Gen Z at home and abroad

Shortly after the midterm US elections finished, and with many outcomes still in doubt, I boarded a plane with the final destination of Rwanda. My job was to spend the week as visiting faculty at the University of Global Health Equity (UGHE) in northern Rwanda, supplementing instruction for sr medical students. Due to the differences in the education system, most of these students were age 21-23, putting them in the Gen Z category. More importantly, they are one of first generations born after the 1994 Rwandan genocide. Their memory of this horrific event is only learned thru reading and the trauma that older generations suffered when a civil war resulted in the deaths of 800,000 Rwandans. Since then, the country has been actively working on peace initiatives in order to reconcile its past. Each year an entire week is devoted to peace building initiatives for all ages as they are committed to “Ubumuntu”, shared humanity that is actively expressed through empathy and care for other people.

The students that I worked with reflect this philosophy; they have committed 6 years of their lives to medical education that will be used to care for those Rwandans that are underserved and in mostly rural parts of the country. Just as the majority of the Rwandan parliament is women (61%, highest in the world), 2/3 of the UGHE medical school class is women. The female parliamentarians have prioritized the education of girls and incentivized them to study male dominated professions. The majority female class speaks to the success of these efforts. It is hoped that with more women in higher education and professional jobs, there will be less chance of a future genocide as women are seen as the center of family life.

As I followed the political headlines back in the US, it became apparent that the votes of Gen Z greatly influenced the outcome of the election. Just as the current Gen Z population in Rwanda is the product of societal change, our current US Gen Z population has grown up during an epidemic of school shootings, loss of reproductive rights and increasing polarization of the political parties. They have seen extremists foment violence and deny long-standing medical information and climate change. They want to see government work together and set policies that improve their lives, no matter the political party that is in power.

Due to social media, Gen Z around the world is increasingly connected to each other. They learn from each other how to effect social change and create a society that reflects their values. They increasingly wish for a world and society that is more cohesive and less polarized. I am hopeful that our future looks much brighter as these young people show us a way forward.

Rwandan countryside

Another consequence of the appeal of Roe V Wade; My Ob/Gyn profession

A gift to myself when I finished residency

By the time I had started my ob/gyn residency, Roe v Wade had been the law of the US for 15 years. I never knew a world where patients attempted to end a pregnancy by themselves or in a back alley clinic. When I graduated from residency in 1991, the world of healthcare for women was rapidly changing and improving. Over 50% of residents were now women, the first residency to see that change. Ultrasound capabilities were rapidly changing; we could diagnose an ectopic pregnancy before the tube ruptured and identify fetal anomalies at 20 weeks, when women still had a choice in whether to continue their pregnancies. Contraceptive options were become more than just the pill or condoms. Minimally invasive surgery technology was in it’s infancy but we all understood how it would dramatically change our future careers. Reproductive options were expanding for infertile couples. It was an exciting time to be part of women’s healthcare. 30 years later as I am winding down my career, I am frustrated that we are suddenly losing so much of what we have gained. Now only will healthcare for women suffer, but the training of new ob/gyn physicians will also deteriorate.

Attracting medical students to consider a career in ob/gyn has always been a bit difficult due to high malpractice costs, work hours and caring for only women. Now, more than 90% of ob/gyn residents are women and most are at a time in their life when they are starting families or have young children. Our profession is one of the few that still involves both office and call schedules, rather than shift work. It is a delicate balancing act that is often worsened with sleep deprivation. In states where abortion is now illegal, that work burden will become even heavier when caring for pregnant women with complicated pregnancies; partial miscarriage, ectopic pregnancies, lethal fetal anomalies, second trimester rupture of membranes. Many medical students will decide not to choose a career in ob/gyn due to one or more of the above risks that are unique to our profession.

And then there are the politicians and Attorney Generals. The AG of Indiana recently called out the young female physician who provided abortion care to a 10 year old pregnant child. Previously she had quit working at Planned Parenthood when there were credible kidnapping threats around her daughter. Her entire career could be destroyed by one man. Politicians have wrongly stated that ectopic pregnancies can be reimplanted in the uterus or that there is no risk to a 10-14 year old to carry a pregnancy. Combating these falsehoods while also worrying about risks to family/self and accompanying lawsuits is a scenario many women will not choose for their workplace atmosphere.

