{working title}: September 2015

Tuesday, September 29, 2015

don't you dare tell me I'm not "pro-life" just because I support I woman's right to choose

There has been plenty of hate being flung about reproductive rights and women's health in the past months, likely due to the upcoming presidential election cycles. Much of it really has been thinly veiled sexism. This discussion, and its attendant media coverage, is centered on how well (predominantly male) society believes women are able to care for their own bodies and how much trust we have in them to make medical and economic decisions. And much of the most aggressively destructive criticism is coming from faith voices. Personally I think this is the most upsetting part of the whole conversation.

I was in medical school, I've studied embryology extensively. I am by no means suggesting that conception and pregnancy are not miracles. But not every fertilized egg makes it to the baby stage for evolutionary reasons, so I have a hard time agreeing that life begins at conception.

I'm quite sure that many readers will be offended by my position on the issue. However, I think it's especially important for people of faith with this opinion to speak it. Our voices have power and I am tired of being made into a villain because of a closely held belief that life should be valued at ALL stages, and not just at birth.

I support life...

That's why I'm so depressed whenever I think of the health outcomes of that child, whose mother was "guilted" into continuing her pregnancy, that grows up in an abusive household with no food to eat.

It's even more depressing when the same people that advocated for that Mama to keep her baby are the strongest voices screaming "Hey poor people, pick yourself up by your bootstraps. It's your fault that you're poor. We don't want to fund safety net feeding programs anymore--Welfare Moms are abusing the system" (research shows this is not the case).
It's also upsetting that these (predominantly) women are failed over and over by a justice system that is more likely to believe a male attacker's story than a female victim. It's already hard enough to report abuse, but even harder when the automatic perception is that you're making it up.

That's why I support (and teach) comprehensive sexuality education. Because how in the world can we expect people to know how to prevent pregnancy if we don't teach them first?
That's why I'm so upset that we perpetuate the idea that women are less than and therefore eligible to be sexually assaulted because they were wearing a short skirt/were drunk and asking for it.

Just to clear the air...it doesn't matter if I am standing naked in front of you, I am not asking for sex unless I verbally and enthusiastically consent (say "yes") to sex. The absence of a no, does not mean yes.

That's why I'm so upset that the number one growing population of homeless people is LGTBQ youth.
That's why I don't support the death penalty and am shocked and saddened that 166,000 Nebraskans signed a petition to get it re-instated in Nebraska, even though it has previously been deemed illegal. This suggests to me that the sanctity of life somehow expires at the age of majority.

In related news, how is it legal/not a conflict of interest that our Governor funded the petition?
Not to mention the perpetual fight to get $54,400 worth of the drugs into the country, even though many governmental organizations have been all-but-screaming about how illegal it is. Why are we spending so much NE taxpayer money on something that's illegal (and also not allowed into the country)?

That's why mass incarceration of African American males upsets me and boggles my mind.

In 2013 there were roughly 745,000 black males incarcerated in the United States. That's more than the entire prison populations (including ALL races) of India, Argentina, Canada, Lebanon, Japan, Germany, Finland, Israel AND England combined.
There is absolutely no evidence supporting the idea that African American males are more prone to being criminal or deviant, so please do not suggest that.

That's why I'm so confused that there's a gun violence epidemic (deemed so since 1995 by the American College of Physicians) and we are doing literally nothing about it. There seems to be short-lived outrage after each mass shooting (285 shootings alone in US from Jan 1, 2015-Sept 25, 2015), but no significant changes in behavior or policy. It's not just mass shootings. In 2013 (the most current data available), more than 21,000 people in the United States committed suicide by way of a firearm--that's more than 50% of all suicides. This is not just a civilian problem. Our veterans are also facing real problems with suicide--and many, if not most, are inflicted by guns.

