Sunday, May 7, 2017

Healthy Stools

There's been a lot of talk about healthcare, and I'd like to do some defining of terms when it comes to health, medicine, and what it means to be healthy.

Medical care and Health Care are different. This, I believe, is at the root of the problem with our insurance system. That is a blog post for another day. Medical care provides medicine, operations, and concrete solutions to clear diagnoses and problems. The goal of medical care is to make some one who is sick, better. This is important! Health care, I would argue, includes medical care as I've just defined it, but goes on to also focus on preventing medical problems before they arise (good medicine is awesome, but isn't not getting sick even awesomer?!), educating patients on medical concerns that may arise in the future, addressing ones hopes and fears in relation to living, dying, and just getting through daily life with as much purpose, energy, physical and emotional wellness possible. (our insurance system was set up to address medical care, but research and experience have lead the medical community to want to provide health care...but like I said, a blog post for another day).

Our health (and therefore our care of it) comes from 3 different places. I often describe this to patients as a three-legged-stool which, without any one leg, wouldn't be complete.

One leg is made of the health related factors that we are born with; our genetics. In medicine we call these non-modifiable factors. You have no control over them. This includes your genetic predisposition for cancer, or diabetes, or any number of illness. It also includes your race, body type to some extent, and some behavioral tendencies as well. One day these may become more modifiable, though I expect even then, our genes will have a large influence over our health.

One leg is made of health factors that are largely up to us. What you eat, if you smoke, how much you drink, if you exercise, if you wear a seat belt, what type of physical and emotional risks you take...etc. We call these modifiable risk factors. They are aspects of health that can be changed by your actions. Though, it is important to point out that while all of us have choices, for some of us the healthy choices are easier, more obvious, more available. For others, they are options in theory, but in reality much harder to choose, even if desired.

The last leg is made of health factors that happen to you because of your surroundings. They didn't have to happen, and are therefore technically modifiable, but they are also largely out of your control. They are modifiable by someone - your parents, the government, your city officials, those with more power and influence than you, but you yourself can't do much to change them. Some examples might be - having a parent who smokes, causing respiratory harm to a child; a city with high lead content in its water causing lead poisoning; what your school serves for lunch; the safety of your neighborhood.

Health care (care for one's health), I would argue, can be seen in a similar 3 legged stool analogy - if you remove any one leg, the goal of improved health becomes much harder.

One leg is the patient - they can choose to follow medical advice, take medications, alter modifiable risk factors, and be an active participant in getting or staying healthy. We all acknowledge that there is some degree of personal responsibility in the movement towards health. It is important for one's mental and emotional well being to find ways to be in control of one's health.

One leg is the doctor or other health care provider, and her or his specific recommendations and treatments. It's the medical professional's job to explain diagnoses in clear terms, review treatment options, discuss goals of care, and pick a plan going forward that is both evidence based and realistic for the patient.

The final leg is the medical industrial complex - insurance companies, pharmaceutical companies, regulatory organizations. From what medication is covered, to how many doctor visits are allowed in a year, to how many days of rehab you are allotted, to which doctors you can see, to how much your doctor will get paid for the care they provide, these groups have a lot of power.

I like the stool analogy because it demonstrates how reliant each leg is on the other one in order to create a sturdy, safe, reliable system of care. If your genetics are so strong in predisposing you to a certain illness, then sometimes there isn't much medicine or you can do to help change that as much as you'd like. If your environment leaves you with so few reasonably healthy options for food, activity, education, mental well being, it is hard to over power that with pure will power or medical advice. If you put no effort into wanting to improve your health, even the best doctor in the world won't get far in making you healthier. If you are highly motivated, but have a doctor who suggest culturally or economically unrealistic treatments, you feel stuck. If your insurance, or the price of a medication, or even the existence of an approved medication, is out of line with your needs and reality, then even the best health care goals and plans won't help you very much.

