taylor and get frustrated when my hot water runs out or I don’t have time to put on my eyeliner. But in early September the idea of working with victims of the flood suddenly became real and I became cautiously excited, knowing I may not have what it would take but willing to take that chance.
On October fifteenth, accompanied by my sister-in-law, Carol, and thirteen thousand dollars worth of donated medical supplies, I boarded an Etihad airliner and flew via Abu Dhabi to Karachi ending the journey in Shikarpur, Sindh. Outside the Shikarpur gates, a kilometer from the hospital where we were based we passed the burnt remains of a convoy of twenty-seven trucks that had been featured in the New York Times “Pictures of the Day,” and I realized that I hadn’t paid as close attention to the location of that picture as I perhaps should have.
The two weeks that followed were filled with holy moments. I watched as a mom pointed to heaven in thanks for food distributed to her family. I laughed with children at my own mistakes in Urdu and Sindhi. I prayed in the depths of my soul for the baby who looked like a skeleton at four months of age and for the emaciated mom who held that child with the love only a mother could have. I put shoes on the ulcerated feet of an ancient woman, countless stories written into the wrinkles on her face. We delivered a sewing machine to a widow who danced with it on her head. We saw and served people created in the image of God. These women and children in their beautiful, brightly colored clothing were “no mere mortals” and dear to the heart of God.
Our team — a doctor, two nurses, a community healthworker, interpreter and food distributors — were like a mini United Nations. We represented six people groups and six different languages, but we shared a unity in purpose and spirit that gave us efficiency, laughter and joy. In fourteen days we covered eight villages, surveying needs, running medical camps, and distributing food. Mud huts, tents provided by USAID, and charpais combined with chickens, roosters, water buffalo and cow dung completed the setting and tested our nostrils and stamina. But everyday provided a new adventure and new moments of awe.
There was, for me, an added bonus. Almost anyone who was raised in a country other than his or her passport country can relate with the immigrant experience. The sense of isolation, nontransferable skills, and being ‘other’ can creep up at the oddest of times and result in a deep loneliness and sometimes conflict with one’s passport country. Our lives are lived between worlds.
But for those two weeks I was not other. I was home. I saw friends who knew me when I was young, received blessings from men who worked with my father and women who had deep friendships with my mother, walked through compounds to the embraces of old friends, and was woken yet again by the call to prayer. These were holy moments that I had not anticipated.
A wise friend once told me that there are times in our lives when we need to remember who we are. During those two weeks, I was given the gift of remembering who I was.
Since leaving Pakistan as a child, I, like many, had to redefine my faith. It has often been a painful process. I struggle with unanswerable questions about life and God. This trip back was a humbling reminder that the God who sustained me when I was six years old at boarding school, crying into my pillow, is a God who still provides holy moments in places where real life happens.
I arrived back in JFK International Airport in New York City after twenty-three hours of travel and within a few minutes felt ‘other’ again. I faced a moment of confusion as I looked at the Immigration line options. Was I really a resident alien? An alien? No. I was a US citizen, shaped by cultures and moments that were not of my own making. In that moment I recognized that the peace of belonging happens deep in my soul and that peace can transcend the outside circumstances.
I don’t know why I was given the gift of going. That is a mystery to me. But I know it was Grace.
“There are many Beths in the world, shy and quiet, sitting in corners till needed, and living for others so cheerfully that no one sees the sacrifices till the little cricket on the hearth stops chirping, and the sweet, sunshiny presence vanishes, leaving silence and shadow behind.”
Anyone who knows and loves the book Little Women knows the story of Beth. Beth is the third sister, quiet and shy, not quick to pour herself into social occasions like her younger sister, Amy. And though Beth is timid around a lot of people, she is quick to notice those who need help. Above all, Beth is kind.
