so the way they keep track of the workload in the clinic is a series of tickmarks on the white board. you're assigned a room that you empty and the nurses fill back up and with every cycle they put another little tally mark. yesterday, my tally was way, way behind everybody else's, but i can explain...
(details tweaked so you can't tell who the patients are)
quick post this time. sitting at clinic waiting for the nurses to take vitals and shove the patients into their rooms for the afternoon. there's this big white board i can peek at from here; they just write the room numbers-- no names. we cross them off as we see them, empty the rooms as we finish, and the nurses fill them back up again and write the numbers. it's gonna be a dead run from here on in. but we've been running like that since this morning.
so i was at this career day thing for high school students. its part of the "pipeline"-- trying to get kinds from the neighborhoods we serve (read: poor neighborhoods, underserved, undersupplied, under-everything) to go to medical school (or nursing school, or optometry, or psycology, or, really, just to go to college at all). "pipeline" projects, community gardens, school clinics, public health promotoras-- these are a big deal to our program. being an intern, i'm stuck in the hospital way too much to be in on most of this stuff, but you can at least see the pattern-- trying to be involved in the neighborhood rather than commuting in and heading right back out again like the tide.
can i just tell you i hate cross cover? does it bug anyone else that in the middle of the night most of the people i'm taking care of i've never met? look, all they are to me is a list of names on a page with a one line description of what they're in the hospital for and a short rundown of tasks to complete fired out at me by someone who is half mad with the desire to get out of the hospital (as are we all, as are we all...)
one of the things that didn't happen was a picture (is it so wrong to want one?) of her surrounded by her family, her neckline shifted-- tastefully, of course-- to show the little reddish bumps on her skin, the cancer, bubbling up from underneath.
This is pretty cool. The Kaiser Family Foundation, which runs KaiserNetwork (where you can view daily updates in health policy, HIV/AIDS, Womens Health and Health Disparities, or have them emailed to you) and KaiserEDU (where you can learn the 101's of various health reform issues) just released a new website -- the Kaiser Health Reform Gateway, which presents all of the following in an aesthetically pleasing manner:
* An interactive tool for comparing major health care reform proposals...
* A new, interactive Web-based timeline that chronicles key events and noteworthy activities in health reform from the early 1900s through today.
* A series of Explaining Health Care Reform Briefs providing an overview of key topics and concepts being discussed in health reform efforts. The initial three Briefs explore "what is health insurance", "what is an employer pay or play requirement", and "what are health insurance exchanges".
* A glossary providing simple, straightforward definitions of key terms to assist in understanding the concepts included in health reform proposals.
More avenues for empowerment on the health care reform front!
([we excitedly welcome new user and health care / disabilities / environmental activist slinkerwink!] - promoted by los anjalis)
Senator Ted Kennedy has affirmed his support for the public option in health care reform in signing the resolution, which was just introduced onto the Senate floor that health care reform MUST include a public option. Now what kind of a public option it'll be is the question we'll be fighting to answer, and to our satisfaction as well.
This diary was posted at DailyKos, as part of the "Thursday Night is Health Care Change Night" series.
I work as a family physician in a county clinic and hospital in Los Angeles and I’m actively involved in activism around the national health care reform process.
So this week as each new move played out – whether by congresspeople or health care advocates or the health insurance industry – it was exciting to hear on more than one occasion from my patients , “Didya hear, doc?” It’s a testament to the fact that people are ENGAGED.
So,didya hear? If ya didn’t, here’s a quick roundup of the national level health care reform updates/news, and please read on to see what some organizations have unveiled this week in response. Because information without action is disempowering, and we’re not about disempowerment. Read on...
Lee Ballinger of Rock and Rap Confidential -- a group comprised of musicians, music appreciators, and healthcare advocates -- sent out this message to its email list:
Yesterday I happened to find myself sitting in a car in the parking lot of a convenience store just outside the tiny hamlet of Clifty in northwestern Arkansas. The bread deliveryman emerged from the store with a tray of bread that had passed the expiration date for sale. He was a middle-aged white guy--he looked something like Hank Hill of King of the Hill. An older black woman was sitting in her car with her window down. He passed right by her and she asked him if she could have the discarded bread...
A recent CNBC segment posed the question of whether healthcare is a right. They brought on commentators to argue in favor and against, one from the Cato Institute and one from the National Physicians Alliance. (The segment is posted on this page below...thanks Anjali!)
The host started by posing the question to the conservative commentator, Michael Cannon. "I think it should be a right," he replied. "And therefore I think physicians should work for nothing." Sarcasm notwithstanding, his point was clear: healthcare cannot be a right because it involves payment. The exchange of goods and services for money equals capitalism, which puts healthcare squarely in the category of commodity.
Mr. Cannon backed up his point by contrasting healthcare with other things we commonly think of as human rights, like freedom of speech and religion. No one has to be paid in order to let us speak freely and worship freely, he implied, which is why they are rights and healthcare is not.
This argument is persuasive. We like to think that a human right is something you are born with, not something that has to be given. The very phrase 'freedom of speech' suggests its simplicity: just let people speak! It's not that hard! Healthcare, on the other hand, is not accomplished by standing aside and letting citizens exercise their freedoms. For healthcare to be your human right, something has to actively be done to you.