Abortion has always been legal while I have been in training or practice. I took that for granted until I started to travel to Haiti for medical mission work in 2006. It was there that I saw the consequences of illegal or self inflicted abortion – women who died of uterine infections or lost their reproductive organs due to uncontrolled bleeding. In the larger cities, entire wards were devoted to the care of these women. Emergency rooms in states that have outlawed abortion will soon start to see some of these very same cases. Unlike my Haitian colleagues, US physicians are ill adapted to know how to treat these complications and may waver in their care as they worry about the legal implications. Worse yet, some may be obliged to report a women who has obtained an illegal abortion.

Maternal mortality is already highest in the states that have chosen to make abortion illegal.

  • Louisiana (58.1 per 100k)
  • Georgia (48.4 per 100k)
  • Indiana (43.6 per 100k)
  • New Jersey (38.1 per 100k)
  • Arkansas (37.5 per 100k)
  • Alabama (36.4 per 100k)
  • Missouri (34.6 per 100k)
  • Texas (34.5 per 100k)

These are also the states where it is more difficult to obtain inexpensive birth control or access to comprehensive sex education. Ob/gyn residency programs in these states will be handicapped as potential candidates preferably seek education in states where abortion remains legal, maternal mortality is low and women have more access to birth control so that pregnancies can be planned.

The governing body of The American College of Ob/Gyn is located in Texas. In order to obtain board certification, every Ob/Gyn has to travel to Texas 2-3 years after finishing residency to take an oral board exam. That exam was made virtual during Covid and was supposed to resume in person this year. Due to an outcry from many in our profession, the exam will remain virtual for the foreseeable future. If our own governing body does not think Texas is a safe place for women, what does that say for the future of women who might wish to practice in those states.

The Book that Deserves to be Banned

Banning certain books in schools has become the current trend to protect a child against uncomfortable information that some parents would prefer be discussed in the home rather than the classroom. This uncomfortable information is plentiful; sex education, sexual orientation, racism, offensive language etc. I would argue that the bible contains all of this information and more, but yet is considered by many who want to ban books as a book that should be taught more frequently in schools.

As a white Christian, I should feel incredibly guilty that some of my ancestors (the Romans) killed a person of color (Jesus), who is considered the prophet of my religion. The way in which he was killed by hanging is depicted at the front of many churches with a cross and sometimes a dead body. That symbol has always caused me to shudder but yet we think nothing of exposing our children to the message via the Easter celebration every year.

The bible has plenty of other stories that parents would want banned from classrooms if they were contained in modern literature. Genesis starts us off believing that Adam and Eve were the origins of God created humans, but then doesn’t explain how the rest of us came to be if they only had 2 sons. Later in Genesis, Lot has sex with his daughters (of course, this is the fault of his daughters and not Lot). The great king David had an adulterous relationship with Bethsheba when he lusted after her and tried to pass off the unborn child as belonging her husband, who he later murdered. The bible is rife with misogyny – women are considered the property of their husbands, they are seldom given names unless they are the mothers of great men, women could be required to marry their rapist, multiple wives were the rule rather than the exception in the Old Testament. So much for the original nuclear family!

Lot and Daughters

As a child hearing bible stories, these are the not the stories I heard or the interpretations that I made. I was left with the impression of Jesus as a kind man who tried to help the poor, sick, women and children. I didn’t focus on incest, polygamy or misogyny because those concepts were above my development level. The same can be said for many of the books on the banned book list. Children/young adults get the message that is age appropriate for them and tend to ignore parts of the story that is beyond their comprehension.

Life experiences also affect how a student interprets a book. Have you ever picked up a book that you might have read and loved in high school and then read again 10-15 years later? Quite often, it is hard to believe that it is the same story that you read before. Life experiences get in the way of how you appreciate literature. I read Gone with the Wind in high school and remembered it as a romance/love story. Rereading it in my 50’s, I was appalled at the racism and treatment of people of color. I had moved from an all white rural community to be part of a diverse urban environment and I was a different person than I had been in my teens. Similarly, students come from many different backgrounds and will interpret literature differently depending on their life experiences.