The story begins at Christmas time. Beloved Marmee has gone to visit a poor neighbor family, huddled in one room with sick children. Later on in the story, when Marmee has to leave to go be with her wounded husband she charges her daughters to not forget this family. The only one of the sisters who remembers and is willing to go see them and care for them is Beth.
Beth ends up with scarlet fever, a disease that she caught directly from the family she had been assisting. It was an illness that we know now is untreated strep infection and includes a sore throat, high fever, and a bright, red rash that covers the body. For her kindness, she ends up teetering between life and death. The family desperate to see her well again, and she does recover from this initial illness. But scarlet fever can carry with it some residual damage, and she later dies from complications of the disease.
Does Beth’s kindness kill her?
History is full of people who die helping others. The “Chernobyl Three” who stepped into a radioactive area to drain a pool, and in doing so averted another explosion; Annalena Tonneli, who fought TB in the Horn of Africa and ended up killed by terrorists; Corrie Ten Boom whose family helped Jews escape by hiding them in their home – there are far too many to count.
We are in an unprecedented time in this century. A global pandemic has been announced and “social distancing” has been strongly advised. As a public health nurse, I agree with this approach. It slows down the spread of the virus, giving hospitals and health care workers opportunity to catch up and be able to treat those who are the sickest. But those health care workers – doctors, nurses, pharmacists, community health workers, physicians assistants, nursing assistants – they don’t have a choice. They work to keep the rest of us safe. They don’t have the luxury of “social distancing.” Some of them, inevitably, will get the virus. It’s the price they will pay for helping. My prayer is that they will not die, but will instead be cared for by people who are as kind and dedicated as they are.
Social distancing is something of a privilege – a privilege reserved for those who live in single family dwellings, a privilege for those who have the resources to stock up on many months worth of supplies. Millions around the world don’t necessarily have this privilege. Maybe we also need to rethink the phrase “social distancing” a public health term used to apply to actions that a health department deems necessary to slow the spread of disease. Could we change that phrase to physical distancing instead? Social distancing gives us room to ignore the other, caring only for ourselves, all in the name of containing a virus.
A culture, like the United States, that prides itself on individuality could happily distance themselves physically and socially, but maybe some of us need a little prodding to go help others. There may be a neighbor who is really suffering, and you may be the one to help them. There may be someone who needs a ride from the airport, and you need to go pick them up. There may be families that need you to not socially or physically distance yourself so that you can bring them food and supplies.
This social distancing may be the right thing for the majority of the population, but there may be some of us who will be called upon to give up that distancing and help others.
It will be easy, if that happens, to opt for fear, to use social distancing as an excuse. I’ve said it before in this space – fear is not good currency. Fear is more viral than the virus itself. There is, and will always be, something to fear.
In the past 24 hours, I’ve watched some of my family members and friends come together to help another part of our family who have been rerouted from their home in Thailand. They are tirelessly gathering clothes, food, a car, and other resources that this family needs. Any one of them could have said “No. We have our own families to care for, to feed, to stock up for.” None of them have done that – they have stepped up and they have stepped in. I am beyond grateful for this coming together, moving in to help instead of moving away.
Please hear me – I don’t advocate being foolish. I don’t advocate walking in to harm’s way just to be noble. But I do think there are times when we need to put others above ourselves, and in this country, we have a lot to learn about what that looks like.
Social distancing may be the kindest thing for some people; for others, we may have to step up and move in. May we recognize the humanity of the other more than ever. May we have wisdom on what is needed, and above all – may we fight fear and be kind.
And these thoughts from C.S. Lewis are apt, though written long ago:
It is perfectly ridiculous to go about whimpering and drawing long faces because the scientists have added one more chance of painful and premature death to a world which already bristled with such chances and in which death itself was not a chance at all, but a certainty.
