When the Refugees are your Neighbors

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This week, the people of Syria have again made the front pages of the news as President  Bashar al -Assad continues to exert his control via military force and now chemical weapons.  For most Americans, the discussion about these individuals is abstract as we don’t live next door to them. Their needs don’t impact our daily lives or finances. We view their stories in the newspaper but they are invisible in most of our schools or churches.  Americans can debate whether the United States should become militarily involved in the Syrian civil war or whether we should continue to accept immigrants that have become displaced by the conflict.  But what happens when you live in a country where those refugees come from just a few miles away and aren’t allowed to integrate into their new communities?

If you are a citizen of Greece, refugees are your daily reality. The Greek island of Kos is only separated from Turkey by 2.5 miles of the Aegean Sea. Migrants from Syria, Afghanistan and parts of Africa arrive on the shores of this island daily during the summer when the ocean waters are calm.  125,000 refugees have been relocated to camps in Athens and other Greek islands. Greek citizens cannot escape seeing, hearing and discussing refugee issues as the burden of caring for these people affects their daily lives.

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I recently had the pleasure to interview two Minnesotans who have volunteered to work in Greek refugee centers and been witness to some of these difficulties first hand. Dr Dave Dvorak and Rachel Hovland, RN, have spent 2-3 weeks working in medical and construction projects on Samos Island and in Athens. They shared many of the same observations:

  1. Syrian men, often highly educated and previously holding middle-income jobs in Syria, exhibit a senses of hopelessness, depression, uselessness, boredom and anxiety. Women continue with their daily housework and childcare activities and tend to fare better psychologically.
  2. Housing is provided in many different forms. Before coming in contact with aide groups, refugees may only have makeshift tents.  Some previously abandoned buildings that were part of the Olympic venue now house 200-400 people per building and separates the women and children from the men and older boys. This tends to exacerbate the problems listed in #1. Women care for each other and create a community structure within their building. Young men become angry and frustrated and often demonstrate and riot.
  3.  Providing medical care/contraception to women can be challenging as husbands don’t want their wives to use birth control and their culture isolates them from healthcare provided by male health care workers.
  4. Many of the refugees have used up their entire savings to leave Syria as they are charged $750-1000 euros per person for boat passage. They have seen their family members killed and their homes destroyed and realize that they don’t have a country to return to even if the conflict is resolved. They will always be Syrians who live outside of Syria.
  5. Everyone is waiting for travel papers to get somewhere else in Europe while realizing that they will be moving away from other Syrians and their only remaining support system. Most of them will be taking jobs that are much below their educational levels and having to learn a new language.
  6. The children are the element that help to elevate the mood of adults as they play and live in the moment. More organized school classes are being arranged by outside aide groups, but the children are quickly falling behind in their studies and soon must learn a new language with their move beyond Greece.
  7. The surrounding Greek community, initially resistant and fearful of the refugees, has gradually become more accepting as the refugees spend their monthly food dollars in the markets and are seen as customers.

I cannot even imagine the horror experienced by Syrian refugees as they have watched the events unfold over the past week. Their neighbors and remaining relatives may have been involved in the chemical weapons attack or may be in the cross-hairs of retaliatory American military strikes. While worrying about the remaining Syrians in their homeland, they are barraged with headlines as to what the outside world thinks of their country and whether it is necessary to intervene. There are no simple answers but the problem is more than just about ruling a land – it is about the people who have called this land home.

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The post-childbirth changes we hide from you.

Last week my daughter goaded me into attending a yoga sculpt class with her as part of her recovery from knee surgery. I participate in hot yoga once a week but had never been lured into the high energy, loud music of the class next door. I knew I was headed for trouble when they instructed me to pick up hand weights before rolling out my mat. Shortly thereafter, the throbbing music started and we were swinging our arms with weights attached. I was managing to keep up, with only a few short breaks for a gulp of water, when the instructor started us doing the dreaded jumping jacks.

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I have birthed three children. I exercise regularly. I am not overweight, don’t smoke and used the bathroom before class. It DOESN’T matter. I can’t do more than a few of those jumps before I start leaking urine. This is probably the reason they make patterned and dark-colored yoga pants. Many of my patients report the same experiences;  Jumping jacks and jumping on a trampoline provoke urinary leakage. Childbearing did this to us….and those changes extend far beyond urinary leakage. Following is only a partial list of what to expect post-childbirth.

