Bookclubs: A call to Action against Racism

I live in Minneapolis, Minnesota. Until recently most Americans had difficulty finding us on a map in the middle of the country. Because of George Floyd and police brutality we will be forever linked to the events that occurred on May 25th, starting a chain of protests across our nation and beyond. My emotions since then have turned from profound sadness to anger and now to needing to create some long lasting justice out of this event.

Over the past week I have reached out to acquaintances that have been active in racism education, inquiring whether they could speak to my bookclub and help us to understand our history as well as a new way forward. The answer I received was short and to the point. “Nope. Thanks for asking but we (African Americans) have been writing about this for years and now white people need to use all that material to educate themselves.”

I am hopeful that this will be a “different time and a different season”, the words spoken by Al Sharpton at George Floyd’s eulogy, and this can finally be the time to change the conversation around racial inequality. But for that to happen, we need to move beyond protesting and determine how we got to this point before change happens. Americans in rural parts of this country, who may never see a person of color other than on tv, are just as much in need of education as those of us who interact with a multi-racial population every day. Rural or urban, books and tv are available to all of us.

I would like to see book clubs, ubiquitous in every state and country, as a good starting point to ignite discussions around racism as well as a path forward for change. Each community in this country is unique and therefore transformation should also be unique. The discussion of a book is an opportunity to better understand what the author intends while also attempting to recognize how each reader uses their worldview and life experiences to form an opinion.

If every book club in this country would commit to reading one book on racism each year for the next five years, we could continue this conversation and affect change both in our community and in our children. Arm yourself with knowledge and allow the written words and experiences to open up a different world. Don’t walk away when the discussions become uncomfortable. It is in that space that understanding can happen. Ask your local independent bookstore to not only order your chosen book but to also stock additional books about racism so that other patrons may benefit. And finally, when your book club has finished the book, please donate them to the public library so that there is a supply for those who are unable to afford purchasing books.

Children and teens are no different. They need to see children that look like them in a story as well as children that appear different and have experiences that they see as foreign. When children/teens don’t hear diverse stories of others, they learn to fear what is unknown….just like adults. Book clubs can use their financial capabilities to purchase and donate books to school libraries and classrooms while also stocking those same books on home bookshelves for their children to read.

The lists of anti-racist books are endless and include both fiction and non-fiction. Out of this list of 61 books by Ibram X. Kendi, I think most book clubs could find a few that interest them. Children’s books don’t necessarily need to highlight racism, but can help to initiate conversations about differences and how we react to those differences in people, whether it is skin tone, religion, country of origin or socio-economic level.

We as white Americans are responsible for making this a different time and season. We need to commit to move the anti-racist caravan forward, however slowly, to create a better world for our children.

The new Wild West – Procuring PPE

Although it has just been 5 weeks since the United States went into quarantine, it seems much longer for hospitals and clinics that are not only trying to care for both Covid and non-Covid patients but also attempting to secure supplies of personal protective equipment (PPE) for their health care workers. Hospitals have first priority for masks, leaving clinics woefully under-supplied. Luckily, I am part of a large group of women who volunteer their sewing skills to create reusable menstrual pads for distribution in developing world countries. We repurposed the cotton used in the construction of the Days for Girls menstrual kits to make fabric masks. Other groups throughout the city had the same idea and soon elastic for the ear loops was difficult to obtain.

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Ingenuity during this pandemic has been incredible and others have shared their solutions via the internet. The University of Florida designed a mask using recycled blue surgical wrap, normally thrown away after it has been used to protect sterilized instruments. This material is flexible, 99% impermeable to pathogens and can be re-sterilized multiple times for reuse. Our sewing group moved from fabric masks to the blue wrap material without a hitch in the process and soon had constructed 500 masks for both clinic and hospital use. Since then we have welcomed five additional sewing groups and will have finished 2500 masks by the end of this week. The masks are being used at both North Memorial Hospital and Voyage Healthcare clinics. As shipments of mass produced surgical masks make their way to our healthcare businesses, we hope to redirect the energy of all these seamstresses and provide masks to local organizations who may need them in the coming months.

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Why American doctors and nurses are ill suited to handle a pandemic

This statement includes me. Healthcare in America is different, both good and bad, than anywhere else in the world. When questioned, most Americans think of our country as leaders in medical technology and innovation. This pandemic is showing that perception to be far from the truth, as well as bringing to light the flaws in our training and how we practice when faced with a serious contagious disease.

