Happy Father’s Day

Father’s Day is a time to honor those men who love and support their families. I remember admitting a dad who had developed pertussis (whooping cough). The pediatrician admitted the infant daughter.  He was so upset that he had been the one to make his child sick.  We explained this can happen.  Back then it was a few cases and now there are more.

Loving husbands and fathers make a difference during difficult times. My husband spent many days taking our son to the Pediatrician alone for shots.  It was difficult for me to get away from my training and later the office.  He did the soccer games, tennis lessons and all the homework.  He was the Book Fair volunteer; he and another Dad would make sure the kids made smart book choices.  He was the chaperone on the school trips. He made all the visits to the orthodontist for the brace, found the Barber for the haircuts and scheduled the music lessons.  He cooked all our meals and even did the laundry.   He also was very involved with his children from his first marriage.  I met him a few years after the divorce.  After we started dating, I met his son and daughter when they were age 7 and 8.  I took the liberty of putting his daughter’s hair in a neater style.  She was so cute. We have celebrated 32 Father’s days together.  I think he still has many of the cards.

Two black male journalist and fathers look at the myth surrounding the absent Black father. Ta-nehesi Coates writes eloquently about this is his article Understanding Out-of-Wedlock Births in Black America He revisits the Moynihan report and sheds new light on the findings. Charles Blow sheds light on this subject in his article Black Dads Are Doing Best of All. 

Black fathers have been the victim of stereotypes of being absent and uninvolved.  The LA times in December 2013, published an article covering a report released by the National Center for Health Statistics.  The table highlights some important statistics.  The report was based on a federal survey that included more than 3,900 fathers between 2006 and 2010.

Fathers

So let’s just celebrate all fathers today.

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Why I love my Mother- Reason 2

“I try not to say too much and stay out of it but you know I will give my opinion.”

This is the basic philosophy of my mother and her sisters, my aunts. I think it was passed on by my grandmother.  Our Saturday check-ins always includes this great line “Now that I have talked about everybody, I will let you go.”  I have always looked forward to talking with her and catching up.  When I graduated college and went off to medical school, I knew I would never return to Birmingham to live.  So my mother kept me in touch with my family.  Back then, there were no cell phones so I had to wait until the rates were low and call nights and on weekends.

I want to let you know that my family is by no means perfect. We have recovered drug addicts, alcoholics, ex-prisoners along with doctor, lawyers, a judge, politicians, healthcare workers, steel workers, people in banking and ministers. I consider my mother and her sisters our family’s moral compasses.  So, when someone gets out of line, one of them will try to set you back on the right path.  One of my relatives was not in the mood to have my mother interfere.  So he told her to “shut-up and mind her own business.” When she called to relate the story, I told her he was right.  I had just finished reading one of my many self-help books and I told her about “the art of allowing” In essence, it is allowing people to be themselves.  She was not about hearing that.  In her mind that is not an option. I did tell her to stay out of it because I did not want her to get hurt. She is such a loving person.  She said she was not going to let him mess up his life with letting him know she cared. When she told my aunts what I had said, to my surprise, they agreed with me.

I have learned from them that it is important to standup for what is right and not be afraid to voice your opinion. You have to try to keep others from harming themselves and if you can’t then be there to help them get back on their feet.  They are there for each other with love.  For us, they always have love and good advice.

“[My mother] had handed down respect for the possibilities—and the will to grasp them.” – Alice Walker

“Grown don’t mean nothing to a mother. A child is a child. They get bigger, older, but grown. In my heart it don’t mean a thing.” – Toni Morrison

Why I love my Mother- Reason 1

MomaThis is one of my favorite pictures.

This is a pre-Mother’s Day shout out to my mother. I think my mother and her sisters are the embodiment of “Loving kindness.”  My mother called for her usual Saturday check-in and recount of all the family news.  She updated me on my uncle’s fight with lung cancer and her new job.  At age 79, she has decided to work 5 hours a day.  She said she just wants to get out of the house. She has been caring for people since I was born.  She was the primary caregiver and health proxy for my grandparents, church members and my late stepfather.  We always laugh and end the call but this time, the conversation shifted to the embattled ex-governor of Alabama.  Of course, we all should know about the scandal and his resignation.  Alabama has a long history of governors who have not shown love and kindness for African Americans.  So, to my surprise, she said “Have you heard about our governor? Don’t you feel sorry for him?”  Well, my initial response was to smile and remain silent.  I wanted to hear what she had to say.  And once again, “loving kindness “and “judge not lest you be judged” was on full display.