  1. Weight – most women retain 5-10 lbs after each pregnancy.
  2. Jelly belly – flat abs of our teen years are a distant memory
  3. Saggy breasts – breast-feeding for a full year is great for your child but does a number on the aging of breast tissue
  4. Emotions – I watched Sophie’s Choice before I was a mom and loved it. Can’t ever go back and watch it again post childbirth. Same for Saving Private Ryan.
  5. Sex – not only the physical changes but also the inability to relax while worrying about the children sleeping in the next room or what time you need to get up in the morning.
  6. Multi-tasking – It seems that we need to always be doing two things at once if we are to get all accomplished. Folding clothes while helping with homework or cooking and making a grocery list.

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But no fear – I have found a cure for all that ails us as women. Steaming your vagina is puported to detoxify and clense your vagina, strengthen and tone your entire reproductive sytem (no more leaking of urine or saggy breasts!), speed healing after childbirth, alleviate pain during intercourse (but the kids will still be next door), balance hormones to reduce PMS and allows one to better cope with unresolved emotional baggage (maybe that is why I can’t read Sophie’s Choice). I didn’t make this up as it is word for word from the website. And all of this for only $399 that includes the wooden seat and the customized potpourri mix. Maybe this technique will even allow me to have another child in my post-menopausal years so that I can try again to get the parenting gig correct.

 

 

International Women’s Day – The Lessons I have learned from Haiti

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As I watched the powerful feminist speeches at the Academy Awards this week, I reflected on my experiences in Haiti that have made me an advocate and messenger for women not only in the developing world but also here in the US.  Unlike women in Hollywood, Haitian women often don’t have a voice – either in their homes or their communities –  but what happens outside their sphere of influence can make an immense difference in their daily lives.

Haitian women, similar to women in most developing world countries, perform all of the household and child-rearing chores with no help from their male spouses. These tasks are often accomplished without the benefit of running water or a steady supply of electricity. No refrigerator, washing machine, microwave, toilet.  Monetary funds are controlled by their spouse and may be wasted on drink and games of chances, while the pantry is empty of food and the kids need new shoes. Physical and emotional abuse is overlooked by a society that places a lower value on females.

These same women have taught me what perseverance and a source of income can accomplish. Each year when I return to Haiti, I am able to meet with the newest microloan group and connect with some of our previous Helping Haiti Work loan recipients. I impress on the women who have been successful in loan repayment that they owe it to the new loan groups to give them advice and support. Numerous of these women have related their personal experiences of the benefits of the loans. Not only do the profits help with clothing and food, but the women are given a higher status in both their immediate family and in the community. Their husbands treat them better because they are bringing money into the family. The women have control over how the income is to be used. Their children see them as a more capable adult and that hard work has more than one dividend. Other women in the larger community ask their advice and apply for the microloan program.

We are also seeing some of these same changes in the women employed by our sewing program. They have brought us ideas as to what products they think will sell well in the market rather than only sewing the reusable menstrual pad kits and diapers.  One of our seamstresses was proud to use some of her funds to pay for a needed surgery for herself. Each time we visit with them they are becoming more outspoken and empowered.

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My journey to make all of this happen also requires perseverance and the commitment to empowering Haitians so that they are better able to help themselves and each other.   I am often asked why I don’t focus my fundraising efforts on causes that would benefit women in the US rather than Haiti (that is another blog post in itself). Just as the Hollywood elite are using the #TimesUp movement to bring recognition to those women who may not have a voice, I hope that the monetary loans provided by Helping Haiti Work and the examples of female leadership by our participants will touch many more women than just the ones that we serve.

Come join us this weekend as we listen to great music from the 60’s and 70’s by the band Morpheus and help to raise money so that more women in Haiti can be empowered to make a difference in their lives. Visit Helping Haiti Work to purchase tickets and for details of the event.