Infectious disease pandemics don’t happen on our shores. We hear about Ebola in West Africa, dengue fever in South American, hepatitis and SARS in Asia, malaria in Africa, but we don’t experience the day to day reality of what that means. Our only experience is influenza, and despite the availability of a vaccine for this infectious disease that kills 30,000 to 40,000 each year, only around 40% of our population is immunized. Basic infectious disease precautions, such as hand-washing or staying home when we are sick, are often overlooked in our efficient and rushed society. Physicians have been shown to have the poorest performance in the hospital setting when it comes to sanitizing their hands between patients.

American healthcare is a disposable society. Nothing is reused between patients, even if it can be re-sterilized, to prevent cross contamination and increase infection. Three months ago we would have been reprimanded for wearing the same mask between two patients. Now we are reusing that same mask for a week. Surgical drapes and gowns are disposable. In my work in Haiti and Vietnam, almost all instruments are reusable, gowns and drapes are cloth and rewashed and sterilized, masks are worn until they are unusable. Healthcare in America needs to learn to use our resources better, especially in a time of plenty so that we have reserves for times such as these.

Most of us are highly specialized. As an ob/gyn, I have never managed ventilator settings and only performed one intubation in medical school. I would be ill equipped to help out in an ICU setting. The same is probably true for the majority of American doctors if we were called into service to start IVs and draw blood. In hot spots such as NYC and New Orleans, fourth year medical students are allowed to graduate early if they are willing to work in a hospital caring for Covid patients. These newbie physicians have more of the needed skills than those of us 10 years out from medical school.

As physicians and nurses, our daily work most often results in the recovery and improvement of a patients health. We are not accustomed to caring for a patient for 2-3 weeks, with all of the medical technology that we have available, and then seeing that patient die despite our best efforts. In places like New York City, health care workers are not returning to work as they are unable to psychologically handle the senseless deaths they see daily. America has not experienced a war zone on its shores since the Civil War. This is a war zone when it comes to death, an experience that other parts of the world have seen more recently.

Informed consent is something that is drilled into our heads from early on in our training. Patients need to be given all of the options for their medical care, free from our personal judgement, along with the risks and benefits of each option. Covid doesn’t allow us that luxury. Often, patients have to be intubated emergently and informed consent is not an option. When ventilators are in limited supply some high risk patients, such as those with a terminal disease, may be offered comfort care rather than aggressive management.

When Covid is still fresh in our minds, but not in our bodies, Americans and healthcare professionals need to reexamine how we can change our medical system for the better so that our future response to an infectious disease is more streamlined and less chaotic. We need to use the innovation that makes us world renown to equip us for a new tomorrow.

Health Care Providers are stressed….and it’s not what you think

I would like to thank everyone who has reached out to to health care providers and expressed their gratitude for our work. The sidewalk in front of the hospital is full of chalk messages of encouragement that we see when we walk into work each day. But unless you are a physician in a current “hot spot” such as New York City or New Orleans, the rest of us are spending our time waiting. Waiting for the anticipated surge of patients that most of us have not seen happen as of yet and hope that won’t happen. The anxiety involved in the wait can be worse than being in the battle.

In preparation for the possibility of a marked increase in cases, our clinic doors have been closed to the majority of patient visits. This is not only to decrease the risk to patients of sitting in a crowded waiting room, but also to decrease the risk of transmission to health care providers as well as to conserve the supply of personal protective equipment (PPE).

Although the financial focus has been on the layoffs in the hospitality industry, health care workers are being laid off in unprecedented numbers. Numerous ambulatory clinics have made the difficult decision over the past weeks to furlough a large contingent of their employees. If there are not patients coming in our doors to generate revenue, we cannot continue to pay the majority of employee salaries. Many of the staff that I work with are not only co-workers but also friends. Some have more resources than others. As a small business, we need to make sure that the business is there and viable when this is over, so that we are able to rehire our employees. Hospitals have asked nurses and operating room personnel to take paid time off as operating room schedules have moved to emergency only cases. Physicians are taking enormous pay cuts of 50% or more.

This list of stresses could go on and on but here are just a few more that I have heard over the past few weeks.

