Sunday, November 30, 2008

Casualties of Conspicuous Consumption

As the friends, family and co-workers of Jdimytai Damour mourn his death under a stampede of eager Wal-Mart shoppers on the morning after Thanksgiving, many of us wonder about the state of a country where crazed bargain-hunters can trample a 270-pound man to death and come close to killing a pregnant woman.

For years, my wife and I have made a point of never shopping on Black Friday, a manufactured day of conspicuous consumption that prays on economic fears and people's perceived need for a bargain. Seemingly, the excitement over such potential bargains is enough to foment a mob mentality that can lead to injury, death, and destruction of property, all in the name of commerce.

While some see shopping as a patriotic duty that injects consumer cash back into the economy, I can easily argue the point that not shopping, staying home with family, visiting friends, and volunteering at local soup kitchens and shelters are activities that are exponentially more patriotic and productive than any amount of spending could ever be. Editorials abound about the way that American shoppers have been programmed by Wall Street, coached that abundance is limited, and urged to be the first to lay their hands on goods that are apparently in short supply, available only to the lucky few who are first through the door.

We all know that times are tough. Many Americans are losing jobs in record numbers as the number of uninsured nears 40 million. Putting gifts under the tree is seen as a parental duty and obligation, and no parent wants to see young disappointed faces on Christmas or Hannukah.

In the early years of our marriage, my wife and I received fuel assistance and Medicaid, visited our local food pantry, and often relied on bargain stores for food, clothes, gifts and other items. Despite our political and social beliefs, we also frequently succumbed to our son's wishes, occasionally purchasing mass-produced plastic toys that his young mind believed would make his Christmas complete. We had some lean Christmases in those years, and it was often the gifts mailed by thoughtful grandparents that made the pile under the tree appear more substantial.

Americans are apparently driven by commerce, ownership, and the acquisition of property. The free market has turned us all into miniature fiefdoms wherein we use our purchasing power to outfit our castles with the commodities that we feel will improve our lives, our social standing, or our level of physical or psychological comfort. But at what price?

But please don't get me wrong. I, too, have wants and desires. That new CD? A book hot off the press? Clothes, shoes, furniture, towels, bedding, bicycles and computers? We all want them, and those desires are not necessarily intrinsically wrong. However, when our desires become a wall between ourselves, our families and the humanity of others, then something certainly has gone haywire. When a worker can be trampled to death under the weight of a crowd solely intent on being the first to save a dollar, then the wall between our desires and our humanity has thickened and grown to new heights of Orwellian insanity.

Jdimytai Damour was said to be a gentle and kind man who loved Japanese anime, politics, and movies. He was working at Wal-Mart for the reason that everyone else takes a job: to put food on the table and a roof over his head. Working for low wages and perhaps no appreciable benefits, he was like so many other temporary holiday workers: hard-working and expendable.

At 5 o'clock in the morning on the day after Thanksgiving, Mr. Damour died a painful death under the shoes and boots of shoppers oblivious to the fact that their utterly unnecessary sense of urgency caused a series of events to unfold which would end the life of someone's son, brother, and friend. Nearby the place where Mr. Damour died, a pregnant woman was knocked to the ground, trampled, and came excruciatingly close to losing her baby. It was a tragic scene on many levels.

Perhaps rather than urging Americans to shop, shop, shop, the government and consumer groups should begin to instill the idea that giving comes in many forms. Donations can be made to humanitarian organizations in a family member's name. Endangered species can be sponsored, with a stuffed animal and certificate of adoption mailed to a designated child who will then be educated to see gift-giving in a new light. Homemade gifts and the gift of time can be much more meaningful than most any item purchased at a store. But if an item is indeed purchased, let it be done so thoughtfully, calmly, and with circumspection.

We are not in a race to consume. We are in a race to love, to connect, and to interconnect. In this interdependent world, our choices and actions as consumers have far-reaching effects, and while the hungry mavens of Wall Street want to see us flocking to the cash registers of America like so many automatons, we can make other choices---saner choices---that honor our families and our communities with the embodiment of the holiday spirit we so wish to generate.

Jdimytai Damour was a casualty of the economy and of people's perceived need to consume and his passing is a sad statement about the current state of American culture. In that light, let's take a moment to remember what the holiday season is really all about, and let's remind our friends, families and children (through our words and our actions) that giving has less to do with what is given than with the heart and spirit of the giver.

Rest in peace, Jdimytai Damour.

Saturday, November 29, 2008

Friday, November 28, 2008

A Thanksgiving Ambulance Ride and the Tectonic Plates of Privilege

Yesterday on Thanksgiving, my wife and I were both in so much pain that we could barely do much of anything. We are both living with chronic pain of different kinds, although hers is definitely on the mend and self-limited whereas mine has no explanation and no apparent treatment that's helpful to any great extent. Mary had a steroid injection to her sacroiliac joint on Tuesday and it seems that it may actually be working, and that is something to give thanks for.

However, to add insult to injury, I had a fever of about 100 yesterday, and had several episodes of very intense bilateral chest pain. At about 11:30pm, we were watching a DVD (season 4 of "Six Feet Under", by the way), and I had a bout of chest pain so bad that I was doubled over on the couch, weeping like I was being mercilessly beaten.