The other reason that parents want certain books banned is that they feel that sexuality should be taught at home and not in the schools. As an Ob/Gyn doc, I have intimate discussions with women of all ages on a daily basis. This is what I have learned about sex education taught at home.

  1. It is often difficult for women to accept new info that is different from what has been taught by their loved ones. Much of my time is spent dispelling myths that women have learned from their female friends and family.
  2. Info that I learned in medical school is often displaced by new scientific understandings. The most up to date info is provided by someone who does this as part of their job.
  3. Parents have biases and communicate those biases around sexuality to their children. Books and sex ed classes deliver facts that are age appropriate for the developmental level of the student.
  4. Parents often don’t have the “sex ed conversation” with their kids because it is uncomfortable. I had a hard time with my own children when we had the “talk” and they were even more uncomfortable than I was. When no one talks about sex, either at school or at home, the student is led to believe that the subject is taboo and then gets the information in the wrong places (internet).

The attacks on our public schools are numerous and those who speak the loudest are the ones being heard by the public. Only 28% of Americans believe that certain books should be banned from schools. Unfortunately, this is double the rate since 2011. The 72% of us who believe in our education system choosing wisely for our students need to become more vocal and supportive of teachers and administrators. Speak out and Vote!

Mothering our Earth

The initial purpose of this blog was to relate my experiences caring for the mothers in this world as well as my own experiences being a mother. Now that my children are mostly launched and on the long road of adulthood, it has allowed be to reflect on the other parts of our world that need a bit of motherly help. A 2021 report of the UN Climate Group stated “Climate change is widespread, rapid and intensifying.” In order to protect our planet we need to immediately reduce emissions of greenhouse gases. But what can each of us do as an individual to effect a significant change? This was my winter Covid project – trying to understand where I could make a difference to be a better mother to the place I want future generations to live.

I started by signing up for 2 remote classes – Master Gardener and Master Recycling. In the next few posts, I’m hoping to pass on some of the info I learned that can make each of us more aware of our daily actions.

Some of the most jaw dropping info that brought an immediate change to my daily habits centered around our food consumption – or more importantly, our lack of consumption! 30-40% of our food supply gets dumped in the garbage. Since the US always likes to lead the world in whatever we do, it is telling that we lead the world in food waste with the average person wasting 219 lbs of food each year and food waste being the single largest component in landfills. This problem is two-fold. We waste greenhouse gases producing the 40% of food that goes into landfills and is not eaten. And wasted food produces greenhouse gases as it is transported to landfills and decomposes. Here are some of the easiest and most effective ways to reduce food waste.

  1. Make grocery lists/meal plans to avoid purchasing food that may not be used. Learn how to best store your purchases so that they stay fresh.
  2. Cook just enough for one meal or plan on eating leftovers the next day. My family dislikes left overs but has quit complaining so much as it is now a weekly meal.
  3. Unless an expiration date is on a dairy item, it is more of a “best if used by” date but can still be consumed safely.
  4. Compost – backyard or as part of your garbage service. This has made an enormous difference in my household food waste as much of our waste is scraps from fruits/vegetables. I use the resulting compost on my garden each fall. Most urban garbage services now offer composting services. You have to pay a bit more but you also can decrease the size of your garbage container.
  5. When eating out, try to share meals or plan on taking home left-overs for tomorrows lunch.
  6. Eat more vegetables and less meat. The growing of vegetables produces far fewer greenhouse emissions than the production of meat, particularly beef. This is the single largest effort a person can make to reduce greenhouse emissions, much more than driving an electric vehicle or investing in solar power.

There are also health benefits to eating a diet that contains less red meat; lower risk of colorectal cancer, heart disease, stroke, diabetes and obesity. Most Americans don’t have the drive to adopt a completely vegetarian diet, but even reducing our consumption of red meat by 50% would make dramatic changes in our diet and our health.

7. Grow some vegetables/herbs. Although this does not significantly change your carbon footprint, it does make you appreciate the work that is involved with food production and thereby make you a better consumer of all food.