She said” I feel so sorry for him. He has lost everything.  I think he meant well.”   I smiled and listened.

“His wife left him and his children are refusing to talk to him. He moved out of the Governor’s Mansion today.  There were only two men and a pick-up truck helping him.”  If anyone else had said this, I would have been laughing out loud. Yet, I listened to my mother and smiled.  As I heard these remarks, I flashed back to all the hate that has defined the political seen in Alabama.  Yet, at 79, that is not what she is focusing on.  She always encouraged us to be decent, loving and respectful.  My grandmother always said ‘if you can’t find anything good to say then just keep quiet.” I found myself reflecting on this and just not saying anything but “I guess you are right.”

I had the honor of participating in a five-series program sponsored by my hospital. We had two hospital chaplains who are Buddhist monks lead us in resiliency and transformation sessions.  The sessions focused on contemplative medicine through refection and meditation. I do find myself really listening to my patients, residents, friends and family members better.  It is caused being present. In his TED talk Julian Treasure talked about “conscious listening”.  You can use this acronym to help you listen and communicate better. RASA stands for “Receive,” which means pay attention to the person; “Appreciate,” making little noises like “hmm,” “oh,” “OK”; “Summarize” — the word “so” is very important in communication; and “Ask,” ask questions afterwards. So, I use this as much as possible to be a better listener.

So, I love my mother because she always reminds me to be a better person by displaying all the attributes I need to accomplish this. I even found myself feeling sympathy and empathy realizing that we all can make mistakes and one day will need someone to show us “loving kindness” and forgiveness

Biology and Chemistry got me into Medical School but the Arts made me a better doctor

I am an avid watcher of Public TV. My senior year in HS, my English teacher was such a brilliant man.  We were reading Shakespeare’s plays.  One assignment was King Lear.  I so enjoyed the play but it came to life for me when the PBS Great Performances series aired the play with James Earl Jones as King Lear, Ellen Holly as Reagan, Rosalind Cash as Goneril and as Cordelia.  It was my first to experience an all-Black cast performing Shakespeare.  I was mesmerized.  PBS has provided many memorable experiences for me such as Dance in America: Martha Graham Dance Company, Brideshead Revisited, and The Six Wives of Henry VIII.   I watched Upstairs, Downstairs and even Poldark I. Who could forget How Green Was My Valley and Madame Bovary?

Public TV has always been part of my life. I watched those early cooking shows with Julia Childs.  What is there for a girl growing up in the South who loved to read books to do?  I was a Premed major in college but after my sophomore year, I changed my major and minored in English.  I took a course in Shakespeare, English Romanticism, Chaucer and Southern Literature.  I was rejuvenated by writing and just reading.  I needed the science to get into medical school but I needed the Arts to make me a better doctor.  The Arts fed my soul and helped me become more altruistic and empathetic.  PBS allowed me to see performances that I never would have had the opportunity to experience because we did not have the money.  In college, I saw plays and live performances that were once in a life-time.  I saw the Martha Graham, Alvin Ailey, and Paul Taylor Dance Companies.  The concerts included Roberta Flack and Randy Crawford.

My life was enriched by funds from the National Endowment for the Arts and I fear that if the funds are cut, other children will be deprived of their opportunity to have their lives enriched. In elementary school, we had trips to the Symphony and arts programs. I spent many hours at the Public Library during the summer.  The Library was our unofficial babysitter. The NEA was created by the US Congress in 1965. Roger L. Stevens was the first Chairperson appointed by Lyndon B. Johnson.  The National Endowment for the Humanities provides grants for high-quality humanities projects to cultural institutions such as museums, archives, libraries, colleges, universities, public television, and radio stations, and to individual scholars. It was created in 1965 under the National Foundation on the Arts and Humanities, which included the National Endowment for the Arts.  The programs I benefitted from in college were funded by the NEH.