CS Lewis
This is the first point to be made: and the first action to be taken is to pull ourselves together. If we are all going to be destroyed by an atomic bomb, let that bomb when it comes find us doing sensible and human things—praying, working, teaching, reading, listening to music, bathing the children, playing tennis, chatting to our friends over a pint and a game of darts—not huddled together like frightened sheep and thinking about bombs. They may break our bodies (a microbe can do that) but they need not dominate our minds. CS Lewis on the atomic bomb
“Take off all of my clothes?” My voice intonates the last word as a question, rather like a child who asks her teacher if she has to complete all of the homework assignment.
I am sitting on an exam table under fluorescent lights in a clinic. I feel cold, not only because it is an unseasonably cold April, but also because there is a deep loneliness associated with clinic visits and full body scans.
You lie naked as a stranger examines every bit of your skin. They concentrate on freckles, moles, and imperfections with frowns and furrowed brows. A magnifying glass assists them on the troubling areas and a computer helps them document what they see.
I feel an indignity as I wait, a feeling of vulnerability and loss. An indignity manifest in a naked body, the words of Adam and Eve reverberating through the centuries “I was naked and ashamed.”
I am acutely conscious of my own frailty and humanity during these times. I am astute at covering my imperfections, at dressing and acting my part in the world where I daily interact. But these moments erase all of that.
And yet, I have come here voluntarily. I have come here because I know that a short time of discomfort is far better than a diagnosis of a skin cancer. I know this well because a few years ago I was diagnosed with a skin cancer. Caught early, I now bear a beautiful scar, a war wound of sorts reminding me that scars are evidence of battles fought and souls made stronger.
We live in a world where our aging bodies betray us and tell a different story than the story that we feel. We watch as through the years people begin to respond to us differently. First, we are masters of the universe, we are young, and we are beautiful in our youth, even if we are not beautiful in our looks. We walk through this time with little thought to the older among us, or to the ones who have bodies that do not work as ours do. We may interact with a grandmother or a cute, elderly neighbor, but in our age-segregated society, we do not really know them. Out of embarrassment, discomfort, or just plain ignorance we avoid those who are trapped in bodies that do not function the same as ours do.
Then middle age comes along and the jokes begin. “Look how she’s aged” we whisper with giggles, certain that we don’t bear those same marks. But then, we catch sight of ourselves in car windows, and we wonder who we are and how we got so old, so fast. We continue to live, but the reflection that looked back at us from the car window showed us a reality that we would rather avoid.
And then the phone calls begin to come. One friend has had a heart attack; another friend is given four months to live when cancer is found throughout their body. Friends are diagnosed with diabetes and heart disease, arthritis, and cataracts. Funerals that used to be for others are now for us and ours.
We are eternal souls in temporary bodies that will need a new heaven and a new earth to redeem a broken process.
We still think we are immune – except for those now yearly physicals or body scans, where we lie naked before God and a stranger. Perhaps it is in those undignified moments that we realize that we aren’t so different from our friends. Then someday, the phone call will be about us. It’s in those times that we realize the reality of our humanity. Our scars, our freckles, and our moles on our earth suits are more pronounced, and we wonder how it will all end.
My faith tradition affirms that I am “fearfully and wonderfully made”. And I don’t think that just means the young and able among us. Even as those who are fearfully and wonderfully made, we still need medical exams and physicals, body scans and preventive health checkups. We who are fearfully and wonderfully made need to brush our teeth and wash our bodies, eat healthy foods and exercise. In coming to earth in a human body, Jesus too was bound by his earth suit. He got hungry, tired, and dirty. He needed food, rest, and soap. He watched people get sick and die, and he didn’t heal all of them.
We are eternal souls in temporary bodies that will need a new heaven and a new earth to redeem a broken process.
How does one embrace every stage of life, appreciating what was and what is? How does one move gracefully through these seasons, putting trust in the Creator not the created; believing that there is something profoundly beautiful in our aging bodies? What does a theology of aging look like? What does holiness look like as I face my birthday and my body scan every year?
Before I have figured out the answers to those questions, the body scan is over. I am told that I don’t need to come back for another year. I am left alone with my body and my thoughts in a room that is still cold.
