From Xico

Why Trust Washington?

In his column today, Charles Blow hypothesized that so many people, not just the extremists, don't trust the government to handle health care coverage because they don't trust Washington itself.  At this point, everything is so mixed up, I think it's impossible to find a single cause, but there's definitely some truth in what he says, though the "Washington" he talks about is a bogey man, a scapegoat.  The Blob, if you will.  When arguments become as irrational as the health care coverage arguments have become on the right, you should know immediately it isn't the issues in front of their noses that people are fighting over, but something else. The people who are screaming about federal health care are people who felt adrift, unconnected, abandoned, whether justifiedly so or not, without the Rush Limbaughs of the world. These demagogues promise belonging to them. Unfortunately, the quickest way to make people belong is to make them feel you are on their side and then to give them someone or something to hate.  More unfortunately, the hate-mongers can plant seeds of doubt in people who aren't buying the whole snake-oil show but who don't know how to look outside the right wing's very tightly built box. The right has succeeded in undermining many, many people's basic common sense. The right has undermined trust in what's reasonable.  

I'm hoping that some of the extreme right's followers watched Ted Kennedy's funeral today on Fox. Here in Mexico, we had no other option except for CNN en español which overrides the English with Spanish, sometimes good for us, this time not.  

While Fox has taken the lowest of the low roads in post-funeral event coverage, the coverage of the events themselves has been impeccable.  Shepherd Smith, the only Fox anchor I can tolerate at all, was the reporter in charge.  He had on with him a woman whose name I don't remember and Edward Klein, a Ted Kennedy biographer who certainly didn't come across as a Kennedy hater.  It was impossible to watch on Fox (and listen to the very unobtrusive) commentary without realizing you were watching the story of a family, with family values, with faith, and also with very definitely liberal political values, definitely spokespeople for "liberal" causes.  You also had to realize that that their liberalism grew out of a Christian concern for the suffering among us.

The Kennedy family as anyone over maybe forty eight must know is marked by not just tragedy but sometimes despicable behavior, by corruption, by arrogance, by unfaithfulness and a barrage of other sins.  And while we weren't privy to see them, I'm sure there have been terrible family rows, betrayals, and their consequences. But that is also part of their importance: they provide many lessons in forgiveness and compassion for themselves as well as for others. And they seem to have learned those lessons. They embody something that horrendous, self-righteous people can't acknowledge: it's how we deal with the bad that makes for good human beings, not that we always avoid it.

I think Obama's team thought that if they tried to appeal to basic decency to, if you wish, religious values, and virtually all religions (though not all interpreters of religion) include the values of caring for one another, looking after one another, building community, then the administration wouldn't get anywhere.  So the Obama team seems to have stressed in the context of better coverage for those whom the insurance system has screwed (not necessarily the poor), cost-cutting and reducing federal deficits.  So they have presented us with a kind of cold picture of health care coverage under the federal government, one that shows very little of how it would expand rather than contract treatment options for the country's citizens, one that certainly doesn't do anything to build a sense of community among Americans. Rather, it seems to draw people to say, "Well, he might get something, but what's in it for me?"

So I think it's time to look at Ted Kennedy as the knight of federal health care coverage: the federal government representative who called on the sick and comforted them, sought treatment options for them, and got some, not just for friends but for children, for instance, and for people with disabilities. Someone who was beloved because he loved so much, not just people he knew, but people he didn't: people who many of us don't even acknowledge exist.

Instead of talking about saving money (which a federal program would do, certainly in the larger context) we should be like Ted Kennedy, talking about loving our neighbor as we would want to be loved: of wanting them to get the kind of coverage we have or feel we should have.  Of understanding that just as the very rich are often rich because of lucky breaks or inheritance or being in the right place, and all the benefits that flow from these, so the very poor are often very poor just because they were in the wrong place, or born in the wrong town, or were of the wrong color or faith or sexual orientation.  And sometimes the not so poor struggle for the same reasons, or because a boss didn't fill out a health insurance form right, or the insurance company found they'd once a long time ago seen a therapist for depression or have had some other pre-existing condition, this very condition being that hich means they can't afford treatment.

We'll get a lot further for all of us with compassion than we will with hate.  Please, Administration, go with the moral imperative! Go with Ted Kennedy!

