Henrietta Lacks in Haiti – Tackling the epidemic of cervical cancer

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For those of you who may not have heard of Henrietta Lacks, allow me to provide a short tutorial of her immortal importance after her death. Ms Lacks died of an aggressive form of cervical cancer in 1951 at the age of 31. During this same time, researchers at Johns Hopkins Hospital in Baltimore were attempting to grow tissue cultures from human cells. Most of these cell lines died within a few days, but the tissue obtained from Ms Lacks tumor reproduced at a high rate and could be kept alive to allow for further study. The cell line became known as HeLa and was instrumental in developing the polio vaccine 3 years later as well as other breakthroughs in medical science. We now understand that the reason that her cells reproduced so rapidly, and also why she suffered from such an aggressive form of cervical cancer at a young age, is that her cells were infected with a high risk strand of HPV (human papilloma virus) which caused uncontrolled growth of infected cells. This understanding has led to the Gardasil vaccine as well as more sophisticated HPV testing, both of which have the ability to eradicate cervical cancer from the globe.

Cervical cancer is becoming strikingly more important from a global health perspective for two reasons:  Maternal mortality has been reduced by almost 50% and HIV infected woman are living longer on retroviral medication. Unlike Henrietta Lacks, most women don’t die of cervical cancer until their 40’s to 50’s. Keeping more women alive in childbirth means that there will be a larger contingent of women susceptible to the effects of HPV. Women living with HIV, although appearing healthy when taking daily retroviral medication, have a depressed immune system and are more likely to develop cervical cancer when exposed to HPV.  Currently, 85% of world-wide deaths due to cervical cancer occur in the low and middle income countries.

During my 25 years of practice in the US I have encountered 4 cases of cervical cancer. Each of those cases occurred in a woman who had not had a pap smear or pelvic exam in more than 10 years. More than 50% of cases of cervical cancer in the US are not due to the inadequacy of screening but rather to the lack of screening. With the recent addition of HPV testing to pap smears, the accuracy of this test has improved even further. My   work in Haiti has revealed a much different picture. In 15 trips over the past 10 years, I have diagnosed 12 cases of cervical cancer, all of which were well advanced. By some accounts, Haiti has the highest incidence of cervical cancer in the world with 94 cases per 100,000 women. Cervical cancer is the leading cause of cancer death in Haitian women, with 1500 Haitians succumbing every year. It kills nearly as many women as all other cancers combined. This is in comparison to the US, where cervical cancer accounts for only 3% of female cancer deaths. Keep in mind that cervical cancer is one of the few cancers that we currently have the ability to not only prevent but also to treat pre-cancerous lesions before they progress to cancer. Cervical cancer can become a forgotten disease in 25 years.

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On the same evening that Henrietta Lacks premiered as an Oprah movie on HBO, I boarded a flight to Port au Prince, Haiti to participate in a conference addressing the need for a cervical cancer screening program in a country with low resources. Members of the Ministry of Health, Haitian ob/gyns and American aide groups came together to discuss and formulate a future plan. We discussed what works and what doesn’t work, the need for education in the community and how best to use limited resources to benefit the majority of women. Haiti sans Cervical Cancer has a tremendous amount of work to accomplish, but is stronger when everyone is pulling in the same direction.

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Partners in Health, known as Zamni Lasante in Haiti, is part of our coalition of Haitian organizations that has approached seemingly insurmountable world-wide public health challenges in the past. They were pioneers in improving tuberculosis treatment when multi-drug resistance to the disease became problematic and were instrumental in bringing HIV medications to poor people suffering from the disease. In both of those cases, the “experts” said it couldn’t be done but PIH proved them wrong. Cervical cancer is an equally deadly disease, killing mothers in the prime of their lives. The solution, however, is much less expensive – receiving 2 doses of the Gardasil vaccine as a young teenager and then a $10 HPV test every 5 years starting in your mid 20s until mid 50’s. By reducing the rate of maternal mortality by 50%, we have been successful keeping many more women alive during childbirth – now we need to tackle the disease that can kill these women later in life.

