Conversations about Safe Sex….

I started a lively discussion at lunch yesterday when I was talking about the lectures I attended this weekend at the conference. One of them was HIV/AIDS prevention. The guy who gave the lecture works in Africa with a prevention ministry. He said they use the A B C method to teach about safe sex: Abstinence, Behavior Modification and Condoms. Considering we were sitting in a church, this was somewhat of a bombshell. Although no one got up and left I would not have been surprised if they did. The guy went on to say exactly that, he knew it was a bombshell but he was in the business of protecting people from a deadly disease and protecting women and children in particular (Men in the culture he works in often have multiple partners and bring the disease home to their monogamous wives and thus their children). He said though even as a American, evangelical father, if his daughter has sex with a guy outside of marriage, he will personally give the guy a condom (right before he pulls out his shot gun…). This got the lunch conversation going…

The discussion at lunch centered on rather we should a similar method for teaching teenagers about sex in the public schools. Depending on when you came through or rather you went to a public school or not, you may or may not learned about condom/safe sex at school. I DID. In case you didn’t know those days are mostly over in NC. Abstinence is the only thing presented in NC public schools, I know this with some knowledge because I recently set in on a AIDS educator training session and was told we can’t bring up “Safe Sex” or condoms in less directly asked by a student due to state policy.

We asked more questions than came up with solutions. The big question is do giving kids condoms enable them to have sex. Or will they just do it anyway yet unprotected? We talked a lot about well “I will teach my kids this way…” but the question is not about how you will personally raise your children…what do you do for the kids whose parents never have talk about sex with them or wait too long to have that talk or just aren’t involved enough to care? I have done pelvic exams on young girls who are too young to drive. Some already have STDs…. Bombshell or not, we have a problem.

So I as a future pediatrician should I start passing out condoms to all my adolescent patients even if I would not necessarily do the same for my adolescent child? Is that inconsistent? Will that really solve the problem? Define the problem…is the problem that the kids are having sex or that the kids having unprotected sex? We come back to where we started do condoms enable kids to have more sex?  Do kids make better decisions when we give them choices or when we pretend the choices don’t exist?

Then there is a whole another level of this issue. No matter what we teach in school, what is our culture teaching our kids? Watch nearly any movie over a G rating and you will find sexual tensions and innuendos. How much MTV would you have to watch to find a single safe sex much less abstinence message?  Even the discovery channel has sex documentaries. Its everywhere, its being screamed, whispered, supersized and marketed.  How do we attack this? How do we make sure our kids get any real information? If we teach them about abstinence in school, do we honestly think they don’t know what else is out there? We are kidding ourselves if we do.  We will lose the battle.  Would you rather the media teach your kids? Their School? Their Physician?

Because they will learn about it from someone…

Another speaker I heard this weekend told the story of an African father who kept telling his doc I am going to talk to my son, I am going to talk to my son. Finally he tells the son that they are going to have a father/son talk. They take a walk and the father finally says so, “I wanted to talk to you about sex.” The son grins and says, “Sure Dad, what do you want to know?”

….thoughts?

…crap

We are 90% sure my parents’ insurance company is not going to cover me after Dec 31. Some of you may remember back in Sept when this first came up. We have been working since then and it appears our efforts have failed. We have gone through the necessary channels to extend this policy but it does not appear to be possible. Our insurance agent is trying one last time today to fight for us but he is not optimistic. My Mother is in battle mode, I haven’t seen her like this since high school when we moved to VA and they told us my sister and my credits would not transfer and she fought the school board saying they were discriminating against military children. My grandmother too. My Mom is furious and calling every state official who has a phone number. I keep waiting for the governor to call and say we have been playing phone tag. She is a little craszy in that way that parents of children with issues get when someone tells them NO we can’t help you because your child is different. Never mind I live in another state independently, never mind I am medical school, I will always be her daughter, her first born and disabled child and God help anyone who tries to get in her way of protecting me.

