Showing posts with label classism. Show all posts
Showing posts with label classism. Show all posts

Friday, January 23, 2009

Dealing with messed-up-ness of medical system as a healthcare provider?

Lately I have been thinking about, or feeling like I need to think more about, becoming a healthcare provider in such a messed up system. Messed up in a lot of ways, including the lack of access and profit-driven system in the U.S. (call your congresspeople about single-payer universal healthcare, expanded/improved medicare for all, now!!), but that's a whole other post. I'm thinking about more the ways in which medicine has such a history AND present of being rooted in systems of domination and oppression such as ableism, classism, homophobia, racism, sexism, and transphobia.

How do I bring into conversation the idea that medicine is inherently a project of domination (an idea I take from discussions I've had with friends - theoretical and personal, and people I've read and heard in activist and academic contexts) with:
-the left-wing but not queer or radical in the same way doctor-activists and nurse-activists that see "good medicine" as a force for change (with whom I sometimes vehemently disagree, but sometimes think have done really good, important work)
-the objectified and rude-ranging-to-abusive way I frequently see patients get treated by providers at the free clinic where I volunteer
-the idea that even if this field is inherently fucked up and untrustworthy, there are still many things people need to get from it (sometimes because it is expertise or a skill specific to medicine, sometimes because medicine and/or government has control and acts as a gatekeeper)
-my own privileged experiences of being a patient (on the object side of the patient/doctor equation, but in a very privileged class, and racial context and a not-visibly-marked body in terms of gender variance and disability)?

What do I need to do when I am a nurse practitioner to make sure I serve the needs of the patients and/or disrupt the messed up patterns and practices of healthcare? What do I need to do now when I am interpreting or facilitating classes at the clinic? To not EVER lose sight of treating people respectfully, like people, instead of like objects to be touched (with or without consent). Or like interesting ideas to be bounced around later with colleagues (a greater danger for me, as I have noticed myself doing this)?

I have decided to go to school to be a nurse practitioner instead of a doctor. I think not entering into the old-white-boys-club (which now some women and people of color can be a part of if they play their cards right and/or have enough class privilege) of medicine, will position me a little bit differently. And when it is problematic, I will not have to have 110% of my time and energy devoted to it, so I will have time to seek out other worlds/people and take care of myself enough to not become a total pompous stressed out asshole that thinks I'm more important than everyone else, especially patients. But it still is part of a messed up, disciplining field, and it would be ridiculous to think being a nurse would escape that. Also, I am going to the top of a very hierarchical nursing field (hierarchies with strong racial and class components), and in programs that skip a lot of the grunt work and go straight to the masters or doctoral level position. Programs that are in some ways designed to position us just like primary care doctors (and that is part of what appeals to me about them).

Some of this is the mind vomit that will be irritating to look back on (and maybe for others to read). But I needed a place to work on processing, and also to be held accountable or discuss ideas if anyone has any.

Further reading (an extremely incomplete list):
Mississippi appendectomy - forced sterilizations on women of color
Ashley X petition
FRIDA on Katie Thorpe's womb to be removed
Interview with Harriet Washington, author of Medical Apartheid
Medical Apartheid book
Bad Blood book (on Tuskegee Syphilis experiments)

Friday, December 12, 2008

Insurance coverage: advocating for CGMS in a system that leaves many people out

Today I received an email from JDRF about their campaign to get continuous glucose monitoring (CGMS) covered by insurance companies. I want my insurance to cover CGMS so that I could use it. I don't think they have any business denying people coverage to this device that is helpful to our health and probably lifesaving for people with hypoglycemia unawareness. But I also don't think health insurance companies or our health care system in general as any business denying anyone coverage. It pisssed me off that this is JDRFs focus when there are more pressing issues for many people.

I wrote back:

I want CGM covered, but MUCH MUCH more than that, I want a single payer health care system that covers everyone in this country.