Fake News in Medicine – or how to get your medical degree from the internet

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A 22 year woman, pregnant for the first time, informed me at her obstetrics appointment this week that she had done “all of her research on the internet” and didn’t want any vaccines for herself or her infant because she is concerned about preservatives. I had a difficult time not asking her what preservative laden food she had eaten the day before. Another patient declined the tetanus/pertussis vaccine that is recommended at 7 months of pregnancy to provide passive immunity against whooping cough to an infant before they become fully vaccinated. This has become recommended due to periodic outbreaks of whooping cough among unvaccinated children. Her reason for declining the vaccine? “My friend told me it is a bad idea”. I spent an extra five minutes explaining why the vaccine is recommended, why contracting whooping cough as a young child can be serious and potentially deadly and that the vaccine has been proven safe in pregnancy. She continued to decline and on her way out the door informed the staff that Dr Jaeger told her that her baby might die.

In the past week in Minnesota there has been an outbreak of measles – 11 children have been affected, 10 of them were not immunized and many required hospitalization. Measles is one of the most contagious of human diseases and it is expected that more cases will be identified. Fortunately, it is very unlikely that any of these cases will be fatal as the children are otherwise healthy and were identified early in the course of the infection. All of these cases occurred in the Somali community, an immigrant population that can be distrustful of western medicine. They are a cohort that is seen as an easy target by the anti-vaccine movement, which spreads its false information via social networks and word of mouth. Studies have documented that Somali parents are more likely to believe that the MMR (measles, mumps, rubella) vaccine causes autism and are more likely to refuse the vaccine than non-Somali parents.

Fake news is defined as false information or propaganda published under the guise of being authentic news. History is replete with medical snake oil remedies to cure disease. But with the widespread acceptance of the internet as a source of information – true or not – the increase in fake medical news has skyrocketed. In an attempt to research what is best for their children, parents can be susceptible to the spread of this false information. Additionally, the anti-vaccine movement is being emboldened by the current Trump administration who has appointed Robert F Kennedy Jr to a task force that purports to investigate the safety of vaccines. Mr Kennedy holds no medical degree, has done no actual research and his intent is to push forward the anti-vaccine agenda with pseudoscience that is difficult for the average American to understand. But when he has the backing of the President of the US, he is given more credibility than he deserves.

Ironically, the anti-vaccine mindset is only possible because medical research and vaccines have almost totally eradicated communicable diseases from the developed world. My patient who declined the pertussis vaccine during pregnancy has never seen a child die of whopping cough, which occurred in 1 out of 5 children in the 1920’s.  As recently as 1980, 2.8 million deaths worldwide were attributed to measles. Global measles deaths have decreased by 79% since widespread immunizations have been implemented. Do we really want to be reminded of what it feels like when you lose a child to a preventable illness?

 

 

Nepal – The land of Everest and Human Trafficking

 

 

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March-June is the height of the trekking season in Nepal. Travelers come from all parts of the globe to climb the highest mountain in the world, Mount Everest. Unfortunately, there is a lesser known but more profitable trek between Nepal and India that is limited to women and children. Poor families in rural areas of the country are fooled into selling their children to traffickers so that they can pay for food for the remaining children. Women are lured into the sex industry and then kept prisoner with violence. The trafficking of women and girls from Nepal to India is considered one of the busiest sex trafficking routes in the world, involving 5000-10,000 females a year.

Bethany Richards, an artist in California, recently had the opportunity to travel to Nepal with the Wall of Hope Campaign. Never having traveled internationally prior to this experience and purchasing her ticket on a whim after meeting one of the mural artists, Bethany had no idea how this trip would change the trajectory of her life. She signed on with the idea that she would be the support team – cleaning paint brushes, mixing paint and hoping that she may get a few brushstrokes on the wall. When one of the artists needed to leave early, she was thrown into the intense day-long process of creating life-size art that was meant to bring awareness to sex trafficking as well as empower girls and women to break thru the cultural barriers that allow this practice to continue.

I know Bethany only peripherally; she is the daughter of my church’s pastor. I recently saw some of her Nepal mural paintings on social media, posted by her proud parents, and was intrigued to find out more. Two hours spent at a coffee shop with her was not near enough time to tell the entire story.  But what I did hear was fascinating and worth sharing here.

Wall of Hope had commissioned two murals to be painted on the European Union and Australian embassy walls in Kathmandu. The first day was spent cleaning and priming the wall, while explaining to passersby the intent of the paintings. 5 – 12 hour workdays later the first wall at the EU embassy was completed.

