Health Care – Page 2 – Marilyn R. Gardner

Unequal Treatment

Published on May 17, 2016May 17, 2016 by Marilyn2 Comments

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.

In a piece called “When white people don’t know they’re being white” Jody Fernando says this:

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.

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In 2002 the Institute of Medicine released a report called Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.

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.

*As quoted in Notes from No Man’s Land by Eula Biss page 189

Note: this blog post was adapted from a piece written in February, 2014

Dear Primary Care Provider…

Published on October 27, 2015October 27, 2015 by Marilyn10 Comments

Dear Primary Care Provider:
I’ve wanted to write this letter for a long time, but never took the time. But after a morning coffee conversation with my 23-year-old daughter, I knew that I owed it to her and to the rest of the United States to write what I’ve seen, write what I know.

Because we’re frustrated. And it’s not your fault, but you are the face of medicine today. So I have a few things I want to say, and I’d like you to communicate these to your colleagues in specialty practices, to your staff, to your former professors, and to your administrators. Thank you ahead of time for listening.

We don’t understand your language. You speak Doctor, and we speak The People. The dialects are completely different. We are smart and successful– but we don’t know what the heck you are saying. So train yourselves to speak with the people, not AT the people.
We are so intimidated by you. Really. You frighten us. You come from a culture that is so rigid and inflexible – that would be the culture of western biomedicine – and we don’t know this culture. And your staff can be the worst. Pick your receptionists, medical assistants, and nurses carefully. Because they can make people feel so stupid and small.
Our bodies sometimes scare us. Look, you study the body for a living. For most of us, high school biology was a long time ago.
When we express something that feels important to us, we often feel dismissed. It’s a horrible feeling to have our vulnerability met by nonchalance. We need you to see the person behind the words; to hear the story beyond the symptoms.
On that same note, I think you expect us to know more about our bodies than we do. We don’t. That’s why we come to you.
Please ask us to repeat back what you have told us. That gives both of us an opportunity to clarify misunderstandings.
We know you aren’t our friends, but we do talk about you at parties. We rave about you if you are good, and we tell people to steer clear if you aren’t. We are your best advertisments. All we ask is that in return you treat us with dignity and respect, and sometimes we feel like it’s missing.
A little empathy goes a long way. And I think in the long run, you will realize that our visits will be shorter if you can express that empathy. I suggest you read The Empathy Exams and The Spirit Catches You and You Fall Down.
Culture matters. We view illness and health through a cultural lens. If you don’t get that, then you will fail as a true physician.
After we leave you, we fight with our insurance providers. Because the fact is, the Affordable Care Act did not fix a broken system. It merely provided a bandaid. So two weeks after we see you, we usually get a bill. And that’s why we don’t keep follow up appointments. Because insurance is a multi billion dollar industry, and we can both agree that it runs healthcare.

We appreciate you and the work you have put into your education and our appointments. But we need you to know these things so that you don’t lose us.

Sincerely,

A patient, a nurse, and a mom.

PS – please teach your staff how to take blood pressures properly….just sayin’….

To Iraq

Published on July 28, 2015July 29, 2015 by Marilyn16 Comments

The text came on an Ecclesiastical day – a day when I was despairing that there was nothing new under the sun. Especially nothing new in my immediate vicinity.

And then came the text: “How would you like to go to Iraq? Call me!”

It was from my husband. I called – immediately. The organization that he volunteers for was putting together a small team to go work with internally displaced people in Erbil, the capital of the Kurdistan Regional Government in Iraq. The president hoped to take a doctor, but after two doctors said yes and then had to back out for personal reasons, he decided to ask me. Timing was critical as he was purchasing the tickets that night.

I took a look at my schedule, rearranged one thing, and breathed a deep sigh. I was going to Iraq. As many who read CAB know, my heart has been across the world with refugees and displaced people from Syria and Iraq for a long time. In November, I was able to go to Turkey and since that time I’ve longed to go again. In fact, my husband and I have prayed long and sought hard to work with refugees full time, so the trip is a gift from God. To make it even better, my husband will be joining me a day later so we will be able to ask questions, find out what needs are, and do what we can during the short time we are there.

It will be a quick trip and include working at a clinic and visiting camps for internally displaced people. Last June, ISIS captured the city of Mosul – the site of the ancient city of Nineveh, best know from the Biblical story of Jonah. Chaldeans, Assyrians, Syrian Orthodox and more all lived and worshiped in this city. That changed when they were forced out of homes and communities, fleeing to nearby cities and towns. Erbil, as the largest city in the area, received many refugees. The churches in Erbil made room for thousands of displaced people, housing them wherever they could find room.

