Health care is a human right

Today’s image from the 50 protest postcards resonates with me for various reasons: some personal, others professional. And, all based on evidence.

I’ve long worked in public health. But, I’ve been an advocate and activist for universal healthcare for all for even longer.

One of the first issues which informed and guided my own political compass was health care. It astounded me then (late ’80s and early ’90s) that the United States was the only developed, high-income country in the world to not have a national healthcare system. It astounds me even more that we continue to occupy that bit of exceptionalism and that the discussions still rage on today in 2020.

I’ve also benefited from living in a country with a well-functioning, high-quality national healthcare system. It’s inconceivable to the average Finn that a resident or citizen wouldn’t be cared for from cradle to grave or that millions face financial ruin or death because they can’t afford the care they need. Or that individuals would need to subsidise and fundraise to afford care when faced with an emergency or life-threatening illness. This reality has become more stark to many in the face of Covid 19.

In the richest country on the planet, in 2020, we spend more on health care per capita than any other country by far, and yet perform worse far poorer countries on just about every single health metric. In fact, the only metric we outperform other countries on is spending.

What good is fantastic care if no one or very few can access it?

I support Medicare 4 All. That said, I’d be happy with a hybrid system, one which features both public and private options because I understand complete change may take time, and be somewhat scary for my fellow Americans.

To me, it makes sense and represents a more humane approach to offer everyone basic, universal healthcare coverage from birth through the end of life. And, if individuals wish to, they may also purchase private insurance and coverage. Choosing between a meal and insulin, a roof or cancer treatment, a tooth extraction or an electric bill should not be a viable or acceptable system. Not for the proclaimed richest nation.

No one should be granted care only because they are privileged enough to afford it. No one should be barred care because they are too poor.

People — all people — will be healthier if they are all able to access the care they need when they need it. And that’s good for all of us.

Postcard #3 of 50.

On ‘The Uncounted’ by Sara ‘Meg’ Davis

The Uncounted by Sara L.M. Davis

My rating: 5 of 5 stars


In today’s world in particular, there are days when it seems as though we are drowning in information. Too much data. Too much ‘stuff’ to process and make sense of. That feeling is only partially true, however. Across various areas and arenas, we know far too little, particularly when we focus on issues surrounding health and human rights. All too often we take the absence of information or data or evidence as a sign that we may relax a bit.

We desperately need to shift that thinking. The Uncounted, by Sara ‘Meg’ Davis provides a road map for how we may begin to shift our thinking and perspectives in order to adjust how, amongst whom and what we collect data in a relatively simple way, and in a way which may pay huge dividends, particularly amongst those most in need and previously most neglected in policy planning and financing.

‘The Uncounted’ is a fantastic read, one which profoundly challenges the notion that in the absence of information or evidence we don’t need to worry about issue X. That is, if we carefully examine those variables for which we have no data or evidence, perhaps upon digging deeper and enlisting assistance from those more acutely and intimately aware than we are, we will find previously hidden information and data. And, that data and information are likely to radically shift how we design programmes or policies on various issues. We will no longer be able to simply dismiss an issue as unproblematic. Quite simply, ‘The Uncounted’ provides a profound argument for carefully considering how we examine and apply the absence of evidence as an indicator.

‘The Uncounted’ is rich in ethnographic descriptions, documenting the various assumptions made by multilateral agencies charged with dispersing funding to and establishing guidelines for countries in how they respond to HIV, tuberculosis and malaria (e.g., The Global Fund to Fight AIDS, TB and Malaria, UNAIDS, WHO, PEPFAR, etc) and local-level agencies and individuals best situated to argue for expanding programmes and funding schemes within communities. For those unfamiliar with such agencies, Dr Davis disentangles these various personalities and agencies rather neatly, making it clear who does what and whose voice is perhaps most necessary in deciding upon programmes and policies to address HIV in particular. Following the progress and steps necessary to count the uncounted within the Caribbean region provides evidence for how we can begin to shift our thinking and truly ensure full inclusion of all individuals affected by HIV and specifically those least likely to date to receive crucial services and support.