Stuffed peppers using garden grown peppers, basil and tomatoes

Dear America – We Are No Longer Great

The title “Greatest Generation” has been taken. History will not be easy on our current generation when a moniker is decided upon to describe our actions during this pandemic. I’m afraid that the description will be far from Great. In the early days of the pandemic, many of our leaders focused on the economy and the stock market, rather than the devastation that was being wrought on essential workers and those in healthcare. These were the people that couldn’t stay home and have their groceries delivered while they worked remotely. In the waning days of the pandemic, we see those who are vaccine resistant and want others to get the vaccine first while they enjoy the benefits of vaccines; elimination of mask mandates, opening of restaurants and bars, freedom to travel. I see this everyday in my office now that we are starting to see the end of the pandemic. Each patient I encounter I inquire about Covid vaccination status. If not vaccinated, I try to dispel any myths as well as encourage by using empathy to protect those around them. Time and again I hear the phrase, “I don’t want to expose myself to any risk if not getting the vaccine doesn’t affect my ability to live my life”.

The Greatest Generation saw life much differently. They were willing to make huge sacrifices – sending their sons and daughters off to wars, rationing food, growing Victory Gardens and initiating scrap drives. A vaccine that protects not only you but those around you seems minor in comparison to these sacrifices.

I recently finished Andy Slavitt’s book, “Preventable”, that provides an overview of the pandemic both from a scientific and political perspective. He highlights the concept of exponential math involving the spread of Covid. Early on, it was estimated that each person infected with Covid would spread their infection to 2.3 people. Two to three weeks later that original infection had spread to 4000+ people and approximately 10-20 people would die or be hospitalized. And this was before the Delta variant which is twice as infectious. The vaccine not only protects you from being hospitalized or death, but more importantly protects 4000 others around you that you may not even know.

The African proverb of “It takes a Village” to raise a child is something we as Americans need to embody in the future when it comes to how we treat not only our family but those around us that we may not know. It is not only vaccines, but how we should view climate change and the effect our actions have on those in far away countries that suffer the effects of rising sea waters. It is why we should make the minimum wage a livable wage so that parents can support their children.

This post was prompted by a recent visit from special friends. Twenty-nine years ago, I made a decision to help a friend create a family. Twenty years ago, we decided to add to our family by adoption. Four of the young adults that resulted from these decisions were together in the same place for a glorious few days. Despite a gap in ages and living in different parts of this country, they have become fast friends that reconnect within minutes of being together. A long ago decision to help a friend by egg donation coupled with a later decision to expand our family thru adoption is my living example of exponential math. With the vaccine, we may never know how many people we have benefitted from getting sick or dying of Covid, but the low level of infection in those states with high vaccination rates is evidence of the village mentality working. Now is the time to help our village of America so that we all can return to a pre-pandemic life.

The Steep Hill We Still Need to Climb with Covid

I live in Minnesota, where summers are short and highly valued. We Northeners spend our winter daydreaming and planning our summer activities, which was probably even more true during this Covid winter. My plans include backyard dinners, weekends at the lake with family and friends, enjoying the bounty of Twin City restaurants and biking along our extensive network of trails. Unfortunately, some of those plans may not be a reality due to the rising Covid cases in MN. And this predicament is what has brought me the most frustration over the past year; the failure of individuals to follow simple guidelines around masks and social distancing as well as the reluctance to get the vaccine.

My clinic is administering hundreds of vaccines each week and I ask every patient if they wish to be put on the waiting list. This includes pregnant patients, as the evidence is strongly supporting benefit to both mother and unborn child with no evidence of negative side effects. At the time of this writing, 50% of Minnesotans have received their first dose of a vaccine. We need 75-80% of the nation to be vaccinated in order to achieve herd immunity and put an end to this pandemic. Getting the last 25% of the population vaccinated is the steep hill that will take longer and require more encouragement than vaccinating the initial 50%.