Please fight for things that will help ALL diabetics and that are much more necessary than CGM. I test 10 times a day, and sometimes wish I had CGM (for example, tonight, I am up late because I worry that my blood sugar is dropping). The diabetics that come to the free clinic I volunteer at are all uninsured, and cannot afford test strips. If they come to the clinic, wait on the waiting list for the diabetes education class, and then attend all the classes, they receive enough strips to test once a day. Though they are type 2s, this includes many people on insulin. People taking insulin that can test their blood sugar once or less a day. As for yearly dilated exams (more often if retinopathy is already present)? The waiting time to see an opthalmologist is 22 months

The millions of diabetics that are uninsured or underinsured and can't even access the basic necessities of diabetes care deserve much more help and I think it's abominable that this is your priority.

Sincerely,
me


We need healthcare for EVERYONE that leaves nobody out. We need a universal single-payer system (expanded & improved Medicare for all) now.

Wednesday, September 03, 2008

Thinking back to the aftermath of Hurricane Katrina

Hurricane Gustav and the anniversary of the destruction and criminal neglect of the people in New Orleans after Hurricane Katrina had me thinking back. Katrina hit before I left home in Chicago to go back to school for the year, and the aftermath continued as I settled in on campus. One of my professors remarked that people "feel like the world is ending" with all of the recent events - Katrina, the tsunami in late 2004, even going back to September 11th.

I didn't share that sense of terror or a strong connection to events like the tsunami or September 11th (especially not September 11th, which did not seem any more tragic to me than the tens of thousands of people that die every year in the U.S. from lack of access to healthcare and other forms of violence the media is not interested in). Yes, sadness that so many were dying, frustration and disgust with the responses of people and structures that could have helped prevent tragedies of such scale or responded better, and dizziness from just trying to understand the sheer numbers of deaths, which my brain couldn't even compute. But not a sense of terror or grief that shook me to the core.

Katrina was different.

I was watching TV with my mom, and suddenly I found myself sobbing. The camera had just showed a young black woman crying and screaming that she was diabetic and she needed insulin and that she was going to die if they didn't get some insulin to her. It just got me - I reacted before I had even thought about it. It made me so upset and scared and incredulous and disgusted. It was just so wrong and so upsetting, and I did not understand how anyone or any structure could do that (deprive someone who is insulin dependent of their insulin) to another person.

Once I thought about it, I got enraged at everyone, the government especially but even all the way down to the news crew. If they had those resources (electricity and transportation and contacts and enough expensive equipment to get on national TV), how could they stand there fucking taping her screaming for her insulin and not get her some? This was not the first day after the hurricane hit either, I think it was at least day 3.

But what got me on such an immediate, visceral level was clearly the type 1 diabetes. And probably some element of seeing myself in that woman. Although I know on a rational level that my chances of being in that situation, as a wealthy white person with connections (in healthcare), are almost non-existant, it struck me. Maybe poked past some of the filters that structural racism has taught me to look through and the mainstream media perpetuates? Or perhaps I shouldn't have been surprised, I don't usually watch a lot of TV and so don't see all of the gruesome visuals on some disasters.

It also seemed much more urgent and close and part of my life because it was closer and happening in my country, a system that I am more directly part of. It was crude injustice: racism, classism and poverty laid out in such a raw, visible way. Ignoring or moving at a snail's pace to help people that are dying, in a way that just showed how little regard most of the people in power had for their lives. That stuff exists here all the time, but it was magnified and made more visible by the hurricane.

Friday, November 02, 2007

Call for submissions on wealth, redistribution, and class, and a few other things

1) I wanted to do "NaBloPoMo," or National Blog Posting Month. I'll admit the initial temptation was due to the great lolcats-themed badges. I am easy, anything related to that website wins me over immediately. But I do think it would be a great chance for me to learn to write shorter (and more frequent) posts, connect more with other diabetes bloggers doing it, and to force me to finish up all the half-written or outlined posts (there are lots) on stuff I've been wanting to write about, and generally get more comfortable writing and enjoy getting stuff out. However, I am really behind with the class I'm taking and at work, and kinda stressed, so I need to be looking for ways to limit, not increase, my internet time.

2) I went to my diabetes doctor this week - a few thoughts, I will write more later. There wasn't much in the way of surprises or even guilt because I know I've been struggling with my blood sugars a lot the last few months, and part of it is this weird absorption issue, among other things.