But is it true that freedom of speech requires no involvement by the government? Let's imagine taking a trip to place where there is very little government, for example Somalia. You might have the basic human right to freedom of speech there, but it's not worth much. If you stand on a milk crate (assuming you can find one) and give a speech that others find disagreeable, those people may choose to gag you, stuff you in the trunk of a car, drive you 20 miles out of town, and perhaps kill you. The government has done nothing to take away your freedom of speech, but they haven't done anything to protect it either.
We often ignore the role of infrastructure, such as our police force and civil and criminal court system, in allowing rights like freedom of speech and religion to flourish. The U.S. legal system is a highly complex bureaucracy, and it plays an important role in keeping the right to free speech alive.
The same principles apply in healthcare. We have a complex bureaucracy in place --- doctors, nurses, hospitals --- to protect our right to health. There's no difference, in principle, between free speech and healthcare, so why is one an unquestioned human right while the other is relegated to a commodity?
In fact, no matter what human right you can name, there is an infrastructure in place to protect and defend it. And the professionals who manage that infrastructure need to get paid. So it's foolish logic to argue that since doctors are paid a salary, healthcare cannot be a right.
The 22-day long December/January Israeli offensive against Gaza is reported to have killed over 1300 Palestinian civilians and injured 5,300. Many thousands more remain homeless and displaced, and there has been severe damage to public infrastructures including access to water and electricity, as well as basic supplies such as food and fuel for heating. The health care system is near total collapse, and sadly many more will be added to the list of dead and injured as a result of this breakdown of civil society. This invasion is merely an escalation of an already untenable situation. Gaza is "like a cage, an enormous prison or a completely sealed off ghetto" where there is virtually no escape by land, sea or air. It is the most densely populated strip of land on earth, where fully two thirds of its 1.5 million inhabitants are registered UN refugees. Eighty percent of people live below the UN poverty line, and 80% are unemployed (1).
Many international and humanitarian groups have called for investigations into alleged violations by the Israeli military during its offensive. The claims include the use of white phosphorus and high-explosive artillery in heavily populated residential areas, of firing on ambulances, medical personnel, and civilians holding white flags, and the indiscriminate destruction of property. Recent testimonials by Israeli soldiers admit to deliberate and brutal killing of unarmed civilians, including children (2). These accounts are under investigation by the Israeli army, but have yet to be investigated by a neutral party. To be certain, international groups have also called for investigations into Hamas: for firing rockets indiscriminately into civilian areas of Israel, as well as for Hamas' violent treatment of Palestinian political opponents and critics within Gaza (3). All of these claims need serious and immediate attention in order to prevent more human rights abuses and to protect innocent civilians.
The importance of documenting and publicizing the public health and social consequences of war cannot be underestimated, and there are many lessons to be learned from the past. Consider first an example from the Iraq War. Prior to a neutral investigation conducted by members of Johns Hopkins University and the Al Mustansiriya University Baghdad School of Medicine in Iraq, official counts of Iraqi mortality and violent-related deaths were grossly underestimated. Publication of their report in The Lancet caused much controversy, but prompted many in the medical community to finally speak out against the war. Similarly, regarding the Seven-Nation War in the Democratic Republic of Congo, official published reports in early 2000 put the number of dead at 100,000. Only after the publication of an International Rescue Committee survey on the front page of the New York Times, which estimated the deaths to be 1.7 million (with a second report in 2001 estimating the death toll at 2.5 million), did the international community generate the political will to broker an accord to end the Seven-Nation War, as well as to dramatically increase humanitarian aid to the situation. Prior to this, perpetual inaction by the international community to prevent these injustices allowed 10% of the population in war-torn areas to die.(4)
These and other examples show the absolutely imperative need for accurate reporting and investigation in situations of war and conflict. At the time of this writing, Israeli officials have barred human rights groups from entering the Gaza strip. A balanced and factual assessment by a neutral party must be allowed to investigate the violence perpetrated on both sides of the conflict, in order to quickly and justly bring peace and stability to the situation. In addition, hope for improving the health and quality of life for Palestinians depends on changing the structural and political conditions that Palestinians endure. This will take the courage and will of the entire international community and its leaders, and should be guided by a clear understanding of the real-life situation for everyday Palestinians.
