Cold Spaghetti

The New Year is upon us, which means the families of New Orleans are gearing up for two seasons: Mardi Gras and School-finding.  Schools have their application deadlines about now, along with lotteries for selection into charter schools and deposits to hold places in prospective elementary (and in some cases pre-k) schools.  It’s a big game in these parts, a system built on payment and privilege from start to finish.  For many schools, families are required to shell out big bucks (think, $300+ per kid) for an “evaluation” of their 3 or 4 or 5 year old child’s “intelligence” in the hopes that if he or she is granted a “gifted” distinction that would allow them eligibility.  For the private schools, it’s yet-another-hurdle to cross.  For the public-schools-gone-charter, it’s a way to keep some screening in place.  (Plus, schools get extra funding if they provide services to a “special needs” population — meaning that programs to fill the needs of the “gifted” 5-year old are abundant in New Orleans.)

As you can tell from my liberal use of quotations, I think the whole system is sick.  The measure of gifted-ness by our local evaluators are, at best, an assessment of how much time a parent or other caring adult has spent nurturing that particular child’s creativity and spirit.  In reality?  Well, children that go to the paid evaluation service have a much greater likelihood of walking away with an intelligence label than children who go to the school system’s service.  We all know it is ridiculous; no one I know actually takes any of these tests seriously.  It’s just one more stupid hoop we have to jump through to navigate our families through the murky and dangerous waters of New Orleans education.  You do it because you have to and then you move on.

One of my largest frustrations is that I have absolutely no idea how I could even begin to advocate for any type of change.  I do believe that personal is political — but that doesn’t mean I’m simply going to send my kids to the public school down the street.  How can I advocate for change when I am using every bit of privilege we have — economic, social, racial — to see that our own children are given the best opportunities we can provide?

These are my frustrations with our local schools.  That they are structured, specifically, to enforce class barriers and continue to be successful in their intent.  It forces me to consider dark and ugly realities of our world and consciously decide where I want to put my children within them.

*****

Even before our kids were born, we knew that early immersion in a second language was our absolute, number one priority for our children.  One of the reasons we love being in New Orleans is that we are able to give our children that gift of immersion right here… in immersion schools.  New Orleans has a number of schools, both private and charter (public) that run language immersion programs.  Each one runs a bit differently, but the bottom line is this: from pre-school through 5th grade, students are taught in a language other than English for every lesson.

Our children have attended a French immersion school for the past 1 1/2 school years.  Our school is private.  The application did not require intelligence testing or extensive observation, focusing instead on questions designed to assess the family’s level of commitment to immersion education.  Other immersion programs run as charter schools through the public school system.  They have yearly lotteries which take in various demographics of applications to ensure diversity in each class.  For Paul and I, immersion schools are the programs of choice.  These are the educational experiences that make life here unique and special.  We believe it’s worth living here to take advantage of those opportunities.

There are scientific reasons.  Language development is time-sensitive in the brain.  It’s easier to learn languages at younger ages because of how the brain develops.  Over time, various doors of opportunity close.  For example, the ability to acquire the sounds and accents of a native speaker ceases around age 6.  In short, if you want to give your child the gift of language — then the earlier you immerse them in it, the better.

Plus, there are other benefits.  Child education and development literature talk about strides in cognitive development in immersion kids compared to English-only education — stuff like more flexible thinking and greater ability to handle nonverbal problem-solving.  Also, there are three decades of solid evidence that immersion kids perform better in both standardized math and language tests administered in English.  Yes, yes, it’s true: putting your kid in a school that teaches him all day in a language OTHER than English will, in fact, improve their English more than if they were in a school that spoke English to them all day.

In short, hearing a second language on a regular basis from a live human being is a great thing for kids.

But.  Being part of an immersion program takes a big leap of faith for an English-speaking parent.  For one, teachers are not necessarily fully fluent in English.  This can be a little unsettling for parents, naturally, because communicating with your kid’s teacher about complex behaviors and assignments and who-knows-what-else is pretty darn important.  But is it a deal-breaker?

Well, Paul and I speak Spanish.  We’ve lived in Latin America over extended time periods (though never longer than 10 weeks) and know what it feels like to work to understand and be understood.  We’re not native speakers nor are we fluent — in short, we’re not unlike many of our kids teachers.  Having been in the hot-seat ourselves (so to speak) we do have a good sense of what they feel when they try to talk to us and we know how that the in-ability to find the “right” word in English does not mean that they don’t understand us, the problem, or our child.  It takes a leap of faith on our part that they are competent in ways that we won’t necessarily see: in their work, in their nurturing of our kids, in the curriculum.  Within many aspects of the school-child-teacher interaction, there are cultural and linguistic factors to consider.