I refuse to entertain discussions about the constitutionality of guns. This is a public health epidemic. They are legal to own, I get it. But people are dying from them. So let's talk about it.
I also refuse to entertain discussions that gun deaths are due to inexperienced gun owners/accidental deaths. While that is true of a minority of deaths, this point is refuted by the high numbers of self-inflicted veteran deaths each year. Our veterans are arguably some of the most well trained gun handlers, so let's move the conversation to something that has a chance of being more productive.

That's why I overwhelmingly do not support involvement in war.
That's why I do support welcoming migrants, immigrants, and refugees into our country. There is a reason that people are leaving their home countries.

"You have to understand that no one puts their children in a boat, unless the ocean is safer than land." (Home by Warsan Shire)

That's why I wanted to be a pediatric neurologist, so that I could be with children and families in those moments when you're really not sure whether life or death is better, but it's just so hard and painful to discuss.
That's why I can openly weep and grieve when a friend gives birth to a wanted, celebrated, and prayed for baby who was tragically and traumatically born still at 42 weeks. That family chose and wanted to have a child, that's not necessarily true for other families.

These ideas are not mutually exclusive. I support whatever choice a woman makes. Because I trust that it's the best decision for her and for her family.

Of course I support life! Please stop telling me I don't. Fully supporting a life means that I give up control in dictating how that life is lived, including what medical decisions are made. I also fully believe in a woman's ability to understand her individual situation and make a decision that is best for her and her current (and future) family.

No one wants an abortion. It's their very last resort. There will not ever be an abortion epidemic. Let's allow women some autonomy over their uteruses and show once and for all that we really do value life at all stages.

Monday, September 28, 2015

United Nations Commission on the Status of Women: Part 1


Looking out on the UN campus from the Church Center

So it’s been 6 months since I’ve been to the United Nations Commission on the Status of Women (UN CSW). Let’s pretend like I did that on purpose and not that I got too busy to write about it before now…

I learned so much while at CSW and it has informed how I have approached homework (and even living in the world), work, and other conversations I've had since then.

A little background on the event: the CSW is held each year for two 2 weeks in NYC at the UN campus. This year's CSW theme was "Beijing +20," a sort of evaluation of how far we've come on issues of equality for women globally since the Beijing Platform of Action was drafted at the UN Fourth World Conference on Women in 1995--and conversely how far we have yet to go. Beijing was the place where Hillary Clinton first said "...human rights are women's right and women's rights are human rights." (If you don't remember the video of her wearing her pink jacket and addressing the crowd, her campaign has re-released the video several times recently). The critical areas of concern then (and now) are:

more UN campus

women and poverty
education and training of women
women and health
violence against women
women and armed conflict
women and the economy
women in power and decision making
institutional mechanism for the advancement of women
human rights of women
women and the media
women and the environment
the girl-child

Our group was going to be there only for the first week of the CSW. Unfortunately we had a rough start to getting there due to weather, but eventually we all arrived and got our UN grounds passes.

Ecumenical Women (Saturday)

Phumzile Mlambo-Ngcuka, UN Women

Our first full day was spent with the Ecumenical Women. Getting an orientation to the CSW, but also the CSW and issues of inequality, inequity, and justice from a faith (Christian) perspective. It was a great introduction of what to expect for the week and also a great networking opportunity.

"When people are busy, it does not mean they are making progress." -Phumzile Mlambo-Ngcuka of UN Women on the busyness of the past 20 years & the work towards equality

NGO Orientation (Sunday)

standing in line to get into the Apollo Theater

This was a really cool event. It was held in the historic Apollo theater in the Bronx. It was the orientation day to the event with all of the other non-profit/NGO organizations that were represented at UNCSW. They had many speakers and a few panel discussions, too. Conveniently, the orientation was held on the International Day of the Woman (March 8th), so there were many celebrations to be had for that also. I was bummed that I didn't get to make it to the big Int'l Day of the Woman march in Times Square, but nonetheless the UN CSW events were powerful.