I need all of those who have been vaccinated or are waiting for their chance at a vaccine to push our nation up that remaining steep hill. Talk to family and friends who may be reluctant to be vaccinated about your experience with the vaccine. Comment on falsehoods that you see on social media. Restrict your unmasked social interactions to only those adults who have been vaccinated. Continue to wear masks in public until we can achieve herd immunity and the prevalence in the the community is very low. I have included some facts below that address the most common falsehoods I hear from patients during my discussions.

  1. The vaccine is too “new” and I want to see how others do first before I get it myself. mRNA technology was first developed in the 1990’s and has been studied in flu, Zika, rabies and CMV. Widespread use of the technology did not become necessary until a worldwide pandemic occurred. Covid-19 is that event. Are we really that selfish as a nation that we won’t take a miniscule risk of getting a new vaccine in order to protect our friends and family?
  2. I know lots of people who have had Covid and they weren’t that sick. This was especially true during the initial wave of Covid in 2020 but has become less true in 2021 as the Covid variants have become more common. Our hospital beds are now filled with much younger patients who are not succumbing to Covid but who are going home on oxygen for weeks to months. The existence of long haulers disease is a reality that we are seeing more frequently with chronic fatigue, shortness of breath and foggy memory months after initial recovery.
  3. The vaccine can cause infertility by changing the DNA of my cells. mRNA never enters the nucleus of the cell where DNA is housed. Rather, it works as a “messenger” telling the cell to make a protein that is displayed on the outside of the cell and initiates an immune response. There is no live virus involved in the vaccine and the mRNA is broken down as soon as its message is received by the cell.
  4. I have had Covid, or think I had Covid, so don’t need to be vaccinated. I have seen multiple patients who have had Covid twice. Natural immunity has been shown to only last 3 months while vaccine immunity has now been proven to still be effective at 6 months post vaccination and is probably closer to a year of immunity. If you have had Covid, the initial reaction to the vaccine is no different than if you have not had Covid.
  5. People get “sick” after the vaccine. While many people develop a low grade fever and body aches within the first 24 hours after getting the vaccine, this is not a Covid illness but the immune system reacting to the messenger and gearing up for a fight against future infection. If you talk to anyone who has had a moderate case of Covid with days of high fever, fatigue and body aches they would greatly prefer the mild 24 hours of post vaccine reaction.

People want to hear from others they trust about their experiences getting the vaccine as well as the reasons they were vaccinated. Please help health care providers spread the word and get us to herd immunity in the next few months. A Minnesota summer is approaching and I am excited to enjoy all of what is has to offer.

Why getting a Covid vaccine can be a powerful Social Justice statement

I signed up for my chance to get the Covid vaccine within five minutes of being notified that I was eligible. I wanted to protect myself, my patients and my family as well as get back to a more normal lifestyle. I assumed that the majority of my colleagues in healthcare would do the same. We have all seen or heard of the devastating effects that this illness can have on our patients and their families. The science behind the vaccine is sound and the effectiveness impressive. For those reasons and others, I was extremely disappointed when I learned that just less than 50% of eligible healthcare providers at my hospital had taken the opportunity to get the vaccine. The most common reason cited for declining to be vaccinated was “I plan on waiting to see how the vaccine affects others”. We have seen how it affects others – that is the purpose of a large study size that both the Pfeizer and Moderna vaccines have published.

If the science behind the vaccine doesn’t convince you to get your shot, I’m willing to try a second argument. The recent increase in awareness around social inequities has lead many Americans to educate themselves about Social Justice initiatives. People of color (POC) have been inordinately affected by this virus in numerous ways. They are at higher risk of contracting the virus due to overcrowded and often multigenerational housing as well as occupying a large percentage of front line jobs. Risk factors for more severe Covid illness, such as hypertension, diabetes and obesity, are more prevalent in POC. Front line workers often don’t have health insurance and delay accessing a medical facility until they become very sick and further along in their illness. Historical injustices around experimentation with black bodies to further the advance of science has also increased their hesitancy to receive the vaccine.

If you are a white healthcare provider, the most vocal Social Justice statement you can make today is to get your vaccine. Actions speak louder than words. We need to prove to our patients and colleagues who are POC that we care enough about their health and the injustices that have been perpetuated against them to get a vaccine that will decrease the overall viral load in our communities. Getting a vaccine may cause most of us to feel a bit uncomfortable. Compare that to the uncomfortable feeling that POC encounter daily due to the lingering effects of racism that still exist in this country. For a change, let’s see white people leading the charge in this newest social justice initiative.