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The story depicted in art moves from right to left, from darkness into light and from the street to the door of the EU embassy. The woman clothed in a red drape, measuring 6 ft tall and 12.5 feet wide,  is seen reaching out for help with her feet entangled in chains. As your eye moves to the left, a bird is seen breaking thru the chains of bondage, leading to the possibility of freedom. This is followed by the eyes of a Nepali girl, the first eye with a teardrop for sadness/empathy and the second eye bordered on the lower lid by a lotus flower, symbolizing strength and resilience.  The girl is able to see the violence against girls and women in her culture,  but unable to change her circumstances. Behind the eyes is an image of paradise drawn in the style of a traditional Thangka painting, a Tibetan style of art popular in Nepal. The wall appears to have “broken” in this area, allowing the girl to see a paradise that has previously been hid from view. The final painting of a girl and clouded leopard faded into each other is representative of the ability to become powerful even when threatened with extinction.

During the week numerous school groups visited and helped to paint while hearing explanations of the various elements of the painting, a form of art therapy designed to increase awareness about violence against women. Midweek a small group of women from a local women’s shelter visited the wall. Without explanation, they were able to interpret the individual elements of the mural because they had lived the experience of moving from bondage/abuse into a better life.  One of the girls stated that she felt that she didn’t yet have the power of the leopard but she hoped in the future to possess that quality.

The second mural was painted on the wall of the Australian embassy and broadened the them to include child labor. The artists were concerned that the Nepalese would be angry that a Western based organization was exposing a shameful part of their culture. Instead, they received only affirmative responses from the crowds that gathered to watch to week-long painting marathon. Most adults were aware of trafficking and child labor and appreciative that the paintings were not only sensitive to their culture but also that outsiders were helping to tell stories that increased awareness of the problem. One young man shared his story of engaging in sex trafficking and felt that society didn’t condemn his behavior enough. He stayed for 4 days to help with the painting as a way to absolve his behavior.

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 On the left, smoke from a brick factory that exploits child labor is invading the room next to a picture of imprisoned children behind a barbed wire. The bed beneath the frame is representative of sex trafficking; the propped up doll reminding us that these are still children despite their circumstances. Serving tea is a universal welcoming gesture in Nepal with the words on the cup spelling out harmony below the peace flags. The steam emitting from the tea ceremony encircles the grandmother’s smile, signifying the ability of elders to look back in time and find degrees of happiness within hardship. The dancer is performing a Buddhist traditional dance with her expressive hand gestures representative of reflection and being grounded in the past while also looking into the future. The final symbol is the bookshelf in front of an open window, symbolizing that education brings knowledge and can be a window to the future and a better world.

The end of the trip culminated in a gathering of 800 students, ages 13-17 and mostly girls, for International Women’s Day. Bethany was asked to speak and share her personal story with the students. But this wasn’t a story about the paintings. Bethany had another story to share. Despite growing up in a stable family with loving parents who  were able to provide her with food and shelter, Bethany had been the victim of sexual abuse. Not once, but twice. Following is the transcript of her speech.

 

I had no choice. My innocence ripped away from me the first night I went to college. Infant, I don’t remember most of the event. I remember tripping and falling, the rough hand that grabbed me and the mean voice that yelled at me for crying and slowing him down. I remember the next morning waking up alone and realizing what had occurred because my pants were caked in dried blood and my insides hurt. I remember the shame and the pain I hid and carried for over a year before anyone else knew.