1. Family members that work in health care. The majority of us, physicians, nurses, respiratory therapists, love our jobs and have passed that on to our children. Many of them have followed us into the profession of caring for others. My oldest son is an RN on the Covid rule-out floor in Vegas. My sister is an RN in a cardiac cath lab where emergency procedures are the norm and there is no time to ask a patient questions about Covid symptoms.
2. As medical professionals, we are often the source of factual knowledge for our friends and family members. Now many of us are being asked questions about hoax-type cures, unproven theories about the origin of the virus and when this will end. My best advice is to follow whatever Dr Fauci says. He has been thru this before with other epidemics and speaks truth to power.
3. The realization that many of us will probably become infected. Despite best practices, 10-20% of health care providers in China and Italy have been infected. The percentages in Singapore and Hong Kong were much lower as they had better access to PPE and fewer patients. That is why it is so important that Americans follow the simple rules of social distancing, handwashing and keeping your hands away from your face. The less of you that are in need of care, the lower the percentage of health care workers that will be infected. It will also give us time to improve our supply of PPE.
4. The lack of leadership from the top of our country. Rather than implementing uniform best practices determined by a scientific, medical committee that has access to the latest world-wide information, we are forced to make up our own policies with the information that we can glean from our colleagues in the hardest hit areas. These policies often differ from hospital to hospital and create angst among employees as to what is most correct. While our colleages in Seattle and New York are taxed with caring for massive numbers of patients, they are also trying to disseminate what they have learned so that they rest of us are better armed for the battle.
5. The realization that Americans will forget what science has tried to teach us. I continue to have pregnant patients refuse the flu vaccine (despite its demonstrable efficacy) so I can imagine that many Americans will refuse the Covid 19 vaccine in the future. This pandemic has demonstrated that co-morbidities such as diabetes, hypertension and obesity, can put a person more at risk than advanced age. Maybe the need to stay at home, go for walks to relieve boredom and cook real food will give Americans an incentive to consider further beneficial lifestyle changes in the future.

Thank you again for your thoughts and words of encouragement. Just realize that our stressors are some of the same as yours…but also different.

Period Poverty

My kids loved creating tree houses, similar to the picture above, in our back woods. They even asked to sleep in them a few times but were never able to make it past the first hour. Imagine sending your daughter to one of these huts that is far removed from your house each month for 5-7 days when they have their period believing that your daughter is “unclean” and cannot share food or lodging with the rest of the family. That is the practice in many areas of rural Nepal and the rustic structures are referred to as menstrual huts. Each year there are reports of several women dying due to smoke inhalation, snake bites or freezing.

Those of us who live in more developed countries may feel that the stigma of menstrual huts is not something we need to be concerned about. But developed countries have their own way of shaming women who menstruate. Many religions do not allow women to fully participate in their faith while they are menstruating as menstrual blood is considered ritually unclean. In the Orthodox Jewish culture, women have many restrictions for 2 weeks each month (the week of menses and the week following) and must bath themselves in a ceremonial bath before returning to their “clean state”. Orthodox Christianity does not allow women to receive communion while they are menstruating. Muslim women cannot enter a mosque, participate in Ramadan prayers or fasting and must complete a ritual washing before they become clean again and can participate in religious activities.

Most of us remember our middle/high school years when we could be excused from gym classes for the “illness” of menstruation. Our first hint that monthly bleeding could be expected was usually conveyed in secretive tones with the caveat that we were not to share the information widely. Although we do not partake in a ritual bath, many advertisements around menstruation products use the words fresh, clean and deodorized. I am often reassuring both young girls and women that menstrual blood does not need to be bright red to be healthy.

The tampon tax exists in 32 states, whereby tampons and pads are taxed as luxury items with a surcharge of 6-9%. While band-aids, sunscreen and condoms can be included in deductions from Health Savings Accounts, pads and tampons are excluded. Tampons and pads can’t be purchased through government assistance programs like SNAP or Medicaid and shelters and food banks say that they’re among their most-requested items. Most of us are familiar with the scrambling needed when you get unexpected bleeding and although we can afford pads and tampons, would appreciate the availability of free hygiene products available in schools and universities as they are in Scotland.

When my daughters want me to pick up tampons or pads on my Target trips, they often screenshot me a pic of the exact product. When we were in China, accessing pads (no tampons available) required finding a pharmacy and asking for the product at the desk as they were not displayed on the shelves. Only one brand and style available. Girls in these countries are fortunate to have hygiene products available as girls in developing countries, especially those in rural areas, have no products available and often are relegated to using rags that need to be rewashed and dried each month. The proportion of girls who stay in school after they get their period takes a dramatic downward turn as they are unable to manage their bleeding when away from home.