How Adoption Made me an Ally

Twenty-three years ago when we first contemplated the adoption of a child, I imagined how it would change a child’s life. Our family was able to offer two loving parents, three siblings and an upper middle class lifestyle. At the same time, I had misgivings about taking a child out of their culture and replacing it with another and the hole that might create in their future life. When we made the decision to adopt a second time three years later, I had those same thoughts. Now that these two children are young adults, I realize that adoption changed both their life and mine in ways that I hadn’t imagined and have made me an ally for the complex emotions and stories that define transracial adoptions.

I recognized that our family would look different to outsiders – three biological sons and 2 Asian daughters, five kids when the norm was two. What I didn’t realize is that the interactions my daughters had with the outside world beyond our family, the circumstances that led to the disruption of their original family and the more recent charged conversations around immigration would forever change how I view the world.

International American adoption has benefitted when societies undergo social disruption and are unable to care for families and orphans. It started with the orphans created by the Vietnam War, continued with the social disruption after the Korean War, the One Child Policy of China, extreme poverty in Central and South America due to militia governments and most recently the physical disruption of Haiti after the earthquake. Over the years I have learned that the majority of these adopted children are not true orphans but placed for adoption or abandoned by their families due to a lack of social supports, malnutrition, unaffordable medical bills and desire for a male heir. I have had to struggle with the knowledge that my participation in this system works to perpetuate these structures by infusing money into a country that does not see a need to change their internal policies.

When others remarked how “good, blessed, lucky, fortunate” our daughters were to be raised in an American family, I instantly thought of the opposite connotations that raised regarding their biologic families. The Chinese and Korean families that had been affected by our daughters adoptions made choices that I don’t know if I could have made if faced with similar circumstances. Would I be willing to walk away from one of my biologic children if I thought they had a chance for an improved life outside of our family?

Over the past 4 years as immigration has led to heated discussions and my daughters have moved beyond our protected household and out into the greater world, I have had to reconcile the immigration story of our family with the stories of families south of the US border who have fought to keep their children by making a harrowing journey to a better life. Why is our family put on a pedestal by other Americans while those families waiting in refuge camps are seen as opportunistic and dangerous? Does our American culture value your black/brown body more if you are raised in a white household?

Adoption is complicated… and so is being a parent. I would not change anything about our journey and am immensely grateful that my life and view of this world has been affected by each one of my children. My ongoing task is to be an ally – one who listens to the experiences of others outside of mainstream white America and helps to amplify their voices.

On Reproductive Choice: The faith difference between Melinda Gates and Amy Coney Barrett and what that means for women

I recently finished Melinda Gates book, “The Power of Lift”, and was most impressed by the intersection of her strong Catholic faith and her views on reproductive choice. The Catholic church is often seen in sharp disagreement with not only abortion but also the use of contraception. Ms Gates acknowledges this dissonance and then lays out a thoughtful argument as to why she is able to honor her Catholic faith while at the same time using her platform and funding thru the Gates Foundation to increase access to contraception that enables women to make informed decisions about whether and when to have children. It has been proven that spacing of pregnancies reduces maternal and newborn deaths as well as increases the health of children already in the family.

Foremost, Gates admits that it is not only difficult but also misogynistic for a celibate male hierarchy to be allowed to make decisions about the reproductive life of woman when these same rules can harm the mothers and the children they birth by perpetuating the cycle of poverty. It is her empathy with poor women and children, per the Franciscan teachings of the church, that has led her foundation to provide funding for innovative contraceptive options as well as increased access to these options. Thru her travels in the developing world, she came to understand that contraception prevented millions of unsafe abortions by preventing unwanted pregnancies. While 93% of Catholic women in the US have used contraception, the Catholic church was working to prevent women outside of the US from having those same choices.