3) There's a new project that I heard about at Aid & Abet that looks great. It's a website called Enough, looking for submissions on wealth, redistribution, and class by November 15th-ish (loose deadline). I think it would be cool to get some stuff from you folks out there that involves health/illness, disability, and how that both affects and is affected by wealth, class, our economic system, and ideas for change, etc. I'm hoping to submit something.

One of the coordinators describes what they're looking for:

Call for Submissions: Enough

What is the difference between financial security and hoarding wealth?
What are some ways we can share resources to support community and movement-building?
How can we talk to each other about personal money issues and politics without guilt, shame, and judgment?
What does a politics of wealth redistribution look like in the day-to-day, and what are the obstacles to developing conversations about this in political communities we belong to?

These are some questions we’ve been thinking about, and we’re interested in jumpstarting conversations about how we conceive of and live a politics of wealth redistribution. We’d like to invite you to contribute some writing to a website we’re creating to explore this topic, called Enough.

The ubiquity of capitalism in the U.S. can limit our ability, even in radical communities, to conceptualize creative responses to oppression and injustice. This can manifest both in how we build movements (reproducing bureaucratic, hierarchical, business-type models; packaging and “selling” social justice work to foundations in exchange for grants), and in how we deal with personal finances in our own lives (defaulting to patterns like hoarding, excessive consumerism, and individualism in how we conceptualize our lives and futures and economic security).

We’d like to address some of the ways that class privilege and capitalist dynamics function even within communities and within the lives of individuals working to fight oppression and economic injustice. It can feel taboo to share details about things like income, inheritance, class background, debt, and spending. Silence and secrecy about money make it difficult for us to challenge ourselves and each other when classist dynamics arise. Social conditioning trains us to hoard money rather than share it and build community. We want to get people talking about building shared values and practices around wealth redistribution, because we think figuring out how much is enough, and when to give away money, are key under-discussed questions in anti-capitalist politics.

Some examples of the kinds of things we’re looking for:

-Pieces about how your class position has changed over the course of your life, and how that has affected feelings of responsibility about wealth redistribution.
-Stories about cool methods of figuring out what is “enough” when it comes to making/saving money. How do class background, class conditioning, fear, guilt, and other factors influence how you think about this question? How do you figure out what you need versus what you want when it comes to consuming?
-Examples of (or ideas for) community-based support systems that serve as alternatives to individualistic models of taking care of ourselves.
-Strategies for redistributing wealth in your community, or to support social justice work.
-Discussion of how ideas about wealth, security, scarcity get reproduced in families.
-Diatribes on the politics of inheritance.
-Discussions of professionalism and salaries.
-Exciting models of people dealing with money ethically in activist spaces and organizations.
-Strategies for overcoming immobilizing guilt about class or money.
-Anti-capitalist/anti-racist/anti-imperialist analysis of personal choices about saving for retirement, buying real estate, taking certain jobs, supporting our community, etc.
-Diagnostic worksheets to help people figure out any of the following:
My place in the economy (local, domestic, global)
Am I rich?
What sources of security do I have that I may not be aware of?
How do I know if I need something or just want it?
What are my resources besides money?

The two of us come from very different class backgrounds (Tyrone grew up in a first- generation owning-class family, and Dean grew up on welfare) and we’re hoping for a specifically cross-class conversation about these issues. We think that the anxiety that can arise when talking about these things among folks with different experiences of class can be useful and productive, and we hope to create a space where we can learn by sharing our experiences and challenging each other.

Please send us an email if you have an idea you’d like to write about, a resource you think we should know about, existing writing you think we should post in this conversation. Your piece can be short or long, written in any style.

Please send submissions to: tyronius.samson(at)gmail.com and/or deanspade(at)gmail.com.

Monday, October 29, 2007

Newsflash!

Did you know that breastfeeding could abolish all diabetes? No, you didn't? That's because it can't!!

Last week, a nurse (possibly a nurse practitioner) said at a health care activism meeting, well, if everyone breastfed, there would be no diabetes.