I get up and get dressed, inhaling a breath of thanksgiving. I am fearfully and wonderfully body scanned, and right now, that is enough.
In the last two years, the immigration debate has become louder and arguably less civil. Political platforms and decisions based on fear have dominated the conversation, but behind the conversation are approximately 23 million people. The number includes those lawfully present as well as those who are undocumented. It includes around 12 million children who are legal citizens born in the United States, but whose parents are non-citizens.
How does the current climate affect the health and daily lives of these millions of people?
Kaiser Family Foundation wanted to find out more, and so began work with a research company to interview families in 8 cities in 4 states. They also interviewed pediatricians who work closely with immigrant families in these cities.
Their findings are significant and troubling. Among those findings are these:
Fears of deportation and overall uncertainty have increased in the last year. These fears extend to those who are here lawfully.
“I feel unsettled. Even though we already have the green card, if we do not apply for citizenship, I don’t think we can be at ease.” –Korean Parent, Chicago, Illinois
“Uncomfortable and unstable; we feel that in any moment a new rule could be issued leading to expelling us and sending us back.” –Arabic-speaking Parent, Anaheim, California
“There’s no stability. [The President] could write a tweet on Twitter tomorrow and turn things upside down.” –Arabic-speaking Parent, Anaheim, California
Children are facing increased fear that their parents will be deported and/or that they will end up having to uproot their lives and go to their parent’s countries.
“My children would come home from school and say that at school they were saying that all parents would be deported…” –Portuguese-speaking Parent, Chicago, Illinois
“All the children, even if they were born here, are fearful. They fear that anytime they’ll come back from school and won’t find their parents there.” –Latino Parent, Chicago, Illinois
“In Brownsville we have about 1,700 homeless children in the schools. Many of those children are homeless because of a parent that was deported or placed in detention.” –Pediatrician, Texas
Pediatricians and participants said that bullying and discrimination at work and at school has increased in the past year.
“They get bullied…told things like, ‘now you and your family will have to leave.’….And so, even though those kids don’t actually have to worry about their immigration status, I think obviously a child, they don’t know the details of how the system works.” –Pediatrician, Pennsylvania
“I work in landscaping, and we’re working and they see you working…and they just start yelling stuff at you…” –Latino Parent, Fresno, California
Families are making changes in their daily lives and routines base on fear.
“I am also concerned because if anything happens to us on the street, if we get assaulted or something, we won’t even be able to call the police because they will see we are immigrants.” –Latino Parent, Boston, Massachusetts
“…but now around six or seven in the evening you won’t find anyone in [the neighborhood]… due to the fear we all feel about what is going to happen.” –Latino Parent, Chicago, Illinois
Increased fear in kids is resulting in behavioral issues, mental health problems, and psychosomatic symptoms.
“The kids who come in with concerns that you can kind of trace back to anxiety are usually the upper elementary age students, like the 3rd, 4th graders, to middle school students… 7th and 8th grade, who have nonspecific complaints like abnormal pain or headaches or decreased appetites… And then, in kids that are in the junior high to high school age range, it’s a little more overt: sadness, decreased appetite, not wanting to engage in usual activities, decreased in-school performance, those sorts of things.” –Pediatrician, Arkansas
Across the board, pediatricians are concerned with the long-term consequences of this environment.
“I think that we are going to have a generation of kids, who, especially in our immigrant homes, who are going to have more adverse childhood experiences than they would have. So, I think that we’re just setting up this generation of kids to have higher incidence of chronic disease, higher incidence of poor mental health, higher incidence of addiction…” –Pediatrician, California
“I think a huge worry is that children who have problems that are minor and fixable now… that, if those children go untreated, those could end up being bigger problems in the future that are going to be harder to treat and are really going to impact the child’s quality of life.” –Pediatrician, Pennsylvania
The health and well-being of immigrant and refugee communities is something I care deeply about. Yes, it is my daily work as a public health nurse, but it is more than that. It is something that is deeply embedded into who I am as a person. I have only benefitted from the many in my life who are immigrants and refugees, and it is troubling to me that there is documented fear and anxiety that is affecting the daily lives of those I care about.