Amy Coney Barrett is also Catholic but has chosen to use her faith as a way to limit reproductive options for women in this country. If she becomes the next Supreme Court Justice she may be the deciding vote in overturning access to legal abortions. Even more timely are her views on the Affordable Care Act and what that means for women and their reproductive health. Prior to the ACA, women were required to pay for contraception and could be charged more for health insurance as having babies is a costly endeavor. After the ACA was passed and the more reliable, but costly, long term contraceptive options became available for free, unintended pregnancies and teen pregnancies plummeted and the abortion rate hit its’ lowest point, dropping 14%.

Ms Barrett has a developing world example in her own home. Two of her children are adopted from Haiti. Abortion in Haiti is illegal and reliable contraception difficult to obtain. Poverty is endemic as is the role of men in controlling women’s lives. When women are unable to feed their growing families, they often place a few of their children in a religious sponsored orphanage with the intent that “when my situation improves, I will go back and get my children”. Most of these mothers are never reunited with their children because their poverty does not improve.

I have worked intermittently in Haiti as an ob/gyn physician since 2006. Some of the most horrific situations I have encountered are when desperate woman seek an illegal abortion. The maternal mortality can be exceedingly high when unskilled providers perform medical or surgical abortions. This may be the future of our country if we restrict access to contraception at the same time that we make abortion illegal.

Religious faith can be a powerful force for doing good, as evidenced by the work of Melinda Gates and her leadership in increasing access to contraception, which she believes, and has been factually proven, to lift women out of poverty. . It can also be a force that demonizes the tragic choices that women in poverty sometimes have to make in order to support their children. That is the faith of Amy Coney Barrett.

Dear Educators,

Five months ago, most of us in the medical profession were where you are now. Unsure of what our jobs would look like in the next few weeks and months as well as concerned about our health and that of our families. Who would be making our work place decisions and would they have both the health of medical providers as well as patients in mind. Would we have access to protective gear as well as tests so that we would know who was infected. Would our most vulnerable patients have access to sufficient medical care. The good news is that we are 5 months smarter than we were and have better answers to the questions. The bad news is that we are 5 months down the road and still seeing increasing cases as well as the ongoing belief from some that this is still a “hoax”.

If I could give you some advice, this is what I have learned.

  1. Best practices will change weekly. This is not just due to improved information but also due to rising and decreasing (hopefully!) prevalence in your area. Often when I see a neglected email about an updated protocol, I don’t bother to read it if more than 3 days old because I know there will be an updated version before I finish reading the previous protocol. Get used to change as this is a new virus and we are constantly learning more each day
  2. Trust the people who are making the decisions that drive the protocols. You may not always agree, but you will waste much needed energy if you try to second guess the decisions. This is a time to adopt a military attitude; decisions made at the top that are carried out without debate from those on the front line.
  3. Realize that the parents/students/teachers who disagree with a decision will be the ones who make the most noise. The crowd that agrees will be busy working and getting sh*t done (per usual).
  4. Healthcare and education are both inequitable. This is a time when we need to put more effort into those patients/students who could suffer greater harm. In my profession, we rapidly created a modified obstetrics schedule for high risk and low risk patients, with less in office visits for low risk patients so that we could devote our limited use of PPE to high risk patients that required more face to face time. Teachers will need to find creative ways to do the same.
  5. Share ideas that work both within and outside your school. The amount of conference calls/journal articles/social media groups that I listened to or read helped me feel that there were others who had the same frustrations and also the same successes.
  6. Thinking about returning to the classroom is much more scary than actually being in the classroom with students. It only takes a few weeks to get used to wearing a mask for 8 hours, most teachers were already washing their hands numerous times during the school day and now you don’t have to see runny noses on students as said nose will be behind a mask. Good news is that we should see a much lower incidence of colds and influenza this fall. Australia and South America, which are now in their winter, have already seen dramatic drops in these illnesses as the practices that prevent Covid also reduce other virally transmitted diseases.
  7. Finally – you will hear many more appreciative comments and thank yous. In the early days of Covid, it always put a smile on my face when I saw the chalk thank you drawings on the hospital sidewalks. Parents remember all to well the difficulties they encountered teaching their children in the spring. I am hopeful that they will have a new appreciation for the job that you do and be willing to help their children navigate the unknown road ahead.