There are already resources all over challenging the lies of the right. 

Here, by the way, is a link to Ted Kennedy, Jr's wonderful eulogy for his father.

More travels with dogs through lyrical, lush Veracruz

We took two little trips recently.  Once again I cannot resist putting up some pictures, though they don't do justice to our surroundings. As usual, we drove for miles on small roads with little, sometimes no, automobile or truck traffic, with large expanses of forest and fields and villages strung along them, mountains rolling up on all sides of us.  People looked at us warily and smiled when we smiled at them. I'm sure they probably laughed after we'd passed by since we are surely a strange site up in the hills where foreigners don't often go: an elderly American couple with their four dogs sitting like passengers in a somewhat ramshackle old Toyota Rav 4.  

We took one trip about a week ago up to Cerro Boludo -- for those of you who have an idea of where we are, we drove to Xico, crossed the river and then drove on the road that goes past the fancy resort called Aguas Benditas and on past Coapexpan where our water comes from and then through Monte Grande up to Cerro Boludo.  You can eventually get to Perote this way.  Then yesterday we took a second trip winding from Teocelo through Ixhuacan de los Reyes and up to a little tiny town at the end of the road called El Futuro Miguel Hidalgo.

On the first trip, we drove through Cero Boludo and parked on the edge of a gentle escarpment just out of site of the town.  I think I wrote about Cero Boludo once. I know I did.  I posted some pictures of several baby pigs.  The men we talked to that time brought us some delicious cherries they picked for us.  This trip, the dogs almost seemed to remember where we were.  They hopped out and right off started trotting back towards the town.  BUT that's not where we wanted to go. They are pretty good at deciding they'd rather be with us, so they were quick to turn and follow us.

This trip was a particular challenge for Giaco because we had to cross streams via logs.  Giaco tried and failed and panicked.  Jim ended up carrying him, or more like it, lugging him across both bridges all four times we had to cross them. 

This is the first bridge Giaco wouldn't cross.  It was the tamer of the two.  I think Jim managed to get him to at least partly walk across it by himself.

 

I don't have any pictures of Giaco's bridge struggles.  I was too scared for him to take pictures, and besides, it would have hurt his pride if he thought people saw him in such awkward, panic-induced positions.

We wended our way past a smattering of houses, children playing, a couple of people on horseback.  Some domestic animals.

Here's a piglet we saw:

And some  geese:

A bit further up the road, we passed this herd of goats.  The dogs with the herd were very quick to circle the goats to move them away from us, but they didn't bother our dogs, nor did ours bother them.  The goatherd was a skinny guy, not really happy to see us at first, but then he talked to us and answered questions about where the roads went.

We came to a farm that straddled the road.  The house was quite large and very pretty, painted white with pink trim and gorgeous flowers growing.  This was an area where driving is impossible. Horses are essential transport here.  At least one of the owner's horses was tethered to the side of his house.  The house had electricity. I imagined the meter reader walking there or riding a horse to do his job. You can see plants hanging to dry under the eaves.  A lot of people seem to have them now. I don't know what they are.  I will ask.

Here is a blossom from a plant near his house:

 

Most unfortunately, Cosi chased a chicken in back of a shed here and caught it and killed it. I've never seen that happen. When I realized she had it tightly gripped in her teeth, I ran sqawking myself as loud as the chicken was doing, trying to stop her, but Cosi eluded me, flattening herself and dodging and weaving and I swear looking back at me squinty-eyed and telepathically communicating, no way are you going to get me. I was too late, but we sure didn't let her keep the chicken which lay pathetically on its side, moving ever so slightly.  Much to my great dismay, RITA, good ole obedient (mostly) Rita was very much an equal in the hunt.  SHE let go as soon as I screeched, but didn't let me near her.  Instead, she ran around looking guilty, her mouth full of soft white feathers. 

After the horse left the barn, so to  speak, we closed the door, and put leashes on the dogs.  And looked for the owner, who turned out to be a pleasant mild-mannered man who came out and smiled and charged us 80 pesos.  Enough, I am sure, to cover the cost. I mentioned to Jim that maybe we should have asked for the chicken.  By coincidence I had just read a column by Randy Cohen, The Ethicist of the NY Times saying that those who paid for the damages should get the goods. But didn't seem like a good idea to go back and ask for it, and besides, I wasn't about pluck the feathers and chop its head off,or whatever. Still too much a city girl.