Reading ‘The Uncounted’ during a global pandemic proved rather surreal,not simply because some of its key characters are also playing a crucial role in current events vis-a-vis Covid-19. As our global health-related realities have been thrown into chaos this year with the emergence of Covid-19, I’m curious to see how various elements of Dr Davis’ careful and thorough work play out. Whilst focused primarily on HIV, and the very real oversights in counting typically hidden populations such as men who have sex with men, transgender people, sex workers and people who use drugs, certainly many individuals, and perhaps the most vulnerable, will go uncounted in the wake of Covid-19. Will health, social, and economic policy makers and planners at local, national, and international levels solicit the perspectives from those at the community levels most intimately associated with the epidemics and acutely aware of problems in providing treatment, care and support to those affected in order to understand who, what, why and where? Or will they rely on the absence of evidence as evidence of absence simply because individuals are not counted by the powers that be? How will key populations be accounted for? Will they?

My hope is that the powers that be across power structures would heed the advice and road maps provided by Dr Davis. The reality is that in some places, that advice and those road maps are not being considered. And, in those places it seems as those Covid-19 is raging unchallenged. [Insert heavy sigh here.]

‘The Uncounted’ provides this cynic with a bit of hope, however, particularly with regards to HIV. Hope that we expand our perspective ever so slightly, yet in a way which we can make a huge difference to communities and key populations who may have previously faced stigma, discrimination and institutional neglect, and who may finally receive the crucial support to transform structures that place them at the response to HIV. It won’t be easy, but it is necessary. And, to my mind, long overdue.

Clearly, we can no longer that that ‘absence of evidence as evidence of absence’.



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On ‘Choice’

Choice by Karen E. Bender

My rating: 5 of 5 stars


This was my first read during women’s history month, and with the full awareness that we are increasingly edging our way towards a reality in which choice no longer exists.

I absolutely think everyone — and I do mean everyone — should read this book. Make it mandatory reading in sex education classes as a minimum.

It’s no secret that I am staunchly and firmly pro-choice. And my life has largely been possible because I’ve been free to make decisions regarding my own desire to reproduce. Had I not had some options open to me, it’s very much unlikely that I’d have gone to graduate school or landed in Moscow or met The Cuban. What an astounding reality and one I’m so grateful I don’t have to contemplate for long.

I’ll never question any choices any other woman makes regarding what she chooses to do with her own body. Those are decisions she must live with as I live with my own decisions. And I will never stop fighting for the young women who follow me so that they will have all of the choices they need available to them.

Abortion should be legal, and safe and rare. And the only way that becomes a reality is if we stop trying to regulate women’s bodies. And my favourite bumper sticker is still this:

‘How can you trust me with a baby if you can’t even trust me with a choice?’

My body, my choice. Full stop.

#womenshistorymonth



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Furiously Happy

Furiously Happy: A Funny Book About Horrible ThingsFuriously Happy: A Funny Book About Horrible Things by Jenny Lawson

My rating: 5 of 5 stars

My introduction to Jenny Lawson began with Beyoncé, the Giant Metal Chicken. Need I say more?

I loved this book. And, I love The Bloggess for simply being her wonderfully wacky self. Several chapters in this particular book resonated with me quite deeply, largely because of her brutal honesty and clarity in writing about her own mental illness. Anyone who has struggled with that voice in their head will know how pernicious it can be. But, in her writing, she makes the reality of living with and dealing with those highs and lows a little more accessible for those who love someone battling the nonsense in their head. And, for that alone, I am grateful to her.

We’re all a little weird. We’re all incredibly quirky. And, we’re all equally wonderful in our uniqueness, whether we struggle with health issues or not. And, when we can, we should all be furiously happy.

And, we should plant giant metal chickens all over place, because why the hell not?!

Giant chickens for the masses

An army of metal chickens spotted in Menton, France, Spring 2014.

 

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I love running

I love running. I do. I’m slow, and I have yet to go very far. But, I love running. And, I suspect it loves me. It’s at least good for me.

Last summer after years of stifling the little black dog that barks and growls and nips at my heels and mind from time to time, I made a series of slight adjustments in my behaviour and routines. I’d sunk so low that breathing hurt. Changes were necessary and long overdue.