"Although we've made changes, we have not been dismantling patriarchy. We need to discuss how to change the paradigm to achieve gender equality. The world must change, not the women" -Phumzile Mlambo-Ngcuka of UN Women

Imagine the last girl: the 13 year old uneducated child in India who is raped nightly by 8-10 customers in the brothel. How do we help her? She does not have access to a phone to report abuse to a helpline. She cannot read laws in English or Hindi. She can't walk to the police to report. They won't let her escape. She is no one. <-- This is who we are working for.

"We need to define equality. Who are we going to be equal to? I look around the community and see men that are miserable. Do I really want to be equal to them?" -Dr. Gertrude Mangella, former Under Secretary General, UN Fourth World Conference on Women

Sexuality Education: The Way Forward for Equality and Empowerment (Monday)


view from my seat in the ECOSOC chamber

Oh goodness gracious was I excited to be at this session. Comprehensive sexuality education has been a passion of mine for many years and it seemed like it was finally coming full circle. I actually was seated in the row behind many people from Advocates for Youth, an organization I had trained with in college. As a generalization, most industrialized European countries are fairing far better than the United States when it comes to teen pregnancy rates, STI infection rates, general sexual health knowledge and reported sexual assault rates. I've already written about what comprehensive sexuality education is, so if you're curious, check it out! This was a report-out of what went well, what needs improvement, and ideas for other countries. It was especially an honor to see the European regional director of Planned Parenthood. She was held up in traffic and arrived late, but didn't even take one minute to compose herself before answering a question. She really is impressive and does amazing work.

"We asked our students what did you learn from your [comprehensive sexuality education] classes. One said "I didn't know girls could be equal to boys. Today I learned this.""

Abstinence-only programs do not address child marriage, sexual violence and non-consented sex. The problem with these programs is that there is no talk about the transition of not having sex to having sex. There's nothing about partner negotiation. And the human development journey is far from the binary idea of having sex to not having sex. Can you change your mind later?

Empower Rural Women to Achieve Food and Nutrition Security (Monday)

I was also really excited about this session because of my research focus on rural food insecurity in the United States. Unfortunately, for me, this session didn't cover anything in the United States. It was interesting, and important, for me to learn about rural women in the rest of the work and the struggles they go through in order to be able to farm. There are many laws, policies, and other structural inequalities that prevent women from being able to grow food--although time and time again they have been shown to have better yields with fewer resources. A quick list of a few things women are working against--must have a man's (her husband) permission to work--where does this leave widows and unmarried women, must be a man to have land owning rights, many businesses will not sell seed or equipment to women, etc. It wasn't what I expected, but it certainly was informative.

Faith + Justice + Culture Meet Up (Monday)

This is a meet up that our group held at a bar for young adults to come talk about the intersections of faith, justice and culture. I, honestly, was over exhausted from a donor event we held the night before and the excitement of the day, but still had a good time. I met some young adults working in STEM fields and continued learning more about people in our own group. The conversations were rich though.

Lego UN

Plenty more coming on my experiences at UN CSW, but for your sake it's coming in parts. Come back later this week to read more!

Wednesday, September 23, 2015

the daily fresh new hell: a story about chronic disease + health insurance

I go to the doctor. A lot. I have wonderful physicians and I'm usually pretty excited to see student providers (especially the ones I know!) that are in the midst of their training. Just this week I will have 4 doctors appointments by week's end, plus labs and X-rays. Next week will continue with another appointment and an MRI. My use of the system isn't usually this frequent...it just happens that all of my long-term follow-up appointments land within a few weeks of each other. But needless to say, I'm what you might call a "frequent flyer".

I was in medical school. I understand how to advocate for myself and for my health when I'm in these appointments. I can talk with lingo that physicians understand and I often can identify immediately when there's something going on in my body that needs medical attention. I have my medications memorized--both generic and brand names plus formulary/non-formulary status according to my insurance-- and their doses.