Not knowing what else to do, Mary called 911 and the kind dispatcher calmly spoke with her and reassured us both. Minutes later, two paramedics and two police officers were standing in our living room, and I was summarily whisked away to the emergency room. I cannot state more clearly how kind, professional exemplary and efficient everyone was, from the paramedics and police to the ER nurses, attending doctor, radiology techs and phlebotomist. I was very well taken care of, and received a complete cardiac workup from head to toe.

As expected, the bloodwork, EKG, chest x-ray and vital signs were all normal, including my temperature. Meanwhile, the nitroglycerin given to me under my tongue in the ambulance caused a pounding headache, but I was simultaneously hydrated with a full liter of IV fluids as I rested. While it was offered for me to spend the night, I elected to come home and sleep in my own bed, and this morning Mary is caring for me like a saint, as always. My temp is about 99, but there is no chest pain in sight, although my body still feels like it was run over several times. Some holiday weekend.

What is very concerning about the episode described above is that we are about to be completely uninsured for the month of December. Mary and I have both started new jobs recently, and our insurance from her previous employer runs out at midnight on Sunday. Meanwhile, my new insurance doesn't start until January 1st.

So, for the month of December, we will more fully understand---through direct experience---the unfortunate uncertainty of living on that all-American edge of having no health insurance coverage. I think that we have planned well and won't run out of any of our medications, but the experience of last night (and my knowledge of the economic devastation that can be caused by unexpected health crises without insurance) does indeed give me pause.

Here in the United States, where more than 30 million Americans live without health insurance year-round, Mary and I are about to embark on a time-limited taste of that reality (something we did indeed experience back in the early years of our marriage when we were poor). We are determined to remain healthy and avoid any costly emergencies, and I'm certain that all will be well.

As professionals, we are indeed members of a privileged class of Americans who can rest assured that we have the economic wherewithal---even without insurance---to take care of our needs as they arise. With access to home equity, credit cards, and family who would of course help us in a pinch, we truly have nothing to worry about. Calling 911 and going to the ER last night, we knew that the entire affair would cost us precious little monetarily, and I received stellar care.

There are so many Americans who completely lack the the certainty that their healthcare needs will be taken care of. Millions of Americans lack insurance, have no credit at their disposal, and have families who are in no position to offer financial support.

As a nurse and as a human being, it is these people who I worry about. These are the adults, children and elderly Americans who live on the edge and who truly live their lives at daily risk of financial ruin and ill health. Lacking insurance, preventive medical care is eschewed, important screenings are missed, and future health and well-being is compromised.

I never want to lose sight of my relative privilege and how so many other Americans lack even the most basic assurance that their health, well-being and economic stability is important to others. It is crucial for those of us who do indeed have such privilege to speak out on behalf of those who do not, and to pressure the Powers That Be to change the calculus of privilege in this country.

Many privileges taken for granted by so many---healthcare, housing, food, education---are not really privileges at all. These privileges are, in my view, absolute rights. And we must fight for the rights that we feel all Americans deserve. It is my hope that the 21st century will be the momentous era in which American history and society undergo a seismic shift wherein the tectonic plates of privilege give way to a new foundation of national equality.

So how, you might ask, did I make the leap from a Thanksgiving ER visit to the utter lack of economic equality in American society? It is actually an easy leap to make, especially on a holiday that asks us to give thanks for the blessings and abundance in our lives. While I generally enjoy Thanksgiving and the true meaning of the holiday, my experience last night and early this morning only further drives home the point that so many Americans lack so much of what I can easily take for granted. And for me, I simply cannot rest until those disparities are truly a phenomenon of the distant past, a tattered remnant of an America whose bad old years are assuredly only a memory.

Thursday, November 27, 2008

Food Insecurity on Thanksgiving

A fifteen-minute expose on tonight's broadcast of The News Hour with Jim Lehrer on PBS highlighted the challenges faced by food banks and soup kitchens across America. With the current economic downturn, massive layoffs and rising unemployment are pushing more and more families and individuals to seek food assistance from local agencies.

As this wave of need crashes against the American system of emergency food distribution, those very agencies are already overwhelmed as requests for assistance continue to rise. Meanwhile, corporate and individual giving has declined as Americans who might normally donate to their favorite charities are themselves tightening their belts and giving less. Today's news reports demonstrate that some food banks and soup kitchens are sadly in a position wherein needy families are actually being turned away this holiday season.

Currently, 38 million Americans are considered "food insecure". Housing costs and fuel prices are a major factor for many families when it comes to affording basic food needs, although fuel has indeed taken a plunge to record lows in recent weeks (perhaps a temporary economic change). And when such families are eligible to receive food stamps from the government, the average amount allotted is approximately $4.00 per person per day (basically $1.33 per meal). How many of us would be challenged to feed our family a healthy and nutritious meal for $1.33 per person?

While hunger was once seen as a problem of the inner city and rural areas, one-third of poor Americans now live in the suburbs, and hunger in suburban areas is indeed growing while still being largely a hidden phenomenon.

Many of us are painfully aware that a significant number of personal bankruptcies in this country are due to the rising cost of healthcare, and as more and more Americans lose their health insurance after being laid off from work, they will indeed often be faced with a choice between food and healthcare expenses, a particuarly difficult dilemma, especially when children are involved.