One of those changes involved recommitting to running regularly. Whilst various forms of exercise obviously carry benefits to one’s mental and physical health, running has always helped me empty my head, meditate on whatever shit floats around up there. Somewhere during those runs, I let go of the garbage that wears me down, both real and imagined. As August turned into September, and September gave way to October and November, regardless of how busy I was or how much I felt unmotivated to lace up and hit the trails, I did. And, it helped. The fog that had clouded my everyday existence slowly dissipated and lifted entirely, and I felt infinitely better as the weeks and months passed.

Running wasn’t so much simply physically beneficial; it was a mental health necessity.

After injuring myself in January whilst running the Malecón in Havana, I was forced to take four painful months off. My ankle healed by late March / early April, but then the flu season hit and, then, I fell and hurt my knees, running to catch a bus of all things. Fast forward to May — four months after my initial injury — and I’m finally getting back into my routine. A few days shy of four weeks back into my running rituals and again the fog is lifting.

This. This is why I run. And, this is why I love running.

I don’t really care how fast I get through a particular route — each run feels like a battle won and conquered at this point. I don’t have any long-term ambitions other than to continue running three or four times a week for as long as my legs will hold up, and hopefully taking part in the Helsinki Midnight Run come September. I won’t win races, but I will stay in the ultimate race — that crazy race called life. Undoubtedly, depression and my little black dog will come barking again from time to time. Whatever I can do to tame him quickly and without too damage to myself or those who love me most, I’ll do. And, I firmly believe that as long as I continue to add miles to my running logs, those visits from the canine beast that haunts me will become fewer and further apart.

I read a story several years ago about an incredibly young 92-year-old woman finishing a marathon. Harriette Thompson, that same woman, just surpassed another milestone by becoming the oldest woman at 94 to complete a half marathon. I won’t break any records, other than those I set for myself. But, I will keep running. For me.

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Waiting room antiques

Unexpectedly transported to another time

Unexpectedly transported to another time

Finland has a most impressive national healthcare system universally available to all residents. In terms of efficiency against quality, Finland ranks 23rd in the world. Touch wood, we’ve been fortunate to remain relatively healthy during our stay here and have enjoyed precious little in the way of waiting times, received excellent services in English and been generally impressed with the level of service and quality of equipment, facilities and medicines (when necessary).

There are moments, however, when we feel as though we’ve stepped into a time machine and been transplanted into the 1950s or so. From the architecture to the fixtures coupled with the design and decor including the furniture in the lobbies, it’s an incredibly surreal experience.

This particular waiting room is situated in the radiology department in one of the local hospital complexes in Helsinki. It’s a gorgeous location not far from our neighbourhood and not far from the very centre of the city. As with much of Helsinki, it is surrounded by a lovely park, and much of the hospital complex seems far too historically significant to house the modern diagnostic tools necessary for a top-notch healthcare system. Yet, it does.

When we returned a few days ago to this particular waiting room for a routine part of a check up, we once again marveled at the furnishings. These particular chairs and the very long bench/sofas which matched them could be equally appropriate for the set of Mad Men or in an episode of The Jetsons.

What made the experience all the more surreal was the film which was showing on the gigantic flat screen on the wall. Nevermind that the flat screen was a complete mismatch with the rest of the decor. The film playing on it was absolutely perfect. We’ve no idea what the film was nor what was really happening other than what appeared to be a lot of silliness. A Finnish film from most likely the same time period during which the furniture we sat on was manufactured, it perfectly matched the era of the room whilst allowing for a little comedic relief for the nervous patients awaiting their various scans. We watched completely perplexed as various Finnish actors from days gone by paraded around the black-and-white set in a series of dance moves which, quite frankly, made no sense at all. It was fantastic. Utterly and totally fantastic.

What a way to spend a bit of time. The scan went well and all is as it should be in terms of our health and well-being. Many thanks to the fantastic folks in the Finnish healthcare system who not only provide great care, but who also might just have a hidden sense of humour which comes through in the most unlikeliest of places.

Day 25: Proekt 365 (Here’s to Finland’s Maternity Box)

Day 25: Proekt 365 Here's to Finland the the Maternity Box)

Day 25: Proekt 365
Here’s to Finland’s Maternity Box

Finland’s approach to ensuring its citizens and residents live a quality life and have equitable access to such a life from the youngest of ages impresses me. Today, whilst having lunch with a few expat friends, one of whom has an adorable baby girl who was born here, I was reminded of just how early that focus begins. If you have never heard of the Finland Maternity Box, look it up. I’ve marveled about this briefly before, but today I was particularly impressed with it for whatever reason.