Imagine using this bathroom to manage your menses. There is no lock on the door to keep it shut, no window to provide light, no receptacle for used pads, no hook to hang your clothes if you need to change clothing due to an accident. This is the most common type of bathroom that exists in rural schools in developing countries.

Period Poverty exists in areas throughout the world as girls and women are limited in their ability to go about their daily lives, limited financially with extra monthly expenses, limited in their ability to participate in religious functions, limited in school attendance and as demonstrated by menstrual huts – their lives can be in jeopardy.

What did the mother of Jesus know about maternal mortality?

During the Christmas season, many of us are reminded of the part of the Christmas story where an angel speaks to a teenage girl and tells her not to be afraid that she has found herself unwed and pregnant. Sermons thru time have often focused on the accusations that Mary would face in her community and the punishment of stoning as reasons why Mary was fearful and put her trust in God that this would all work out. As an obstetrician I have always thought of another reason that she would be fearful; fear of death in childbirth or shortly thereafter.

We have no statistics as to the maternal mortality rate in biblical times. The first evidence in the early 1800’s was that 1 out of every 100 women died during childbirth, or a 1% chance of death with each pregnancy. With no access to birth control and marriage occurring around age 13-14, Mary would have had 5-7 children before she died of “old age” in her mid 30’s. Overall, her risk of dying due to pregnancy related complications was 5-7%.  As well as seeing an angel in her dreams, Mary may also have seen visions of her death due to post-partum hemorrhage or puerperal sepsis (childbed fever), the two most common causes of maternal death in 1800.

Just a few millennium later, newspapers headlines in the US have been announcing the rise in maternal mortality, especially for women of color,  in our country as compared to other industrialized nations. Although we are not even close to the 1% maternal mortality rate of the 1800’s, the US rate of  24 per 100,000 pregnancies far exceeds the lowest rate in Finland of 2 per 100,000 pregnancies and the overall rate of 8/100,000 deliveries in the European Union. Even more concerning is that the US rate has risen since 1990.

What is happening in the US as compared to other industrialized countries? Why is it less safe to have a baby here than in Belarus? When we compare healthcare for women in the US to those countries with lower rates, we find a few glaring discrepancies.

1. Lack of access to universal healthcare. Expansion of Medicaid after the Affordable Care Act was not equal in the US and we are now able to see what a difference that has made. In those states where Medicaid dollars cover pregnancy, the maternal mortality rate is lower compared to states that have not expanded access. This expansion not only benefited mothers but also decreased the rate of infant mortality, especially among women of color. Women who do not receive prenatal care have a 3-4 times higher risk of maternal mortality.
2. Contraception. In developed countries with access to free or low cost birth control, the average number of children per women is just under 2. The conservative agenda in this country has decreased the number of reproductive health clinics that supply many women with birth control options, increasing both the number of unplanned pregnancies and the maternal mortality as these women are less likely to seek prenatal care and be able to adopt a healthy lifestyle during pregnancy.
3. Chronic Health Conditions. The epidemic of obesity in the US as compared to other developed nations has increased the rates of chronic hypertension, heart disease and diabetes both before and during pregnancy.  Pre-existing conditions such as these are now the leading cause of maternal mortality as compared to complications of delivery, such as hemorrhage.
4. Diverse Population. The majority of the countries who have the lowest maternal mortality also have a homogeneous population: Finland, Japan, Iceland, Singapore. They do not have to deal with as many genetic and lifestyle factors when working to reduce overall mortality. African American mothers have a 4x greater risk of maternal mortality and also have higher rates of obesity and hypertension as well as lower socio-economic status. We have many more moving parts of the problem to tackle in this country as compared to the EU.

Solutions to this problem come both from a policy perspective (universal insurance coverage, access to contraception) and individual lifestyle change to reduce obesity, hypertension and diabetes. The mother of Jesus did not have many choices in her life – her job was to become a teenage bride and produce children until her reproductive years were over or until death, whichever came first. Today, we have choices. Vote for those who support equal access to reproductive health care as well as universal pregnancy coverage.