Even as millions of Americans sit down to glorious Thanksgiving feasts this afternoon and evening, it is imperative for all of us to realize that there are more than 30 million Americans who face very serious food insecurity on a daily basis. For these individuals and families, even the idea of a Thanksgiving meal might seem like a dream. Perhaps all of us lucky enough to have kitchens filled with nutritious food should consider how we might ourselves contribute to making such dreams more likely to come true.

Wednesday, November 26, 2008

The Mathematics of HIV Infection

A new mathematical model suggests that the HIV virus could be virtually eliminated in 10 years if every person in every country with high infection rates was tested and treated.

Published in "The Lancet", the study is indeed intriguing, and the World Health Organization promises to examine the findings more closely. The model includes voluntary testing of every citizen, with AIDS drugs prescribed for any patient testing positive for the HIV virus, regardless of whether they are symptomatic or not. (Current practices often dictate withholding treatment until a patient has symptoms, or when their T-cells---immune cells that fight opportunistic infection---fall below a certain level.)

At this time, the price tag for such a strategy is estimated at $3.4 billion per year initially, with costs decreasing over time.

With approximately 33 million people infected with HIV worldwide, increased testing and treatment would, of course, cost money. However, an already overwhelmed healthcare infrastructure in places like sub-Saharan Africa (where HIV rates are still rising) would pose significant logistical challenges. (For an interesting map detailing the number of HIV cases and AIDS deaths worldwide, please click here.) How those countries would be financially and logistically supported by the global community in implementing such a strategy remains to be seen.

From a human rights perspective, critics of such an approach feel that universal testing and treatment might infringe on individual rights. And as many patients with HIV and AIDS already know, taking antiretrovirals is not easy, and side effects such as liver toxicity or failure, heart attacks and kidney failure are all relatively common.

Such studies and models for a plausible expansion of the global effort against HIV and AIDS are laudable, and perhaps the AIDS epidemic will indeed be significantly curtailed in the decades to come. Perhaps the greatest gift that we could give to the children of the 22nd century would be to eradicate HIV and AIDS from the face of the earth in the current century, a goal that has generally been seen as virtually impossible until now.

Some nay-sayers may feel that we're getting ahead of ourselves as infection rates steadily rise in Russia and other countries, but there are scientists and researchers around the globe seeing the possibilities of near-complete eradication. One can only hope that plausibility will eventually give way to reality, and someday we will truly look back on the epidemic as a disturbing yet finite piece of post-modern medical and societal history.

Monday, November 24, 2008

So, What Does A Public Health Nurse Do, Anyway?

This is a question that has already been posed to me several times, and coming up with answers helps me to define what it is I'm actually supposed to accomplish in my new job.

Public health nursing has a long and illustrious history which I will not illustrate here, but in terms of my new position, there are a number of things for which I am directly responsible:

-Tuberculosis case management: I closely monitor and follow any cases of active or latent tuberculosis in my community, assuring that patients take their medications as prescribed and follow up with the regional TB clinic as required.

-Emergency preparedness: it is my job to actually make sure that our town has protocols and plans in place for emergency preparedness, whether it be for natural disasters, terrorist attacks, pandemic illness, or other public health emergencies. I will cooperate with other regional agencies and serve as coordinator of our local Medical Reserve Corps.

-Immunization clinics: I will hold monthly immunization clinics for immigrants and other citizens in need of urgent immunizations. Influenza clinics are also an important part of our work in the late Autumn and early Winter.

-Infectious disease surveillance and investigation: I am responsible to track, report, and investigate infectious and communicable diseases in our community.

-Resources and referrals: I will provide the general public with resources, referrals and advice vis-a-vis medical issues, psychosocial issues, and other needs as they arise.

-Employee wellness: on some level, I am supposed to provide employee wellness resources for employees of our town. I'm not sure what this is supposed to look like, and only so much can happen in thirty hours each week. Still, I see this as a potentially interesting aspect of the job if there's any time to actually do it.

There is so much to learn and so much to know. Infectious disease surveillance in general is an enormous area of expertise and I feel ill-prepared to take it on.

The learning curve is indeed quite steep, but in exchange for my own sunny office, a great cafe next door, and excellent health insurance, I think I made the right choice.

Saturday, November 22, 2008

Public Health and Me

So, I have officially accepted a position as the Public Health Nurse for my town, and my hours were approved by the town government just yesterday. While I've been filling in as the Interim Public Health Nurse for ten hours each week over the last several months, I will begin working thirty hours a week beginning on Monday.

After ten months of being a free agent, consultant, and general slacker, having a job to responsibly report to four days a week is indeed a wake-up call. While consulting and working per diem jobs has allowed me a great deal of flexibility and self-determination, the need for high-quality health insurance and a more steady income have also reared their heads. Thus, my decision is propelled by economic need as well as the realization that this will certainly be an interesting and growthful career move on many levels.

As a Public Health Nurse for a town of approximately 40,000 people, I will be responsible for emergency preparedness (including the management of the local Medical Reserve Corps), infectious disease surveillance and reporting, tuberculosis case management, a monthly immunization clinic, influenza clinics each fall and winter, fielding questions and calls from citizens and town employees, and other important responsibilities.