Now I'm in public health. I have a pretty solid grasp of insurance. I understand the marketplace--I've never needed to use it myself, but I can navigate it easily. I know what I want/need out of an insurance plan. I understand how deductibles, co-pays, co-insurance, and max-out-of-pocket all relate. I can tell you better than most insurance representatives precisely what is covered by my plan and how much I pay in co-pays at general, specialist, urgent care and emergency room visits. I have my plan ID number memorized and I can tell you how much each of my many medications costs after insurance.

But through no fault of my own, I recently learned that I haven't been on health insurance for almost a month.

You see, I got a new job starting in August that paid for my insurance. It turned out to be a better plan than the one I was on with my family, so I started the process to drop my old insurance and was automatically enrolled in the new plan through UNMC. I wrote a letter to Nebraska Medicine per the protocol with Blue Cross Blue Shield to ask that my deductible met so far this year be rolled over to my new plan (they often do this if you switch midyear, but you have to write a formal letter and go through the process).

So far, so good. The plug was pulled on my family's plan at the end of August. I hadn't heard yet from the student health plan provided by UNMC, but that's okay cause they weren't going to send a physical insurance card until late September, as far as they told me, no news was good news.

Turns out, I didn't have any insurance...which I didn't find out until after I had gone through many X-rays and a specialist visit. The office couldn't figure it out and didn't want to deal with it so they sent me away. I had to physically visit the student health coordinator (1st unnecessary visit to deal with problem) and call about 10 people between 3 insurance companies to find out that "there was something 'hanky' with [my] application, so we put it in a separate pile of people we can't easily enroll" (direct quote from someone at the enrollment insurance company) (1st instance where I spend hours on the phone dealing with the problem). I asked this kind lady if anyone was going to bother following up with any of these "hanky" applications in insurance enrollment limbo, but she said that's it's not their protocol to do so--at this point I'm SERIOUSLY concerned for anyone else at UNMC that maybe had a "hanky" application...you do not have health insurance and you have no idea.

Eventually, I got enrolled in the plan (that was supposed to start 8/24/15...it's now one month later and the only reason I got enrolled was because I called to get it figured out), but they still can't send me a card to present at a physician. I begged for the policy and ID# so I could just freaking go to the doctor.

I show up at the physician's office and they are not super happy to not have a physical card to copy and put in their records, but I promise to bring it to them just as soon as I get it in the mail (2nd unnecessary visit). Then they ask me why I don't have a referral to see this physician. Which makes absolutely NO sense. I've seen this guy for 3 years now. I don't need a referral to see someone I'm established with. Apparently I do with this new insurance so I called to get the referral (2nd unnecessary phone call to receive referral to physician I am an established patient with...now will need to do this for every appointment with this physician and all others in the Nebraska Medicine system I see).

Appointment goes wonderfully and I head to another appointment to get a PPD skin test placed (to test for TB...a requirement of all UNMC students and faculty each year...which I know because I've been at UNMC for 1,000 years, but no one actually reminded me about it--it's a good thing I've got this health literacy down, eh?). I show up and the nurse has no idea why I'm there, even though I made the appointment on Monday. In person. Eventually we get there.

Knowing what a hot mess this whole process has been, I go to verify my enrollment into the insurance plan AND that it correctly got into the electronic health record (3rd unnecessary visit). The student health coordinator cannot ascertain that herself so she must call the student health enrollment person (3rd unnecessary phone call). The enrollment person is out for 10 days, so no one on the UNMC side can verify that I have been enrolled completely--this after 10 minutes of calling 4 different departments and an insurance company.