It can be pretty consequential when your dog kills a chicken around here. Paul the English gardener had to put a dog to sleep because it wouldn't desist, and our neighbors across the street who get along a bit better now didn't speak for quite a long time because one was sure the other's dog had killed her chicken.

Anyway, slightly shaken, we turned to return the way we'd come.  Here is a picture of the goats we'd seen going up, this time looking at them from the curve in the road above them.

 

And to end, just a few plant pictures:

A plant whose seeds stick straight up

And some wildflowers.

Obama's Reading List and the State of the Nation

Obama sometimes seems SO much like a Nancy Pelosi pol that I could just scream (I can't think of anything I could do that would actually have an impact.)

However, the list of books he took on vacation has been released and it includes a few interesting novels, to say the least, which cause me to maybe see Obama in a different light.  The least interesting is Plainsong, about some midwesterners from the flatlands drifting through sad lives.  Though I enjoyed Plainsong, if he was looking for a book set in the midwest, I would much rather he had chosen Marilynne Robinson's Gilead, which is mostly set in a small town in Iowa and which is truly one of the great books of our time, though it is as quietly written, as unpretentious, as any you could imagine.  

Obama has also chosen to read The Way Home by George Pelecanos.  ANY book by George Pelecanos is worth reading, though this latest didn't get quite the reviews some of his others have. I haven't read it yet.  According to critics, it deals with the juvenile justice system, and Pelecanos has not hidden his criticism of it, so some have said it seems more a polemic than a thriller.  Pelecanos doesn't ever hide his perspectives on justice, crime, the terrible travails of poor people outside DC. His books are so good and so compelling because his characters are so very real and so terribly poignant: a mix of taudry and decent and mixed up and at times heroic, that it is easy to come to understand his points of view. Richard Price's The Lush Life is the second really interesting book Obama is planning to read.  Price is another author who peels back the skin of city life.  And I  haven't read this one, though I will.   

That he wants to read these two authors suggests that Obama is in his heart both the Chicago politician and the community organizer, and that perhaps he sees the world most with through these experiences.  This is a good thing, but I'm having a hard time explaining it clearly.  Pelecanos writes of a world in which nothing is pure, in which the most all-American looking young couple can be small-time gun-runners, in which addicts die in filth, in which a few people manage to maintain their dignity without blinding themselves to the corruption around them. The heroes, of course themselves flawed, understand that sometimes people cheat, and worse and sometimes they don't care to consider alternatives and that they aren't necessarily bad or good, and that the system works best for the powerful.  No knight on a white horse is going to gallop into Pelecanos's world and cleanse it of its sins.

So here I am, a liberal who shares with many the current extreme annoyance that Obama doesn't seem to manage to do anything "pure."  His AG is going to have hearings on the torture during the Bush years, BUT some people, probably the higher ups, will escape prosecution; he's pushing for health care reform BUT (and you all know the buts here); he has let the rich keep their wealth in his economic reforms, etc. etc.  And yet it occurs to me, maybe he's on the right track.  Maybe the nation, of which Pelecanos's DC suburbs are a microcosm, is woven together with such bonds of  corruption and bloodiness and power that you can't come in on a white horse and undo it.  Maybe Obama feels like he's dealing with a camel with a very fragile back: too much from him and it would break.  Or a time bomb whose wires he has to undo very, very carefully.  Who knows?

A Better Approach to Foreign Aid Projects

Recently we ran into a young woman, a sociologist, who loves Mexico and is planning to bring some of her US students down here so she can share her experiences.  She is arranging a tour of various development projects in which foreign aid programs and some Mexican university folks are involved.  We got kind of cross-wise because she pushed one of my numerous buttons about Mexico.  I'm actually not at all sure she assumes this, but a lot of people in the US do: that Mexicans somehow always need foreign aid to learn how to do stuff, to get themselves going.  I suggested she should visit some locally successful farms and projects which had nothing to do with foreign support.  

