Monthly Archives: December, 2007

Narragansett Spoken Here

I remember the good old days in the hospital. We didn’t have interpreters, we just called Luis in maintenance. Luis was a kindhearted guy who was willing to help out with the Spanish-speaking patients and still get his own work done before his supervisor got all over him. If Luis wasn’t working that night we could always nudge the patient to grab someone from the waiting room to interpret, or else we would talk through their children. This was before the HIPPA privacy act, and you can bet there was nowhere to hide. We were not insensitive, we were just trying to get by. I want to thank Luis, and Faina and Pakyaphet and Celeste and all the other well-meaning people in maintenance who were willing to help, and I want to thank all the people who worked to pass laws that ensure that hospitals provide real interpreters.

I don’t miss the chaotic, confusing, dangerous old days.

When I worked in a community clinic I found myself calling maintenance again, as more and more of our patients were Spanish-speaking. We nurses began to acquire some basic Spanish skills, and thought we were getting by. But we really began to reach our patients when we hired Ana. Ana interpreted Spanish and taught us some of the norms of Dominican culture. She did so much more than just translating. She got to know the patients and the clinic staff, learned the standard procedures, what information needed to be obtained and what every patient needed to know. With one consistent interpreter we were able to build relationships and give better care more efficiently.

Like many small grant-funded programs, the clinic closed, and the patients were referred to a network with more resources, including bilingual staff.

Recently I worked for a home care agency and had a Spanish-speaking patient. She understood some English, studied books, listened to tapes, she really tried. She was far more comfortable in Spanish. My agency sent out a Spanish-speaking nurse’s aid, which was a great help. As the patient and I got to know each other better I felt comfortable falling back on my limited Spanish and my patient’s limited English. As a safeguard, I called the AT&T Language Line at the end of each visit to review what we had discussed.

The Language Line had helpful, courteous staff and was easy to access, but not easy to use. You lose a great deal when you have to communicate through a voice on the phone. I had to think carefully how to word my questions and instructions so that there was no ambiguity. I then had to get the patient to repeat the information through the translator so I knew she understood. It was laborious and time-consuming. The Language Line charges by the minute.

When you need interpreters infrequently, or you need a language that is uncommon, the Language Line is a good option. But when you are going to serve a large number of people who speak the same language it’s much better to have an interpreter, more efficient and less expensive. If you have a member of your team who is full-time and experienced, they do more than translate. They facilitate. They are a mediator between the organization and the client.

Governor Carcieri has laid off three interpreters from the Department of Human Services. He proposes to find private contractors. If he’s planning to use a service like the Language Line it will be very expensive and slower, with more potential for error. If he can get people to come on site, they will not have the familiarity with DHS and its clients that the full-time employees have. We will end up paying more but getting less.

A lot of serious foul-ups in medicine start with miscommunication. It takes longer to straighten out a mess than to get it right the first time. I’m sure that is true in social services and the rest of the universe. If the Governor is trying to make political points by firing interpreters, he is taking apart a system that works and trying to replace it with a less efficient one. If the press lets it go by, the Governor may win with the anti-immigrant crowd, but this budget cut will hurt the people most in need and end up costing the state more money. Remember the brilliant idea of putting 17-year-olds in the adult prison? We’ll be cleaning up that mess for awhile.

Narragansetts excepted, we all came from somewhere else. What Cheer, Netop?

Desperately Selling a Kidney

It was a strange experience reading Sally Satel’s essay, Desperately Seeking a Kidney in last Sunday’s New York Times. The writer, a resident scholar at the conservative think tank, American Enterprise Institute, needed a kidney transplant. She offers her personal narrative, and then some proposals for inducing the poor to sell their bodies in a free market.

Ms. Satel begins with her experience as a woman suddenly faced with a life-threatening illness…

Three days a week, for four debilitating hours at a time, I would be tethered to a blood-cleansing machine. Even simple things like traveling to see friends or to give talks would be limited. This would very likely continue for at least five years until my name crawled to the top of the national list of people waiting for kidneys from the newly deceased. On average, 12 names, the death toll from the ever-growing organ shortage, would be scratched off the list each day.

She is a psychiatrist, working in a methadone clinic, and she knew from her medical training what dialysis involves. She dreaded it so much that she chose not to wait on the transplant list, opting instead to search for a live donor. She writes honestly and unsparingly of her failed negotiations with two friends, then with a man she met online. Finally she received an offer from an acquaintance, Virginia Postrel, a fellow conservative writer, and the transplant was successful.

While Ms. Satel calls the gift she received, ‘altruism’  she has a different definition when applied to people outside her circle.