Whether we like it or not, these three pieces are woven together to make this system we've created called Health Care. A less than holy trinity. But, as power and influence shifts more to one leg, we become unbalanced. Sometimes this unbalance is non-modifiable (genetics) or very hard to modify (systemic poverty and all its causes), and sometimes it is hard, but slightly more modifiable (policy, law, regulations, encouraging evidence based medicine).

We're all faced with a different set of modifiable and non-modifiable factors that affect our health. But for many, there are aspects of their health which should be modifiable that have become non-modifiable, and this is the greatest task the health care world has to address right now.

PS - extra props if you got and enjoyed the pun in this blog title. :)

Sunday, January 29, 2017

Nazis and Refugees

My ancestors were both Nazis and refugees. So are most of us.

I was born in Germany, and half of my family is German. My grandparents and great grandparents lived in the eastern German countryside, with a few of them also in Berlin. There's not exact information about what they all were doing during WWII, but the evidence generally indicates that some escaped to the countryside to avoid all conflict, and others, though not my direct grandparents, were likely Nazis.

When the war ended, my grandparents were still in eastern Germany. The Berlin contingent experienced the soviet blockade in the 1940s, and moved as far West in the city as they could afford. The eastern Germany group was forced into the Russian labor camps. While they weren't concentration camps, conditions were bad, food was scarce, lives were lost, and my grandmother was raped. They were, somewhat miraculously, released, and returned to eastern Germany to settle down once again. There, my dad was born. When it became apparent that conflict with the Soviets was not going to end, and the Iron Curtain began to fall, they escaped on literally one of the last trains to cross from East to West Germany for the next 30 years. The needed refuge. They lived in Hamburg and Berlin for the rest of their days. There I was born, in West Germany. My baby clothes and toys are marked, "Made in West Germany." **

We moved to the US in the late 80s, after seeing the Berlin wall come down. My father brought me a piece of it - graffiti red and black on one side, and grey concrete on the other.

I loved my German-ness. I enjoyed our few remaining traditions, being able to speak German, getting to travel internationally at a young age. It made me feel unique. Until 6th grade. Our history class did projects on injustices throughout history. At least half of them were about the Holocaust. It took me years to figure out how I could feel ashamed and sorry for something that happened before I was born. I could have gone off-campus to take German as my required foreign language. Instead, I took Spanish.

This (his)story may sound uniquely dramatic, but it's not. Not really.

Most of us have within us, within our families, within our culture or country or religion, stories of being oppressors and being oppressed. Perhaps not to this degree. Nazis, after all, are essentially the gold standard example for oppression, injustice, and hate. They may not be our personal stories, but we carry them with us. We exist, because of and in spite of them. Some of our stories are neater, more obviously lacking of evil and oppression, and perhaps more filled with mercy. Some are messier, making us feel dirty and wishing we could dissociate from that part of our unchangeable identity.

I've thought again and again about how to hold these two identities at the same time. I've wondered, what I would have done, had I been alive back then.

At any given moment, we all hold the ability to enact either hatred or mercy. It's a grace in and of itself that we're able to choose mercy and kindness as often as we do. At times we are the oppressed, the refugee- powerless, alone, vulnerable, the object of oppression. Some face this intensely and physically. At times we are also the oppressor, or at least given a choice of being the oppressor- powerful, safe, able to harm others. Some experience this in large, dramatic ways; all of us experience it in smaller, day to day actions and choices.

Just as my family history holds both evil and escape, hatred and harmony, mercilessness and mercy, so do I. So do we all.

Let us be refugees from our own hate and fear- to flee from evil and darkness, and run with abandon towards goodness and light; to find refuge in something outside of our selves.



** while my family were not refugees when they came to the US, they were relatively well-off immigrants, they were also descendants from one of the largest terror organizations, in modern times. Yet, we had no trouble getting into the US.

Thursday, December 22, 2016

History. Whostory?