What might we do to change this? What might we do to help those whose anxiety is affecting their health and the health of their families? The answer is bigger than any one of us, but some of the things that can help are these:
Know the law* and be able to point people to the law. Some of the fear is based on rumor. It is important to squash rumors and to point people to laws.
Sensitive locations. Both ICE (Immigration and customs enforcement) and CBP (Customs and Border Patrol) consider hospitals and other health care facilities to be “sensitive locations.” Both agencies have issued memoranda that say that immigration enforcement actions are to be avoided at sensitive locations, including at hospitals and other health care facilities, unless urgent circumstances exist or the officers conducting the actions have prior approval from certain officials within the enforcement agencies.
Right to remain silent. While immigration enforcement at health care facilities is limited by the “sensitive locations” guidance, immigration agents may enter a public area of a health care facility without a warrant or the facility’s consent and may question any person present, but those people have the right to remain silent.
Reassure your patients. Educate and reassure patients that their health care information is protected by federal and state laws.
An appeal to those of us who are Christians:
Caution and compassion are not incompatible; instead it is reasonable to assume that they work well together. The state is not the master of the church. If you are part of a faith community, none of this prohibits you and your faith community from reaching out to those who may be affected. They do not prohibit you from reaching out, in love, to refugees and immigrants in your midst. It is a lot easier to wear a sign and yell than it is to make a hot meal and take it to strangers, to check in with sick neighbors, to pray for those who are anxious and fearful. We must be willing to do more than react emotionally. We must be willing to put our loudly voiced news feeds into real action.
“The ability to love refugees well doesn’t require a certain party affiliation. It doesn’t require you to vote a certain way. But it does require us to show up, to step across “enemy” lines, and to choose love over fear.” from Preemptive Love
Note: Communicating Across Boundaries has never been, and never will be, a political blog, but I see this not as a political issue, but as a human health care issue. The brief is much longer and more detailed than this blog post. This post is simply to raise awareness of the issues that result from an environment of fear and anxiety.
“If you were giving a talk on teen pregnancy to a conservative, faith-based group who cares, what messages would you want to convey?“
A couple of years ago I asked this question of someone in our family planning division at work. I was serious. I wanted her perspective. She did not hesitate.
“I would tell them we live in a sex-saturated society, and everyone else is talking about sex – they need to be part of the conversation. I would tell them that you are not giving a teenager a mixed message if you tell them what you believe and what you would want them to do, and yet arm them with tools and knowledge about contraception if they make a different choice.” It was a great conversation.
So armed with this, as well as facts and figures that tell more of the story of teen pregnancy I ended up leading a discussion at our church.
Along with the facts, I wanted to give a face to the story. I chose to show a clip from a documentary called “The Gloucester 18”.
In 2008 Gloucester, Massachusetts – a seaport city known for its lobster, fishing and The Perfect Storm found itself in the center of a world-wide media frenzy. Reporters from as far away as Australia and Brazil descended on the town with cameras,microphones and all the other apparatus needed for a sensational story. The reason? There were four times the number of teen pregnancies than previous years and word had surfaced that 18 teenage girls had made a pact to become pregnant. As the nurse practitioner at Gloucester High School said “People love scandal”.
News networks preyed on this story like hawks and the girls and their families were deluged with phone calls from CNN to Dr. Phil.
So what is the real story behind these Gloucester teenagers?More importantly what’s the story behind teen pregnancy in general?