 

 

Creating an Intended Family

Earlier this month I had the honor of speaking at the local Resolve seminar, a day for people who have been challenged in their family building journey to educate themselves about the various options. I was speaking as a patient and not an ob/gyn physician, although my experiences helping create families via non-traditional options certainly had an impact on my presentation. For those of you who may be new to my blog, a bit of background. I started writing because of my personal experience with non-traditional families as well as my work as an ob/gyn physician both in the US and abroad. My immediate family is comprised both of biological and adopted children. My extended family involves three children who were created thru my egg donation to a friend. All of these children are now young adults, ages 19-29, and we recently had the pleasure of adding our first in-law when my son was married.

Walking into the Resolve conference brought back numerous memories from my brief time as a patient in the infertility world. Countless pieces remain unchanged… the injections, uncertainty, invasion of personal space both physically and mentally to name just a few. However, much has changed with improved technology. No longer do you need to find a friend/sister if you are in need of an egg donor, as technology has advanced to allow for the freezing of both eggs and embryos (fertilized eggs). Young women can donate their eggs just as men have been able to donate sperm. Surrogates or gestational carriers are available if a couple is in need of a person to carry their pregnancy.

I was asked to speak not only about my experience as a known donor, but more importantly about the experience of an “open” donation where all of the children were aware of their biologic relationships. Traditionally the majority of couples that have used either egg or sperm donation to create a child have kept that part of the infertility journey secret from their child and family. Research has shown that open adoption, or the knowledge from an early age about how you became part of your forever family, allows for development of better self confidence and identity. Due to the advent of genetic testing thru such services as 23andme, it is believed that anonymous sperm and egg donations will soon be a thing of the past.

Eight children connected thru both nature and nurture has had few drawbacks in our families. Our agreement early on in this process was that any children created thru the donation of my eggs would be made aware of their origins, as would children that were raised by my husband and myself. My husband and I chose to tell the story to our children individually around age 10 at a time when they could understand the biology involved. Our families had remained friends and it was often uncanny to see the close relationships between the children despite only seeing each other every 1-2 years.

As I spoke, I realized one of the most important lessons I have learned during this journey. Although there were four adults involved in the decisions that were made to create our “intended families”, our children are required to navigate the family bonds and stories behind their origins. These stories involve loss of biologic parents and culture in international adoption, living in a multi-racial family that often draws unwanted attention and vying for parental attention and resources as a triplet. It is not my story to tell any longer as these children are the individuals that will write the remainder of the book as they live their lives.

 

Love Them First: How to Make A Difference

My Love Them First post last week compared the community around two schools – one in North Minneapolis and one in rural Minnesota. Kate O’Reilly from Minneapolis took the Star Tribune article about Worthington to heart and started a Go Fund Me campaign to provide assistance to immigrant students with both monetary funds and a coat drive. It was featured in the local Worthington paper and has raised just over $10,000 already. Funds are to be donated to the Immigrant Law Center of Minnesota in Worthington as well as the Nobles Country Integrative Collaborative, a consortium of school districts promoting community acceptance of cultural differences.

The rural-urban divide has become a catch phrase to describe political differences, economic disparities and racial animosity. This is a wonderful opportunity to show rural Minnesota that we not only understand the burdens that immigrants can have on schools, but also show our support and offer encouragement by demonstrating how immigrants have improved our urban areas. I grew up in rural Minnesota and have lived in urban areas since my early 20’s. I understand the divide but am hopeful that situations such as this will generate more bridges than partitions. Please consider donating so that immigrant students are given the resources to be successful … and we can start to heal a fractured society.

Love Them First: 2 schools, 2 different responses

Two news articles, albeit from different ends of the spectrum, caught my attention last week. The first article described the conflict in Worthington, MN created by immigrants and unaccompanied minors from Central America. The second article described the impact that teachers and a principal in a North Mpls school working together to help their students succeed. Both touched me in different ways; I grew up 30 miles from Worthington and my current job involves taking care of families that live in North Mpls.

As an obstetrician, taking care of pregnant women is part of my job. However, my job doesn’t end once a child is born. Raising a child is much more difficult than a 9 month pregnancy and a journey that requires medical and emotional support. Keeping a mom healthy via preventative health care, providing information on birth control options and screening for mental health problems are all part of what I do as a gynecologist. Healthy moms who feel connected to their community give a young child the best chance of success in life. For these reasons, I also volunteer at an elementary school that has a large percentage of children that qualify for free/reduced meals. These children are often in need of extra help with encouragement, tutoring, mentors and guidance.