We must be bold and experiment with offering prospective donors other incentives for giving, not necessarily payment but material reward of some kind– perhaps something as simple as offering donors lifelong Medicare coverage. Or maybe Congress should grant waivers so that states can implement their own creative ways of giving something to donors: tax credits, tuition vouchers or a contribution to a giver’s retirement account.

This is the kinder, gentler version. She is not ignorant of how desperate things can get for the poor in this world…

I flirted with the idea of becoming a ‘transplant tourist’  in Turkey or the Philippines, where I could buy a kidney. Or going to China, where I would have to face the frightful knowledge that my kidney would probably come from an executed prisoner. Grim choices, but I was afraid I could die on dialysis if I didn’t do something to save myself.

In all of this long essay Ms. Satel never wonders what would have happened if she were poor and uninsured. She seems to live in a bubble where the only problem is a lack of donated organs. And she downplays, almost callously, the risk to the donor.

The operation is done by laparoscope, leaving only a modest three-inch scar. She would have been out of the hospital after two or three nights. Most important, the chance of death is tiny–2 in every 10,000 transplants– and the long-term health risks are generally negligible.

This kind of reasoning explains a lot about why conservatives can be persuaded that whatever works for them is just peachy. There is a reason nature gave us two kidneys, a woman with chronic renal failure should be able to figure that out. If you lose one, as did my aunt, to a tumor, or my friend, to a motorcycle accident, you have a spare. And I’m not so casual about the long-term health risks — we haven’t been doing these transplants for all that long. Not to mention the risk of post-surgical infection as antibiotic resistant germs increase. Myself, I would gladly take this risk for love, but god grant I never have to for money.

But back to the kinder, gentler. The mother who sells a kidney so her son can go to college ( no pressure, Sonny), or the eighteen year old who needs cash and feels invincible. Or the man who needs insurance and can’t get accepted on an affordable plan. David Holcberg, of the Ayn Rand Institute puts it a little more frankly. This was printed on the Journal’s editorial page –

A person may reasonably decide, after considering all the relevant facts (including the pain, risk and inconvenience of surgery), that selling an organ is actually in his own best interest. A father, for example, may decide that one of his kidneys is worth selling to pay for the best medical treatment available for his child…

Opponents of a free market in organs argue as well that it would benefit only those who could afford to pay–not necessarily those in most desperate need. This objection should also be rejected. Need does not give anyone the right to damage the lives of other people, by prohibiting a seller from getting the best price for his organ, or a buyer from purchasing an organ to further his life. Those who can afford to buy organs would benefit at no one’s expense but their own. Those unable to pay would still be able to rely on charity, as they do today. And a free market would enhance the ability of charitable organizations to procure organs for them.

Just think, all those deadbeats sitting in the waiting room at Hasbro with their sick kids, they could be persuaded to put out if they want ‘the best medical treatment for their sick child’.

But don’t consider giving free medical care to needy children, or scholarships to hardworking poor students. That would be immoral.

We are really on the edge of a class disparity that is not only about money but blood. We already pay lip service to ‘serving our country’ while dangling cash and scholarships in front of the kids at Central and Hope High. The recruiters know where to go.

No matter how well written, and no matter how much natural sympathy one feels for anyone who goes through a dangerous illness, Sally Satel’s essay is horrible. In countries where desperate people sell their kidneys, you can be sure there will be many who die prematurely when their remaining kidney gives out, and there will be no help for them. I wonder where in the Libertarian scheme of things you put the person who sold a kidney, and now needs one. Do you chalk it up to ‘bad choices’ ? We will be going down a very dark road if we give up the principle of taking care of our own, rich or poor, and instead let the rich use the poor for spare parts.

For another, less temperate, take on this, check out Daily Kos. And yes, I’ve signed a donor card, but they’re not getting them until I’m dead.

Blizzards & Hurricanes

I know I’m not the only Rhode Islander who sat in a traffic jam on Thursday wondering what on earth would happen in a real disaster. If a few inches of snow shut everything down what will happen when the next hurricane hits our coast? Was the Governor was more focused on politics than public safety? He left town without bothering to tell Lt. Governor Elizabeth Roberts he was in Iraq, and he took all the keys with him. It reminds me of the shabby treatment Gov. Kathleen Blanco suffered when she was falsely accused of not declaring a state of emergency prior to Hurricane Katrina. News outlets, including the Providence Journal editorial page (Questions after Katrina 9/8/05 p.B4) repeated that slander and few bothered to print a retraction.