That said, last year, it was Will’s teacher who suggested that Will was having trouble hearing.  (She was 100% correct.)  This year, his new teacher continued to help us with Will’s hearing problems, as well as with his particular learning style.  When we have had a question or a concern, cultural and linguistic differences did not matter.

For us, we have found it exciting and educational to learn some French.  Will and Kate participate in French holidays, learns French songs, sees French cartoons, reads classic French tales, and cooks French foods.  Each and every one of these have been different from the early education experiences had by Paul and me; but we are enjoying each opportunity.  It is a big leap of faith for parents, because it is so different: school performances aren’t of Row, Row, Row Your Boat — but of Le Petits Poissons.  I admit that I feel some relief when Will spontaneously sings Down By the Bay, or Jingle Bells, because I want him to know these songs, too.

It is both exciting and scary that he is learning things I cannot teach him.  Even more, he is learning things that I, myself, don’t know.  That, I think, is the greatest sacrifice a parent makes within these programs — you have to trust someone else so much that you are willing to let them teach your child things that you, yourself, don’t understand.  It’s sort of scary to suddenly not have total control and awareness.  It requires a big leap of faith.

Even with that uncertainty, we love the immersion experience.  Will’s enthusiasm for French is inspiring.  We are impressed at Kate’s sophistication regarding language, her clear comprehension of the many ways there are the communicate, and how many words exist to describe the same thing.  It was no small feat to trust in a system completely new to us and we can confidently say that we are thrilled: our children love their school and embrace the culture and language it teaches.  We enthusiastically recommend immersion education and are grateful to be a part of our school.

*****

But then there is the here and now.  Rising tuition is forcing the questions of schools, which forces me to the harsh reality that the quality of schooling my kids are getting is not commonplace.  ALL kids should have access to education that fosters their creativity, imagination, and spirits — that gives them new skills and confidence.  And I feel badly that I am better positioned than others to fight for my child’s right to that experience, and guilty that I am weighing financial considerations into the equation.  Will we find a more affordable immersion experience?  Will we be able to afford another year where we are?  Is there a clear “right” choice in there that we are missing?

I’m so glad Harry Shearer gets it.

He spoke compelling at today’s Rising Tide, poignantly describing the how New Orleans lost the media battle regarding the city’s story of Katrina, the Flood, and recovery.  He’s absolutely right, of course.  Read any article about New Orleans’ recovery and go to the comments; they are ripe with misinformation, sweeping falsehoods, and complete hatred towards this city and the people within it.  The reason it’s important for the people of New Orleans to continue to tell the story is because, somehow, the facts are still not understood: that this city was destroyed in a man-made disaster, a Flood that occurred when a Federally-funded agency failed to perform as it had been designed to perform because it was never built correctly.  And I can’t believe we still have to say this, again, but FOR THE LOVE, this city is NOT below sea level!  Can we move on now, please?

(See some video of Shearer’s speech here.)

—

A last minute cancellation resulted in my being a member of the Health in New Orleans panel (versus its moderator) — along with two well-known, established mental health professionals.  One is consistently named a Top Female Achiever in the City for her well-respected work with the police mental health crisis unit; the other, a psychiatrist and medical director for a large local non-profit.  I was an out-of-left-field addition to this group… I don’t have one primary affiliation with one organization, my scientific perspective is a bit different (public health), and I’ve spent nearly 4 years volunteering and researching how clients and health promoters navigate the waters of New Orleans social systems.

I wasn’t intimidated by the other panelists, but I definitely wanted to take the conversation to other places that I didn’t feel it was going (or maybe could not go).  Instead of sticking to questions and topics that had been pre-arranged, the my fellow panelists opened the talk to the floor to do a large Q&A.   What followed were a lot of discussions about local services, which I don’t find particularly useful in this type of venue: the panel wasn’t envisioned as a laundry list of mental health services for a reason, because people tend to not remember those sorts of specifics.  (If you want to list services or achievements or whatever, bring a resource guide and pass out copies.)  Panels, I feel, should build on that sort of available information.  A more productive conversation may be one that discusses how we can supplement existing programs.  As an example: what can be done to better support families to care for their loved ones transferred to facilities an hour or more away with the closure of NOAH?   Or maybe a discussion of the sorts of a strategies we all can use to handle our own stress and mental illness outside of seeking professional providers?   In my thought, the power of a group like RT is when you excite the room — after all, these are folks who write and read and write some more — so I think it’s important to try and throw out big issues.  Let people get charged up and see what types of good actions come out.