I am honestly slightly overwhelmed as I realize the steep learning curve involved in this undertaking, but I also realize that my desire to work for Partners in Health, Doctors Without Borders, or a similar organization in the future will be even more likely with significant public health experience under my belt. While public health is not necessarily hands-on nursing, it is a crucial part of the healthcare infrastructure of the country, and many of my new skills will certainly be transferable to other countries and societies.

Stay tuned for developments as I dig in to my new position, and I surmise that issues of public health will become an even more intrinsic part of the regular conversation here on Digital Doorway.

Friday, November 21, 2008

Keith's Ephemera

Dear Readers,

If you are so moved, please pay a periodic visit to my newest blog---Fiction, Prose & Ephemera---a collection of fiction and poetry, some of which are works in progress, and others that are more or less complete. It is a project whose time has come.



Thursday, November 20, 2008

The Office of the National Nurse and the Obama Administration

Now that Barack Obama has been elected and some changes in the trajectory of American healthcare are on the way, those of us who support the creation of an Office of the National Nurse are asking that citizens supportive of our cause please communicate that support to the Obama team. For a review of the importance of such an office, please see my previous blog post on the subject. To communicate your opinion to the Obama-Biden team, please click here.

While the current Chief Nurse Officer (CNO) of the United States serves as Assistant Surgeon General, many of us feel strongly that it is time for nurses to be taken seriously as key players in the development of far-reaching preventive measures to improve the health and well-being of the American people. Rather than have the CNO remain in a subservient role to the Surgeon General, giving the National Nurse a prominent, autonomous and equal part in the government's efforts vis-a-vis preventive healthcare would send a clear message that the nursing profession has finally received the recognition it deserves.

Nursing has a great deal to offer to the American healthcare system and to policy discussions vis-a-vis the changes that are needed to improve the health and well-being of all Americans. The establishment of the Office of the National Nurse would be a major step towards recognizing the profession of nursing for its contributions to medicine and health (separate and autonomous from the medical profession), and for moving the United States and its citizens towards improved self-care, improved health outcomes, and renewed standing as a country that views the health of its citizens as a true measure of "national security".

To send the Obama-Biden administration a message regarding this issue---or any issue close to your heart---simply click here to visit a special page for communicating your vision of America to the incoming administration. Your support for the establishment of an Office of the National Nurse would be greatly appreciated.

Wednesday, November 19, 2008

Obama, Daschle and Healthcare

It is now confirmed that Barack Obama has asked former South Dakota Senator Tom Daschle to serve as the administration's Secretary of Health and Human Services. While the nominee has already undergone a rigorous vetting process by the Obama transition team, he will of course face a Senate confirmation hearing after the President-Elect is inaugurated on January 20th. I will venture a guess that Daschle will be handily confirmed by the Senate, and I imagine that he is already setting his sights on a broad plan of action. Whether that plan leads to successful change in the healthcare trenches remains to be seen.

Meanwhile, a powerful bipartisan group of senators met in the offices of Edward Kennedy (D-MA) today, at the behest of Senator Max Baucus (D-MT), to begin shaping potential Democratic legislation vis-a-vis broad healthcare reform.

With 15% of the country's GDP going to healthcare and the number of American uninsured (estimated at 40 to 47 million) expected to rise as layoffs and unemployment increase in response to the economy, the stakes are high for meaningful healthcare reform.

We all know we can do better. In terms of healthcare access, funding and quality of care, the World Health Organization has ranked the United States as 37th in the world. Concurrently, our ranking in terms of infant mortality and life expectancy also continue to plummet when compared with other nations. These statistics bear out the widely accepted notion that the enormous per capita expenditures on healthcare by the United States government have fallen far short of their potential, and many other countries have somehow managed to produce far better results utilizing a percentage of what we spend here.

The battle regarding the potential benefits and pitfalls of universal healthcare is on. Yesterday on Digital Doorway, I pointed readers towards an excellent website where the arguments for and against universal government-sponsored healthcare is being argued quite cogently. This nationwide conversation will only intensify, and it remains to be seen how the Obama administration will rise to this Herculean challenge.

I am personally and professionally invested in the developments vis-a-vis healthcare reform in the United States, and I assume it will be years before we know the true successes or failures of President Obama's efforts, with support from Tom Daschle and other key players (not to mention the input of the American people, if it is heeded amidst the noise).

These next months and years will be an interesting affair, and great grist for writers, bloggers, healthcare policy professionals, pundits, and ordinary citizens alike. Meanwhile, as the conversation and debate rages, the statistics related to the uninsured and underinsured will certainly worsen. We can only hope and pray that a truly remarkable (and successful) solution is indeed within reach.

Tuesday, November 18, 2008

Opposing Views: The U.S. and Universal Healthcare

I would like to bring readers' attention to a website called "Opposing Views" wherein "real experts go head-to-head on issues you care about". From the spanking of children to animal rights, an open forum of debate, discussion and commentary allows experts and readers to chime in on pressing issues of the day.