This brief assessment is not meant to understate the complex political and historical situation that has been ongoing for decades in the Middle East. The point here is that Gaza is a situation that in many ways is similar to other humanitarian crises, and for this reason it is our obligation to seek the truth of the matter, to learn from this crisis, and do our best to bring justice and peace to the situation and all future situations that concern the liberation of people dehumanized by war and violence. To borrow from the teachings of Ignacio Martin-Baro, if this work contains truth, "it has permission to be more than just a simple reflection of data...it can become an account of what needs to be done... and to make a real contribution to human liberation". (5)
"If the Hippocratic Oath means anything, all doctors whatever their situation, specialty, or seniority should live up to this name by calling on their national governments and the international community... to ensure that civilians injured or affected by conflict receive the attention they need, wherever these people may be in the world. Such action is not being a so-called humanitarian, it is what being a member of the medical profession should be about." - The Lancet
Ways to get involved and further information:
(courtesy of Denise Zwahlen of Doctors for Global Health)
American Jews for a Just Peace (http://www.ajjp.org): Organize delegations to Israel and Palestine every fall. They work with PHR Israel and a grassroots health organization in Palestine
Gaza Community Mental Health Center (www.gazamentalhealth.org): Founder Dr. Eyad el-Sarraj. Their focus is children and women who are the victims of violence and the victims of torture.
www.combatantsforpeace.org: Israeli and Palestinian individuals who were either soldiers in the Israel Defense Forces or part of the armed resistance in the name of Palestinian liberation. They are working to stop all forms of violence
US Campaign to End the Occupation (http://www.endtheoccupation.org).
References:
1. The Lancet vol 373, Jan 17 2009 pg 201
2. The Times of London, March 20, 2009
3. Human Rights Watch (www.hrw.org)
4. Levy and Sidel (2008) War and Public Health. Oxford University Press
5. Ignacio Martin Baro (1994) Writings for a Liberation Psychology. Harvard University Press
Last night, CNBC featured a segment on "Is Health care a right or a privilege?" and invited two speakers to debate the question.
One of the speakers was Dr Mai Pham, senior policy advisor at the National Physicians Alliance (NPA). The NPA fimly believes that health care is a human right and its campaigns and mission speak directly to that. The other speaker was Michael Cannon, director of health policy at the CATO Institute, a free-market, libertarian organization.
Make your own conclusions about some incendiary statements made in this debate, but I must highlight one here.
"Saying health care is a fundamental human right is one of those simplistic nonsense slogans" -- Michael Cannon, CATO.
Unbelievable. No it's not. Saying health care is a fundamental human right is an important statement that we must embrace fully as a society (and to an extent have already embraced).
i do not deserve a good job, or a beautiful home, or health care because i went to school and got my degree. i deserve them because i am a human being. if i were to say that i deserve them because of how many years i spent in school, or how much money i paid to go to school, or the number of letters behind my name, then i am saying that i deserve basic human dignity because of my educational privilege.
- - - - -
I applaud Dr. Pham's calm and composure in the debate. I think we could learn some tips on how to stay on point and how to debate an issue, from her.
In any case, it was a pleasant surprise to see this issue covered by CNBC; perhaps the station will cover such issues in the future.
In case you thought the private insurance industry was going to sit back and healthcare reform happen....well, check out this article in a local Massachusetts paper:
"I did not write a letter to the editor. It's not from me," said Gloria Gosselin, 75, of Lawrence.
Gosselin's name was on one of three strikingly similar letters touting the Medicare Advantage program that were sent to The Eagle-Tribune.
...
The letters were, in fact, composed and sent by the Boston office of [Dewey Square], a national political consulting firm, attempting to create the appearance of a "grass-roots" movement for Medicare Advantage.
America's Health Insurance Plans, an industry trade group, hired Dewey Square to defend the Medicare Advantage program.
It gets worse:
The Eagle-Tribune received a call from a man who turned out to be an intern at the Boston office of the Dewey Square Group, a national political marketing and consulting firm.
The man, who identified himself as Noah, wanted to know if Gloria Gosselin's letter had been published. Asked what interest he had in the letter, Noah replied that he was Gosselin's grandson.
Gosselin does not have a grandson named Noah working in Boston. Her only grandson is a student at Central Catholic.
Got it? The fight will be dirty. AHIP knows that to block healthcare reform, they will have to get rough. And they're not going to sit back and let the groundswell of support for healthcare reform wash over them.
Conservative estimates are that AHIP has $100 million set aside to fight against healthcare reform. And they seem to have every intention of playing dirty with it.
So this is it. We've been warned. Consider this a shot across our bow. It's going to be a serious, heavy-duty fight.
And if we fail to reform the system because we don't fight back hard enough.... well, i was going to say we have no one to blame but ourselves. But we can always blame the big bad insurance industry. We can fail, and then we can comfort ourselves that they had more money, and they played dirty.
But I'd rather not comfort myself. I'd rather win. And we can. We have the truth on our side, and better arguments, and oh yeah, history is on our side too, both in the U.S. and around the world. Those are far more powerful than a willingness to play dirty.
Smears can always be defeated by the truth. But someone has to speak that truth. Unfortunately, it never speaks for itself.
short blog today. on call. carrying 40 patients. pager goes off every ten minutes. am three admissions into the night and have two more to go before i cap and it's someone else's turn. am also 14 hours into my thirty hour shift and am starting to have my usual trouble remembering what i was originally doing when i'm interrupted in the middle of being interrupted in the middle of doing something (which makes two interruptions and makes me feel like a ping pong ball in a clothes dryer)
What is health justice? How is our health fiercely connected to the wellness of our neighborhoods? What do we prioritize in transforming our communities? How do we begin to dream again, especially when so many of our struggles revolve around reacting to the problems of the day, or around just surviving?
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