I did try to throw in a few cents — pointing out that health is so much more than access, more than doctors and medicines.  We are resource-poor in New Orleans, without a doubt, but focusing on access and getting more providers and opening more clinics and getting more people health insurance is ultimately a disservice to the people of New Orleans.  I’m not saying these things aren’t important.  I’m saying that in the end, these are not the factors that create healthy lives.  What does create healthy people are the more difficult, more sensitive, more POLITICAL realities of our lives.  Our physical living environments (FEMA trailers, polluted properties, abandoned structures, proximity to blighted areas), our work environments (are we respected? do we have benefits and fair pay? do we feel useful?), our school environments (are our children eating healthy lunches? are they learning? do they have pride in who they are?), our streets (can we exercise without fearing for our safety? are children safe walking home?), and our neighborhoods (can we buy affordable healthy foods close to our home? is there a clinic nearby to see a doctor for non-emergencies? can we get a medicine when we need it?)  All of these factors contribute to our health: they create stress, they weigh on our hearts and minds, and when not addressed in comprehensive ways, they make us sick.

And, since the feeling of having no control over your life is a key part of mental illness, (as mentioned by a panelist) perhaps involvement in some of the issues above on a community level would help individuals find more purpose and agency in their lives.  Just a thought.

But that’s not all.

And here is where I am embarrassed.  My one note, the one thing I most wanted to discuss, maybe even the most important thing to discuss within the context of health and New Orleans, did not get mentioned.  I didn’t know where to put it in without sounding like the crazy loon in the armchair throwing off the conversation… so I waited for a question from the audience that would let me bring it up.  Unfortunately, it didn’t come.  So I didn’t say anything about the issue of race and class… and neither did anybody else.

Which is a shame because we cannot consider the scope of health challenges of any kind within our city — access, stress, mental health, behavioral concerns, nutrition, whatever health issue one can think of — without discussing race and class.  Race and class shape any health experience regardless of the location.  But in New Orleans, it is a paramount issue.  For one, before 2005, New Orleans was the only city in the country that had a defined two-tier system with separate and (un)equal medical facilities for the haves and have-nots.  What has not returned post-Flood are those services for the have-nots.  So what isn’t being said is that the reason these services aren’t here, or are being taken away, is because they are for a population that many do not want here in the first place.  The rest of us work away at putting money and resources into community clinics (whose funding is not indefinite) and outreach and signing individuals up for public services — but how effective can we be in the long run if we never take a step back and look at the big picture?

In the panel that preceded ours, John Slade mentioned that the movement to re-open Charity Hospital was gaining support because Uptown whites were having to wait longer in medical facilities for treatment and were unhappy with the current desegregation of the system.  Although flip, I think his comment speaks to an important truth… at the heart of our health concerns about access, treatment, and who gets care are long-held ideas about race and class.  Until we address those base realities and histories with honesty, I’m not sure we can build a solidly healthy community — no matter how many top-of-the-line medical facilities we open.

My silence on the issue is not because of lack of interest, thought, or evidence.  Either I’ve become so apathetic that I’ve lost the ability to hold faith in anything (a distinct possibility) or I’ve smartened up — after awhile, you just have to face the fact that the dining room table is never going to respond.

Then, this past week, we were faced with situations that necessitated medical attention. The first occurred while in Pensacola, where we visited a walk-in clinic that was part of the medical center Kate was unexpectedly born in 3 years ago; the second took us to an urgent care center favored by many in our area as one of the best around.

The differences were distinct and pronounced in every respect.

At Pensacola’s Baptist Medical Center, both Kate and I were seen by a friendly, good-natured, respectful, and competent provider who gave both of us very thorough exams with no ounce of hurry.  Kate had a chest x-ray to check out some wheezing heard in her lungs.  We had several pharmacy prescriptions filled.  The kids played in a children’s area.  And, all of the above happened within a 2-hour time frame.

Then, over the weekend, one of the kids who was staying with us at the beach tested positive for Type A influenza (aka: H1N1 flu).  The testing occurred on Sunday, with Will’s first day of school Monday, the next day.  We couldn’t send him to school until we knew that he was without flu — and in the interest of due diligence, needed to show that the rest of our family were not harboring flu as well.  Both Kate and Will had some fever on Sunday afternoon, and on Monday morning, all four of us were showing fever.

Despite pre-arrival calls to the one clinic that would see all four of us, and despite filling out all paperwork before our arrival, we waited for over an hour and a half in the open waiting area.  It was not particularly busy.  When we did see a nurse, she was secretive in her assessments (if you take a measure, you share it with the client, and you most certainly do not hesitate in reporting it), and was incomplete in her evaluation.  I had good reason to believe that some of the equipment was showing measurement error and one of the machines even broke during use.  We heard the doctor insulting us from the other side of the door.  When we finally did get seen, they did not provide the service we requested, I had to correct an inaccuracy the physician made regarding influenza, and in the end, they prescribed medicines the CDC specifically advises against for H1N1 flu treatment and prevention.  From start to finish, the whole thing took about 4 hours.  Note: we did not take the extra 2 hours it would have taken to fill the prescription.  (Buying a house is faster and involves less paperwork than filling a prescription in New Orleans.)