It’s a year later, but the crisis continues despite the world moving on. The figures are staggering in their magnitude. UNHCR (United Nations High Commission for Refugees) estimates over 3.5 million internally displaced people. Added to that are Syrian refugees who have made their way into Iraq. I can’t get my head around the figures. Take a look here to see more: UNHCR – Iraq

So we are going and it feels like even less than five loaves and two fishes – but then, that’s all most of us have. It’s barely a band-aid. But my friend Rachel says this, and I’ve quoted it before but it’s worth repeating:

“It is small. And you are just one person. But a mustard seed is small. That’s the way of the Kingdom. May we always delight in being part of small things.”

For those who pray, I would ask for prayers for this trip, but more so – for the internally displaced people and refugees in the area. I go for a week – they live there all the time. Also, if you would like to give to the clinic or to the camps in Erbil, click here. You can designate the funds specifically for Iraq. The trip is paid for, every bit of money goes toward the clinic and camps. Your gift is tax-deductible.

In Praise of Community Health Workers and Patient Navigators

Published on May 20, 2015May 20, 2015 by Marilyn1 Comment

Yesterday was the busiest and best day of my entire work year. Every May we hold a conference for community health workers and patient navigators. The purpose of the conference is to bring this workforce together for learning, skills-building, and networking. It is a gift to work with these outstanding women and men who are serving their communities so well. Yesterday was that conference and I am once again overwhelmed by the privilege of working with these people, many of whom I have trained, others who have become personal friends.

Community health workers have been around for a while — their earliest mention was from Russia in the 1800’s. They were called “Feldshers” and were trained as layleaders to assist physicians and work in rural areas when physicians were not able to be present. The program that brought this idea to greater recognition and popularity was the successful Chinese Barefoot Doctor Program. This began around 1930 and is foundational to the idea of community members successfully working within their communities as lay health leaders.

In the 1980s, as health programs around the world faced budget problems, this workforce was unfortunately almost forgotten. We have only recently seen a resurgence and emphasis on community health worker and patient navigation programs.

A report published by the World Health Organization in 2007 highlights the work of these lay health leaders, not just as health care providers, but more importantly as advocates for their communities and agents of social change to “fight against inequities and advocate community rights and needs to government structures.”

This year our conference theme was “Telling Our Stories.” Anyone who has read this blog knows my love of stories. I wanted the theme to highlight the stories of these community health workers and patient navigators and how those stories intersect with the work they do. We had participants from across the country as well as Puerto Rico and Turkey. We had presentations from people on care of immigrants, maternal child health, caring for young adults who have cancer and more. It was a beautiful picture of the work that is done every single day with little recognition by a system focused on more and more education and less and less true patient care.

Each year we try to highlight the work that patient navigators and community health workers do through film. Film allows us to showcase their work in ways that others can better understand, without acronyms and medical speak, but with passion and heart. This year we focused on three navigators – Maria, Sabrina, and Mariuca. Not only are they navigators who do amazing work, I am also proud to call them my friends.

I have included the film so you can hear some of their stories and be inspired by the work that they do. Thanks for letting me brag on this group of people today. It is my privilege to work side by side with them.

Patient Navigators: Our Stories from Sean Clark on Vimeo.

Raccoons, Tigers, and Okapis and How Where You Live Matters

Published on May 5, 2015May 5, 2015 by Marilyn2 Comments

“Pooling people in race silos is akin to zoologists grouping raccoons, tigers, and okapis on the basis that they are all stripey.” from Genes Don’t Cause Racical Disparities, Society Does

An article from The Atlantic, as quoted above, says this “Researchers are looking in the wrong place: White people live longer not because of their DNA but because of inequality.”

It’s NOT about race people!

Basically, billions of dollars have gone into funding studies that look at race as a basis for health disparities when, in fact, it is far more about living conditions. For years conventional wisdom has argued that there is really nothing we can do about these health disparities, because it’s really about biology. But a review of the literature showed none of that. Jay Kaufman, lead author of the study “The Contribution of Genomic Research to Explaining Racial Disparities in Cardiovascular Disease: A Systematic Review” says this:

“If you show that this is a predisposition that is genetically determined—black people just have this gene, there’s nothing we can do about it, this is just nature—then society is completely absolved. We don’t have any responsibility to solve this problem….If you show that it is because of racism and injustice and people’s living conditions, well, then, there is some responsibility and we have to do something about this.”