Apropos of Digital Doorway's predilection for issues related to healthcare, there is currently a lively and very interesting debate on the site which poses the question, "Should the U.S. Have Universal Healthcare"? I highly recommend visiting this particular debate, leaving a comment if you so desire, and perusing the site for other debates, such as "Does Marijuana Have Medical Value?", "Is There a God?", "Do Guns Make You Safer?", and "Should Your Daughter Receive the HPV Vaccine?"

Debate is a healthy way for issues of interest to be discussed under a framework of civil discussion and intellectual sharing. Opposing Views certainly offers a valuable forum for such discussions to take place, and I encourage anyone who enjoys such lively give and take to frequently pay this excellent site a visit.

Sunday, November 16, 2008

Hospitals and Consumers on the Edge

Economically speaking, times are tough all over. People are losing their jobs, the unemployment rate is rising, and retailers and consumers alike seem to be facing a lean holiday season.

On the healthcare front, a number of U.S. hospitals are now in the difficult position wherein they now must buy back debt incurred from "Variable Rate Demand Notes" (VRDNs) and other forms of loans that hospitals use to do many things, including making capital improvements to their facilities. According to some reports, U.S. hospitals may be forced to buy back up to $8 billion dollars of debt, not an easy task in these cash-strapped times.

For hospitals, the economic times are indeed challenging. Patients with outstanding bills are less likely to be able to pay on time, if at all. Many employers are scaling back health insurance coverage for their employees, thus patients are often stuck with hospital bills that they cannot afford. Additionally, the numbers of uninsured and under-insured patients is rising in most states, and charity care is becoming increasingly burdensome for hospitals and health systems that provide such services. As some patients shift to Medicaid, hospitals also understand that reimbursement rates from Medicaid and Medicare often cannot match those from some private plans, thus revenues hemorrhage from numerous economic blood vessels simultaneously.

Equally troubling for hospitals, borrowing is exceedingly difficult, despite dire need for improvements to facilities, upgraded IT equipment and systems, and rising labor costs. With increased costs of utilities, food, supplies, and health insurance premiums for their own workers, hospitals also understand that many patients will continue to cancel or postpone many elective surgeries and procedures that bring much needed revenue to hospitals' bank accounts. With consumers charged co-pays of $200 to $400 for elective procedures such as colonoscopies and vasectomies, hospitals face a serious decrease in such procedures which are much less costly since they generally involve a stay of less than 12 hours from registration to discharge.

From The Wall Street Journal to regional news outlets in the mid-West, the signs all seem to be the same: hospitals are in for a difficult season as the economic belt tightens on the healthcare industry.

As a self-appointed advocate for the uninsured and vulnerable in this country, I am seriously concerned that an enormous cohort of Americans currently face a significant decrease in the availability of affordable preventive healthcare in all regions of the country, not to mention access to many specialists and other providers.

Overall, my fear is that the availability of free and low-cost care will suffer in the current economic climate, and patients in need of care will need to travel further and further afield in search of providers willing to see them, a burden that may keep numerous people from seeking medical attention at all. When access to medical attention is limited, it is frequently the uninsured and under-insured who are left in the healthcare dust, and there are millions of children who will fall into this unfortunate group as their parents simply struggle to make ends meet.

There will be much for the new Obama administration to consider when assessing the current (horrible) state of the American healthcare system. As impatient as we all are for change, it may be many months before any improvements are even suggested for fixing healthcare in this country.

Meanwhile, as hospitals struggle with their bottom line and millions of uninsured Americans struggle to stay healthy, we all must hope that there is still a possibility that the damage, as extensive as it may seem, can still be undone. And as for those millions of uninsured children out there, it should never get any worse than this.

Saturday, November 15, 2008

UNICEF Petition for Child Survival

UNICEF is currently sponsoring an urgent petition to President-Elect Barack Obama requesting that child survival around the world be made a top priority of his administration. With approximately 9.2 million children and babies under five dying unnecessarily around the globe each year (that's 25,000 children per day), this initiative is clearly an investment in our global future and should be taken seriously by governments and NGOs the world over.

On UNICEF's website, they state the case clearly:

"At UNICEF, we believe in children. We believe deeply that every child—regardless of race, gender, religion, nationality or economic status—is equally deserving of a future. We believe that every child, not a percentage of children, should be afforded basic lifesaving vaccines, clean water, nutrition, protection from violence and a chance to survive to adulthood."

And they earnestly continue their message:

"UNICEF believes it is possible to reach zero—zero child lives lost to preventable causes like pneumonia, diarrhea, malnutrition and infection; zero children disabled by unnecessary illness; zero mothers dying as they give birth for lack of health care.

"An impossible dream? No, an achievable goal—with enough will and enough resources. UNICEF has proven that we know how to stop this from happening, with integrated, cost-effective solutions.

"What’s missing? Leadership. Everyone has a part to play: individuals, corporations, civic groups, church organizations—and, yes, government. We need the United States to provide leadership on child survival. That means both Congress and the President."

At this time of global economic meltdown, it is widely recognized that humanitarian aid and related initiatives might be seen as somehow superfluous based on current financial realities. but despite---or perhaps even due to---the economic crisis that is gripping the world, the continued fight to eliminate poverty, hunger and early child mortality is in fact more important than ever.