And then, three years later, it happened again. A different scenario. My boss and a coworker held me down one night after work while they took turns and choked me while demanding that I repeat words and phrases they dictated. This one, I couldn’t hide. This time, I not only lost my dignity, I lost my job, my boyfriend’s trust and I lost my ability to walk down the street and hold my head up high.
This time, I decided to press charges. This time I went to the hospital. This time, I gave my clothing to the police, gave blood and fluid samples to the nurse and this time, photographs were taken of my bruised body and I repeated my story multiple times to multiple people in order to get the true story. This time, shame piled ever higher.
It’s called the justice system. I thought it would bring me justice, I was told it would ease some of my suffering. A process to right a wrong that was made, to punish the men who scourged my body and who took years away from me through emotional and physical trauma. But the courts didn’t care about me, I was only a number, an unfortunate statistic for their book.
I will never forget the phone call that confirmed this, I was told I had no case because they claimed mine was a he said/ she said situation. There were two of them and only one of me and they said it was consensual, so there was nothing that could be done. The court decided this was not a crime, but if I wanted, I could pursue a civil case.
Just to reiterate, two men almost twice my age, held me down, choked and bruised a 21 year old girl in a restaurant while they took turns sticking their extremities into my orifices and the court system deemed this acceptable.
Think about what that does to a person. Think about the ripples that makes in the life of a girl, in the life of anyone.
In order to prove my innocence to my boyfriend and others who believed the court over me, I continued on with a civil case. I met with a lawyer in a fancy office in a tall building downtown. I was told this would not be pretty, that pursuing a case like this would force me to re-live my trauma and my life would be under a microscope. I would be drilled and have to defend any situation that could be perceived as a lie.
Ultimately, I decided to close the case. You see, I had made mistakes. I took a shower after the event, I didn’t report it until the next day. I had an extensive list of sexual partners, a residual coping mechanism from my first rape; an attempt at normalizing something I had not been able to control. I wasn’t living, I was reacting and I was scared. I did what I felt I needed to do in order to cope with this terrible shame that nobody seemed to care about.
This is why rape happens.
This is why violence toward women continues to happen.
This is why something needs to change.
I married that boyfriend who thought I was at fault in my rape. Abuse and shame were my companions. When the finger of blame is pointing at you from places of power, it becomes truth.
On my 28th birthday, I reached a breaking point, an incident involving a knife was my wakeup. I had had enough. I didn’t know it at the time, but something inside me said, you are worth more.
I am now 31 years old. I have spent the last three years in extensive therapy and I can now proudly say, my body is my own. I relearned basic movements. I relearned how to walk, how to hold my head high. I relearned how to talk to myself and give myself care when needed. I had to relearn how to think of myself as a person instead of an object. I had to relearn how to fear and how to love.
And now?
Now I want to hold all other women in my arms and in my heart. I want to hug you all tight and whisper in your ears that you are worthy, you are strong and you are not alone.
But whispers and hugs don’t stop rape or violence. Abuse, violence, rape won’t stop until we put our collective feet down and say enough. We must influence the perspective of our masses, our countries and our world so that we can heal as a society.
I have found my voice and I chose not to be silent any longer and I call on all of you to join me. Let us all become the role models we need for our children. Join me in saying enough to the perpetrators, the power seekers and the boundary breakers. Remove the stigma of being a victim and applaud them for coming forward. Lets use our voices as a tool to remove the fear and shame of talking about these crimes, because I did not choose for this to happen to me and I do not choose to let anyone think rape and abuse and violence are acceptable. Because I am a human. I am a woman and I have a mind, a soul and my body belongs to me. We don’t have to just survive, but we will all thrive because they might have bruised me, but together we can never be broken.
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Reflecting back on this life-changing experience and being cited as a “modern-day hero” by the audience that day, Bethany has chosen to believe that her past has a purpose – it allowed her to travel to Nepal and share her story, healing not only her heart but also the hearts of many other women and girls. Bethany’s heart has been torn and patched with tears, violence, love and laughter. She has found her leopard and is hoping that other women will hear her story and find the same strength to break free of their chains of bondage.
While the remainder of the team left for other projects, Bethany stayed on another 2 weeks and painted a third mural near a restaurant. Hand prints of girls from the school across the street were used to create the winds of change as a girl in a traditional sari stood in front of the Himalayan mountain range. The owners of the restaurant fed her two meals a day in payment for the painting. Not a bad way to end a life changing trip. Bethany is now working to develop a personal website and explore how she can use her art to empower women and girls throughout the world.
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Our non-traditional family and why it matters

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The non-traditional part of our family

I forget about the unusual origins of my family until I am asked a question or view another family that shares some of our qualities. This happened three times this past week and became a good way to reflect on how far we have come as a society over the past 25 years – and how far we still have to go.

  1. South Dakota recently passed a bill and was signed by the governor that allows adoption agencies to discriminate against LGBTQ couples, single parents, mixed faith and inter-racial couples when it determines placement for children from the foster care system. Since there are many more children in the foster care system than there are prospective parents, this means that children will wait longer for permanent placement. Or, they may never find a forever family. Multiple studies have shown that children raised in non-traditional families function as well as those children raised in traditional families. South Dakota is sacrificing children’s futures due to religious beliefs.
  2. A woman who has acted as a surrogate parent for another couple questioned whether I had a difficult time separating  emotionally from my egg donor children. While I did have emotional moments when the children were young, they have been replaced by a thankfulness for the ability to connect with these three kids as teenagers/young adults. I see my current role as extended family, providing emotional support and fun times that a day-to-day parent is not afforded.
  3. One of my daughters classmates was featured in the local paper this week. His single mother died when he was in middle school and his extended family lived out-of-state. He was taken in by his best friend’s family, where he often lived during his mother’s illness. Over the past 4 years, this couple have become “Mom” and “Dad”.  The parents are white, the young man is black.