On my end, I have been praying it wouldn’t come to this. But I am not surprised, because I daily hear about the horrors of insurance companies. I already held a weeping patient or two who can’t get coverage or can’t get insurance or can’t pay for the insurance they have. It does not surprise me that the insurance companies don’t give a dam that I am a full time student yet if I was unemployed and never left home they would be happy to cover me for the rest of my natural life. Nor do they care that I have never smoked, drank to excess, done drugs. I exercise regularly, see my primary care provider once a year, I wear my seat belt and I take vitamins. They ask those questions but they are not interested in the answer. They don’t care that I never had choice in being chronically ill. They are happy to punish me anyway, punish me for being born.

On my end, while my mother is picketing the commonwealth and telling anyone who will listen that her medical student daughter is being discriminated against by American health care. I am here on my way to the Student Services Office trying to convince them of the gravity of the situation. Trying to help them understand that while they insist I am covered when I call the company, they say NOTHING CONGENITAL. Everyone I talk to is so calm, so matter of fact as if it all doesn’t matter. And I realize I prefer my mother’s response. The injustice is staring them in the face and they just don’t care. I want to scream “This is not a game. This is my life, my health and my education on the line here. You can either help me get this in writing or you can become part of the problem.” And I realize two things in fast succession:

1. I am just like my mother.
2. My Deans, my professors, my classmates 98% have never been here. They have never been and WILL NEVER be in my situation. They have no clue what it is like. While they fill out insurance papers for other people every day of their professional lives, they have never worried if they would be able to afford healthcare.I don’t hate or resent them for it, I just realize I can’t expect them to understand completely, nor can I judge them.

And despite how terrified and angry at the system, at the school I am grateful. Grateful that I have a family who fights for me and taught me to fight for myself and grateful for perspective. Because the next patient who I see crying over insurance, I will hold them and I will say I’ve been there, it sucks. This is wrong, unjust and un-American. Let’s fight this together.

Praise God for perspective.

why its dangerous to ask for directions

For those of you who know me, you know I am passionate to a fault. You know that I am stubborn and persistent. I don’t just let things go.  This a blessing and a curse.

For those of you who don’t know me, let me give you the short of it. When I was a freshmen in college, I read an account of two Catholic physicians’ experience in Eastern European hospitals just after communism fell. They described rows and rows of children tied to their cribs, malnourished and severely emotionally neglected. The children’s only crime was being born with some medical abnormality whether it was a heart murmur or spinal biflda. The children all had the same fate, a life sentence in a prison called a hospital without family, without medical care and without a name.  I am not sure what made this so much worse in my mind than all the other horrid injustices disabled people face every day all around the world. But something in me broke when I read this.  That something might have been my sanity. 6 months later I found those rows and rows of children and I held them. I am pretty sure everyone thought I was a little nuts but my passionate stubbornness was driving.

And I think at some point I just hit cruise control. Because I kept going back… 2 more summers in Eastern Europe, an 88 page honors paper, a giant Romanian flag on my wall, countless pictures of children whose names I still remember, reoccurring dreams of holding babies, a semester of Russian, etc, etc.  A little obsessed?  I admit it I am.

Everyone still thinks I am crazy but most of them  are now waiting for me to  move to Eastern Europe and practice medicine,  adopt babies and teach about disabilities, inclusion, Jesus and liberation theology.  So naturally when I found out that I have exactly 8 weeks during my 4th year that I can go abroad in during the next 3 to 5 years, I was set on going back to Eastern Europe.  Then this past weekend happened.

