America Needs A Nelson Mandela

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It is ironic that I became aware of the Pittsburg synagogue shooting while traveling in South Africa. Ironic because South Africa had an apartheid system that America is hurtling towards. Apartheid was specifically designed to pit individual groups against each other in order to keep the minority whites in power. The black majority in South Africa were labeled by their tribal affiliations, pitting neighbor against neighbor and leaving little time or energy for opposition to those in power. America seems to be following in these footprints….We are continuously self identifying into white vs black, Muslim vs Jew vs Christian, citizen vs immigrant, men vs women. We are quick to note the ideals that divide us and less likely to look below the surface at what we share.

Nelson Mandela, the man considered to be the father of modern day South Africa, spent 27 years imprisoned on Robben Island reflecting on apartheid and its consequences. As he was released he encouraged a non-violent means of reconciliation and that South Africans (Boers, English, Black and Colored) work together to reconstruct a country that had been destroyed by divisions. As our guide stated, Nelson Mandela was made Nelson Mandela during
his time in prison when he matured and reflected on his experiences, realizing that violence would only serve to drive the country into further trouble. Rwanda had a similar experience of intra country strife, followed by peaceful reconciliation. America and its leaders can learn from these countries.

in late 2015 I was horrified by the turn our country was taking when some of our leaders used the Paris bombing to divide our country against Muslims and immigration. I reached out to our local Mosque, expressing my support for their place of worship as well as inquiring about an ongoing Christian-Muslim interfaith dialogue to educate others about our religions so that we could reduce fear and hate from both sides. Two months later, Tapestry Interfaith Women held their first official meeting where we packed hygiene kits for distribution to refugee families. Ironically, our most recent meeting was hosted by a local synagogue and occurred 2 days prior to the Pittsburg synagogue shooting.

Sharing stories of faith, family and work has brought the women of Tapestry into a friendship that might have never occurred without the events of the world that has tried to divide us. We run the gamut from liberal to conservative. We have not always agreed and there have been misunderstandings that have hurt feelings. But we are united in believing that we are all Americans and can be better if we work together to form an interconnected world and to help others.

If our leaders can’t lead like Nelson Mandela, individual Americans should work to set a better example for the world. An African word, Ubuntu – the interconnectedness of humans, animals and nature – or “I am because of you”. People are not people without other people. We need to embody the spirit of President Mandela. Walk in the shoes of another human. Organize your own Tapestry group, observe a religious event different than your own, reach out to a new co-worker or neighbor that has moved from a different state or country. Our shared African ancestor, Lucy, would smile as any mother does when her children can cooperate.

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Dear Son,

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This week our President lamented that young men in American should be very afraid of being incriminated of  sexual assault when they had done nothing wrong. All week American women, some famous and some not, have been sharing their stories of assaults that have happened in their past.  I want you to know that this should not be a scary time for you but a time when you applaud the young women who are your girlfriends, friends and co-workers. Because when women are given an equal voice, whether it be in America or anywhere else in this world, workplaces, families and societies do better. Scary is when people are treated differently based on their gender, sexual identity or skin color. Scary is when assaulting women is seen as “boys being boys” and not for the violence and control that it really is.

Your father and I have tried to exemplify equality by being equal partners in this journey of parenting. Household jobs are not designated male or female, but delegated to whoever has the time or interest. Our incomes are put into one account and decisions about spending made after discussion.  We have treated our children differently, based on personality but not on gender. We argue but treat each other with respect and consideration.

And those  traits that we have demonstrated to you and your sibs are the same traits that we hope you carry out into the world – both at work and at home. Treat all humans with respect and kindness, regardless of their gender or sexual orientation. Just as different backgrounds produce varying attitudes, so does gender. We are never able to walk in someone else’s shoes, but we can listen to their story and try to understand.

I am proud of you, not only for what you have accomplished in your life thus far, but more importantly because you are a nice human that is kind to others and treats people with respect and empathy, whether male or female. This is not a scary time, but rather a time when you can expect to have richer relationships due to the different experiences of those in your life. My wish is that you find a life partner that can enjoy the journey with you.