Coincidentally, today in The New Yorker,  read Atul Gawunde's commencement address to The University of Chicago Med School's graduating class.  In it, he talked about a very good friend of his who worked to bring better nutrition to Vietnamese villages:

Jerry Sternin was a professor of nutrition at Tufts University, and with his wife, Monique, he’d spent much of his career trying to reduce hunger and starvation in the world. He was for awhile the director of a Save the Children program to reduce malnutrition in poor Vietnamese villages. The usual methods involved bringing in outside experts to analyze the situation followed by food and agriculture techniques from elsewhere.
The program, however, had itself become starved—of money. It couldn’t afford the usual approach. The Sternins had to find different solutions with the resources at hand.
So this is what they decided to do. They went to villages in trouble and got the villagers to help them identify who among them had the best-nourished children—who among them had demonstrated what Jerry Sternin termed a “positive deviance” from the norm. The villagers then visited those mothers at home to see exactly what they were doing.
Just that was revolutionary. The villagers discovered that there were well-nourished children among them, despite the poverty, and that those children’s mothers were breaking with the locally accepted wisdom in all sorts of ways—feeding their children even when they had diarrhea; giving them several small feedings each day rather than one or two big ones; adding sweet-potato greens to the children’s rice despite its being considered a low-class food. The ideas spread and took hold. The program measured the results and posted them in the villages for all to see. In two years, malnutrition dropped sixty-five to eighty-five per cent in every village the Sternins had been to. Their program proved in fact moreeffective than outside experts were.

You can see where I'm going with this.  Knowledge of how to do things exists here already.  As foreigners, perhaps the best help aid workers (and Plan Mérida workers also!) could bring is to help poor communities (and communities in Mexico are not, by and large, so poor as those Sternim visited in Vietnam)  to connect the dots.  I would add that good internet access would be an enormously beneficial in this regard.  Thus, I would say that for US students interested in their southern neighbor (and there aren't enough of them), they should come here and learn what's already here before muddying their experiences by looking at projects that have a foreign overlay.  

Obama, Lead Us!

Obama for me thus far is a big disappointment.  It's like I want to say to him, get off your ass.  He seems to for some reason feel it's necessary to keep going with Bush policies until he can somehow shift course seemlessly. He seems not to be able to make any clean breaks at all, indeed, he seems to be strengthening some policies from the past that got us into so much trouble. When he said at an early press conference somethng to the effect that the US is a big ship and you can only change its course by a few degrees at a time, it seemed like a smart, perceptive observation. But a few degrees ends up being big change, and in not that much time.  And we haven't been making those changes.  He seems not to realize a WHOLE lot of people wanted him to make chanage.  He's out-Pelosi-ing Pelosi.

So here is a link to an article in the Huffington Post by David Bromwich, a professor of literature at Yale, that offers some theories about why Obama is being such a nebbish and such a buddy to nasty establishment types.  If Obama doesn't change his approach, it really will be too bad.

Death Panels No, End of Life Counseling, Yes -- small update at the end

In 1986 my mother suffered a massive stroke which left her in a vegetative state.  But this was at the time when turning off artificial life supports even on people as clearly beyond awareness as my mother was was still not something hospitals were altogether comfortable with.  We had no opportunity to discuss with doctors as a family what my mother's condition was, what she might actually be feeling, what options we had. My father, a physician who himself had had one major stroke and a number of minor ones applied to become, at the hospital's request, her guardian. It was simply for legal/bureaucratc reasons.  In spite of his somewhat diminished capacity, the court still deemed him competent enough to be made her guardian. The only option we had was to challenge him, something which would have been worse for all of us.  We never met to discuss the issue with the treatment team, a social worker, or a chaplain.  My father lived the next four years in a kind of delusional fog in which he spent his days reading to her, talking to her, putting perfume on her, telling her how beautiful she looked as she lay in a hospital bed, and briefly in a nursing home bed, attached to a breathing machine and to feeding tubes and medication drips and a catheter. He could not and would not tolerate any suggestion that she wasn't really benefitting from further treatment.  Through these years, she had quite a number of opportunistic infections which my father insisted on treating aggressively. She developed sores whch had to be treated, and the ventilator had to be inserted in her throat, something which also led to infecton.  If she felt anything at all, she sure didn't feel comfortable. And yes, this was expensive for the insurance companies, for the hospital, for my father.