As developing countries strive to come to grips with the worldwide economic downturn, increased assistance from the world's industrialized nations is paramount. And in terms of global security, keeping the world's citizens fed, housed, safe from violence, and protected from unnecessary illness and death is in fact in our best interest, singularly and collectively.

Appealing to potential donors on a crudely economic basis, I would say that children are especially crucial to the future of the world's economic well-being. As future parents, workers, doctors, lawyers, humanitarians, farmers, etc., they are key to developing a healthy and robust workforce as their generation comes of age. Economically speaking, investing in children's lives is an investment that will pay countless dividends for generations to come.

However, beyond their economic status as future workers and consumers, humanity as a whole has a vested moral and ethical interest in assuring that no child dies unnecessarily from an otherwise preventable cause. This means that children in Iraq, Japan, the United States, Nicaragua, Sierra Leone, Brazil, the Phillipines, Pakistan, or any other country, all deserve the chance to grow, to learn, and to fulfill their potential as human beings and have the opportunity to contribute to the world's development and humanity's evolution. This notion is incontrovertible, and the moral imperative of saving children's lives simply cannot be debated.

I believe that one of the best roads to international security, future global prosperity, and humanity's greatest potential is through realizing the value of children's lives and investing in programs and initiatives to assure that those lives are not cut short by the lack of healthcare, food, shelter, education, and the economic means of survival. 25,000 preventable deaths per day is no laughing matter, and UNICEF's call for a "laser-focused" initiative by the new American president is a good start to what could be a moving and potentially wildly successful undertaking.

Please visit the UNICEF site today and sign the petition calling for a Presidential Initiative to Accelerate Child Survival. 25,000 children will die unnecessarily today. Let's make sure that, within our lifetime, we will bring that morally unacceptable number to zero.

Friday, November 14, 2008

The Charter for Compassion

A new organization and movement have been founded with the goal "to build a peaceful and harmonious global community".

Utilizing the minds of some of the greatest religious thinkers of our time---including
Archbishop Desmond Tutu---The Charter for Compassion "seeks to remind the world that while all faiths are not the same, they all share the core principle of compassion and the Golden Rule. The Charter will change the tenor of the conversation around religion. It will be a clarion call to the world."

The following video clearly illustrates the goals of this burgeoning global movement, and simply and coherently verbalizes the widely accepted need for a universal propagation of compassionate tolerance.

The Charter for Compassion will be collaboratively created using input from people from every corner of the globe via new innovative software that enhances a collective decision-making process.

The previously mentioned group of religious elders, dubbed "The Council of Sages", will work together to distill the thoughts and input of thousands of contributors into a concrete document that "will not only speak to the core ideas of compassion but will also address the actions all segments of society can take to bring these ideas into the world more fully. The Charter for Compassion will then be signed by religious leaders of all faiths at a large launch event, followed by a series of other events to publicize and promote the Charter around the world".

First, collaborative suggestions regarding the preamble of the Charter are being sought at this very moment.

Starting on November 20th, input will be sought regarding the "eight core elements of compassion":
  • Compassion as empathy not pity.
  • Compassion as concrete action.
  • Compassion as a lens for scripture.
  • Compassion’s role as a spiritual tool and its relation to be
  • Compassion as fundamental to all faiths.
  • Compassion as an urgent global need.
  • Compassion as concern for everybody.
  • Compassion and the Golden Rule.

Then, beginning on November 27th, there will be specific calls to action for different groups:
  • Educators
  • Scholars
  • Congregants
  • Religious leaders
  • Media
  • Youth
Subsequently, beginning December 4th, a summary of the Charter's declarations will be created, reflecting on how the Charter will actually bring about change in the world.

If you would like to submit your own story as a part of this growing conversation, click here to visit the segment of the site devoted to contributors' personal testimonies.

The Charter for Compassion may be the exciting birth of a new expression of how compassion, tolerance and global cooperation can change the world and alter humanity's very way of thinking. Please consider visiting the site and perhaps even sharing a story of how you feel compassion can be generated, propagated, and disseminated throughout the world.

Change of Shift is up at Crzegrl

A new edition of Change of Shift, everyone's favorite nursing blog carnival, is up over at Crzegrl, Flight Nurse, complete with one video offering, a new twist on the blogging paradigm. Enjoy!

Thursday, November 13, 2008

Evoking the Power of Compassion

Evoking the power of compassion in us is not always easy. I find myself that the simplest ways are the best and the most direct. Every day, life gives us innumerable chances to open our hearts, if we can only take them. An old woman passes you with a sad and lonely face and two heavy plastic bags full of shopping she can hardly carry. Switch on a television, and there on the news is a mother in Beirut kneeling above the body of her murdered son, or an old grandmother in Moscow pointing to the thin soup that is her only food. . . .

Any one of these sights could open the eyes of your heart to the fact of vast suffering in the world. Let it. Don’t waste the love and grief it arouses. In the moment you feel compassion welling up in you, don’t brush it aside, don’t shrug it off and try quickly to return to “normal,” don’t be afraid of your feeling or be embarrassed by it, and don’t allow yourself to be distracted from it. Be vulnerable: Use that quick, bright uprush of compassion—focus on it, go deep into your heart and meditate on it, develop it, enhance and deepen it. By doing this you will realize how blind you have been to suffering.