In short, we tried to do the right thing so that Will could be cleared to attend school.  In the process, we paid a gross amount of money, lost precious work hours, were insulted, and came away with poor treatment advice.  Such is the nature of health care in New Orleans.

Yes, without question, the health care system in the United States is incredibly broken and dysfunctional.  Our country is among the worst in the developed world in virtually every indicator of health.  Without question, it’s bad.

And in New Orleans?  Whether from lack of providers, lack of resources, lack of compassion, or apathetic frustration (all of which are factors) — it’s even worse.

—

A few months ago, I was asked to help on a survey that a local agency wanted to do regarding experience with the health system.  It was being put together last minute, by well-intended people who were driven by a need to show the dysfunctions within our medical services.  Surveys in New Orleans are incredibly difficult post-Katrina (if not impossible) because we simply do not know how many people are here, particularly within marginalized, minority populations.  Still, this organization had a group of health students coming from a respected northeastern University during their spring break, and these students wanted to “help” by doing whatever “survey” this group could concoct.  Upon investigation, I discovered that the students were under no supervision from their institution, had no IRB approvals despite the sensitive nature of the questions they were wanting to ask within high-risk groups, and (most alarming) felt no ethical conflict about any of the above.  These things would be in-excusable for work done in their own city, but in New Orleans, a place known to be low on resources, it was seen as perfectly acceptable by both these students (who, frankly, should have been trained to know better) and the local organization.  In short, the idea was that it was fine for New Orleans to accommodate lower standards of research and be accepting of unethical inquiry simply because we are resource-poor.

I withdrew from the survey and advised the organization to put the students to work finding information that was needed for an area benchmarking of services.  The students protested that it wasn’t a good enough use of their time and proceeded with the survey… which grew into a monster so unethical and alarming that I pondered reporting it to their home institution.

All people deserve ethical treatment in research, no matter how resource-poor they or their communities may be.  I do not feel that this is negotiable on any level.  What does that say about us when we decide which kind of people get respect and value in a health inquiry and which do not?

—

How we can talk about health without talking about ethics?  About what it means to be human and the ways in which our society should reflect how we define humanity?  Isn’t that the point?

I do not know how ethics have left the conversation of health care.  How, in our debate of it, we have forgotten to discuss what is right, what is the most human response.  But it isn’t there.  And in New Orleans, ethics is not only ignored but deliberately surpassed as an annoying step one can causally eliminate.  As if the people here are so desperate and pathetic that we should be thankful for any “help” we can get.

It is beneath us to compromise ourselves, no matter where our community stands in recovery, no matter where our society stands in development.

This Saturday!

The many talents of Harry Shearer are gracing this year’s event.  Panel topics include… the future of New Orleans food, music and parading culture; the state of New Orleans health care (moderated by yours truly), and politics in the Last Year of the Reign of Nagin.

Registration can be found here… and includes lunch from Cafe Reconcile!

Right after All Things Considered, just moments before the classical hour begins, our local public radio station has the owner of a consulting firm give advice in minute’s time.  They call it “The Louisiana Rebuilds Minute.”  We call it “The WWOZ Minute.”  (A friend coined the term, meaning that this is when he switches the radio to the local music station for that minute).

The idea of the Minute is that the people of Southeast Louisiana are too stupid to realize that it just takes a web search to find the answers to all problems related to an unprecedented rebuilding of an American city.  Since we’re too idiotic to figure it out, The Minute does it for us.  Paul and I have been joking for years that we would make a “Louisiana Rebuilds Minute” Generator — you just add in a common post-Katrina problem, throw in some patronizing ‘pull yerself up from yer bootstraps’ talk, and suggest that one consulting firm’s website has alllll the answers.  Insert those few tidbits, press enter, and BOOM, you’ve got your manufactured minute.

The point that The Minute doesn’t get is that JUST BECAUSE there is one organization out there with funds to build playgrounds, doesn’t mean that every school that needs one and applies will get it.  JUST BECAUSE one bus is available to a few folks who have the magic combination of ills and scripts to qualify for reduced medicines doesn’t mean that everyone who needs meds can get them.  And JUST BECAUSE The Road Home offered funds to some families doesn’t mean they have all that they need to rebuild their homes and lives.  Just because there are programs and grants and applications and dollars out there doesn’t mean that they are thought through, that they are honest, that they actual reach the people that they are meant to reach, and that they make any impact at all in the outcomes of our daily lives.

It is easy to get mislead.

It is easy to think that ideas are either good or bad.

I’m not so sure.  If I have learned anything from being a part of New Orleans’ recovery, it is that EVERYTHING is mired in thick, silty gray.

And in the middle of all that mess sits Charity Hospital.