As his own condition worsened, my father's daily trip to the hospital became increasingly difficult for him: he could barely walk the distance from his car to the hospital entrance; his driving became erratic; his house started to sag from neglect.  I made trips east from St. Louis to go through paper bags of bills, to fix the furnace, to get the house cleaned, get him cleaned. Finally, he couldn't go anymore.  We got home health care for him.  But he still was in charge of my mother's care.  Then one day my mother's doctor called me at work.  "She's died," the doctor said.  "Thank God" were the first words out of my mouth.  "I wish I'd known you felt that way," said the doctor.  "I never made it a secret," I said.  

As I've said, we never had any meetings with a treatment team or anythng where we could all discuss these incredibly difficult issues.  The chaplain was very nice, but not someone charged wth such family counseling, and the social worker's job was discharging patients as quickly as she could.  As far as I know, there was no such thing as end of life counseling in those days. We sure could have used it.

Today it is definitely more common and people benefit enormously.  Having experienced my mother's tragedy without such counseling,  I find myself furious with people who would deliberately confuse this with "death panels".  Such counseling is vitally important. It can help families BEFORE what happened to my mother happens; it can help families when unexpectedly and without previous discussion, the unthinkable happens. It can ease the last days of the dying and the hard road of those to be left behind. The fake brouhaha stirred up by Palin, et. al. has apparently led the Senate to strip payment for it from the health care reform proposals.

Here is a link to a very good Economix post in the NY Times on end-of-life counseling and the health care bill as intended to increase, not eliminate, persona choice.

Good Stuff to Read -- and Important

Two more weeks until I get back to meaningful blogging.  In the meanwhile, follow this link for a wonderful article about Barak Obama's mother.  I wonder what she would say to Obama if she were alive today.  She would be my age.  Weird!  I just realized all our kids are old enough to be president!

And read this.  Yes, yes, I know it is about the Gross Domestic Product and the very idea makes your eyes glaze over. But this is a very important summary of why we absolutely must shift the way we evaluate our economy.  And as you all know, dull as thinking about economic jargon is, our little tiny boats are riding on the very stormy sea that our economy is today.

Plan Mérida and Mexico's Drug War and US Policy

Patrick Leahy has blocked approval of Plan Merida funding this summer by refusing to certify Mexico's human rights record.  Hurray!  The drug war is not doing much good and it promises to grow into another endless and dangerous swamp like Iraq, Afghanistan and Colombia.  Obama's administration is failing miserably to come to any understanding of Mexico, US relations with Mexico, and the role of drugs, laundered money and human trafficking.  Most of Mexico is not yet enveloped in the drug war disaster, but it seems it will only ooze into more areas the longer the "war" continues.  Here is a very good analysis of the present situation with a post following pointing out that Felipe Calderón is NOT Mexico.  Obama wake up!!!! This isn't a joke.  And all of you write or email Patrick Leahy that you support his move.

Health Care in Mexico and Facing Mortality

Recently I read Abraham Verghese's new book, Cutting for Stone, a novel in which he  describes a young Indian man's growing up in Ethiopia -- actually mostly in a hospital compound--and his subsequent move to the US when he himself became a doctor.  It is a wonderful, passionate book.  It is also a psalm, a hymn, a prayer -- about what practicing medicine should be.  Verghese's mission is the noblest: to call doctors back to their art and to their compassion.  

So recently we went to our doctor in Xalapa for an annual checkup, my first in three years.  In fact, my first visit to a doctor who was not an obgyn in three years. He is an internist who was trained at the University of Guadalajara.  He is a warm, formal, ever so slightly authoritarian man, perhaps in his mid-forties. As is generally the case, he doesn't have an desks and rooms and counters full of assistants and accountants and nurses.  He shares two receptionists with three other doctors in a minimally decorated suite of offices.