I will continue to support PBS every opportunity I get. We buy our favorite shows and give during the Annual Fund drives.  I can’t imagine my life without it.  From Foyle’s War to Downton Abbey, I have been educated and entertained.  What would I do without all those Ken Burns’ documentaries and Henry Louis Gates?  Oh my, how could I live without Nature? After a long day of seeing patients, I get a great laugh from Father Brown and Death in Paradise.

We don’t need more warships, aircraft or a wall on the border. We need the arts to allow us to dream and enrich our lives.  A little girl from the South can go to college, medical school and finish her medical training while maintaining her love of the arts because with the remote in her hand and right in her living room on her TV set, she could see a world that she never would have had the time or money to see.  That is what we may lose if these funds are cut.

Meals on Wheels

This month marks the 45th anniversary of the Older Americans Act Nutrition Program has been the primary piece of federal legislation supporting social and nutrition services to Americans age 60 and older since 1965. We have to  protect the critical funding for the Meals on Wheels programs that are working tirelessly day in and day out to provide nearly 218 million meals, either at home or in group settings, to more than 2.4 million seniors each year.  OAA programs are vital for seniors who are at significant risk of hunger, isolation and losing their ability to live independently. Services provided include:

  • Home-delivered meals and meals served in group settings such as senior centers
  • Transportation
  • Personal care and homemaker support
  •  Caregiver assistance
  • Preventative health

Did you know 1 in 6 seniors struggles with hunger. Meals on Wheels can provide a senior meals for 1 year for about the same cost as 1 day in the hospital.

Nationally, Meals on Wheels serves more than 500,000 veterans each year. The OAA covers 35% of the total cost to provide nutritious meals, safety checks and friendly visits to more than 54,000 Seniors. Programs rely on contributions from state, local, private donations and other resources to cover the rest.

I have worked with seniors in three different states.  This program kept them in their home and out of the nursing home.  It also prevented hospitalization and malnutrition.  I remember admitting several seniors to the hospital for dehydration which was due to lack of food and support services. Instead of going to nursing homes they went home.  Medicaid is the major funding source for covering the cost of nursing home care. Meals on Wheels  decreases the rate of falls, which cost our nation $34 billion each year. When a senior falls, they have serious injury that leads to hospitalization, admission to a Rehabilitation Center and then too often to a nursing home.

Sign the petition by 3/31/2017

http://www.mealsonwheelsamerica.org/take-action/advocate/sign-our-petition-to-protect-meals-on-wheels

Yes, Health Care is Complicated!!

“We must come to see that the end we seek is a society at peace with itself, a society that can live with its conscience.”  Dr. Martin Luther King, Jr.

When I launched my private practice, it was on the eastern shore of Maryland in a small town. I joined a physician who had been in practice for several years.  I managed to keep my schedule light for a few weeks so I could study for my Board Examination.  I had just finished my residency training but I was no stranger to outpatient practice.  After my return from the test which I opted to take in Orlando, I never saw fewer than 20 patients a session.  The busiest days saw us seeing 30 or more patients.  I admit that many walked in but most were scheduled.  This was in 1990 which was the beginning of the rise of HMO’s.  My practice was hospital sponsored.  In less than 1 year, I had repaid the hospital the loan and started to make a profit.  Many of my patients were uninsured but a significant number were Medicaid, Medicare and HMO. I welcomed the Clinton Health Plan and even was interviewed by local newspapers.  Sadly, for my community, it never happened.

While I was on the Eastern Shore in the 90’s, it was apparent that many of the residents had no way out of the cycle of poverty and the health problems neglected from being uninsured.  The reality played out in the Emergency Room of the local hospital day and night.  Being uninsured affected every family. Our community had business owners who were farmers, fisherman, mechanics, contractors and shop owners.  Many made too much money for Medicaid but they could not afford the cost of private insurance.  Many of them landed in the ER with serious medical conditions they had ignored.  Some even called my office and were seen as emergency visits.  One particular case was a bit scary.  One of my staff called and brought her brother in.  He was complaining of chest pain and would not go to the ER. They came to the office and I did an EKG.  To my surprise the brother was having an acute myocardial infarction.  He was uninsured and was still refusing to go to the ER even as the ambulance arrived.  We did get him there.  He and I had a tense ambulance ride together to the tertiary care hospital and I handed him off to the cardiologist who greeted us both and whisked him off to the Cardiac Intensive Care Unit.  Weeks later, the community came together for a fund-raiser.  I attended and was to my surprise honored by everyone for my excellent care.  Unfortunately, I had to leave to go to the ER to care for a patient that was not so fortunate.