One of the big discussions flying around Southeast Louisiana surrounds Charity Hospital.  Until Katrina, Charity was the second largest hospital in the country and one of the oldest continuously operating hospitals in the world.  It was the primary source for health care for many of New Orleans’ poor.  Actually, considering that many of Charity’s former patients have not seen a physician since Katrina, technically, Charity is still their source for health care… it’s just not open for them to receive it.

In fall 2007, Jim Aiken, the LSU University Hospital Chief of Emergency Medicine who worked the Emergency Department through Katrina and the aftermath, came to a class I was assistant teaching.  His fascinating lecture included discussion of Charity’s pre-storm emergency plans, his experience of the storm and flood from within Charity, how he helped coordinate emergency care in the extended aftermath, and finally some of the issues involved with long-term planning for health care for the city.  At every step, the issues are overwhelming at best — but what struck me was his passionate and pointed arguments for medicine, good medical care, and services to the community.  He left me convinced that we need to rebuild a top-tier medical facility in this city, one that serves the poor within it, both because it draws good doctors to gain experience within it and because providing care to those who wouldn’t otherwise receive it is as important in this community as drinkable water and drivable streets.

A little over a week ago, the Schweitzer Fellows held our second symposium.  This one was on “The State of Health in Louisiana” and Dr. Larry Hollier, chancellor of LSU health sciences center (encompassing the training programs for all allied health fields at LSU), was one of the speakers.  His presentation was about the new LSU health sciences center — a center which is desperately needed, but is incredibly controversial in how it plays out.

The issue is that Louisiana’s doctors come from LSU graduates… by no small amount.  The physicians practicing in the State are close to retirement age by overwhelming numbers, and the physicians coming out of LSU are not the type to stick around and take their places.  Even before Katrina, LSU was seeing a substantial increase in the numbers of foreign-trained medical students who were ‘matched’ to attend LSU for their residencies — these are students who tend to go back to their home countries after residency.  There were also increases in ‘matches’ with students for whom LSU was not a top choice… indeed, has not been a first choice for many in recent years.  In addition to bringing in students who are not necessarily going to stick around… LSU has not been attracting the best talent, who are going to get picked up by the more desirable residency programs.  Post-Katrina, these enrollment numbers have been even more dire, suggesting that the outlook for Louisiana to have competent, young physicians to support the State’s medical needs into the future is grim.  Dr. Hollier argued that plans for a new science center were in place long before Katrina, and that the need for an expanded, updated center for treatment, training, and research was critical to the survival of health care in Louisiana.

And I believe him.

Don’t get me wrong: my impression of the guy was that we’d have some seriously different views on just about any medical or social issue… but the numbers and his argument was compelling.  More than that, it completed echoed my experience as a student: my peers don’t stay.  Heck, *I* am having trouble figuring out how we’re going to stay.  Even if Paul had gainful employment, the fact is that the research dollars to study health inequalities in our city don’t go to researchers in New Orleans.  If I want to stay involved in research here, it seems like I need to move to Chapel Hill or Ann Arbor or Boston or wherever in order to do it.  (I’ll save this rant for a later date.)

I think that we need a commitment to a new, state-of-the-art facility to attract new talent, house research programs, and rebuild health infrastructure in the city.

Dr. Hollier spoke ONLY of the LSU plans — NOT the combined VA plans.  In the LSU plan, only 33 homesites are impacted over an area that encompasses more empty parking lots than businesses or homes.  (The VA plan, as outlined in a wonderful advocacy website, impacts many more people and historical properities.)  He argued rationally that the Charity hospital building could not be retrofitted to the needs of the new center and any expansion did not include parking or other supportive infrastructure necessary for that sort of facility.  He suggested the renovation of Charity as apartments for residents.

Everything that I know about New Orleans and the way things work make me question people in power — question their motives, question their reasoning, wonder about what they haven’t considered.  (In contrast, it also has shown me that New Orleanians are some of the most change-resistant people on the planet… but possibly for good reason.)  Yet, I am compelled to WANT this new center.  I WANT a place where I can collaborate and build and learn and serve.  I’m EXCITED about the possibility of this center… it makes me want to be here, stay here, work here.

Those first couple of blocks closest to I-10?  The ones that are predominantly occupied by empty parking lots?  I can’t think of a better use than to build a new science center.

But.  The rest?  Well.  I’m uncertain about this.  Because I feel that Dr. Hollier would drive through a community like lower Mid-City and not see a community worth saving.  He wouldn’t necessarily see a pattern of New Orleans rolling over yet another predominantly African-American community for the sake of progress.  Or, maybe he would — maybe he would but he would argue it was necessary for the common good.  And sometimes?  Sometimes I believe in the common good, even if it stomps all over individual rights.  Early public health efforts involved holding people down for immunizations against their will… and that is WHY we were able to control disease.  Sometimes common good is a good answer.