I have an opportunity to work with a community based rehab program in the developing world. A program that teaches parents and lay people from rural villages and towns how to integrate disabled children into their communities and help each child reach their physical, emotional and spiritual potential. They care for children’s medical needs including orthopedic and neurosurgical interventions (for things like spinal bifda, cerebral palsy, hydrocephalus, muslcoskeletal issues, craniofacial abnormalities etc, etc), help families and communities accept the children and continue their rehab. I as a 4th year would get to work in the rehab side and play pediatric hospitalist for post-surgical kids.  Plus they want me as a disabled young adult to go into schools and teach about disabilities and build relationships with parents of disabled kids. The medical education program is well established in one of the best teaching hospitals in the developing world.  I would live on site and I will work with students and physicians from around the world. Its like someone took my vision for my life in 20 years (minus a husband and 2-3 kids (at least 1-2 from Eastern Europe) and made it into a 4th year elective (a year and half from now).

One small detail. Its not in Eastern Europe.

Its in Kijabe, Kenya. That would be A F R I C A people and while I have joked about living in a hut in Africa one day, I really was joking. Africa is not in the 10 year plan. Africa is hardcore, Africa is not a train ride away from Western Europe.  A place that I can’t even name the countries around it. A place of overwhelming needs and problems.There are very few disabled children in institutions in Africa. They just die.

If I go back to Romania, I will work in a family practice clinic and only be able to work with the disabled kids on the weekends. I will have little to no rehab education and little to no supervision while I minister to these kids.  There is such a depersate need for rehab medicine which is why these children haunt my dreams, yet there is no education for me there.  However, in Kenya my primary task would be take care of disabled folks and I would sit at the feet and veteran rehab missionary physicians and surgeons. The choice is clear.  If I ever want to be useful in Eastern Europe or elsewhere I need to go to Kenya.

But it breaks my heart. 5 years is a long time to go without Eastern Europe, I know that sounds ridiculous but remember my passionate stubbornness.  It also terrifies me. Eastern Europe is familar. I know its history, I know its problems, I know bits of its languages. I know its food, its culture and customs. I know how to navigate its cities, I know how to take a wheelchair on its public transit.  I have friends there. I have buried friends there. I have unfinished business there, I have children who I am following. I am clinging to Eastern Europe because  I can handle it.

I wasn’t looking for a change of plans, I wasn’t looking for a one way ticket out of my comfort zone. But I have should have seen it coming.  Because I think I have let my passions get ahead of my calling. Its not about being comfortable, its about the work. And the work is taking me to Kenya.

God is for about the millionith time reminding me that its really not about you. And I am learning to let go, slowly and with tears.  There is joy in the journey, praise God for that.

It means I don’t always wash my hair

I had someone asked me what it was like to live with chronic pain this week! And I just sort of sat there and tried to come up with some sensible answer.

I thought about pathology and degenerating cartilage and all kinds of medical jargon. But I realized quickly that has absolutely nothing to do with the answer.

The answer people want is something like well its not that bad or you get used to it or I handle it fine, it doesn’t get in my way that much. Thats an answer that makes people feel good about you, it makes them either be like wow i don’t know how they do it. And I am somehow transformed into some inspirational noble person who overcomes it all and has a very high tittering pedstal.

The answer people secretly suspect is true is something like its terrible, I cry myself to sleep every night. You have no idea how hard it is….woe is me. Pity me.  I need narcotics.

The truthful answer is not an answer people want.

Because the answer would go something like this: Well I haven’t washed my hair in a week because my shoulder hurts or I am too tired when I get home to stand for a shower, so I just take a bath. Or I just didn’t wear socks today because it was just not worth the pain of bending over and fighting with my funny shaped feet and aching hip. I didn’t make lunch last night because I was too tired and had run out of energy (spoons).  Or I just can’t quite focus on a movie much past 10:30 on a day I have worked or gone to school because I just run out of energy. And last week I went hiking and ever since then I have this shooting pain in my knee and as a result I didn’t exercise this week.

I am just always a little mystified when people ask so what’s life to live with degnerative arthritis? or how’s your pain today? Because I am skeptical that they really want the answer to that. In fact my life is not so terrible, nor is it noble, it just a bit more of a game of calculated risk and energy economics and a few extra bad hair days.