I had hoped that the HMO’s would make healthcare affordable but that did not happen. The reality for patients then and now is that if you lack insurance, you end up in the ER.  I worked with the local health department.  My office was ground-zero for many programs.  We saw patients enrolled in the Breast and Cervical Cancer Screening Program, Vaccines for Children and participated in every pharmaceutical company sponsored free medication program. We saw patients from the Mental Health programs, Drug treatment programs, and Adult Daycare.  My office was such a high utilizer of one Pharmaceutical Company Patient Assistance Programs; one company invited me to give a presentation to a group of providers.

I was part of the steering committee and a board member of the new Federally Qualified Community Health Center (FQHC). It was our answer to tacking the rate of uninsured patients.  It was hard work to get the grant written, not by me thankfully but I did read it and had to give input on the clinical operation.  I also had to pledge my service which meant clinical sessions, on call coverage and hospital admissions.  I was also involved in recruiting the first full-time provider.  We were fortunate to be designated a National Health Service Corp (NHSC) site.  This allowed us to recruit a NHSC scholar who could use our site and a 3-year commitment to repay medical school loans. The good news is that built into the Affordable Care Act is increased funding for the NHSC.  The program is now expanded and will allow an increase in primary care providers in areas where they are needed.  We were fortunate to get a brilliant young Family Physician in our community. The CHC is still there but it is now part of a bigger network. Across the US, FQCHC are providing care to uninsured and underinsured patients.

Medicine for me has always been about helping my patients. The Affordable Care Act has changed the delivery of medical care in the US. There is no restriction for preexisting conditions. The Affordable Care Act (ACA) decreased the number of uninsured patients in the US.   The dilemma was increasing the number of providers to care for all of the patients.  Across the country this has happened. The defeat of the Republican’s health care plan was a victory.  I knew it would fail. It was written without the input of anyone with experience in the present health care climate.  After 34 years in medicine, I know how complicated health care is.  I live the reality everyday as I see patients and teach residents and medical students.  The problem is that the history behind all those social programs is not passed on.  Medicaid, Medicare and the Children’s Health Insurance Plan have saved lives and provided care to so many Americans of all ages.

I work with my residents in a Health Start Clinic that provides maternity care to uninsured women. They can get emergency Medicaid for prenatal care.  The Republican plan would have cut this program. We already have poor perinatal health outcomes for an industrialized nation.

Let’s continue to be vigilant and keep up the fight. We must never fail to uphold our democratic process and institutions and remember  what happened when the Germans ignored Adolf Hitler.

 “When a man assumes a public trust, he should consider himself as public property.” Thomas Jefferson

“There comes a time when one must take a position that is neither safe, nor politic, nor popular, but he must take it because conscience tells him it is right.” Dr. Martin Luther King, Jr

Medicaid Expansion under the ACA

 

Under the Affordable Care Act, health insurance coverage increased. Between 2010 and 2015, the uninsured rate among women ages 18 to 64 decreased from 19.3 percent to 10.8 percent, a relative reduction of 44 percent.

As of 2016, national enrollment in Medicaid has grown to 75.2 million from 57.7 million in 2013, or total growth of 17.6 million (31%). Nine states have posted over 50% growth, with Nevada just shy of doubling at 97%, Colorado 89%, Montana 82%, Kentucky 73%, and California up 71%.

https://aspe.hhs.gov/sites/default/files/pdf/187551/ACA2010-2016.pdf

Medicaid is the nation’s largest insurer. It is the centerpiece of the U.S. health care safety net, providing benefits to adults and children who would otherwise have difficulty getting and paying for care. Yet the program is not well understood by the public

  • Nearly 16 million people have gained Medicaid coverage under the Affordable Care Act’s expansions; most had previously been uninsured
  • Most people are satisfied with their Medicaid coverage. A recent Commonwealth Fund survey found that 88 percent of adults are satisfied with their new Medicaid coverage: 77 percent rate it as either good, very good, or excellent (Exhibit 2). These ratings have remained consistent since 2014, when states began expanding their programs
  • Medicaid helps people get care and improve their health.
  • Medicaid provides access to timely care.
  • Medicaid provides comprehensive benefits and financial protection from large medical bills.

http://www.commonwealthfund.org/publications/blog/2016/dec/~/media/5b2abe91c9b74cec8b4a24c90ea6826b.ashx

Did you know?