One of the things that we pay a lot of attention to in public health is something called the “social determinants of health.” The social determinants of health are defined as “the conditions in which people are born, grow, live, work and age, including the health system.” This takes into account not only your genetic code, but also your zip code.

Here is an example: Four years ago I did some consulting work in Washington state for community health workers. One of the classes that I held was in a public housing space in Tacoma, Washington. The space was beautiful. It was a ‘mixed use housing’ area which means that some people owned their homes while others rented. There was a beautiful playground, a clinic, an assisted living space, and a school down the road. But when I asked someone who lived there where residents purchased food, she looked at me and said “It takes three different bus rides to get to a grocery store.” This is what we call a “food desert.” Right across the street you could buy 1500 calories of junk for a dollar and yet it took a major part of the day to buy good food.

A researcher who goes into that community, a community largely made up of “people of color,” may find high rates of heart disease. But it has little to do with the color of their skin, and perhaps a lot to do with the fact that healthy food is so far away.

All of us, regardless of our station in life, interact with the world around us. And it is in this world that our health is created. So if we live in a neighborhood that has clean air, wide sidewalks, well-lit streets and play grounds, along with affordable farmers markets for fruit and vegetables, we have a far better chance at health than the person who has none of these things. Turns out that person is far more likely to struggle with asthma, lack of physical activity, obesity and poor nutrition. It also turns out that most of “those people” end up being people of color.

Where we live matters!

In the PBS series “Is Inequality Making us Sick?” questions about the social determinants of health are asked. Like the article in The Atlantic, the answers are troubling, because it’s a lot more to do with our neighborhoods and zip codes than our genetic codes. And that means we can do something about it.

All of this is best summed up in this statement:

“When it comes to why many black people die earlier than white people in the U.S., Kaufman and his colleagues show we’ve been looking for answers in the wrong places: We shouldn’t be looking in the twists of the double helix, but the grinding inequality of the environment.”

But, like almost everything, it is far easier to write about it, then to take concrete action and actually do something about it.

Cross-cultural Connection

Published on October 28, 2014 by MarilynLeave a comment

Recently I went to an outreach center in a different part of the city, a few blocks from the subway and behind the mosque in Roxbury. This area is perhaps the most diverse area in Boston. Here people from all over the world find their homes in apartments and houses. Residents are from Somalia, The Sudan, Ethiopia, Iraq, Senegal, Nigeria, Ghana and many more places. A large community health center in the middle of the community attempts to meet a myriad of health and social needs of residents.

We have tried to outreach to this community with health education for about a year and a half. We partner with a community based organization who are part of the community and committed to working within to make it a healthier and better place to live. I love this group. They are smart and funny. They work hard to create safe places where health messages can be heard and understood.

Tuesday was a breast health education session delivered to Somali women. They were all over 50 years old so in the age range where the majority of breast cancer cases are found to occur. Through interpreters and funny stories, poignant re-telling of hard events and sharing of different cultural beliefs we went through the session page by page. Time stopped as we gathered in a hot room talking, listening, learning. Between trainers, attendees, and a colleague we were from Nigeria, Ghana, Ethiopia, Eritrea, Somalia, and America.

This is where I learn why certain myths about breast cancer exist – for they don’t come out of mid-air, rather they are based in stories and events. This is where I learn that the women present believe that trauma to the breast causes breast cancer. “We come from a place where there is war” says one. “And the soldiers take their guns and hit us in the breast to keep us moving. Then we get breast cancer.” We talk about this and I’m not sure how far we get. It will take more conversations, more events, more relationship building to convince them that this is not founded on fact, on evidence, but on story.

This is a world I love. A world where interpreters and native speakers gather with others and connect over a common cause. A world where it doesn’t matter that the session was supposed to take 45 minutes and it took an hour and a half. A world of women from different cultural backgrounds, where I in my western clothing and they in their Somali clothing, head scarves wrapped tight, could begin the long dialogue of understanding. A world where skin color varies from pale cream to glowing, dark brown and every shade between.This is a world that resonates soul deep. My heart was full of the joy of connection and belonging. This is a world I know. A world I love.

It’s times like these that the early mornings and occasional mediocre days of the working world fade into the background, gloriously overshadowed by cross-cultural connection and with this, contentment.

Readers – I want to connect you to an amazing resource today! A friend of mine from years past has started a service called Kids Books Without Borders. Gail grew up overseas in France with a British mom and an American dad. And she loved to read! She has collected over 2000 books! 2000 BOOKS!!! And she now extends this love of reading and books to those who live overseas. All she asks is that you pay the postage. This is what Gail says:

Does your family live overseas and enjoy reading? I have collected over 2000 books, available to you. I will send you a box of books to a US address or directly to you overseas. All books are free. If shipped in the US, postage is also free. If shipped overseas, I ask that you pay half the postage. Check out my website and submit a request. I will then send you my booklist, so you and your family can shop!