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Female Body Parts 101: The cervix – Soon to be #1 Cancer Threat to Women Worldwide

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I have previously written about the uterus and menstruation, but have been lax in finishing the reproductive system. Two patient stories reminded me of how neglected the cervix can be.  As I was interviewing a new patient, age 24, I noted that she had not received a Gardasil vaccination in her teen years. I informed her of the benefits of the vaccine, preventing Human Papilloma Virus (HPV) infection of the cervix, thus markedly reducing her long term risk of cervical cancer. The vast majority of cervical cancer is caused by HPV, with strains 16 and 18 accounting for 70% of cervical cancer. The vaccine can be administered from ages 12-26 in both boys and girls and is covered by insurance. Following our discussion, she declined the vaccine stating “My family doesn’t believe in vaccines”.

Later in the week, I was called to the ER to see a 65 year old woman who presented with vaginal bleeding after menopause. She had not seen a physician since her last child was born in her late 30’s. A large tumor had completely replaced her cervix and was extending into her uterus. Her survival chances are around 60% – after radiation, chemo and extensive surgery. Due to age this woman did not have the option of a Gardasil vaccine, but the cancer could have been detected in a pre-cancerous state by a pap smear and easily removed via an office procedure.

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Obtaining cells for a pap smear

The cervix is a muscular structure that is located at the top of the vagina and encompasses the lower third of the uterus. It is the gateway that allows blood to leave the uterus during a period and remains closed to keep the developing fetus inside the uterus until labor ensues. It responds to uterine contractions by slowly dilating to allow for passage of the infant.

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Pap smears were developed to screen for pre-cancerous changes on the cervix that could be treated before they developed into cervical cancer. We have only recently discovered that HPV is the virus that causes cervical cancer and now screen for HPV when we do pap smears. HPV is a virus that is passed back and forth between men and women during intercourse. It is a silent infection in men – no symptoms, no testing available, no treatment and no long term health consequences. Completely sexist but so are many health problems – ie breast cancer, pregnancy, uterine and ovarian cancer.  So it only follows that vaccinating young men to prevent them from transmitting the virus will help to reduce the burden on women.

Pap smears should be performed every 3-5 years, depending on age, and don’t need to be performed after age 65 if you have not had an abnormal pap in the past 10 years. A common misconception is that pap smears are performed whenever a speculum is placed in the vagina – NOT!  Pap smears are never done in the ER or urgent care, even if a speculum is placed or pelvic exam done. You just need to believe me on this fact.

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By 2020, cervical cancer is expected to exceed deaths during childbirth as the number one killer of women during their reproductive years. Currently, 70% of cervical cancer is diagnosed in the developing world due to lack of screening for pre-cancerous abnormalities. In 2011 Rwanda initiated a school based vaccination program for both boys and girls and thus far has a 93% coverage of eligible youth. The current rate in the US is 60%, with many states less than 50%. Rwanda, still recovering from a horrific genocide and 70% of it’s population rural, beats the US in vaccination rates by a great distance. We are the richest country in the world with the most expensive health care system. Treatment for the 65 year old patient described above will cost hundreds of thousands of dollars. Where are we willing to spend our dollars?

Cervical cancer is one of the few cancers that is well understood and has a single cause; HPV.  We have the ability to eradicate this cancer in the near future via robust vaccination programs and regular screening. Former president Jimmy Carter had a vision to rid the world of Guinea Worm, a parasitic infection in tropical countries. It will soon be the second disease eradicated in the world, after smallpox. Cervical cancer can be #3 and the first cancer.

 

Birth vs. Adoption; Child vs Animal

 

15 years ago this month I was agonizing over the delay in travel plans to China where we would meet our soon to be 2-year-old daughter for the first time. Fast forward to last week when that same daughter, now 17, lamented that the rescue puppy we were adopting was getting older without her. Although we have had 3 dogs over the past 29 years, this is the first dog that we have obtained thru a rescue agency. I am impressed with the thoroughness that is provided to make sure that each dog goes to a home where they will be loved and well taken care of.  I am saddened that we as a society do not do as good of a job with children – both those who are born into a family and those who are adopted. Over the past month we have been made aware of the family in California who kept their children hostages in their own home while using  home-school as the cover and the father in Texas who disciplined his newly adopted daughter so severely that she died.  I was struck with the similarities between adoption of an animal and a child and believe that we would make lives better for our country’s children if we borrowed some of the same guidelines.