A “block grant” is a fixed amount of money that the federal government gives to a state for a specific purpose.

The Republicans propose that the Federal Government would fund Medicaid as a block grant. Counter to what proponents claim, block grants don’t give states more flexibility with their Medicaid programs.

What does this mean for state Medicaid expansion?

The federal government would set each state’s Medicaid spending amount in advance. That amount would be based on some estimate of state Medicaid spending.  This would mean a significant cut in federal Medicaid support and an increase in state funding.  Most states would meet this need by limiting eligibility.

http://www.cbpp.org/blog/medicaid-block-grant-would-add-millions-to-uninsured-and-underinsured

Overall, hospitals in Medicaid expansion states saw increased Medicaid discharges, increased Medicaid revenue, and decreased cost of care for the poor, while hospitals in non-expansion states saw a very small increase in Medicaid discharges, a decline in Medicaid revenue, and growth in cost of care to the poor

http://kff.org/health-reform/issue-brief/how-are-hospitals-faring-under-the-affordable-care-act-early-experiences-from-ascension-health/

What a year it was

Looking back 2016 was a year of celebrating but also a year of disappointment. The year started with spending time with my best friend from medical school and her husband in Oakland, CA. I took this trip to regroup after leaving my position as a medical director at a major university to resume teaching in a family medicine residency program. My friend is always so open and honest. She keeps me grounded because she always tells me the truth. That is important because I can be hard on me. I spent three months reacquainting myself with hospital inpatient medicine. It was a really exciting period which I enjoyed. Getting back into prenatal care in my new position as the Women’s Health Coordinator for the residency program was the most enjoyable.

In May, I attended the annual Society of Teachers of Family Medicine Meeting in Minneapolis Minnesota. I accepted a position as a trustee on the STFM Foundation Board. My husband got the chance to explore Minneapolis. The meeting was highlighted by the keynote speakers. The first was Camara Phyllis Jones, MD, MPH, PhD from the Satcher Health Leadership Institute and the Cardiovascular Research Institute the topic was “Achieving Health Equity: Tools for a National Campaign Against Racism.” She presented several tools for dealing with racism: https://www.youtube.com/watch?v=3aXoBfmSBNQ

June was a spectacular month. We attended our family reunion in Savannah Georgia. It was attended by members of my grandmother’s family.   We had an opportunity to tour Savannah and learn about the impact of slavery in the shaping of the history Savannah and the south. During this time we were in the midst of the most divisive presidential campaign in history.Family_Reunion_Poster_new

In September we went to DC for the opening of the National Museum of African-American History and Culture. The weather in DC was beautiful and we walked all over the place. We did not have tickets to tour the museum but we went to all the festivities. We sat out on the National Mall with the crowds watching the ceremony on one of the many jumbo Trons. We all shed tears after each speaker. Patti Labelle sang “A Change is Gonna Come” and there was not a dry eye. Former President George Bush and his wife Laura Bush were instrumental in getting the bill signed and serving on the board for the museum. The Obamas continued their work. In the words of Lonnie G. Bunch III, founding director of the Museum, “there are few things as powerful and as important as a people, as a nation that is steeped in its history.”aviary-photo_131196457148080220

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We spent election at a friend’s. The party was not the celebration we had hoped for. The last time she had an election night party was when Bill Clinton won. I was in Maryland and that was the last time I attended one. It was a heart breaking night. We all were in shock. The next day, I spent the day consoling my residents. I am still coming to terms with my disappointment over Hillary Clinton’s loss. She would have been the first female president of the US and could have joined Angela Merkel and Teresa May.

In December, we spent a week in Ocean City Maryland. The weather was beautiful. I needed the change.