We began to see some of these attacks over the weekend. Sunday’s Washington Post cited an anonymous Bush administration official who explained that one reason that the federal government didn’t intervene more quickly in Louisiana was because Kathleen Blanco, the state’s Democratic governor, failed to declare a state of emergency there, a necessary step for federal help to flow. An article in Newsweek repeats the same claim.

But there’s a problem with the White House’s excuse: It’s patently false. As Josh Marshall points out, Blanco declared a state of emergency on Aug. 26 — a day before Bush declared a federal emergency in Louisiana.

Reading the Journal’s M.Charles Bakst I got a feeling of deja vu.

Roberts groused that Carcieri administration officials rebuffed her offers of assistance and her advice that the state Emergency Operations Center be activated.

She said, “This is New England. We have snow. I understand we can’t control nature. The timing of the storm was difficult. But we should be able to respond to a situation like this more effectively.�

You perhaps thought Carcieri’s Iraq/Kuwait trip made Roberts acting governor. But a 1992 constitutional amendment deleted wording that put the lieutenant governor in charge whenever the number one was out of state. Indeed, Roberts said she hadn’t known Carcieri was going away until she saw news accounts that he was already abroad.

The Lt. Governor is a Democrat, and a woman, and clearly didn’t get invited to the important meetings. Reading Kiersten Marek’s ‘Partisanship Putting Everyone in Danger’ is enough to give you heartburn — especially the absurd excuse that the Lt.Gov. was kept out of the loop for security reasons. Yeah, I feel more secure now that Gov. Carcieri went to Iraq and got his picture taken.

But I’m not interested in watching various officials throw blame around. I just want to see them start working together and come up with a better plan so this doesn’t happen again.

Partisanship Putting Everyone in Danger

There is a very concerning aspect to Carcieri spokesperson Jeff Neal’s comment about why Elizabeth Roberts, the Lieutenant Governor, was not informed that the Governor was going out of the country. According to Ian Donnis’s post on the lack of communication between the Governor and Lieutenant Governor:

Neal said he would have to check with the Department of Defense on the specifics of Carcieri’s Iraq trip, “but my understanding is that we were not permitted to share that information [in advance] outside this office.”

So national security now requires not communicating with your own Lieutenant Governor? This is where we have to really wonder if our national security protocols are actually causing more problems than they are preventing. If this is really true (and I doubt that it is) we are going to have real issues with emergency management, if we are wondering whether every piece of information we share outside of our office is going to go directly into the hands of “the enemy.” Come on, Mr. Neal. The Governor was not supposed to tell “anyone outside his office?” Whatever the rules may be, common sense also needs to be exercised. Shouldn’t the Governor of a state tell his successor when he is going to be out of the country, particularly as he is going into a war zone and may be at risk for being caught in the crossfire?

This is partisanship at its worst. And the results were abundantly clear in the ways the city of Providence and the State of Rhode Island could not respond to the needs of the community by enacting emergency management communication on Thursday.

We are lucky to have gotten a “test-drill” and not an even worse emergency with major power outages. Let’s hope we can learn from Thursday’s experience and improve our communication in this divided state.

Loophole the Size of a Drive-Thru

Elizabeth Seal of The Cranston Herald has written an informative piece on the way that a Dunkin’ Donuts drive-thru got approved at 480 Pontiac Avenue despite community opposition because of traffic concerns. From the article:

The neighbors of the gas station on the corner of Pontiac Avenue and Laurens Street are preparing a lawsuit after, unbeknownst to them, an application for a Dunkin’ Donuts drive-through, which they thought had been killed in 2005, was approved after all.

The property, which had previously been abandoned and, neighbors say, had become a “dump,� was bought in 2005 and scheduled to become a Citgo gas station with a Dunkin’ Donuts inside the associated convenience store. Since the store building is set back from the rear of the property, there was room to install a drive-up window and the owner applied for permission to include one.

That irked many area residents, who already consider the Laurens/Pontiac intersection a magnet for accidents and near misses. Sue Pacheco, who lives on Pontiac kitty-corner to the gas station, said the Department of Transportation finally had to install a raised median to help control traffic. [full text]

The story goes on to explain that although there is a law on the book allowing citizens to appeal zoning issues within 20 days of notification about them, it is unclear what decision people can appeal, since traffic engineer decisions can’t be appealed, and the original zoning board decision was completed two years ago.

Dave Fergueson, the traffic engineer who first denied the drive-thru and now has approved it, says he welcomes discussion on this process. I wonder why Mr. Fergueson did not contact Susan Pacheco before he approved the drive-thru, since he was aware of community opposition to the project.