Love,

Mom

The Unmade Bed: A lesson in raising 5 kids with 2 working parents

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September of 2019 will be the first time in 23 years that I don’t spend the month frantically filling out school forms, filling the fridge with meal ready food and packing backpacks with folders/tablets and markers.  As our youngest child starts her college journey 3 hours away, I now have a chance to reflect on how my husband and I  managed to get thru those incredibly busy years, keep our sanity, enjoy our kids and remain best friends. Some memories are easier to enjoy than others, but both the good and the not so good times are part of the fabric that has kept us together.

Many of my patients ask me how many children I have and when they hear the size of our family the next question is inevitably how I can continue to work full-time. I joke that my workday is what keeps me sane, as staff and patients are interested in what I have to say and the paycheck each month helps to pay for the expenses of a large family. The truth is I love my job and my family and have learned how to make both work, albeit some days better than others. With more young women pursuing professional careers, I am hopeful that they are able to take some lessons from those of us who went before.

Unfortunately, I had no role models as none of the women in my family had paying jobs outside the home. I grew up on a farm in the 60’s and 70s, when the job of a wife was to provide all of the childcare/household duties as well as help out on the farm when needed. There were clear boundaries between women’s work and men’s work, with women crossing over into the male realm much more frequently than the reverse. My mother assumed that a physician career limited the possibility of a family and that I would quit my job if I decided to have children. Additionally, there were few female physician role models in the generation prior that could provide my generation with support. In retrospect, creating my own how-to manual had certain advantages as I had to figure out what worked for our family and wasn’t afraid to make mistakes.

My immense advantage in this endeavor was my husband. He also has a professional career, loves kids, is a great cook and can clean a bathroom. The distinct boundaries between husband and wife duties that were present when I was growing up is quite blurred in my own marriage and fluctuates daily.  I can be seen mowing the lawn and shoveling the driveway of snow while he is inside helping kids with homework and putting a meal together. If the homework is English or spelling, I am more likely to be involved and if the snow blower is in use, he is usually the one behind the handlebar. Thru experience, we have learned that a job done is not open to criticism. If the lines on the lawn from the mower are not straight, the lawn is still mowed. If the kitchen counters need an extra swipe to be shiny, the kitchen is still clean enough for eating. By consensus, we have agreed that there is not enough time in the day for the extras: a perfectly made bed with pillows artfully arranged,  nightly baths for young kids and coordinated school outfits.

Growing up on a farm, much of my unscheduled time was spent outdoors making up my own fun. With my own three rambunctious boys, I was often pushing all of them outside to use up some of their energy, just as I was taught to do. Some days I questioned my sanity as it took longer to get everyone dressed in winter gear than the time spent outdoors. This parenting style was much different from what I saw among other families in my neighborhood. Parents preferred their children to have supervised play, arranged play dates with desired friends and spent their time at the park following their children around the play structures, making sure they didn’t take chances and get hurt. I “let” my children climb trees, dig in the mud/muck, build scary contraptions to ride in and walk one block to our neighborhood park to play on their own. I didn’t have a choice as they would have done all of those things and more as soon as my back was turned. This made my life easier as I was able to enjoy what they created for themselves and didn’t need to be concerned about the organization of scheduled activities.

As young adults, my kids have all pursued different passions at different times, never being afraid to fail the first 10 times. Studies have now shown that unstructured play time is critical for a child’s development and decreases future anxiety and depression, giving them permission to fail at the easy stuff so that they continue to persevere as adults when hit with adversity.

Five children can create a messy house and have a need for large meals. I didn’t have the time or the will to do all of that housework on my own. As young children they were put to work doing meal prep and as they got older were assigned to start the evening meal when they got home from school. Weekend mornings involved yard work and housework. There were always complaints about their friends not having chores and sometimes it took longer to get them to move in the right direction than if I had done it myself. But as they moved out of the house, I knew they could wash their own clothes, clean a bathroom, vacuum and cook a decent meal. They knew that I depended on them to make our household survive and how to negotiate with their siblings for a more desired chore.

This recent article about Maya children articulates what I witnessed when my youngest daughter arrived home from China at age 2. The first few months were a struggle for her as she adapted to new foods, a different language and a brand new family. There were few smiles until one day when she walked over to the bucket I was using to clean up the kitchen floor, grabbed the mop handle and started to scrub the kitchen floor. She had found something familiar. A mop in America works the same as a mop in China. Almost every day for the next few weeks she scrubbed the kitchen floor or helped cut and clean produce for meals. The tasks gave her a sense of contributing and linked her past to her future.