What we know:
We know several things. We know that teen pregnancy is a complicated issue and those that ignore the complexity are living in denial. “Just Don’t Do It” or teaching kids about sex by showing them Barbie and Ken in a shoe box seem to be ineffective ways to deal with teens and sex, teens and pregnancy. While the United States has seen a significant decline in recent years, the lowest rate in 70 years, we still have the highest rate in the developing world, surpassing Great Britain, France, The Netherlands and Sweden.
We know other things as well….
that 50% of teen mothers get a high school diploma by age 22, compared with 90% of teen girls who do not give birth.
that teen childbearing costs U.S.taxpayers about $9 billion each year.
that girls born to teen mothers are about 30% more likely to become teen mothers themselves.
that children of teen parents are more likely to do poorly in school and to drop out of school
that half of teen pregnancies end up in abortion – if we care about abortion we need to face and care about the issue of teen pregnancy
that southern states have a higher rate of pregnancy than northern states
that when money is put into sex education and birth control, the abortion rate goes down.
So when the discussion comes around to “Do we expect abstinence only programs to work in the world as we know it” I would say no. Any good sex education program has abstinence as a part of the curriculum, but the operative word is part not the entire curriculum.
Back to the Gloucester 18 – a face to the problem. The truth is, there was no pact. There was no conspiracy to all get pregnant at the same time. Most of the girls found out about a pact by watching the nightly news. The stories portrayed are poignant and real. In the spirit of a good documentary there is a raw and compelling truth that comes through and you can’t stay detached through facts and figures because they now have names and faces and most of all, babies. Beyond the newspaper stories were kids having kids. Girls searching for meaning and purpose, girls looking for stability and love, girls trying to please boyfriends and parents, friends and school authorities. Girls who were still trying to grow up and ended up facing the task of motherhood and parenting.
God doesn’t force his boundaries on anyone; He may long for us to stay within them, but He doesn’t force us.
As much as I may want to wave my wand and make teenagers make different choices, I don’t have that ability. But I can understand the problem, present my view passionately and at the same time be willing to recognize the world we live in, a world we must respond to in ways that are wise. We live in a broken world, a world that is not as it should be.Our world is made up of people who have choices. God doesn’t force his boundaries on anyone; He may long for us to stay within them for our own protection, but He doesn’t force us. So what should my response be? Compassion? Common sense? Tough Love? Interest? All that and perhaps more?
As I think about the issue of teen pregnancy and teen sexuality I think about sex as a china cup. A fragile, expensive china cup created by a Master Craftsman, with a unique and beautiful design. But once passed from the Craftsman to us to care for, the china cup broke into many pieces. And each of us try to put together these broken pieces, try to put back a pattern and restore a sense of what was.
Teen pregnancy is just one broken piece of the many. Can the Church be part of a solution to put it back together?
Note: This blog has been revised from a post written in 2012. I chose to repost because of the decision to cut millions of dollars from prevention programs.
Note: Seema Verma is President Trump’s nominee to lead the Centers for Medicare and Medicaid Services in the United States.
Dear Seema,
I’m a Registered Nurse who works in Boston, Massachusetts. I have witnessed first-hand what it is like for people to go without insurance, to delay preventive health screening only to find out that cancer is a far more expensive problem.
There are not a lot of things that make my proverbial blood boil, but reducing access to preventive healthcare, including maternity benefits, does. It makes me so angry I can’t see straight.
Look, I get it. Health care is expensive. Someone has to pay for it. But everyone bears the burden of an unhealthy society and while the Affordable Care Act (aka Obama Care) was not perfect, it began to put some policies in place that have been needed for a long time.
I come to this not from any political party line. I am a proudly independent voter – in fact, prouder by the day that I don’t buy into that assanine system called “two party.” I also live in Massachusetts where a Republican governor put health care reform as a top priority over 8 years ago and we are slowly reaping the benefits.
When, at your confirmation hearing, you mentioned that coverage for maternity benefits should be optional, I shook my head in disbelief.