  1. Home Study – Thankfully we passed both the child and dog home study. Slightly different requirements each time. We didn’t need a fenced in yard for a child, but did for a dog. All family members required an interview for the child but not the dog. Fifteen years ago the house was large enough to add a fifth child; today the house is too empty and we are adding a dog. In contrast, no home study was required when I became pregnant with each of our first three children. In my job as an ob/gyn,  I often recite a silent prayer when discharging infants to a parent that I feel is living in a dangerous situation or has had difficulty taking care of  herself during pregnancy. The lives of many children could be remarkably improved if we were proactive in helping families provide a safe living situation.
  2. Cost – The cost of a child adoption, whether domestic or international, is something that many families are not able to afford or need to take on additional debt to accomplish.  The cost of a rescue dog adoption is considerably less but still significant.  Creating a child is free. I wish there was a warning before conception similar to the one on the rescue dog webpage. “If you don’t think you can afford the adoption fee, you probably shouldn’t consider adopting a dog”.  Access to free birth control and improved contraceptive education would help to reduce the incidence of unplanned human pregnancies – currently at 50%.  And when you plan a pregnancy, you are much more likely to be able to afford the costs of raising a child.
  3. Parenting – As part of the child adoption classes we attended, we heard from parenting counselors about problem solving and resources for seeking help. We agreed to puppy obedience classes as part of the dog adoption and were instructed in how to perform redirection type of discipline. No formal parenting training was provided for my birth children. I quickly learned with boys that parenting is similar to dog training – short, repetitive commands with frequent redirection and lots of love. We could help break the cycle of child abuse if we required basic parenting classes of both birth moms and dads and resources for follow-up support.
  4. Healthcare –  We needed proof of medical insurance with the adoption of a child and were encouraged to purchase pet insurance for the puppy adoption. Many children in this country don’t have health insurance because their parents can’t afford it. Needed childhood immunizations and check-ups are put off, only to incur greater healthcare costs later in life. This is only one of the litany of reasons why our healthcare system needs to change.
  5. Food – The multitude of choices for puppy chow is overwhelming – organic, high protein, vitamin supplemented, minimally processed.  We were instructed in portion control and not overfeeding.  Putting a priority on feeding children similar quality food in appropriate amounts would pay dividends in reducing the epidemic of obesity and diabetes. If I wouldn’t give my dog a Happy Meal with a Coke, why should I feed it to my children?

Our puppy has now been home a week and has settled into a routine. That process took much longer for the Chinese 2-year-old. Different language, food, smells and faces, in addition to grieving for her foster family, required 3-4 months to produce a child who slept thru the night and allowed her dad to hold her. Giving her wings this fall as she moves on to college will likely dredge up memories of those first few months; sleeping beside her so she could fall off to sleep, sharing a meal @ 3am as she recovered from jet lag, listening as she lost her Cantonese language and formed a new vocabulary in English. Tears will be shed on that day – mine for sending off the last child to college, hers for missing her dog.  But she has assured us she will facetime weekly – if only to see her dog.

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My Love Affair with a Sh*thole Country

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I first visited Haiti in 2006. It was not love at first sight, or even a like. I spent a week on a medical mission trip, missing my family and sweating in the operating room while I performed some of the most difficult surgical cases of my career, without adequate lighting and unfamiliar instruments. Climbing the steps of the airplane to return home was a welcome relief from the searing heat of the tarmac and the aroma that is Haiti (think rotting fruit mixed with exhaust fumes and burning charcoal). I’m not sure when the amnesia set in over the next few months, but I was soon planning my return visit the following year. 15 or so trips later, I look forward each visit to spending time in a country that I have visited more frequently than any other.

My  trip last week coincided with the recent comments about Haiti from President Trump. While he was ranting about the immigration of Haitians to America, I was participating in distributing microloans to a new group of 10 Haitian businesswomen. The women received $200 to help fund their small businesses and will be responsible for paying back the loan over 10 months with a low rate of interest. Each of these women has worked hard selling clothes, food, shoes and motor oil to support their families. This is in addition to the daily tasks that a Haitian woman must perform without the benefit of running water or electricity. Entitled or lazy would be the least descriptive terms that I would use.