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I had the hardest lesson to learn. The age of the working woman was buoyed by the slogan that you could have it all – a career, family and happy marriage. The reality is that you also have to sacrifice to make it all work. When I wasn’t at work, I was home with my family. My husband and I tried to squeeze in a few date nights a month and one vacation without kids a year, but finding someone to watch 5 children can be difficult. Me time was non-existent and time with girlfriends  rare. Spending 12 years of my life beyond high school becoming a physician honed the concept of delayed gratification, making it easier to realize that there would a future time when I would be able to develop outside interests.

Now that the time has come to fully embrace those outside interests I am more than ready, albeit with a small tear in my eye. While I have lists of places to visit and new volunteer opportunities, I also miss the kids running thru the house, sitting in the kitchen with me as I cooked dinner and they did their homework, snuggling together at night as we read books and road trips. But it is even more delightful to interact with them as young adults – hearing their excitement and disappointments, discussing movies and current events. I wouldn’t change a thing about those crazy early years, except to worry less and enjoy more.

Lessons learned at Culture Camp

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I just completed my last year of Korean culture camp after attending with my daughters every summer for the past 14 years. We started attending the week-long family camp, Kamp Kimchee, when they were 4 and 5 years old. Initially I had two reasons that I thought the camp would be beneficial to our family: 1. Provide friendships for my husband and I with families that looked like ours.  2. Allow my biological children ( 3 sons) a chance to understand what it was like to be a minority.  As an afterthought, I considered that my Asian daughters might find a few friends to re-connect with each year. Once again, I have found that parenting wisdom is often replaced with a reality that we couldn’t imagine … and often a reality that is better than we ever dreamed.

Regarding the adult friendships I wanted to establish. Some of these moms have become my best friends in a way that others are not. They “get it” about how the outside world views our family, they don’t judge parenting styles and they are only a phone call or text away when I need to vent. My husband and I reconnected with a college friend and have had children from both families attend our alma mater.

Exposing my bio children to a predominately Asian mix of kids didn’t work so well as they were teens when we started camp and didn’t connect with the kids that had formed friendships over the previous years. I would like to think it expanded their culinary horizons as they love Korean food and know the distinct smell of kimchee.

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Korean lunch served daily at Kamp

The lessons learned at camp that have been the most important were those that I didn’t have the ability to imagine when my daughters were young. Society views our internationally adopted children quite differently when they are part of a family that includes two Caucasian parents as compared to how they are viewed when they move out into the world on their own. Racism is alive and well in our country, particularly since the election in 2016. What Americans think, is now coming out of their mouths without the filter of human decency intervening. Here are a few examples shared by both kids and adults during camp.

  1. An elementary school child was being bullied by a classmate, teased about his eyes and kicked in the back during passing time. After his family discovered a large bruise on his back, they brought their concerns of racial targeting to the principal, who chose to downplay the behavior until surveillance video proved the Asian child’s story.
  2. A teenager was walking in his hometown parade passing out literature about a local politician. Someone yelled at him, “Go back to where you came from.”
  3. Our kids are told that their English language skills are very good, asked “Where did you really come from?” and “Why did your parents abandon you?”

Lessons on white privilege don’t need to be taught – we as parents live them in the eyes of our children as they move into the world away from us. When my children left Korea and China, they lost a culture and a connection to a birth family. When they leave the security of our home, they are losing the advantages that our white skin has provided them. My daughters will need supplemental skills that I can’t teach them, as I don’t understand what they encounter every day. These are the skills that those who went before them are able to convey. Those friendships that they have nurtured over the years outside the boundaries of camp are the most important part of the past fourteen years. These are the friends who understand a simple text and get the nuance behind the frustration. They understand makeup uncertainties, haircut dilemmas, lactose intolerance, difficulty with glasses that won’t stay on your face and finding clothes to fit.

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The graduating senior class this year condensed all of the above into a video that will be used to tell the story of Kamp Kimchee as well as to recruit new families to attend. It is important to them that culture camp is there in the future so that other families will benefit as well as allowing them to return to share some great food and mentor younger campers.