Optional? Optional? I had to repeat it to myself to believe that you actually said it. The argument goes that if you’re a man or too old to get pregnant, then why should you have to pay for someone to have a baby? The lack of logic and understanding in that idea astounds me! The logical conclusion is that I shouldn’t have to pay for any of the choices that others make. So, by your logic, I shouldn’t have to pay for the business man who has a heart attack and needs bypass surgery. After all, I wasn’t the one who ate and drank too much. It was him.
Maternity benefits are an essential part of a healthy society. Maternity benefits speak to the value of family and children, they provide essential care for a future generation.
As Linda Blumberg, a senior fellow at the Health Policy Center at the Urban Institute. Women says: “We buy insurance for uncertainty and to spread the costs of care across a broad population so that when something comes up, that person has adequate coverage to meet their needs,” But insurance is not designed to be an “a la carte approach”. “Women don’t need prostate cancer screening, but they pay for the coverage anyway.”
When as a nation did we allow politics to co-opt our health, to feed us misinformation about insurance and that terror-producing term ‘socialized medicine’? Truth is the term ‘socialized medicine’ is a made up phrase. It was first heard in the early 1900’s but came into wide use when the American Medical Association fought against a national health insurance plan proposed by President Truman. It conjured images of a hammer and sickle approach to health care that would lead us down the slippery slope to communism. That was in 1947 – and it was a public relations coup, for in the six and a half decades since that time we have allowed the term to rule us, to be thrown around willy nilly to produce fear and anger, obnoxious and ignorant voices leading the way.
Here’s what happens when you let politics coopt prevention:
A breast cancer lump ulcerates and eats away the flesh of a breast; a cervical lesion, easily removed, grows and turns into a completely preventable cancer; a gnawing indigestion and bloated feeling turns into cancer eating away at your colon – fully preventable had screening taken place early in the disease process. You know what else happens when politics coopts prevention? Abortion rates, already far too high, go up. You can’t have it both ways – you can’t want abortion rates to go down and yet reject the notion of maternity care and birth control coverage.
Preventive health is not about being Republican or Democrat or Independent or Green Party or Libertarian. Preventive health is about the health of a society as a whole; it is about being human, living in a broken world where illness and death and “pre-existing” conditions are a reality. Preventive health and being sick is not about politics. When will we in the United States get that?
What you should want to do in your tenure is make the Affordable Care Act better! You should want to expand on it and leave a legacy that puts Obama Care into the water. You should want to make a name for yourself as a person who makes health care great, not just tolerable.
Instead, I’m shaking my head and saying: “What in the name of Sam Hill is she thinking?”
C’mon Seema! Be a Woman. Stand up for what is right.
These past two days I’ve been at a summit on race and equity. Specifically, A Call to Government and Community. The conference goes across spheres and participants represent housing, justice, immigration, education, the arts, and health. It has been full of stories and ideas –ideas that I agree with and ideas that I don’t agree with. Overall, I feel privileged to be a part of this conversation.
Taking ownership for my part in racism is not easy. There are times when I think “Well, I didn’t do that” or “I don’t think that.” But, as difficult as it may be for me to admit it, I am part of a bigger picture that benefits white people.
When white people don’t recognize how our position of cultural dominance influences us – when we don’t know that we’re being white – we can be like bulls in a china shop, throwing everything in our wake askew without even realizing what we’ve done. For us, this understanding begins with learning a perspective of cultural humility and seeking to understand another’s experience without judgment. May more of us boldly begin to walk on this long and winding path.
Part of what the last two days have been then, is a soul-searching on what this means to me personally and professionally.
The report was a landmark study that documented the disparities that racial and ethnic minorities experience even when their insurance and income are the same. Prior to the study, many thought that the narrative of disparities verbalized by both patients and health professionals was just that – a narrative. Or they thought that it was about health care access. The conventional wisdom was that if you give a person health care access the disparities will go away.