All beings, everywhere, suffer; let your heart go out to them all in spontaneous and immeasurable compassion.

---Sogyal Rinpoche

Tuesday, November 11, 2008

Radio Interview: Columbus, Ohio

For anyone interested, my interview with Fred Andrle on WOSU, Ohio Public Radio, is available online at Just scroll down the page to the Monday, November 10th section, et voila! You can listen from the website or download it is an MP3 file.

Monday, November 10, 2008

Bloggers Unite---Refugees

Today, November 10th, 2008, bloggers around the world are posting about issues surrounding the plight of refugees. As we writers sit at our computers, composing thoughts to provoke the thinking and compassion of others, millions of men, women, and children on several continents fight for their lives and their rights to a safe home, free from fear and persecution.

For as long as human beings have engaged in battle and warfare, displaced persons have wandered the earth in search of a home. Recently, tens of thousands of refugees within the Democratic Republic of Congo have fled refugee camps due to increased fighting and direct attacks on refugee camps, possibly due to ethnic or religious differences. The Congolese people have suffered for decades, and there is no end in sight to their continued persecution and internal displacement.

The main global organization vis-a-vis the coordination of refugee protection is the Office of the United Nations High Commissioner for Refugees (UNHCR). Other organizations such as Human Rights Watch, Refugees International, and the American Refugee Committee are all committed to protecting refugees and providing relief and financial assistance that can mean all the difference for displaced persons struggling to maintain their health, safety and economic well-being under extraordinarily difficult circumstances. Similarly, organizations such as Doctors Without Borders manage to provide essential medical care to individuals and families suffering from acute injuries, untreated disease, psychological trauma, and the effects of poverty and deprivation.

Refugees from Iraq, Afghanistan, Palestine, Georgia, Darfur, Somalia, Sri Lanka, Myanmar and other troubled regions amount to an enormous population of world citizens who require medical care, advocacy, protection, shelter, clothing, food, and a means by which to make a living and educate their children, many of whom have never known a normal life free from displacement and suffering.

It is our collective responsibility to support the organizations that provide services and advocacy to refugees throughout the world. It is also our individual responsibility to pressure our elected officials to take action and to push for legislation that enhances the work of the lead refugee agencies that bear the brunt of the Herculean labor involved in supporting the millions of displaced people in need of essential services.

War, when waged by any country, almost ubiquitously creates refugees, and such battles frequently stir up---or are originally caused by---religious, ethnic and cultural differences between groups that fuel the fires of hatred and genocide that we have seen all too often in the current century and the last. While much of humanity has called for a universal end to war, there is currently no end in sight, and it is thus incumbent for humanity as a whole to work collectively to assuage the effects of war, racism, hatred, and violence.

Just as it has been said that none of us are truly free while others are enslaved, it can also be said that none of us are ever truly living in peace and safety until all are living in peace and safety. Perhaps a day will come when the plight of refugees will be an historic anomaly. However, the 21st century, indeed in its infancy, has already offered us a myriad of evidence that war, displacement, and genocide are still realities necessitating a powerful communal response.

Yes, today is indeed a day for blogging about refugees. But when the day is done and the articles are read and digested, it is then that the message truly must take wing---and we all begin to take action.

Bloggers Unite

Bloggers Unite

Sunday, November 09, 2008

Disability Discrimination in Australia

This past week, a German physician living and working in Australia was denied permanent residency due to the fact that his 13-year-old son with Down's Syndrome does not meet alleged health requirements for citizenship. Citing the potential cost of the child's future medical care, the Australian immigration authority denied that this is a case of discrimination based on disability.

The case has sparked a veritably international outcry, and the boy's parents---Bernhard and Isabella Moeller---vow to appeal the case to the highest court in the country.

Apparently, Dr. Moeller was aggressively recruited to live and work in Victoria, a rural section of Australia which is currently experiencing a severe shortage of primary care physicians. Taking into consideration the relatively disastrous impact of the loss of yet another valued physician in this underserved region (especially in light of Moeller's son's current state of good health), there seems to be a misguided---and blatantly discriminatory---calculus at work on the part of the Australian authorities.

While it is true that Dr. Moeller and his family are indeed Europeans living in Australia as guests, I am nonetheless shocked that the Australian government would choose to take such a course of action towards a gentleman who has provided an invaluable service towards the health of the Australian people. With an enormous rural area in need of qualified medical providers willing to relocate in order to serve such far-flung populations, why would the Australian Powers That Be take such a myopic stance? This clearly discriminatory action flies in the face of moral decency in a truly Orwellian fashion, bringing to mind troubling images of immigrants being administered genetic tests to look for "potential" future costs to the petitioned state.

Meanwhile, The Australian---an online newspaper---reports that another case of a healthcare provider being denied residency due to having a child with Down's Syndrome is concurrently being appealed. The article elucidates further, stating that these two occurrences are "the tip of an iceberg" wherein numerous potential immigrant families are apparently discriminated against and denied residency by the Australian government in the presence of Down's Syndrome.

Luckily, many figures in the Australian government are coming out strongly in favor of Dr. Moeller, demanding a swift review---and reversal---of this appalling ruling.

