Olympics and Mental Health Clinics

http://www.chicagoreporter.com/index.php/c/Spin_Offs/d/Black,_Latino_Facilities_Shuttered

With the budget cuts, 4 of 12 city mental health clinics in Chicago are being closed. All of these 4 are in predominantly Black or Latino neighborhoods, none are in predominantly White or "Mixed" neighborhoods. Of the clinics in predominantly Black or Latino neighborhoods, half will close. Of the clinics in predominantly White or Mixed neighborhoods, none will close. 3 of the 4 clinics being closed also just happen to be near the proposed sites for the olympics (Washington Park).

They say they can't come up with the $1.2 million to keep them open... but Chicago just spent OVER 50 MILLION on the olympic bid and also got a bunch of $$ from privatizing parking meters.

STOP (Southside Together Organizing for Power) has information about public hearings, protests and how to write the mayor on their website http://www.stopchicago.org

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)

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.

Not exactly, Dr....

Today my doctor called me back and was off in her ideas and suggestions to me, and mostly the timing of them, in a way that was kind of hilarious to me. She was just so out of context.

Basically, a few months ago, I was having problems with insulin absorption from my pump sites, resulting in high and up and down blood sugars, occasionally ketones, and therefore feeling shitty, physically and mentally/emotionally. Went on shots for a few months, which was better but made exercise, especially longer workouts, really hard to manage. Three weeks ago I started back on the pump, and overall things have been going well, but I've been having a lot of lows. These are mostly exercise related, since it's been easier to do a lot more of that with my pump back than it was for me on shots. Also, it is summer and I tuned up my bike.

But anyways, I said something about being able to exericse more, and she was like, yeah, it must be easier and you must feel much better without all that ketosis! Ha ha ha. That was um, about 16 weeks ago that my pump wasn't working and I had ketones. A lot has happened since then. If I had ketones for all that time, she definitely would've heard from me again. Slash I would be REALLY frustrated and sick and ended up on sick leave from my job or something. What I meant was because of the pump vs. shots in the last 3 weeks making it easier to exercise, not the no longer having ketones thing from bad pump sites months ago.

I don't fault her for that; it wasn't like she was being negligent to my health. And some of the things she said may be relevant if problems come back (hopefully they won't). I hadn't asked for continued help because I was doing better, and she was actually calling me back about something else, a basic logistical question about getting my next A1C (that's a routine diabetic blood test, for you folks that have internal automatic pancreases and are challenged on this lingo).

My diabetes is mine; it's a little weird to negotiate intrusions on that. Usually I think I am right to react in a way that let's people know this is my business and my body when they are intruding in a way that I find unhelpful or annoying. This doesn't mean it's off limits and noone can talk about it except me (in fact, I like it when friends or acquaintances are comfortable talking about it), just that I get to make the decisions, and be the expert. It's my body, and I have a lot of experience dealing with it, and generally know what I'm doing (or if I don't, probably you don't have the magic-bullet solution either).

With my doctor (and I mean my doctor that manages my diabetes, not all of the assorted people related to me that are doctors and bubbling with ideas about parts of my diabetes that they sometimes have no idea about), I definitely see the need for this shift, letting her in, it just is funny to figure out sometimes. Back when I was having the absorption problems, I felt like I was a little kid regressing and begging for her to hold my hand when I read her all my numbers and got help on dosing - it felt kind of wrong, even though it was probably necessary.

She has knowledge and skills that are different and help me, whether it is her training/experience or just another perspective from someone else familiar with the issues. She recognizes my expertise on my own body, because she is a good doctor and respects me*, but also because she is forced to because I just know so much more than her about what's going on. She needs my knowledge and assessments and details to even think about understanding anything or making treatment recommendations. I think this is one thing that might differentiate the relationship between type 1's and their healthcare providers (and maybe other folks with chronic issues and their providers?) and the way a lot of other people's relationships are with their healthcare providers. It is so constant and intensive and hundreds of decisions are necessary day-to-day, when the doctor isn't around, that the person with type 1 has to be recognized as an expert. Of course, I think healthcare would work a lot better for most people if providers ALWAYS recognized (and respected) the patient as the expert on their own body. And probably their are a lot of doctors that are bad at this even with type 1's, and don't do this even when it is painfully obvious that it's the case.

*hopefully this is how she treats all her patients, and this respect isn't just from me being well-read on my issues and considering nursing or medicine as a profession

EDIT: Another diabetic blogger just posted a news story that's a lil' empirical evidence for what I just wrote about, that obviously the person with diabetes is the expert over the doctor. Interestingly, this study on insulin dosing was with type 2 diabetics, who usually (not always) have less intensive medication and testing regimes than type 1's.

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.