In fact, they found this to be categorically false. In compiling hundreds of studies across the nation, documented disparities were found in almost every area of health care. The results were absolutely clear: Racial and ethnic minorities get poorer quality of health care then white people. Here are just a few of the disparities that were found:
Receipt of appropriate cancer treatment
Pain control – Minority patients more likely to be under-medicated for pain than white patients (65% vs. 50%), more likely to have severity of pain underestimated by physicians
Mental health services – “plagued by disparities.” One study indicates 44% of White English speakers to 27.8% of Blacks received treatment after a diagnosis of depression.
Heart procedures – including bypass surgery
Diabetes – from diagnosis to amputations disparities were found in diabetic care
Pediatric Care – Less satisfaction, cite poorer communication, perception of lack of response
It is a thorough report that shows many factors contributing to these disparities, some of which are stereotypes, unconscious bias, and lack of cultural competency. The report gave a number of recommendations and also demonstrated that we have a long way to go to provide equal treatment for the minority populations in the United States.
And that brings me to Tuskegee.
Between 1932 and 1972 the public health service of the United States enrolled 600 poor, black men into a study to document the effects of untreated syphilis. Approximately 400 of these men had syphilis before the study began. The men enrolled thought they were receiving free health care from the government and they were promised food, burial insurance, and medical care for participating in the study. They were merely told they had ‘bad blood’ and were never treated for the disease. In the early 1940’s Penicillin had become a standard and effective method of treatment for the disease. None of these men received penicillin, in fact – treatment was never offered for 40 years. The study is known as the infamous Tuskegee Syphilis Experiment.
It has been 42 years since Tuskegee and to this day, it is difficult to get African Americans to participate in research studies. It does not take a rocket scientist to wonder why.
It was 30 years after Tuskegee that the report Unequal Treatment was released.
“For a serious offense,” writes psychiatrist Aaron Lazare “such as a betrayal of trust or public humiliation, an immediate apology misses the mark. It demeans the event. Hours, days, weeks, or even months may go by before both parties can integrate the meaning of the event and its impact on the relationship. The care and thought that goes into such apologies dignifies the exchange. For offenses whose impact is calamitous to individuals, groups, or nations, the apology may be delayed by decades and offered by another generation.”*
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I am a white woman. Anyone who reads this blog and has seen any pictures knows this. I did not grow up in this country and did not think about race – ever. I was raised as a privileged white minority in a country that still had memories of British occupation where whites ruled and were regularly sent to the head of the line. I now work as a nurse in public health with minority populations and regularly confront issues of racism and unequal treatment in health care.
The disparities that happen in health care have historically been wrong. The disparities that occur these many years later are wrong. There is no other word for it. They are wrong and a corporate apology is in order.
And I want to apologize. It doesn’t matter that I was not involved with Tuskegee. It doesn’t matter that I was not one of the care givers in any of the studies documented for Unequal Treatment. What matters is that I am part of a health care system that has routinely discriminated against people because of their color; a system that has treated people unequally based on their outward appearance, not their presenting symptoms.
To use some of the words of Aaron Lazare who I quoted above – these offenses were calamitous to individuals, to groups, to our nation as a whole.
In Notes from No Man’s Land, author Eula Biss talks about being a teacher at a public school in Harlem. A young boy a foot taller than her hissed at her in the hallway. As she sat in the principal’s office, waiting while the principal went to “hunt him down,” another kid stepped into the office. She writes the following about the interaction:
“I’m sorry I sexually harassed you.” I stared at him. He wasn’t the same kid. “But it wasn’t you.” I said finally. “Yeah,” he said as he pulled down his baseball cap and started to walk away, “but it might have been my cousin.”*
So today, as the conversation on race and justice is at the forefront of my mind, I borrow from the last sentence of Eula’s book. I apologize for the unequal treatment that is a present part of our health system. I apologize for Tuskegee. Because no – it wasn’t me — but it might have been my cousin.
Marilyn R. Gardner 