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The following day I worked with one of the Haitian seamstresses that we employ to construct reusable menstrual pads for distribution to Haitian girls. She uses a manual sewing machine and is able to make $4 a day working  5-6 hours. She also participates in menstrual hygiene instruction at area schools so that young girls will have the benefit of knowledge about their bodies and not the fear that her generation of women experienced. She has no desire to immigrate to America away from her family, but wants the opportunity to make her life in Haiti more comfortable.

I am not quite sure why this country has occupied so much of my time, energy and pulled at my heart. The opportunity to leave a frigid Minnesota in January makes the idea of sweating in the operating room more palatable. But is much more than that. Haiti is a land of contradictions – corruption and family strength, sadness and laughter, illiteracy and value of education.  There is very little black and white, rather many shades of grey. But it makes my brain think and try new ideas, something that is more difficult to do in my American job. I have been the recipient of many opportunities in the US, and although I have worked hard and been the first to graduate college in my immediate family, there were many along the way that provided encouragement and a helping hand. I would like to think that I can be that helping hand for Haitians – providing business loans for women, saving a baby’s life when her mother is suffering from seizures/eclampsia, removing an enlarged uterus so that a woman can better perform her household chores and providing education and hygiene products so that young girls are able to stay in school during their period. Yes, Haiti is a destitute country that has suffered from both outside forces and its own corruption. But its people are willing to change that – if we would only give them a fighting chance. And remarks such as those from our President don’t help to provide that chance.

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The Search for Happiness in 2018

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With the upcoming New Year, most of us will make resolutions that we seldom are able to keep beyond January. Many of those resolutions revolve around changes in diet and exercise. Because if we are more fit and weigh 10 lbs less we will be happier.  Health clubs depend on the uptick in memberships in January, but they would not be able to sustain those memberships if everyone that signed up continued to attend on a weekly basis. So what can make us happy beyond January 2018? Dan Buettner, a native Minnesotan and author of “The Blue Zones of Happiness”,  has studied cultures around the world that live successfully into old age with the greatest degrees of happiness. Membership in a health club was not on the list of lessons for longer living, but an active lifestyle was. The other lessons included:

  1. Socialization – face to face communication, not work related and not social media. The happiest people socialize 6-8 hours a day with positive minded people and often use humor in their conversations.
  2. Financial Security – but more money does not always buy happiness and usually has the opposite effect.
  3. Buy experiences, not things. A good experience gains luster with time.
  4. Eat more fruits and vegetables, less meat. Eat less processed food. Share meals with friends, especially friends who laugh.
  5. Find a purpose in your life – whether that be at work or in volunteer efforts.
  6. Pursue an inquisitive life by learning and trying new things.

I recently had the opportunity to check a box on my bucket list and unknowingly incorporated all of the above into my 10 day journey. It involved a trip to the tip of South America and an awe inspiring 5 day trek in Torres del Paine National Park, Patagonia. We had the opportunity to sample the local cuisine – grains, vegetables and seafood in plentiful supply. We became acquainted with new friends that were part of our trekking group and shared stories of families and work as well as the events that occurred during our daily travels. Each day was a new adventure and involved learning about the history, flora and fauna of Chile while laughing, fording glacier fed streams and climbing rock fields.  I was able to put aside the divisive culture that has become so prevalent in our country as I didn’t have internet access.  My time was spent framing pictures for my camera while laughing at the stories from my fellow trekkers. All of this for me invokes true happiness. So it was no surprise when I realized that the National Geographic magazine that I had purchase just before we left was the “Happiness” issue and included many of the above items that I have come to believe can make us all happier if we are only willing to listen.

I believe that a large part of my job as a doctor is to help patients stay healthy thru improved lifestyle and circumstances. As detailed in the National Geographic article, happiness doesn’t come thru reading the latest self help book or making a New Years resolution. The best way to be happy is to not worry about being happy but surround yourself with the right environment and relationships. Pictures can often be more informative than words, so enjoy some of the many pictures that help to explain the above.

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Humor as we dressed for our zodiac ride

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It is easy to be happy when this is your trekking view.

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The camera that never left my neck, even over water.

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My crazy friends from Germany, Chile, UK and US.

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My personal stairmaster

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Sharing food, drink and conversation after a long day on the trail.

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Quinoa, radishes and mushrooms.