 

First World Business over Breast

This disturbing article from the New York Times has appeared in my inbox and Facebook page at least 20 times this week. It details the power of large corporations, ie formula manufacturers, to influence not only our government but also international policy in order to increase their bottom line. Simply put, US government officials present at the United Nations-affiliated World Health Assembly this spring tried to pressure developing world countries to place less emphasis on breast-feeding and allow the promotion of alternative feeding methods, namely formula. This is at a time when US hospitals are competing for patients by hiring lactation consultants, providing free breast-feeding classes and training all of the maternity staff in best practices for nursing. We will not allow a formula manufacturer to advertise in American hospitals or clinics, but we are ok with the promotion of formula products in the developing world. Two empiric situations should make clear why this policy will increase childhood mortality.breastfeeding-mother

  1. An American woman is planning to nurse her child but her husband has misgivings about this as he is concerned that he will not be allowed to feed the newborn. Following an uncomplicated delivery, the newborn had difficulty latching to her breast but was finally successful due to the assistance of an experienced lactation nurse and the benefit of a breast pump and breast shields. She was able to exclusively nurse for the first few months of her child’s life and her husband managed diaper changes and the occasional bottle containing breast milk, allowing him to feel more involved in his child’s care. When she returned to work three months after delivery, her insurance provided her with a breast pump and her employer allowed her to take additional 20 minute breaks twice a day to pump breast milk and store the milk bottles in a small refrigerator. The mother introduced solid food when her child was 6 months but continued to supply her child with breast milk until a year of age. 12. A Haitian women delivers one month prematurely due to pre-eclampsia, a common condition in Haiti. Her infant is smaller than average and unable to nurse for more than a few minutes at a time. The woman’s grandmother is helping to care for her in the hospital and believes that the early milk, colostrum, is bad for baby and tries to finger feed the child water. Because the child is not nursing well, the mother does not produce enough milk. After one week, the infant is lethargic and dehydrated. A local mission group shows up distributing medications and has some extra formula that was donated. The grandmother hears about this while she is getting her free blood pressure medications and takes the formula home for the infant. Within days the baby is much more responsive and greedily sucking on the bottle that was donated with the formula. However, the mother’s milk has now completely dried up so the grandmother returns to the site of the medical mission clinic to get more formula. The medical team is gone but has left a message that they will return in 3 months. The grandmother is able to purchase a small amount of formula in town. In order to make it last longer, the mother mixes it half strength with the drinking water they get from the river. Soon the infant develops diarrhea and becomes lethargic again and won’t take even the diluted formula. The family doesn’t seek medical care again as it is too expensive and their extra money was spent on formula. The infant dies a few days later. Since the mother only breast feed for the first few weeks of her infant’s life, ovulation returns within a few months and she becomes pregnant when her child would have been six months of age. Her mind and body have not recovered from her first pregnancy and due to poor nutrition she again delivers a premature infant. The story is likely to repeat.

Breast feeding provides maternal advantages as well as being the perfect, age adjusted food for children. Mothers who breast-feed reduce their long-term risk of breast cancer, uterine and ovarian cancer. Exclusive breast-feeding is a means of contraception for the first six to twelve months after childbirth, allowing for better spacing of pregnancies when more effective means of birth control are not available. When women in the developing world don’t have access to a safe drinking water supply, it provides their young children with immunity to diarrhea causing illnesses, the #1 cause of death for these children after childbirth.

Formula has its place in infant care but business interests of large US corporations should not take higher precedence over the lives of children. This article in the Atlantic gives a history, both past and present, as to the lengths these companies have gone to promote their products. Email, tweet or phone these companies ( Nestle and Similac) and let them know how you feel about their policies.

Families are changing… and so should their Physicians

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As an ob/gyn in practice for 27 years, I have been present for the creation of thousands of families. In the beginning of my career, the vast majority of those families involved a mom, dad and their biological children. However, over the years family structure has been changing and I have had to change my understanding of family in order to support my patients both during pregnancy and after childbirth. This change became very evident over the past few months as I had the privilege to be present at the beginning of some unique families.

Many of our patients are first generation immigrants with their extended family living abroad. I have had to understand the visa process so that I am able to complete paperwork allowing grandparents to share in the joy of a new grandchild.  Frequently, these grandparents extend their stay for the first year of a child’s life while the mother returns to her job. The stress of living and working in a foreign country can often be exacerbated by the lack of extended family for support.