Our family is non-traditional: 2 white heterosexual parents, 3 biological children, 3 children via egg donation to another couple and 2 Asian adopted children. 25 years ago when my husband and I were first considering the idea of egg donation for a good friend, we decided that it was to be kept a secret from our extended family. Due to religious reasons, my friend’s family was also not made aware of the origin of a triplet pregnancy. As society changed and the children grew older, the story was explained to relatives and friends. By this time, both families were well established in 2 different communities separated by 5 states and the reactions were overwhelmingly positive.

Adoption stories have undergone the same transition over the years. Many children adopted domestically in the 1940’s thru 1960’s were not informed that they were adopted. As society changed and became more accepting of adoption, as well as the emotional damage that was noted when young adults discovered their hidden origins, adoption became more open and celebrated. Now you can make the cover of People magazine if you are a celebrity in your late 40’s who adopts a baby.

Early international adoptees were seldom connected to their original culture and parents were instructed to raise the children as if they were white and their biologic children. The trouble was that the outside world did not see them as “white” when they became adults, and these adoptees had to navigate the world between 2 cultures, one of which they had few connections to. Diversity training for potential adoptive parents is now part of the adoption process. The Asian culture camp that we attend each summer has many discussions about culture, identity and diversity.

The role of  mom/parent has been the most rewarding/difficult part of my adult life and one I would not trade for any other experience that I have had. Being able to offer that opportunity to a friend was an easy choice despite the knowledge that there may be bumps in the road as the children became older.  Providing a home to children born in another country was also an easy choice as I knew that love developed while caring for a child and was not necessarily automatic. Each of these choices was made available to me as a white heterosexual female married to a white male who shared a mainstream religion. We are not special and should not be any more privileged than a gay biracial couple who is able to meet the same requirements for providing a home for a child in need of a forever family. Religion, sexual orientation and skin color are only part of who we are as individuals. Loving children and providing them with a home and future should be open to all of us.

The cost of being a woman

 

Two headlines caught my attention this week. One focused on the luxury tax for tampons that is part of the law in 46 of the 50 states. The other headline was buried in all of the news about the Republican sponsored Health Care Act.  Tom Price, head of HHS, would like to see the co-pay for contraception reinstated. As part of the ACA, contraception is free under the majority of health care plans. Both of these costs are charged to women. On a monthly basis this may not seem too costly. But let’s look at the average sum that a woman would need to pay over her lifetime for both tampons and contraception.

Tampons: an average woman uses 30 tampons for each menstruation. A box of 36 tampons costs $7 at Target. That amounts to 360 tampons per year or $70. When multiplied x 35 years that costs a woman $2450.

Contraception: Prior to the ACA, an average co-pay per month for birth control pills was $30. If a woman were to start pills at age 20 and continue to age 45 it would cost $9000 for contraception.  The average family size is 2 children, so you could subtract $1000 for the time it takes to become pregnant and the pregnancy itself. I would argue that there are other costs during that time that offset the $1000 (maternity clothes, nursing bras etc…) but those are probably considered “luxury items” by society standards.

$10,450 is the total cost of tampons and contraception for a woman during her lifetime. But some of our lawmakers want to extend this burden even further, questioning why men should have to help pay for maternity care as part of health insurance. Despite the backing of Ivanka Trump, I doubt that the current legislature will approve any bill that provides for paid maternity leave. Women caregivers are the norm for elderly parents who need assistance and many choose to decrease their paid work commitments to provide this care.

At what point will our society honestly discuss the financial inequalities that exist between men and women?  Male partners should share the finances of contraception – much cheaper than the cost of supporting  a child to age 18.  Women should not be the only members of society that are burdened with the cost of maternity care.  Removing the luxury tax on tampons is a no-brainer as I have never heard any woman describe her period with the work luxury.  And I have heard many words used to describe periods! Paid maternity leave is present in  every  country in the world other than the US and Papua New Guinea. If we want to make this country great, maybe we should start with the women.

 

International Women’s Day #Be Bold for Change

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The message for today, International Women’s Day, is to call on yourself and others to work together to forge a better working world – a more gender inclusive world. As I write this entry, I am reflecting on the headlines this week that are not exemplary of that aim.