I'll openly admit that history is not my best subject. I appreciate it. I enjoy when it is told to me in engaging ways. It is certainly important.

I took a fair bit of history in grade school that I still remember. I don't remember all the details- dates and names and specifics- but I recall the overarching themes and lessons from each period and nation. Still, my knowledge of history is millions of miles behind Jonathan. To be fair, he's a history buff. I'll ask him a simple question about a basic historical fact and 15 minutes later he's managed to retell the entire story of some nation or people.

I've been wanting to increase my own knowledge of history but have always felt a little overwhelmed at where to start. I enjoy reading, but history books have never quit been my thing. I don't always enjoy documentaries, though there are some good ones. There are probably some decent audio programs out there.

It used to be that learning more history just wasn't really a priority in my extracurricular life. It's still not truly a priority, but more and more I've found myself wishing I had a better understanding of the context and past of different people and places to help me process the present. We've watched a few engaging documentaries recently that have helped start to fill in the large gaps in my history knowledge.

But, I still feel hesitant about diving in. I used to think I was just intimidated by the vast amount there is to learn. I'm coming to realize, however, that it isn't intimidation, but concern, that keeps me at arms length.

I feel concerned that what I read will only be one side of the story, that my view of a nation or people, and subsequent interpretation of history and even the present will be colored by an only partial truth, or worse, by a false retelling of events.

History, so often, is written and told by the victors, the powerful, the resourced. I know many true historians, past and present, place great value on truth and strive to retell the stories of the past with the greatest truth they can find. They do research and care about the information they are sharing with others. I appreciate their effort, but it doesn't feel good enough. I feel constantly concerned that whatever I choose to read or watch or listen to will only be part of the story. An honest effort to tell the whole story, perhaps, but still just a part. There will be people's voices who won't be heard.

Even two similar people can experience the same event or time period so differently. What and how they recall what happened will sound different. I know this to be true even from simple examples of my own life- my sister and I, I'm sure, would tell different versions of life together growing up. Neither are wrong, but neither is complete.

Current academic historians, I believe, do try to research and tell the fullest and truest version of history, though even they have special interests and agendas. But the primary documents they have and period literature they use to research is still generally written and told by the wealthy (not the losers of battles), powerful (dominant culture, men), and resourced (not the poor, uneducated). In school we're taught history as though it is fact- simply a set of events that have happened that we are to memorize and take for granted. But who decided on that version of events, on those set of facts?

So I find myself feeling trapped- wanting to learn about the past, but concerned I won't hear the whole story. Arguably, this is not a reason not to being learning (got to start somewhere). But, it does make me feel cautious. I don't have time to read multiple sources and accounts and vet authors and such. I haven't found a good solution to this discomfort. I know there are authors out there who focus on telling history from the perspective of the losers and powerless- their books aren't as fancy, mainstream media and publishing doesn't promote them in the same way, so they feel less credible, which is the whole problem to begin with! These are the people whose story wasn't incorporated into history the first time, it's hard to weasel your way in decades or centuries later.

Truth is so exhausting to search after, sometimes.

Saturday, December 10, 2016

100 Days

Today marks the 100 day mark in Tallahassee.

A few reflections on life here, with some (perhaps unfair) comparisons to DC and Philly.

Tallahassee is not a morning city, but I am a morning person. Streets and playgrounds and stores are close to empty until closer to 10:30 or 11am on the weekend. There are a few more serious runners out, but weekend mornings are very quiet.

Religion (Christianity, in particular) is a fair topic for conversation among almost near strangers. I was never once asked "where do you go to church" in DC by anyone but a close friend. Strangers ask this here. Politics, however, is not a fair topic for conversation. The city overall seems much less "in the know" about what goes on abroad and throughout the country. Perhaps it just isn't talked about.