Think Christmas! Think Books! And then contact Gail at kidsbookswithoutborders.wordpress.com

From Skin Check to Confession

Published on October 14, 2014 by Marilyn13 Comments

A couple of years ago I was diagnosed with melanoma and after a biopsy and surgery I fell into the routine of regular full body skin checks or scans. My “melanoma check” was a bit over a week ago on a Friday. I had my day all planned. I would go to my appointment, then pick up a cup of coffee, and then head to meet Father Patrick for confession.

As I waited at the desk of the receptionist I looked around me. It was early in the morning but already the waiting area was full. Every age, every color, every size, every gender, every income level.

I quickly checked in and looked around again. There was the teenager, his face scarred with acne, a mom hovering beside him dancing the awkward dance of concern and nonchalance. If scars could speak they would probably tell a story of merciless teasing by clear-skinned kids who knew how to make life miserable for one who already suffered. There was the older couple, he with a bandage over a part of his face, perhaps a result of skin surgery. And there were so many more, all of us with our imperfect skin, there to be checked over by a specialist who knew just which imperfections we should be worried about.

This yearly visit is fairly painless other than the humbling experience of having my naked body in all its wrinkled, spotted glory fully exposed to fine specimens of young male residents (where are the females in dermatology I ask you?) A resident goes over my body with a magnifying glass. Anything suspicious they swab with alcohol and take a closer look. All the while they are talking to me and asking me questions about my skin. Do you wear sunscreen? Any history of cancer? Any history of melanoma or other skin diseases? And then statements – Ah – looks like you didn’t wear sunscreen here! It’s a bit like a dentist asking me if I floss.

All I am to these physicians is a body with a skin disease. Nothing else. I am not a wife or a mom; an employee or a friend; a nurse or a trainer; most certainly not an author. It’s immaterial to them – what matters is my body, separate from my soul, my heart, and my mind. The Big Doctor comes into the room toward the end of the visit and the residents are clearly in slight awe of him. He talks about me in the third person and turns out the lights holding a black light over my leg, focusing on the four-inch diagonal scar where the melanoma first presented. See he says see you can really visualize all her sun spots here. This is called “solar lentigo” he launches into the technical name for the white sunspots that are now gleaming like stars in a dark night on my skin. For a moment I separate myself from my body as well and look down on my legs like they are a foreign thing, unattached to my person.

And then we’re done. All set. No need to come back for another year unless you see something that is cause for concern. Out the entourage goes. The residents (who incidentally looked like they were 12 years old) off to check another body.

And as I began dressing I thought about where I was going next and the juxtaposition of these two visits. From skin checks to confession. One interested only in my body, the other primarily interested in my soul, yet cognizant of the role body, soul, and spirit play in our personhood. One concerned only at that moment, the memory of my skin fading as quickly as a door closing and opening to the next patient; the other concerned on an ongoing basis – concerned with my outward roles as mom, wife, and more, but more so my inner being – my soul.

At the first visit a resident is equipped with a magnifying glass and a black light, at the second there will be no magnifying glass other than the eyes of God, there will be no black light, there will be no talk about me in the third person. It is my choice to reveal that which I want to reveal.

I am leaving a place where I am a specimen and entering a space where, as a human being created in the image of God, I have inherent worth. At one there is a Big Doctor, a specialist known worldwide, his residents trying to please at every turn.At the other – a priest relies on the Great Physician, the one who heals body and soul.The contrast has me shaking my head in consternation and amazement.

From skin check to confession. Both important but one infinitely more so. I check out of the office leaving with an appointment scheduled a year away and head to confession. My body is okay. My soul still needs checking.

State of the World’s Mothers 2014 #SOWM

Published on May 14, 2014 by Marilyn6 Comments

I was 13 when I first witnessed the miracle of birth at a women’s and children’s hospital in Pakistan. Ever since I have had a part of my heart reserved for mothers and babies.

The picture of two seeming opposites, strength and fragility, in both mom and baby broke through my insufferable teenage arrogance and I was captivated.

I went on to witness many births – first as a student nurse, then as a maternal-child health nurse, until finally I began having my own babies. I remember vividly the line on the pregnancy test showing up, dark and clear. I remember the first flutter of movement and the excitement I felt early on a spring morning in Chicago. I was barely awake, but the flutter sounded louder than an alarm clock and I woke my husband to share the excitement, to rejoice in the miracle. As a mom there are some things you don’t forget – and those were just two of them.