BUT!  Common good should come out of insight and input from the community.  That’s what it’s all about. I’m not convinced that LSU are taking alternative plans seriously.  I don’t understand why the RMJM Hillier plan isn’t feasible and while I am not convinced it is the right place to go, I do think it signals to LSU that it needs to look for compromise.

And I’m worried that this will be locked in years of debate and at the end, the people of New Orleans will continue to suffer for lack of a comprehensive medical center and a generation of medical talent will slip through our fingers.

There is no easy answer here.  And I’m sort of all knotted up inside over it because it involves my field (public health) and my passion (community-level advocating/organizing) — with one tromping on the other in the name of common good.

Got anything good for this one, Louisiana Rebuilds Minute?  What website of yours solves this??

(If anyone still reading has thoughts, comments, insight, or ideas… I’d love to hear them.)

From the T-P:

Rep. William Jefferson, D-New Orleans, announced Tuesday that he will run for a 10th term in office…

Get out!

…even as he faces a Dec. 2 political corruption trial in what he called an “overly zealous” prosecution based on “false factual allegations.”

If the “allegations” are based on facts, then doesn’t that mean that they, by definition are not false? Oh, wait. I’m a scientist. I think way too logically to understand law.

Actually, regardless of your point of reference, the whole article is hilarious. I’m placing a bet that before this whole thing is over, he’ll be quoted saying, “I’ll be goddamn. Bitch set me up.”

Though I arrived shortly after 8am, had a friend in line not spotted me, I may not have made it in. As it was, we got in on the tail end and were rewarded with fabulous seats opposite from the speaker’s podium and high enough above the media throng to take it all in.

Boy, that man can talk. I was impressed.

I’m too cynical to be an Apostle, but have no doubt that he’s been my choice since Edwards dropped out of the race. After hearing him speak, I may have even been swayed to his camp even if Edwards had stayed in. Maybe. He’s not my vision of the perfect candidate, but of the playing field he’s the best candidate hands down. I only hope he can do even a piece of what he promises.

He promised a lot: 100-year storm protection starting in 2011*; restoration of wetlands and barrier islands; no cronyism in Federal Government positions; FEMA director a nonpolitical position (similar to the Director of the Federal Reserve); tax incentives for businesses opening in rebuilding areas; a six month turn-around for Road Home applicants; a new city hospital and new Vets hospital; loan forgiveness for MDs willing to serve here; speeding up $58m approved in Congress to rebuild schools; $250m for teacher programs to give bonuses and incentives for teachers to come here for 3-year positions; college tuition tax credits each year of college; and educational systems that embrace all learning (arts, music, dance, poetry). Phew!

The stump speech was strong; followed with his contract — “we will invest in you, and you will invest in us.” It was stirring, motivational, and exciting. He made me forget how much optimism has been beaten out of me and for a minute, really think that the world he envisions is maybe, possibly… possible?

Some may have thought I’d be on the Clinton bandwagon, since she’s the female in the race. Not so. For one, she’s a Republican. She votes for war, she stood by her husband’s disastrous “reform” of welfare, and she went soft on universal health care. Second, I am constitutionally adverse to supporting the continued control of the Executive Branch of our government by two families into a third decade. Third, black men voted, served in the U.S. Senate, and were elected in the House of Representatives before women, so I figure electing a black man into the White House before a woman just falls in line with our traditions (okay, this is glib, but it’s still sort of an interesting bit of history). If I needed another reason, Ann Coulter may be endorsing Clinton and while I am all for the Kumbuyah mentality, I can not ever see a day when supporting anything Coulter endorses is a good thing. For other reasons to vote Obama and not Clinton, read this.

—
*I swear I heard him say 2011, following his saying that we “can’t gamble” the protection of New Orleans, but I’m not sure my ears can be trusted. For a minute, I heard the crowd shout “Let’s Pretend” and then “Let’s Begin” before figuring out that the clamor was actually the words “Yes We Can,” the official Obama fan shout.

UPDATE: Read Obama’s speech HERE. Really, read it. It’s worth it.

We met a candidate for public office today. Briefly, but we met. I shook her hand, took her flyer, and engaged in 3 seconds of conversation where she politely complimented our family, street, and neighbors. She seemed like a perfectly nice, pleasantly scattered lady who would make a very good neighbor. Just the type to swap recipes, seek out for child-rearing advice, or ask to watch the house while you go out of town.

Public office? Well. Maybe not.

It’s not about the issue of the first and last names being the same, really. And it’s not anything about her, personally. It’s not because her circa-1995 web-page has more typos than some of the worst college freshman papers I’ve ever read. And not because I’m completely perplexed about what that “post graduate degree in Health Care Administration” means (do you mean an MPH? that’s a graduate degree… so do you mean another doctoral degree, in addition to the PhD and MD that it says she already has from LSU?)