People aren't as obsessed with work here. Work seems to start mostly at 8:30 or 9. None of that 7 or 7:30am craziness that happens in DC. It's not the first, or only thing people talk about. Then again, I don't have that many people I talk to regularly, so maybe they do. Tallahassee is less pretentious, a little more humble. People don't walk around thinking they have all the solutions and answers. Or at least that's my impression. People here don't go boozy brunching every weekend. They just eat normal breakfast and lunch. People seem to care most about comfort and security.

The first thing everyone says when they hear where we moved from is, "Wow, that is quite a change. How's it going?" Then they ask, "Why did you move?" Then, "Do you have any kids?" Then, "This really is a great place to raise a family. You'll learn to love it." I find that amusing, because I never say during these conversations that I'm not enjoying it here, it is inferred that because we moved from a big, bustling, full of life city, that we must find this place boring and conservative. Everyone feels the need to reassure us that this is a wonderful place to raise a family. I wonder what they would say if we didn't have kids? If we were single? Where does the need to reassure come from?

To elaborate a bit on the family friendly point- It is certainly nice to have more space, a yard, a safe street to run around in. There are some playgrounds and parks. There are weekly lists of "family friendly" events going on throughout the week. I find the term "family friendly" interesting. It just means your kids will like it, or will tolerate it, or will be tolerated. No guarantee that the whole family will actually feel they're meant to be there. BUT, I actually found both DC and Philly to be very family friendly. There are way more parks, playgrounds, public spaces to be in. When everyone owns/rents less personal space, more time is spent out in public. There are small playgrounds every few blocks, you can walk or metro to school/daycare/church/groceries/zoo/friends house. Here, it seems everyone has enough space in their yard and house, they don't need to go out as often. The streets always seem quiet. Where are all the kids playing outside? Don't people work in their front yards ever? Getting anywhere means at least a 15 minute car drive it seems, plus the hassle of getting in, out of the car, taking kid gear with you, buying gas...etc. In DC I don't think we used our car for anything except going to work, and then later on groceries.

Life rhythms in DC/Philly aren't about going to specific events/places most of the time. You just go out for a walk and spend a few minutes at the park, maybe pick up a gallon of milk, and head home 30 minutes later after running into at least 2-3 people you know and many others who look familiar. Your life syncs up with the life of the city- you become a part of it and it a part of you. Your feet are familiar with the cracks on the street and your eyes notice even small changes in your surroundings.

I don't hear gunshots in our back alley in Tallahassee, I've never left my wedding rings at home while running to lessen the chance that someone might mug me. I don't see people peeing on the side of our house when I leave for work in the morning. I don't walk by corners on which I can recall the names of young men and women who were shot in gang fights. But then, I also don't run into people I know while walking/metroing to work. I don't have the chance to talk with Theo about all the evil that is sometimes so blatantly obvious in big cities. (Good and evil, are everywhere, of course. But they look different in different places). I can't pop into a friend's house while going for a walk. I don't notice if our local school has planted a new garden or if the homeless man on the corner is gone. I just don't naturally see people as often. Maybe as I meet more people this will change.

Finally, race relations here feel quite different. It's hard to put my finger on exactly what is different. The city feels uncomfortable talking about race, out of practice. Though, it's clearly a segregated city. Philly and DC are exhausted from racial tensions- they're stuck in the fight to figure out how to live life closely with those who are different. I haven't figured out yet where Tallahassee is in that glorious battle. By numbers, Tallahassee is actually quite mixed, much more than I'd ever guess just driving around. Why is that? It is easy to live here and to never need to interact with those of a different race, class, religion if I don't want to (except for work). That isn't true for everyone here, but it does seem true for large swaths of the city. It requires great intention to be with those who are different because the city is set up in such a way that it doesn't happen naturally. It's why we intentionally put Theo in a daycare where he's one of few white kids, mixed mostly with Latino and Black kids. There are parts of the city where this seems to happen more easily, I'll admit. In DC/Philly, the city requires you to interact with those who are different. You can avoid doing so, but it takes intention. My feelings about this, too, may change as I get to know people and places more. But, after going to a historically black med school and living in an incredibly diverse city and neighborhood, life here feels a bit homogeneous. I've never lived anywhere where I felt a part of a religious majority, and it's been a while since I've lived so obviously as part of a racial majority (though my privileges by being a part of each of those groups have never diminished despite my geographic location).