A patient that we had cared for during her last two pregnancies chose to become a surrogate for a gay couple that resided outside of the US. Each of the men donated sperm that was used to fertilize a donors eggs (not our patient) and the fertilized embryos placed within her uterus to grow into a boy and girl. Seeing the smiles and tears on the fathers faces as they were each handed a baby was a reminder that love is found in many places. Their ongoing concern for the woman who had carried their babies, allowing her to hold and visit the babies during the next months as the paperwork was completed to allow them to take their children home, was a testament to humanity. My patients post-partum visit involved a conversation about loss as well as gratitude for her help in creating a new family.

Pregnancy is not always a risk-free venture. Two years ago one of our patients had an uncomplicated pregnancy followed by a severe post-partum hemorrhage that resulted in a hysterectomy in order to save her life. She and her husband wanted a second child to complete their family and were matched with a local woman to carry their biologic child. The surrogate also happened to be our patient and antepartum visits are scheduled so that both of the women can be there. It was a full house at the time of the 20 week ultrasound appointment when both husbands were also present. The plan is for the surrogate, her husband and their children to remain as extended family after the child is born.

At the time of her annual exam last year, one of my long-term patients that I had seen during the birth of her child 5 years earlier and a subsequent divorce, lamented the fact that her son would not have a sibling and her vision of a family with two children was quickly fading as she approached the age of 40. We discussed other ways to create the family that she wanted and one year later she delivered a healthy daughter that was created with artificial insemination using donor sperm. Along the way she had extended her “village” of support to include men who would provide nurturing to both of her children.

A same-sex female couple also chose artificial insemination with donor sperm but found the selection process for the donor more difficult as the couple wanted the donor to reflect their mixed race relationship. Their beautiful olive-skinned child will be born at the end of the summer.

I always enjoy visiting with my patients at their annual exams, especially when I have a special bond having delivered their children many years earlier. A bittersweet moment happened a few weeks ago as a patient in her late 50’s broke down in tears describing the mental health issues of her son that I had delivered early in my career. Those tears ended in smiles as she showed me pictures of his 3-year-old son that she and her husband are adopting and will raise with the help of their son. Instead of retirement plans, she is making plans for kindergarten.
The unique structure of my own family enables me to understand that the social structure of our patient’s families affect their physical and mental health. After giving birth to three sons, my husband and I adopted two daughters from Korea and China. When a friend experienced premature ovarian failure, I offered to donate eggs so that she and her husband could create a family. Raising children of color in a predominately white society requires discussions about racism and intentional relationships with other cultures. We have developed a “cousin” relationship with my egg donor children that has both challenges and rewards. All of these struggles have enriched our family, but not without the need for some difficult conversations. Part of our job as a physician is to recognize these same familial relationships with our patients so that we can better understand their health care needs.

I can understand the grief of immigrant kids; My daughter was that same toddler 16 years ago

2UBRJBO6VMY67MUDKJSZAO7GOYThis picture of an immigrant toddler on the Texas border has helped to galvanize opposition to the current administration policy of separating children from their parents who are seeking asylum. When I first saw this picture, I was reminded of a similar toddler who had been removed from her caregivers and placed into a strangers arms without much explanation. That stranger was me and the toddler was our 25 month old Chinese daughter.

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But the similarities in these two situations ended there. By all reports, children removed from their asylum seeking parents are placed into large facilities and cared for by a rotating list of individuals.  Our daughter had 2 parents and 4 siblings who devoted themselves to her care and adjustment. She never left my side during the 2 weeks we were in China, sleeping with me and sitting next to me as she ate. We walked the hallways at night as she grieved for her foster parents before bedtime. The grief she experienced was heart-retching but I knew she would adjust over time with love and stability at home.

The children that our government is taking away from their parents don’t have that assurance. They don’t have a single caregiver to hold them, lay with them at night or walk with them when they can’t fall asleep. Many are too young to understand what has happened to their parents. They don’t have permanence in their holding facility. I can’t even imagine the horror that their parents are experiencing. One father has gone so far as to commit suicide.

My immigrant Chinese daughter is now a thriving 18-year-old who just graduated from high school with honors. Our country will be a better place due to her empathy and experiences.  I hope we can say the same in 15 years about the thousands of children that we have cruelly detained because of a “campaign promise” and are using as a negotiating tool for immigration reform.