No, it’s not about any of those things (although each concerning in their own way). The reason that she’s unfit for Senate is because of seriously whack things like her thoughts on how to improve health care in Louisiana. This is her “healthcare plan,” in its entirety, from start to finish:

Creating effectiveness within our Healthcare system, electronic data capture, standardization of insurance forms, electronic submission, “smart cards” to help both providers and patients with demographic and eligibility data, utilizing the quality care organizations in our state to identify at risk groups, i.e. diabetes and enhance intervention programs.

It’s ridiculous on many levels. One of them is the shocking realization that this mess of a run-on sentence was written by such a highly decorated scholar. Yet another comes out of actually trying to understand what she is saying (which takes some work) and realizing how alarming it is to think that it came from someone working in medicine. (As an ophthalmologist. In private practice. Apparently, that is what you do when you have at least two, and possibly three, major terminal degrees.)

What I want to run away with here is the “card” system mentioned in the tangled web above. This, along with her gag-worthy proposal (mentioned randomly on her neighborhood flyer) of making Charity run both private and public clinics “to make it financially independent,” speaks to a larger issue within healthcare. Namely, that health inequalities (which are extreme, more on this in a moment) has lines of color and privilege — and that this system works for those in the privileged group and they want to keep it that way.

A card system would facilitate that process a little faster. Mr. and Mrs. WealthyWhites present their card and are ushered to the private facility where they have no wait time, spend plenty of time with their doctors, and walk away with oodles of ultra-thorough tests and procedures. Mr. and Mrs. PoorPersonOfColor present their card — whoops! underinsured? or uninsured!? sorry, it’s this way for you — and off they go into the crowded masses to wait (a long time) for misdiagnosis, extended morbidity, and early mortality. If this all seems crass, I assure you, it’s not. I’m speaking right out of the science. A lot of it.

Take for example some very basic measures within black-white disparities. Here’s one. The ratio of black to white infant mortality was greater at the close of the 20th century than at any other point in the preceding 100 years — and that the last 50 years saw a 90% increase in that disparity (1.6 in 1950 to 2.5 in 2000). How about mortality from coronary heart disease, cancer, diabetes, and cirrhosis of the liver? All of these (black:white ratios of mortality) were larger in the late 1990s than in 1950*.

And yes, those diligent public health folk have run themselves ragged trying to find reasons to explain the widening gap in disparities. Focusing on infant mortality, one thing that is clear is that a key to reducing infant mortality disparity means reducing the similarly widening gap between whites and blacks regarding low birth weight and very low birth weight babies. In an effort to get at birth weight, public health folk have studied it from a number of vantages… Maybe it’s more preterm births! More multiple pregnancies! Whites have more access to abortions! Access to medical care! Personal habits! Genetics!… All of these theories are discussed, studied, and dissected widely in the literature. Yet:

“The etiology of black-white disparities in low birth weight is complex and is not explained entirely by demographic risk factors such as maternal age, education, or income (8). Factors that might contribute to the disparity include racial differences in maternal medical conditions, stress, lack of social support, bacterial vaginosis, previous preterm delivery, and maternal health experiences that might be unique to black women (9).”

In other words, we have no idea what causes these health disparities. But we do know (almost by process of elimination) that it isn’t anything that we can measure well. These days, best science is suggesting to us that those “other” things: stuff like “stress” and “health experiences… unique to black women” could be the culprit. Darn those difficult to quantify, endogenous little factors!

Personally, I see a “smart card” that can quickly streamline the haves from the have-nots to be a “unique experience” — one that might be “stressful”. It might also fit into a pattern of how things tend to sort out in a racially divisive environment. Like how they might fall out between public and private schools. Or hospitals. Or ophthalmologist offices.

But I digress. Actually, pregnant women can get health care in this country. It doesn’t make an impact on closing disparity, but at least it’s something. (I shudder to think of what it would look like if there was no WIC.) An even brighter note: as of last May, in Louisiana, women don’t even have to show documentation to get prenatal care. (I know, I couldn’t believe it passed, either! Hoorah!) But as of this morning, it’s a bummer for their kids.

But back to those disparities. That pesky infant mortality. So what are we doing to work on it? What cutting-edge research is happening to better understand and solve the problem? Well, earlier in the year, the American Journal of Public Health published a study on just that. Here’s what they found:

“Ninety-seven percent of grants were for developing new technologies, which could reduce child mortality by 22%. This reduction is one third of what could be achieved if existing technologies were fully utilized. There is a serious discrepancy between current research and the research needed to save children’s lives. In addition to increased research on the efficacy of treatment, there is an even greater need for increased research on delivery and use of technology.”

In other words, putting more layers of technology on to the very real and very great health challenges that face us does not solve any problems. (So, even if the aforementioned “smart card” is a completely altruistic method of making the life of a hospital benefits coordinator — or an over-indulged ophthalmologist who doesn’t want to mess with clients who can’t pay — easier, it’s a waste of money that will have no impact on health outcomes.) Further, we have got what we need at our finger tips — we just need to figure out how to get it used appropriately.