I have a lot more learning and listening to do about this place. I'm sure all my observations are not reflection of the full truth of this place. They are just what I have experienced so far. Part of that experience comes not just from moving cities, but from also moving from one type of neighborhood to another, namely from lower income to higher income.

Life is full and complicated and best lived when all the hard questions of where and why and with whom to 'live and move and have our being' are brought to the light and struggled through in truth and grace.

Sunday, November 27, 2016

Waiting for Advent

I've been waiting for Advent for weeks.

It's strange, I suppose, to anticipate and wait for a season that is all about anticipation and waiting.

Holidays, I find, are too quick. One day of celebration and it's over. Advent is a season. I need the time to marinate. Advent is like a walk in the woods- there's time for marveling at big trees, dipping toes in the stream, a picnic, bouldering to the highest point, and maybe even a nap in a sundrenched clearing.

Advent is about remembering how to be and become more human.

Advent gives us four weeks to find light in dark places, to remember that wandering and searching have both purpose and an end, to remember promises and long for their fulfillment, to be human in all humility and glory, to find hope in unexpected places, to be near to God, and yet feel not near enough. It brings out our every longing and need, and yet doesn't leave us vulnerable or taken advantage of- it mysteriously holds both our needs and their fulfillment in the same breath. It gives us hunger while it cooks us a feast. We are safe to long for, anticipate, and even expect, and that honesty and security is a gift.

As much as I enjoy this season, perhaps the greatest glory of Advent is that it ends.

Come Thou Long Expected Jesus

 It's Advent. Finally. I've been looking forward to this season for weeks, and hoping to do more writing during this time.

To kick it off, something I wrote for a different blog last year:

Expectations. They get us into trouble, or at least leave us with dashed hopes and broken hearts.

I expected that my best friend would remember my birthday. I expected that I’d be married by now. I expected that I’d be able to have children. I expected that my boss would respect me. I expected that my hard work would pay off and I would feel fulfilled. I expected that black and brown lives would matter.

I expected that things would be…different.

Even when expectations seem quite reasonable, they leave us vulnerable, at the mercy of someone else to meet…or not.

A great deal of conflict arises from differences in expectations- among friends, co-workers, family, local and international leaders alike.

God’s people, too, had (and have) expectations that were heart wrenching and conflict inspiring. From the moment Adam and Eve left the Garden, God went before his people, and followed after them, leading and leaving trails of expectation. “Expect me to show up,” he was trying to teach them. It was the beginning of Advent.

I will bless your children and your children’s children. Expect me.

There’s fire in this bush. Expect me.

There’s water in this rock. Expect me.

There’s manna falling from heaven. Expect me.

I rescued you; I will rescue you. Expect me.

I give you this king; I will give you a King. Expect me.

I am your strength, your consolation. Expect me.

I will bring joy to your longing heart. Expect me.

“Expect me,” God whispered for centuries into wandering desert trails, on cliffs and in valleys, in 
palaces and huts, to men and women and children, to the young and the old, the familiar and foreign, the rich and the poor. All of creation was living in Advent- looking for signs of Jesus, feeling vulnerable and impatient, caught between great hope and anxious despair.

Wilderness wandering and high leader turnover taught a stubborn and self-reliant people how to expect God to show up. Faith-filled expectation doesn’t come naturally to them, or me. It’s one thing to expect to be paid on time, or for a good friend to lend a listening ear. It’s quite different to expect the God of the universe to come and fulfill all of my longings, to be the restorer of the whole wide world.