Um... I say, I am diabetic and I was definitely breastfed for a long time.

Instead of owning up to the stupidity and insensitivity of her comment, or at least backing off a little, this woman says, "Really?!! Wow, you must be the outlier, the one exception! It's an inflammatory process!"

Hell no. This woman did not only just talk about me and my mother, but then she tried to defend her statement and act all surprised.

I thought about not even telling my mom (a nurse practitioner) about it because even though we both know it's bullshit, I don't want her to even think for a second about blaming herself or that I might blame her. But, I decided to, and she articulated another thing about it that bothered me. She said, "Doesn't sound like politics to me, sounds like blaming the victim." Yes, the blaming the victim thing. Stupid and fucked up. But I think it was politics, or "blaming the victim" masquerading as a political statement/rebellion, which bothers me even more. And blaming mothers is a recurring theme in our culture.
EDIT: As I was writing this post, I found this great discussion going over on Scott's blog about diabetes, breastfeeding, and blame/guilt.

I am actually all about breastfeeding for mothers that are able to, but this comment was just ridiculous for a couple reasons. Even though I do think traditional medicine can be harmful sometimes and natural methods have a lot to offer, the "natural medicine" pusher people piss me off a lot because they take it to an extreme that is able-ist and/or just dumb. Also, not all mothers are able to breastfeed for various health and other reasons.

In general, people that think they have a cure-all "natural" solution for my diabetes, or whatever else, are pretty arrogant to think that they have the fix to something that I devote endless time and energy to on a daily basis. If it was that simple and complete a solution, don't you think I would have found it? Or am I just stupid for muddling through with my traditional medicine? Do you want to see what happens to my body for even 4 hours without any insulin?

Now, that nurse wasn't suggesting she had a cure for me now. This is just an example of where that kind of statment takes you. It's a way of invalidating my very real experience. That's the problem with universalizing especially when you havent had that experience (and especially when you're working out of this ableist framework).

Also, even if it really was true that breastfeeding can prevent all diabetes, that's a pretty serious, loaded thing to say in such a cavalier way to someone you met 15 minutes ago.

I need to learn to write shorter posts. If you're getting bored, you can consider yourself done here! More ramblings of mine follow...


There are studies that show breastfeeding does significantly reduce the chances of a kid developing type 1 diabetes. And inadequate nutrition as a fetus, infant, or child can be linked to higher risks for stuff like type 2 diabetes and other health issues as an adult (one reason why I think we need to look at environmental stresses like poverty, etc. before anyone chalks up racial health disparities to genetics, which can often end up being just a new sophisticated incarnation of scientific racism). But for her to talk about this one single cause is really inaccurate. And her justification that it's an "inflammatory process" doesn't help her case, because there are so many different triggers that contribute to inflammation.

Also - speaking of ableism - this nurse also made a bunch of comments about well, if something ever happens to me, that's it. pull the plug. She was trying to make a point about the excess money we spend in the U.S. on heroic measures like ventilators at the end of life. I actually agreed with some of what she was saying, that we need to reexamine what life is and how we're spending our healthcare dollars, and if we really want, from a financial
and quality of life standpoint, to be living hooked up to tons of stuff instead of letting ourselves die peacefully when life is ending. But I don't think needing outside assistance from other people, machines, or drugs are the definition of when life is worth living or not, and her statements went too far into ableism and almost even eugenics.

Do you really think life with illness isn't worth living? And do you want to say that to me and the woman sitting next to me that looks like she might have cancer? Besides being a messed up way of thinking, MOST people live with illness or disability in some form at some point (especially people that are not upper-class white people like she and I). And I think to not recognize that is both inaccurate and ableist in that it reinforces this idea that healthy and perfect (and requiring no outside help from other people/medicines/therapies/etc) is the "normal" state for everyone, and a fall from that is remarkable or abnormal.

Saturday, April 14, 2007

Drug prohibition is stupid aka GIVE ME MY SYRINGES, JERK!