  1. Stories about nude photos of female Marines that were published without consent to secret websites.
  2. Moves to defund Planned Parenthood – an organization that provides contraception and cancer services to low-income women
  3.  A potential ban on refugees, the majority of whom are women and children,  from war-torn countries.

Discouraging to say the least. But them I remind myself to take a look at the world now as compared to 50 years ago, both for myself and for women throughout the world. When I finished my Ob/Gyn residency in 1991, 22% of all Ob/Gyn providers were female. Currently 85% of Ob/Gyn residents are female and since 2003 female applicants for medical schools have outnumbered male applicants. Most college campuses are 55-60% female. Women are making their way up the ladder in education and the next mountain to scale is the workplace.

In the greater world, extreme poverty has been markedly reduced over the past 25 years. Women and children are disproportionately represented in this sector so will see a greater benefit when they have enough food to make them more productive workers. Educational opportunities for women in the developing world are increasing at a rapid rate and with education comes the ability to control the size of your family and participate in higher earning jobs.

We still have work to do in this world to equate opportunities for women. #Be Bold for Change within your neighborhoods, places of worship, social environments and workplace to create equality for women,  because when we all have the same opportunities everyone benefits.

Dear Kellyanne Conway – This is what feminism looks like

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Ms Conway spoke at the CPAC convention last week on the contemporary definition of feminism as anti-male and pro-abortion. I consider myself a feminist and don’t identify with either of these definitions. I heard about her commentary as I was driving between appointments and reflected on my “feminist” activities on the same day as she was speaking at the convention. Following is the run-down of what a feminist does on her day off from her usual job as a physician serving women – the ultimate feminist job.

  1. Awake at 6 am to make breakfast for daughters as they head out to high school.
  2. Text with 26 year old son about upcoming interview for nursing school.
  3. Spend 2 hours on Haiti non-profit, Helping Haiti Work, that grants microloans to women and operates a sewing center that constructs reusable menstrual pads for sale in the community. Women that participate in this program are empowered to be leaders in their families and communities.
  4. Volunteer at a local public elementary school tutoring first graders in reading and math. 90% of the students in this school are children of color. The teachers are dedicated and constantly working to involve each child in the curriculum.
  5. Grocery shopping for the week. My husband and I split this task, but he often does more than 50%. Arrive home and start dinner in crockpot for husband and daughters as we will be eating at different times. I cook because I love to and not because I am the mother. Husband also does his share of meal prep.
  6. Drive across town to the MN legislature. I have volunteered to speak before the Health and Human Services Committee in opposition to 2 bills that are being introduced to restrict access to abortion. I am NOT pro-abortion, but rather pro-choice and pro-contraception. Along with many of my colleagues, I feel that government should stay out of the room when a physician is counseling a patient.
  7. Attend a year-end meeting of our independent medical clinic, one of the few non-hospital owned clinics left in our area. I am a board member of this clinic and up for re-election so give a 5 minute speech about the value of independence and what measures we need to take in the future to stay that way. My value as a board member is based on experience, working hard and ability to appreciate other’s opinions. Being the only female board member is a responsibility I do not take lightly.
  8. Head back to St Paul to attend a visit to an Eastern Orthodox church, arranged thru Tapestry, an interfaith group of women that works to break down religious and cultural barriers thru education and service. I am proud to be one of the 3 founders of this growing organization but saddened to know that our existence is needed now more than ever. It was interesting to hear the stories behind the iconography that is so much a part of the Eastern Orthodox religion, but also to reflect on the similarities between the Jewish faith and to view the women in the pictures as wearing the traditional head coverings or hijab. During the social hour following the church tour, I lamented with my Muslim friends about the difficulties of encouraging our teens to stay involved in their respective religions. We found that we shared many of the same difficulties as well as joys.
  9. Arrived home around 9:30 and discussed husband’s experience at local town hall political meeting that was attended by 1000 constituents but not our legislator. We made plans for future involvement in politics and discussed our shared values with our daughters.
  10. Crawled into bed around 11 pm as I had an early morning surgery and clinic the next day. This is where the real feminist is unleashed – advocating for free birth control, vaccinations, knowledge about our bodies and how they work and access to health care as a human right and not a privilege.

Feminism is the right to be treated as an equal human being and to be able to make our own choices. That is not anti-male or pro-abortion. That is human decency and what I teach both my sons and my daughters.

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