If you want an inside view of the struggles that many of these children face, “Love Them First” is an inspiring documentary about an underperforming school in Minneapolis where not only the teachers but the entire school staff is committed to lifting up their students. It also opened my eyes to more of the inequities and injustices that my patients and their children face every day as a person of color. For the month of October, this movie will be streaming for free on the Kare 11 webpage. Make sure a box of kleenex is close to you while you watch.

The article about Worthington is how individuals can choose to close their minds and hearts to the struggle of children in need. Many of the townspeople are upset about the change in demographics as recent immigrants from 80 different countries comprise 1/3 of the population. This has put a strain on the schools, not only in increasing numbers of students but also in the need for language and tutoring services. The immigrants have  traveled to this town on the wind swept prairie for a good reason – the draw of jobs at meat packing plants that require minimal education or training. Jobs that local residents do not want and would otherwise be unfilled. The tax base of this busy food industry fills the coffers of many small towns while the immigrant work force opens ethnic grocery stores and restaurants to further improve the health of rural communities.

Rather than refusing to greet these students as they board the bus, as described by one farmer turned bus driver, or organizing a community to vote down a school referendum, the residents of Worthington could live out their Christian faith by seeing  immigrants as a means to authenticate the message of Jesus. Love Them First as the staff of Lucy Laney in Mpls has chosen to do. Volunteer in the school as a tutor so that when that child graduates from high school, they feel the support of the local community and choose to live and work where they have friends and family.  See immigrants as opportunity, not a burden.

 

Why Gratitude can be difficult for Immigrants and International Adoptees

Rep Ilhan Omar has recently been criticized for her lack of gratitude to America, a country that took in her parents as they were fleeing war-torn Somalia. The reasoning is that she should not criticize America because this country “saved” her family and provided her with the educational tools to become a legislator.  Further, Rep Omar should be more humble and refrain from criticizing the injustices that she sees in our country as well as our policies abroad, especially when it concerns Israel.

These criticisms have brought back memories of similar conversations that I have heard in international adoption circles. Some adult adoptees have coined the term “toxic gratitude”.  International adoptees are expected to be grateful to their adoptive parents as well as the US for saving them from a life in their birth country.  How can you be grateful for losing not only your birth family but also a birth culture, growing up in a country as a minority rather than the majority? Gratitude implies choice. Adoptees don’t have a choice in their circumstances, in the family or countries that become their forever home. They should not be burdened with the additional weight of gratitude.

Similarly,  immigrants often don’t have choices. If their home country was stable they wouldn’t be looking for a different country to call home. They wouldn’t be leaving a language, culture, food and family to relocate to a place where all of these items present new and difficult challenges. When they arrive in America, they are expected to embrace all that is America without hesitation or criticism. How dare immigrants be ungrateful for the material wealth and opportunities that America can provide.

A recent patient shared her immigration story from an African country with me when she was discussing her post partum low mood. If she had had her baby back in Africa, she would be surrounded by friends and relatives that dropped by daily to visit, often without calling first. Food would be prepared for her and household duties completed. She moved to this country years ago to provide a better future for her children. Now she is questioning that decision, as the lack of community in this country seems too large a price to pay. Would we call this ungrateful or constructive criticism of our culture?

Many adult women in the Somali culture have undergone female circumcision prior to their arrival in this country. Western terminology used to describe this practice include mutilation, illegal, abhorrent and disfiguring. Should Somali women now be grateful that they have escaped this practice for their daughters, only to be raising their daughters in a culture that accepts breast implants and labiaplasty?

Many medical professionals that immigrate to America do not have financial resources to commit to redoing their education in this country. I have worked with many medical interpreters who were esteemed physicians in their home country. Are they to be grateful that their years of medical training and language skills only allow them to explain medical visits to more recent immigrants?

When there is dysfunction within a family, often it takes an outsider to provide better insight and allow each of us to examine what we value in our relationships. Immigrants have the ability to bring the best ideals from their countries and mix with the best traditions from America. We are and have always been a country of immigrants. We should allow immigrants to be a reflection of what is best in this country and acknowledge that we are not perfect but can strive to do better. I am grateful that I have the opportunity to learn from them and share their stories.