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I completed my a 200 hour yoga teacher certification program at The American Yoga Academy .  I am certified as a Health and Wellness Educator. wp_20161211_019

We spent Christmas Day in Baltimore with family. We spent the day visiting family. With Christmas falling on the Sunday, we both had Monday off. We have celebrated 33 New Year’s Eves together.  We spent a quiet evening at home and watched “Casablanca”

Here’s to 2017.   I am going to work very hard the first few months because of projects I need to complete but I do plan to spend time catching up with old friends. I do not make resolutions but if I chose a theme or a word, it would be “Gratitude.”  I am thankful for who I am and what I have which includes friends, family and work that I enjoy. As we celebrate MLK Day and anxiously await the peaceful passage of power from the first black President of the US, Barack Obama, to Donald Trump, I am thankful that the Constitution of the United States has checks and balances. I am hopeful for our future. As a physician, I am confident that the Affordable Care Act will not be repealed because it will have disastrous consequences.

Happy New Year: It is finally 2017

I made Gumbo New Year’s Eve. The first time I made it was while we were living on the Eastern Shore.  I had what I thought was a great recipe in a cookbook titled “One of a Kind: Recipes from the Junior League of Mobile.”  It was a wedding gift.  I was making the Gumbo for our Mardi Gras Party at a colleague’s house. A group of us decided to bring Mardi Gras to us. Being the only true southerner, I volunteered to make the Gumbo.

I took my cookbook to my husband’s aunt, Tommie.  She was a New Orleans native and true Cajun (her father was from Paris and her mother, African American). She was known for her Gumbo recipe which she guarded like a state secret.  She took the book and crossed out (with great emotion) some of listed the ingredients and added no new ones.  I did not know that really good gumbo is simple.  She did not use crab meat, chicken or the gumbo file. It’s just good Andouille sausage and lots of shrimp.  The secret is the roux and the cooking time.  The best okra is frozen and do not cook it long.  Add the shrimp and do not overcook.  It only takes a few minutes if the gumbo is hot.

We always purchased the shrimp in Baltimore at Lexington Market for years.  That meant, we always had an ice chest in the trunk and we have transported shrimp as far as Chattanooga, Tennessee.  I always tried to get the sausage there too.  One year, we almost did not find the sausage.   Well the Gumbo was the hit of that party and many more.  Over the years I have made it so many times and it never fails to impress. I have had to toss out a couple of bad batches of roux.

What is unfortunate is that our beloved aunt has Alzheimer’s.  I always made sure we talked for hours when we visited her in Baltimore. So I know a great deal of family secrets.  She lived two row houses down from my mother-in law.  The two of them were more like sisters than sister-in-laws. My mother-in-law passed first.  Tommie was heart-broken. We cleared the house together. When she started showing signs of memory loss and became more difficult to manage: Roy and I would visit, take her to lunch at her favorite place, the “Cheese Cake Factory, and then to church.  We also would take her to the mall and to visit friends and relatives.  Roy had a calming effect on her.  He would drive and talk to her.  She had taken care of him when his mother was working. He always made her laugh.

I made the Gumbo a few years before we lost Tommie’s husband. It was the year Christmas Eve was on a Friday. When I told them I was making it, they all reminisced about Tommie’s Gumbo and told such sweet stories. Well, when I told them I was using her recipe they were in disbelief. They asked how I had been so lucky and I told them. That was a special pot of Gumbo and I was so proud to make it. It was downed with love. We had leftovers for Christmas dinner. They all said it was indeed her recipe. It was also the year after we lost our great hostess, Sylvia. She was the wife of Tommie’s son Jack. Jack is like my husband’s baby brother. Sylvia was the one who put together all the holiday dinners. So that pot of Gumbo was in honor of two great ladies.

I can’t help but speak of Tommie in the past tense.  That is what Alzheimer’s does.  It robs you of the person and leaves just the body. The woman I knew is not here but I did take her to lunch right before she had a turn for the worse. We had a great time.  We may have even gone to church.  She would have been wearing a mink stole or her Persian lamb jacket and I would have been wearing Josephine’s coat (also Persian lamb). Both of the coats are over 50 years old.

New Year’s is a time of reflection.  My New Year’s commitment is to catchup with old friends and colleagues. I want to put the past year behind me. I do plan to stay vigilant but that is for the next post.

Happy New Year!