So, sorry, MM. I can’t give you my vote.

I’m stopping here. Coming soon: the universal health care rant.

—

*Check out the MMWR article for some of these stats. Also see David Williams’ Race, SES, and Health, Ann NY Acad Sci, 1993; 896, 173-188.

The last conversation I had with Helen Hill was a friendly hello at Abeona — we both wanted to say more but were overwhelmed with our kids at the time. I had hoped to send the images from Oak Street Cafe to her over the break and we had talked about getting together for New Years, neither of which happened. So, it may sound silly, but it was very important to me to get the images to her family directly. We dropped them off in a sturdy folder with the flowers and cards at their front door. Soon after, Emmy and Renee (friends and Abeona instructors) visited the memorial. They saw the folder and recognized it; wanting to keep it safe, they gave it directly to a family member and showed the photos I took. They were very well received, and were brought directly inside the house to Helen’s family. Media swarmed. Emmy felt they all were piranha-ish… with the exception of one British man who she felt was very respectful and caring. She gave him my phone number.

… And this is how I met Charlie Varley. When we first spoke, I had no idea who he was and acted very suspicious. Photography is a funny medium. It can easily be exploitative and I am very sensitive to this. I consider it a privilege to photograph people and feel that, particularly where children are involved, a photographer needs to be very careful with their work. So at first, I was very unsure how to handle Charlie Varley, who wanted to send some of my work to several news sources that were preparing memorial articles for Helen. By the end of our conversation, I was assured and agreed to send him some images. Then I googled him and realized who he was… when I sent him the photos, I wrote that I felt like I was sending a crayon sketch I made at age 10 to Picasso.

I was surprised to receive a wonderful email response from him. For one, he encouraged me to protect my work by adding a photo credit to the images and made some suggestions in that regard. Before sending them on, he embedded my credit into the image file for me. Second, he said wonderful and encouraging things about what I had done: “very professional and not at all amateur if you ask me.” He went on to say some personal things about being a parent and covering this story. It was, in every regard, a kind and thoughtful message.

Quickly following on the heels of Charlie’s message, came a phone call and email from Schroeder. Another uplifting and friendly bit of light coming unexpectedly.

Yesterday was my birthday. These little pieces of kindness and thoughtfulness were wonderful presents!

After taking photos at the Abeona Winter Formal two weeks ago, Paul and I went to Oak Street Cafe, our favorite local spot. While there, we visited with Helen Hill and her son, Francis. Francis attends Abeona; we got to know him and his parents (mom Helen and Dad, Paul Gailiunas) in the kids’ Sunday music class. Over breakfast at Oak Street, Helen gave me a photograph that she took of Will and Kate during a Music Together session. We talked about local photography resources, growing up in South Carolina, getting together for a “family” New Year’s Eve party with other Abeona parents, and laughed as Francis pointed to the Cafe counter, requesting donuts. When Charlie (the Oak Street pianist) sat down to play, Helen and Francis went over to the piano — and I took pictures of them.

We are just getting to know Helen and Paul. Paul is a physician and co-founder of a community clinic; Helen is an artist who grew up in Columbia, S.C. They are also musicians and involved in social activism efforts. Like the other families that make up our Abeona family, Helen, Paul, and Francis represent the kind of people that make us want to live in New Orleans. They are, like us, a family that has chosen to be here because they believe in the importance of making the world a better place and are willing to do the work that is required to see that happen.

The phone calls and emails reached us late this afternoon. From the Times-Picayune:

In the sixth New Orleans murder in less than 24 hours, a woman was killed and her husband shot in their home at about 5:30 a.m. Thursday, said New Orleans police, who found the bleeding husband kneeling at the door of the couple’s Faubourg Marigny home, holding their two-year-old son.

The toddler was not hurt; the husband, 35, underwent surgery at Elmwood/Charity Trauma Center, police said. The woman, 36, was pronounced dead at the scene. But friends identified the Marigny couple as Helen Hill, an animator and filmmaker, and Paul Gailiunas, a doctor.

We are feeling and thinking many things right now. But there is one thing that is important for us to get across.

Before you dismiss this grand tragedy and tremendous loss as a causality of living in New Orleans; before you blame the citizens, the local ‘leaders’, the corruption; before you resolve to forget this city and recommend its decay and elimination — remember that THIS IS OUR HOME. And it is important, vitality important, to all of us. New Orleans and its rebuilding should be a symbol of what our country stands for — that the suffering among us matter, that resources should not be saved for the needs of a privileged upper-class, that the incredible contributions of this city be celebrated.

PLEASE BE ACTIVE. GET ACTIVE. Make New Orleans matter in your life, because it does. HELP US. Help us build back a beautiful, strong, safe home.