We went into his office together. Jim had seen him a number of times, I never, though I'd always accompanied Jim (translation needs). He examined each of us in the presence of the other. He took our histories.  Mine is rife with people who have or who have died of heart disease or strokes.  Great longevity is not so normal, though my dad's mom and one of my mom's sister made it into their nineties.  He gave us physicals.  He thunked my back and searched for glands and felt my thyroid. He pressed my sinuses and my belly and listened to my lungs and heart and looked at my legs and my feet and my hands.  He looked into my throat and made me say "aaah" and he looked into my eyes.  Then he took my blood pressure.  Both arms.  And listened to my heart some more. And then he said, "Your blood pressure is high.  Is it always high?"  I said, "No.  It's usually under 120/80.  It's probably just nerves."  But the last time I knew what it was was three years ago.  Now it was 156/94. We sat across from each other now, at his desk.  "Am I so frightening?" He smiled.  "I don't think I am.  Does this happen often? Your blood pressure goes up when you are nervous?"  I had to admit, "Not too often."

So he sent me home with instructions to have my blood pressure monitored at least three times at different times of the day and on different days.  A friend lent me his blood pressure monitor.  I followed the directions scrupulously.  I sat quietly for five minutes, then I sat perfectly still, the monitor at just the right level. And of course I measured it many times, not just three.  Surely it would go back to the low levels it had been.  No luck.  My blood pressure was lower than in his office, but the diastolic pressure seemed especially fond of lingering around 90.  Too high for a person with my family history.

Then we went to get our lab work done in Coatepec. As usual, the lab gave us the results for us to take to the doctor.  I was shocked, literally.  Jim, who at times seems to me to shovel butter into his mouth by the spoonful had no cholesterol abnormality.  I had not a shockingly high reading, but high enough.  Not fair!

So we went back with my readings and my (sob) cholesterol results.  And he carefully read them and quietly pointed them out.  And took my blood pressure and listened to my heart and lungs.  And he took it skillfully, by habit, holding my arm so it rested on his.  And he took it twice in both arms and he listened. It wasn't a nurse or an assistant who did it.

And it was still high.

So I am taking a small bit of a diuretic, on orders not to eat any animal fat, not to eat pork (I thought it was supposed to be the lean meat!) and OF COURSE not to eat sausage and bacon and to eat only very lean beef (which is very easy to find here) and chicken sans skin and to keep salt intake low and to walk at least thirty minutes a day, and so on and so on.

I suspect he's not used to computer-savvy patients, but for all that, he pretty much jibed with what this computer-savvy patient had found out. He's not a perfect doctor, and  I had questions after I left which I will ask next time. But I'm pretty sure he'll recognize me and remember my name.

So what does this have to do with Abraham Verghese?  Our doctor scheduled us each for an hour for each visit. AN HOUR!  We didn't take quite that long, but close.  And he listened to our bodies and looked at them and touched them.  He depended on his own ears for the blood pressure.  He asked us questions. He thought. He related what he learned by physical exam -- by touch -- and by history with what he'd learned from the lab results. And he was, of all things, relaxed and friendly. There was no wall. He was a Verghese model of a doctor.

And what did this cost?  Five hundred pesos for each of us for each visit, maybe $38 US dollars.  We could go to IMSS, the Mexican health system with which we have coverage.  It is also good with good doctors, like a US HMO:  not today's version of an HMO in the States, but the kind we experienced in Minnesota some thirty five years ago, which was not-for profit, which was when Minnesota was considered progressive.

To have such attention from a doctor: it's worth the cost.  IMSS will be there for hospital coverage. IMSS is available for a little less than half the Mexican population: all those with jobs in the formal economy.  Many can also visit doctors privately as we do, if they are in that less than fifty percent of the population. And they can get private insurance, but we don't at this point feel the need to.  We still haven't come close spending what we did on the monthly premiums we paid in the US, and we have come nowhere near our annual deductible, not to mention the copays.  

We now have Medicare, at least Part A.  We screwed up applying for Part B.  I assumed that you applied for it when you applied for Social Security.  But there are enrollment periods and we missed them.  We will have to wait a year and pay a slightly higher premium.  I can tell you the people we dealt with for our social security were not relaxed and friendly.

There is a move afoot to bring Medicare to Mexico.  I think it already can be used in Canada.  The US government would save itself money if that happened, and a lot of USAers would be very happy.

Here is a link to Verghese's current article in The Wall Street Journal.  Read it even if you don't read his novel.

And here is a link to his website.

AND he is a correspondent at The Atlantic Monthly.  His posts are definitely worth reading here.