My babies were born all over the world. Beginning in a birthing room in Chicago; moving on to a hospital in Islamabad, Pakistan; still further to Daytona Beach, Florida; ending in Cairo, Egypt in a hospital on the banks of the Nile where my last two took their first breaths of life, and saw the world for the first time. I was so fortunate. I was so privileged.

And so every year I pay attention to the report released by Save the Children: The State of the World’s Mothers. This report has come out yearly since 2000 and is always released just before western Mother’s Day. It is considered a reliable tool across the world to show where mother’s and children do best and which areas they face hardships, often to the extreme. The report always ends with recommendations, calling on the world to make mothers and children a priority, to make moms and kids healthier worldwide.

“In this report, Save the Children examines the causes of maternal and child deaths in crisis settings, and suggests urgent actions needed to support mothers who are raising the world’s future generations under some of the most difficult and horrific circumstances imaginable.” from the 2014 report.

This year the focus of the report is on mothers in areas of humanitarian crisis. Here are just a couple of the things that stood out to me from the report:

More than 60 million women and children are in need of humanitarian assistance this year.
Over half of maternal and child deaths worldwide occur in crisis-affected places yet still the majority of these deaths are preventable.
Worldwide women and children are 14 times more likely to die in disaster settings than men.
For every person killed by armed violence, anywhere from 3-15 die indirectly from malnutrition, diseases and medical complications.
Over three-quarters of the projected 80 million people in need of humanitarian assistance in 2014 are women and children.
Areas of most concern include Democratic Republic of th Congo where civil war has caused terrible violence against women and children as well as high rates of disease and death from diarrhea, malaria, pneumonia and general new-born difficulties brought about from too few health workers and pregnancies and births in these difficult situations; Syria where data on how bad things are can’t even be gathered as the countries enters its fourth year of horrific conflict; Philippines where Typhoon Hainan ravaged the country in November affecting infrastructure and health care access.
The first day of life is the riskiest day of life for the newborn everywhere, but complicating this with all that comes with a fragile situations — lack of medical help, poor sanitation, violence, disease, insufficient water supply, living in close quarters with hundreds of others — makes it even riskier.

So where is the hope?

First off it’s in the mothers themselves, because no matter where you go moms want to keep their babies and children healthy – they will do anything to make life better for their kids. Moms want a better and more secure future for their children. That is a strength. Second – there’s hope in breastfeeding. This, as a natural source of vitamin-filled nutrition, keeps the baby full of nutrients that fight infection and malnutrition. It also works as a way to prevent postpartum hemorrhaging, helping the uterus to return to its normal state pre-pregnancy.

Hear this: When formula is distributed where it shouldn’t be it hurts everyone!

In emergency situations it is near impossible to prepare formula properly. It’s irresponsible to send formula and randomly distribute it thinking you are doing people a service. If it is distributed, it must be done carefully with extra attention given to how to prepare. To quote the report directly:

“In all situations, children who are fed infant formula are more likely to become ill and die than those who are breastfed. In an emergency context such as the Syrian conflict, where the risk of dying is already high for children, breastfeeding saves lives, providing critical protection from infections and death.”

Third – what Save the Children’s report does not highlight is the amazing work going on throughout the world by unacknowledged women’s and children’s hospitals. I know people in Pakistan, Haiti, India that work with no need for recognition, daily doing their part to assist with healthy births, to teach breast-feeding techniques, to vaccinate children. A project in a rural area of Pakistan teaches literacy and hygiene to women and children. Community health workers in many parts of the world take on the role of educating their communities. All is not hopeless.

I’m convinced and the data itself shows that when you invest in women and children you make the entire community healthier and more economically stable. For every dollar spent on key interventions for reproductive, maternal, newborn and child health, about US$ 20 in benefits could be generated.*

Readers of Communicating Across Boundaries live all over the world. And so I’ll close this by saying wherever you are in the world, work to spread the word that mothers and children matter and are worth investing in. They matter to their families, to their communities, and to society as a whole.

*If you use twitter tweet the report using this tag #SOWM

On my travels I’ve met with mothers recovering from the devastation of ongoing conflict, mothers trying to make a refugee camp feel like home, and mothers who fled from violence with their children on their backs. Despite the horrors of the past, every mother I meet is focused on the future and how to make it brighter for her children. – Jasmine Whitbread CEO of Save the Children International

To download a full copy of the report go here.

*A study by Victoria University in Melbourne in six Asian countries