There needs to be a time-limited window for when revised plans can be resubmitted to the city. There should also be a mechanism for notifying the community of the resubmitted plan, so that people affected can be part of the decision-making process. I am confident our councilmember, Emilio Navarro, will help in reforming this process.

Predicting Snow and Other Disasters

It took three hours to drive three miles from Chalkstone Avenue to North Main Street in Providence on Thursday when the storm hit. It was right around lunchtime and everyone had the same idea — leave work early and avoid the rush. I did not see a single snow plow or grain of sand on the road, and people were sliding even at 5 mph. There wasn’t even that much snow–looked about three inches.

There’s nothing like gridlock in the city to show how interdependent we are. I’m not blaming anyone for the fact that it snows, except the Lord (couldn’t He have saved it for later?) I’m just saying that with it being Rhode Island in December, and with the weather reports and all, we probably could have been more coordinated and gotten word that the storm was moving faster than expected. Still, it did come up awfully fast.

I had a lot of time while stuck in traffic to think apocalyptic thoughts.

Should we expect a National Security Advisor to anticipate potential threats?

“I don’t think that anybody could have predicted that these people would take an airplane and slam it into the World Trade Center, take another one and slam it into the Pentagon, that they would try to use an airplane as a missile.”
–Testimony from Condoleeza Rice to the 9/11 Commission

Well, actually, it was on TV a few months previous to September, 11, 2001, in the pilot episode of a show called ‘The Lone Gunmen’. Ms. Rice should have watched it.

There’s nothing like a traffic jam to bring it home that every system has its vulnerabilities. We have 21st Century information technology, and 1950′s implementation. A reverse 911 would have been cool, to call every number to warn us which roads were hopelessly blocked. A plan for staggered closings would have been good, so everyone didn’t all pour out of work and school at the same time. A little mercy to people who might have had to leave their car parked and walk or bus. The buses were out bravely working their routes. I can’t help thinking of what a mess it would be if we had something worse than a few inches of snow.

But I’m not griping about nature, the snow was a great excuse to take the afternoon off. Now it’s dark and the snow is real pretty in the streetlights. Take it slow, drive safe.

Everyone Wants to Give

I volunteered at the holiday gift shop at my daughter’s school this morning. My job was to help the 1st graders and 3rd graders who came to the shop to buy gifts for their relatives and friends. Everything is priced between .25 cents and $5.00, with most gifts being in the $1 to $2 range. They are cute little things, mainly ways to express gratitude to mothers, fathers, grandmothers and grandfathers, brothers and sisters, nieces and nephews. Most kids arrive with a budget of about $10 and a list of 5 or 6 family members. One little girl had only a dollar. She had no list. It was not clear why. So she wanted to buy something for her mother, but all the things she picked out were $2 and $3. Finally, she settled on a $1 gift. She asked about whether she could get something for her sister. She picked up a necklace and said, “My mom would love this so much.”

I felt bad. But there was nothing I could do. It would not be right to give her the money. I didn’t know why she did not come with an envelope or money. Maybe she doesn’t celebrate a winter holiday (unlikely, but possible). Maybe her mother or father couldn’t read and so didn’t know how to help her fill out the list (unlikely, but possible). Maybe the envelope got buried under some other things at home because Mom and/or Dad are both working lots of hours and don’t check her notices every day when she comes home (seems more likely). Or maybe her family just didn’t have the money.

There is no way to know, but the episode served as a strong reminder to me of how much we all want to give. Everyone wants to give back. It’s evident in my toddler who brings her doll everywhere and tries to help with kitchen activities. It’s evident in the child at the school holiday gift shop who wants to buy presents for all the people in her family, but who does not have the money to do it.

If we take as a metaphor for well-being the desire of children to give gifts, to give back to the people who provide for them, then what of the plans for the state to cut off health insurance for 20,000 low income families, including children, in the state? It strikes me as a sad omen — another way in which we will take away our collective power to give. Many of these children and families will go without health insurance, or will pay for it with a large portion of their income. These are the same families who perhaps struggle to come up with the extra $10 to give to their 6-year-old so she can go to the school’s holiday gift shop and buy something to give back to the people who love and nurture her.

Today at noon, a group of Rhode Island business, health care, and community leaders came together to express opposition to the proposals to cut health care. I wasn’t there in body but I was certainly there in spirit. From the health care organizing project:

Community, Business and Health Care Leaders Will Stand Together Against Proposal to Cut Nearly 20,000 from RIte Care

The broad-based group of leaders will outline why the proposal is financially short-sighted, and harmful to the people of the state.