While I'm there, I ask about the referral nonsense. She verifies that I need a referral to every physician I see, each time I see them. I ask to get referrals created for the appointments I already have scheduled, which she grants. She asks for a list of my physicians. I give her the list of 5 (just at Nebraska Medicine--these are people I've been seeing as an established patient for 3 years), she panics and leaves to talk to the student health provider. I have only see this student health provider once for a flu test--she's not my primary care person and she wasn't on staff when I had my initial referrals 3 years ago, but she is CC'd on every single note and healthcare visit that I've ever had at Nebraska Medicine and she has access to my chart. This APRN requires that I have an appointment with her before she will give me any referrals to any other physician--you know, the ones that actually know me and I'm established with (4th unnecessary appointment--of course this cannot be done in conjunction with reading my PPD/TB spot, so I will have to pay 2 copays to get this done). Okay fine, I'll see you on Friday.

Now back to the insurance thing...officially I didn't have insurance when I had the first appointment that tipped me off to this whole debacle (well, I did but it wasn't in any system, so it doesn't count as far as they are concerned). This means that I will get sent the whole bill from that appointment which I will need to take into both the student health enrollment person and the Nebraska Medicine accounting/billing department, so that they can re-bill through the insurance (5th and 6th unnecessary visits) and send me an accurate bill. I would imagine that this will require at least one phone call also (4th unnecessary phone call).

I have probably spent 5 hours on this since Monday alone and the process is far from over.

It is lucky that I have the health literacy and education that I do to know what to say and how to advocate for myself and my healthcare with the right people. Most people don't have that. I can usually get a good idea of who to call right away, so I can avoid the long hours on hold or being transferred between departments. Most people don't even know where to start. It is also lucky that I have the time/am able to make the time to deal with this problem. Most people don't have that time during business hours.

The system has failed me over and over and over again this week. It's not the first time and it certainly will not be the last. And there is absolutely NOTHING I can do about it to make it better. There's not even really any one specific person or department I can write to or call to complain (thus, I complain to you, dear readers).

But this needs to be talked about. This systematic breakdown is not new. It's no fault of the Affordable Care Act. It's no fault of the individual physicians and other healthcare providers that I see. It's no fault of the student health coordinator, she's just doing her job. It's the fault of the system. We need further reform and transparency of the system itself. This is especially true for those with low health literacy who have no idea how to navigate the system and for chronic care patients who are juggling lots of balls in the air, but have no one advocating for and with them to not get screwed and drop everything.

My best advice to you, is to know your body. Know your health insurance. Know how to advocate for yourself. And don't back down because people will pawn you off as not being "their problem". The system is broken, don't just follow it blindly into the rabbit hole.

Or else you could unknowingly end up without health insurance for a month.

Sunday, September 20, 2015

#JennyGetsto50: a photo blog

Just got back from a week-long vacation with some of my family. We've been planning the trip since early spring, but were actually unsure if we would be able to do some of our trip due to the recent plague outbreak in Yosemite National Park and the many fires raging through California right now. There were a few changes to itinerary, but all in all, it was a wonderful time and relaxing vacation! But most importantly, I made it to my 50th state (Nevada)!!

Starting the vacation of right with
chocolate milkshakes on National
Chocolate Milkshake Day (Sept 12)!

Yosemite National Park

Yosemite National Park: Giant Sequoia trees

Yosemite National Park

Yosemite National Park: The fambam!

Yosemite National Park: tree tunnel

Sequoia National Park: this little bear cub
came to eat lunch with us

Sequoia National Park: the largest tree in the world,
General Sherman, is 109 ft (33 m) girth

Sequoia National Park: sequoia selfie!

Sequoia National Park: I guess these trees are a little big...

Sequoia National Park

Sequoia National Park: The President, The Senate, and The House on Congress Trail

Shinzen Japanese Garden

Forestiere Underground Gardens

Forestiere Underground Gardens:
A Sicilian man moved to Fresno to be a citrus farmer, but found out the soil was not conducive to planting. So he built/dug an underground "farm" and resort over 40 years of his life (in the early 1900s) using only simple chisels and shovels...in his spare time after work! The result is an eerie, but beautiful catacombs-like experience. He had 80 acres, many of which he excavated, but only 2.5 acres are shown on the tour now.