It is this blogger's strong opinion that a broad review of the Australian immigration authority's practices in regards to physical and mental disabilities must be conducted. Furthermore, the revelation of such egregious actions by one segment of the government bureaucracy may reveal even deeper layers of covert discrimination not yet publicly exposed in multiple areas of Australian jurisprudence.

If there is indeed an iceberg of discrimination lurking beneath the waters of Australia, perhaps the current international disgust being expressed at these recent nefarious actions will spur disability rights organizations across the "Land Down Under" to make their voices heard far and wide. This type of discriminatory behavior has no place in any society, and the citizens of Australia who care about such issues will certainly rise up and make their politicians and officials take notice, or said officials will only ignore the issue at grave risk of their own political future.

Saturday, November 08, 2008

Live Radio Call-in Show about Nursing, Nov. 10th

Dear Readers,

Just an FYI that I will be interviewed live on the radio on Monday, November 10th at 11am EST on WOSU-AM, Columbus, Ohio. The interview will center around the recent publication of "Reflections on Doctors", and will feature myself, another contributing author, and the host of the program, Fred Andrle.

The show will be streamed live at and call-in questions will be accepted from listeners after the first 20 minutes of discussion. Please listen if you can!

Friday, November 07, 2008

Belgian Missive

Europe certainly does charm one easily with its cafes, chocolates, and that otherworldliness that is somehow familiar yet distinct from everything American.

Bicycling with a giggling Dutch seven-year-old girl clutching my jacket from her perch on the seat behind me, my hands and ears are bitter from the cold while my mind gleefully takes in my surroundings. The Belgians don't have that famous tolerance and awareness for bicycles so common to the Dutch, so we're careful as we make our way through the densely populated and crazily busy streets.

I play with my hosts' young children, our only common language being the universal language of play. Their parents, my dear friends, translate as necessary, but we laugh and engage in all sorts of imaginative play without the need for intelligible conversation. I speak to them in English, they speak to me in Dutch. We shrug our shoulders and continue with our games.

Yes, it's easy to be charmed, easy to fall into the rhythms and practices that are novel yet familiar. My heart has always partially resided in Europe, a place where I feel strangely at home in so many ways.

My brief time here is precious, and I drink it in like the thirsty traveler I am.

Wednesday, November 05, 2008

A New Day

Well, here I am in Europe, and Belgian television is awash with news of Barack Obama's massive win over John McCain, and the increasingly Democratic Congress. The news and talk-shows here are absolutely buoyant, and Europe seems to be rejoicing at this turn of events vis-a-vis American politics and world diplomacy.

As for me, I am struck by the historical significance of an African-American President of the United States. I am equally struck by the message that his election sends to young people of color everywhere.

Based on what I'm gleaning from my European perch, I can also see that the world is expecting change, openness, inclusivity, and a major about-face by the U.S. on climate change, global security, the wars in Iraq and Afghanistan, the global economy, and more. Meanwhile, many of us who voted for Barack are also demanding and expecting the same, and much more.

Power is corrupting, and the ways of Washington are devious and deceitful. I send my support and prayers out to the President Elect that he can truly deliver at a time when all eyes are turned on him, ears pricking up at the long-promise of deliverance to a land of hope.

Monday, November 03, 2008

Off to Brussels on Election Day

Well readers, I'm flying off to Brussels, Belgium to visit old friends amidst the maelstrom of Election Day here in the States. I do indeed plan to blog from my European perch a few times during my stay, but it will most likely take a few days for me to find my feet and recover sufficiently from jet lag.

So, until then, be well, and please check back in a few days for an update. By then, I'll hopefully be able to gleefully report on the high quality of chocolate, beer, mussels, and french fries at my disposal.

All the best,


Saturday, November 01, 2008

Value Care, Value Nurses Blogger Scholarship Completed

I have now completed my series of posts under the auspices of the Nurse Blogger Scholarship which I was awarded in July of this year from Value Care, Value Nurses. I would like to take this opportunity to thank VCVN and the Service Employees International Union (SEIU) for their generosity and support. VCVN and SEIU exerted no influence on the subject matter, tone, or content of my posts, and I was given absolutely free reign throughout the length of the scholarship period.

As a way to make all of my entries available in one place, I am creating links to each post---in chronological order of their publication---here.

Value Care, Value Nurses Scholarship
The Nursing Shortage: A Global Crisis, Close to Home
Obama, Healthcare and a Trio of Mythic Figures
The Aging World
Hispanics and the U.S. Healthcare System
Religion and Discrimination in Healthcare
Nurses' Voices, Nurses' Image: Nurses' Power
The Office of the National Nurse
Economics and the Elderly
The Irony of Mental Health Parity
Multiple Chemical Sensitivity: A Hidden Disability
The Nursing Shortage, PBS-Style
New Nurses, Primary Care, and the Calculus of a Multifaceted Shortage

Nurses have a great deal to say, and nurse bloggers are frequently outspoken, taking risks and shining a light in some interesting (and sometimes disturbing) corners of the healthcare system. My hope is that the Value Care, Value Nurses Nurse Blogger Scholarship will become an annual award that will continue to bring nurses' voices to the fore at a time when those voices are greatly needed.

Again, my sincerest gratitude to VCVN and SEIU for their support, generosity, and encouragement.