On Wednesday, December 12th at Noon, leaders from business, health, faith, education and the advocacy community will gather at the Capital Hill Health Center, 40 Candice Street, Providence to respond to the budget request sent from the Department of Human Services to the Governor that would exclude nearly 20,000 children and parents from the state’s RIte Care program.

Dawn Wardyga, Director of Family Voices at the RI Parent Information Network, states “We’ll respond to this outrageous proposal to warn Rhode Islanders about the unacceptable economic and human cost this type of wholesale attack on RIte Care will have on our state. There are real solutions on the table that this proposal ignores. The truth is we have seven months ahead to impact state budget decisions and must all work together to demand more responsible, long-term solutions for the people of Rhode Island.�

What: A press conference in response to the Department of Human Services budget request to the Governor

Where: Capital Hill Health Center, 40 Candice Street, Providence

When: Wednesday, December 12, 2007 at Noon.

Speakers Will Include:

Merrill Thomas, Executive Director, Providence Community Health Centers

Barbara Torres, Parent of kids enrolled in RIte Care – three with special needs

Ted Almon, President, The Claflin Company, E. Providence

Andy Snyder member of the RI Medical Society and of the American Academy of Pediatrics

Donna Paolicastro, Executive Director, RI State Nurses Association

Dawn Wardyga, Director of Family Voices at the RI Parent Information Network

Ann Marie O’Hagan, Parent of kids enrolled in RIte Care

Lucie Burdick, President, SEIU Local 580

Survival of the Richest

The SCHIP children’s health insurance program is fighting a Presidential veto. Governor Carcieri and the legislature are considering cutting health care for 18,000 poor children. In a really Darwinian situation you would think we would make children’s health a priority, but we hold to a different standard. Is it financial or political triage?

From the California Nurses Association

“The patient’s history and prognosis were grim: four heart attacks, quadruple bypass surgery, angioplasty, an implanted defibrillator and now an emergency procedure to treat an irregular heartbeat,� the ad states, referencing Cheney’s lengthy medical chart. “For millions of Americans, this might be a death sentence. For the vice president, it was just another medical treatment. And it cost him very little.�

The Republican slime is already spewing but the nurses are standing by their words.

Showing no signs of backing down from its controversial ads, a spokesman for the California Nurses Association and the National Nurses Organizing Committee tells The Washington Post’s The Sleuth blog that it’s Cheney and the Bush administration who are outrageous:

“What’s outrageous is we have an administration that sits on its hands while we have 47 million people who are uninsured … This administration has ignored this health care crisis,” says Charles Idelson, spokesman for the California Nurses Association and the National Nurses Organizing Committee. “They’re indifferent to pain and suffering.”

Today the federal reserve put more truckloads of funny money into the stock market, so that speculators won’t be falling out windows like in 1929. And as in the Great Depression, it will be the working people who are told to practice ‘austerity’. The people preaching it will never have to sit in a plastic chair in the emergency room at the Rhode Island Hospital, hoping they can get a chance to tell a doctor about their chest pain.

Let’s just admit that we have an American elite, and dream we’ll be good enough to join it. Or else pay close attention between now and November, to which candidate is willing to commit to accessible healthcare for all.

Impersonating a President

If you’re not familiar with Frank Caliendo, he is a masterful impressionist (think Rich Little, not Claude Monet) who is perhaps best known for his impersonation of sports analyst John Madden. Caliendo also does one of the best George Bush impressions around, as you can see for yourself in the following video clip:

Armistice Declared — War on Christmas Over!

Yes my fellow Americans, the War on Christmas is over, and we won. You can take that list of obligatory present type items and set it in the fireplace, then use it for tinder while you enjoy a quiet evening with family or friends or your cat or computer because…

You don’t have to go shopping!

If you like colored lights on the dark days you can string them on your bushes for everyone to enjoy, and in your house to look pretty and you can…

Leave them up until spring!

When the malls are a mob scene and everyone is out in the cold and the slush frantically shopping you can…

Go out and hear some live music!

And best of all, you can pick and choose. You can get a tree, or just a few tasteful evergreen branches, or put a bow on the cat. No one else owns your Christmas.

Just do the stuff that is fun!

Really. The Pope called me up last night and he says it’s okay. Bill O’ Reilly is putting all his Christmas money into the Heifer Project. The good Christians are putting up manger scenes on their own lawns! Imagine that! The churches have stopped bugging City Hall, and they’re opening their doors and inviting the whole lonely world to come celebrate with them. The War on Christmas is over! Jesus is very relieved.

Peace on Earth, Good Will to All.

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