But amidst all the chaos and tenuous promises of the world, we have a God who whispers gently, and sometimes shouts, into our stubborn ears and hearts: expect me! The glory of Advent is that the longing and expecting, the searching and wandering, does end. Jesus comes! (Perhaps not as was expected…those expectations, man, they’re tricky business). God bids us wait, expect, learn to long for him. But not forever. Advent was never meant to last forever. Jesus came! Messy and fleshy from birth to death. He tastes our sadness. We taste his glory.

It encourages me that the impulse to long for a world more beautiful, more peaceful, more just, more healthy is not simply childish discontentment; instead, it is living a life of Advent hope. God’s final word to us isn’t “wait, hold on” it’s “I’m here, come in.” I’m not always sure what exactly I’m expecting when I long for the end of our current Advent, for a time when Jesus returns and shalom invades and reclaims the earth. The Advent of Christmas tells me that expecting Jesus, now and one day more fully, is the surest and most glorious expectation I can have.


Sunday, September 18, 2016

The First 100 Days

The first 100 days a president is in office is often used to define the entire term's agenda. The most important, or most pressing business gets addressed first- or at least that's the goal. The administration is full of energy, enthusiasm, support, hope, and fresh gratitude for getting elected. Some go as far as to say it the most productive, if not only productive, time of the entire term.

During RA training in college, I recall learning, similarly, that what a freshman commits to and does in their first 100 days of college will likely play a big role in shaping their entire college experience. 100 days is long enough, they said, to try out a few new things, find a niche, a few friends, and to start forming habits, trends, patterns. Students who start out partying, continue partying. Students who start out going to the gym, continue going to the gym. College, more than maybe any life stage, is full of change and growth, and yet the stats they showed us back then still supported this 100 day trend.

I recall reading (wouldn't be able to tell you where, or who) that the first 3-4 months (ie. 100 days) in a new job, or new home, set the patterns and habits that tend to stick for years to come. Workers who start out arriving on time or arriving late continue those trends. The time you get up, where you park, whether or not you pack your own lunch, if you say hi to the door man- they are all small parts of a routine that start out as a myriad of small decisions and quickly become a routine rarely requiring questioning or second thought.

The "100 days" theory, which I more or less to believe to be true, isn't meant to be restrictive and prescriptive. It is simply descriptive of the way things often go. Habits and patterns are comfortable, even if they are unintentional. The discomfort of being in a new place drives us to develop routines that foster a familiarity that brings comfort and belonging.

Of course change is always possible. Change, though, is often reactive. The first 100 days have the freedom of being more proactive. Most decisions in life lie somewhere on the spectrum between proactive and reactive, often having a good mix of both. There is much importance and value in reactive change and decision making too- realizing something is not the way you want it to be and working to change it is what most of us spend all day doing in one way or another. But, there is something special about more proactive change- you've got a few more raw materials to work with, fresh dirt, new seeds, rather than old soil that needs fertilizing and a garden that needs weeding and uprooting.

Since we've just moved, I've had lots of proactive questions for our new life. Small questions like where to get groceries, and big questions like how will we establish life in a way that cares well for ourselves as well as our new city? In some sense, there are no small questions. Everything says something about what we value and why. The challenge (and fun?) in being proactive is that it marries the big and little questions to produce or create a culture of "me" or "we." Culture creating is a more helpful term, I find, than culture change. We're created to create, are we not? Given how hard culture (and habits, patterns, trends...etc) is to change once it's in place, it seems worth spending time thinking about the culture we want to create before it mindlessly forms on its own.

I've been in Florida 18 days and thought a lot about what creating life here might look like. So far I've settled on planting gardens, killing mosquitoes, getting to know the names of my neighbors, killing more mosquitoes, learning about who lives where and why in this city, not having a TV, getting reacquainted with my piano, and going for long walks.

December 10th. On December 10th I'll have been here 100 days. I wonder what kind of culture will be created by then?