Today I tried to buy 10 syringes without a prescription and was denied. I had left a box at work in a building locked over the weekend, and I needed more. I knew from working in HIV prevention/surveillance about the IL law that allows people over 18 to buy (and possess) up to 20 syringes without a prescription. Although it is limited in it's ability to increase access to clean syringes (cost, needing an ID to prove age for undocumented immigrants, trans people, young people, and poor people, and the issue of pharmacies actually complying), I think it's a great step in the right direction because it supports harm reduction and drug decriminalization.

Moralizing is stupid and an obstacle to accessing dignified healthcare and other services. The U.S. war on drugs is racist, harmful domestically and in other countries (like Colombia), and ineffective. Yes, non-prescribed injectable drugs can be harmful, but dirty needles are harmful too, and forcing someone to use them doesn't help anything! Several studies have shown that pharmacy sales of syringes without a prescription did not increase illegal drug use, and decreased high-risk behaviors for HIV. Sharing syringes is a major source of HIV and Hepatitis C infection:
  • In the U.S., about 50% of all new HIV cases can be traced back to injection drug use (in people that use, their partners, or their children).
  • Sharing syringes is the leading source of Hepatitis C infection.
  • In Illinois, 70% of AIDS cases among women and almost all pediatric AIDS cases are associated with sharing syringes (including sharing of syringes by the mother of the child who is then exposed at birth).
I think that, among many other things, a fundamental disrespect of or apathy towards the lives and well-being of people affected by these issues is at the root of policies refusing to provide access to clean syringes. In addition to moralizing anti-drug sentiments, racism, classism, and sexism play into this. The Chicago Department of Public Health reports that the 2005 HIV diagnosis rate in black females was more than 15 times that of white females.

Despite citing the law and threatening to report her to the AIDS Foundation of Chicago syringe access project, the pharmacist still refused to sell me the syringes. She acknowledged that the law exists but said, "it's at the discretion of the pharmacist." Even when I appealed to the fact that I am diabetic and needed them for insulin, offering to show her my medic alert bracelet and blood test meter, she refused. I think that people that need clean syringes to prevent HIV/Hepatitis C infection when they use syringes for other purposes not sanctioned by laws and/or medicine (illegal drugs, unprescribed hormones) "deserve" them just as much, but my diabetes is seen as more deserving by many people so I tried that appeal.

It was pretty incredible to have someone look at me and say, no, I am going to deny you access to the supplies that you NEED to stay alive and healthy. And have them have the power to make that decision. I guess a lot of people face this kind of cruel denial on a routine basis, from lacking funds or other issues with our fucked up health care system.

(I did get the syringes from another pharmacy without a problem).

Thanks to the diabetes art pool for the image.

Tuesday, March 27, 2007

What you get when you "hold your nose and vote for someone." Or, painful reminder that Democrat does not equal less classist or anti-immigrant.

"Dr. Robert Simon, chief of Cook County health services, said the county should fly illegal immigrants living at Oak Forest Hospital back to the countries they came from."

He goes on to actually defend this comment, discussing the logistics and viability of this idea and that it should be done "humanely." Wow. This is what I get for thinking that I had to vote for the icky corrupt Democrat (Stroger) because the Republican (Peraica) opponent had to be avoided because he was so anti-immigrant and anti-poor people and would hurt the county health system. The Democrat appoints an outspokenly anti-immigrant anti-poor people doctor to run (or more like destroy) the county health system. This is the same doctor that said several years ago that he didn't come to County to take care of homeless people: "You can give them any opportunity in the world, and they would not take advantage of it. They could do things for themselves, but they won't. So who the hell cares about them?". The news article also has Simon lamenting that taxpayers are spending $800 a day to take care of patients at this facility, including undocumented immigrants. I am lamenting that taxpayers are paying Simon $1893.15 a day (he makes $691,000, that's if he worked all 365 days a year, which he doesn't) to increase the classism, racism, injustice, and all around bad policy already rampant in our healthcare system.

This is just the latest in a series of barabaric cuts devastating the healthcare safety net (already overburdened) for tens of thousands of people that mostly can't get healthcare elsewhere. The Movimiento 10 de marzo/March 10 Movement (immigrant rights/legalization group) and the nurses' union are both demanding Simon be replaced.