Last year as the world awaited the birth of one prince or princess in particular, news focused briefly on the brilliance of the Maternity Box. For more than 75 years, Finnish mothers-to-be have received these boxes, which contain an impressive collection of clothes, toys, personal hygiene items for baby’s first bath (and for Mom), outerwear and various other necessities for newborn babies. All of the items are packed neatly into a decent-sized cardboard box, which can also be used as a baby bed — the package also includes all of the items for baby’s first bed, including a mattress that ingenuously fits snugly in the box.

Mothers can also opt to get cash. But, the loot which comes in the box far exceeds in value the cash disbursements (€140 as of 2013). So, most of the moms I know opted for the loot. I would! The picture above is an item my friend received in her Maternity Box when she was expecting her daughter. Not only is it as cute as her precious little girl, but her daughter LOVES the little bug and kept herself quite busy playing with it when she wasn’t concentrating so completely on being cute. Who wouldn’t love that bug?!

It’s impressive. Mighty impressive really when you consider the reasons behind and history surrounding the Finnish Maternity Box. Their distribution is designed to give all children born in Finland an equal start in life — regardless of socio-economic background, geographic location, family composition or cultural heritage. Every child born in Finland is entitled to receive the box (or cash equivalent) with just one condition placed on its receipt. Mothers wishing to receive the box must have visited an OB-GYN clinic by the fourth month of her pregnancy. In the late 1930s when the boxes were originally distributed to the poorest families, infant mortality in Finland was quite high (65 per 1000 births). Once the programme was expanded for all women and families in the 1940s and then following reforms to ensure all residents in Finland had equal access to all types of healthcare, infant mortality dropped and fewer complications were reported. Now, infant mortality is negligible.

Infant mortality over time has dropped incredibly in Finland

Infant mortality over time has dropped incredibly in Finland

The contents of the box are brilliant. Items are gender neutral (so that they are suitable for boys and girls) and are now chosen for their sensitivity to the environment. They are also durable and not cheaply made or designed. Many of the items in the box would be prohibitively expensive for the poorest families. Snow suits alone are incredibly pricy despite their necessity given the length and depths of winter we experience here in Finland. The contents even include baby’s first books. Yet, every mother is entitled to the box. And, every child can start life out with the same basic necessities. Well done, Finland. Very well done.

It doesn’t at all surprise me that Finland is ranked top in terms of where its best to be a mother. When you get a box like this to welcome your little bundle of joy, how could it not be pretty fab for moms? It should be. And, I’m delighted to live in a country that takes its newest and youngest residents so seriously, and which helps out its moms in the process.

Days 20 & 21: Proekt 365 (Why my husband is awesome)

In case you missed it, yesterday was lovely (</sarcasm>). A particularly sudden and thoroughly lovely stomach bug finally reared it’s ugly head, leaving me feeling miserable and sleepless all whilst facing a deadline. I missed my deadline, but was graciously given an extension by that particular and amazingly understanding client (I owe you HUGE). But, I was pretty much a mess by yesterday evening. Think weepy and whiney and not particularly pleasant in any way.

Enter my awesome husband.

Day 19: Proekt 365 My husband chanelling South Park

Day 20: Proekt 365
My husband channeling South Park

(Whilst I may not have actually posted this pic yesterday, I did take it.) Not only did he provide the support and care I needed, but he also braved the Arctic blasts once again to get me and my unhappy tummie crackers. On top of that, he provided a little comedic relief at a key moment. Yes, he is just that awesome.

Once I finally gave up on finishing work yesterday and migrated from my desk of misery to the sofa of suffering, he tucked me in, made sure I had all of the necessary items to help me feel better, brought me whatever I’d forgotten and gave reassuring kisses and glances until I finally passed out. What would I do without him? (I honestly hope I never have to experience that reality again.)

As if all of this awesomeness wasn’t enough, I woke up this morning (feeling much improved, thankfully!) to find the following:

Day 20: Proekt 365 Who doesn't love a clean screen or two?

Day 21: Proekt 365
Who doesn’t love a clean screen or two?

Not only does he get what I need when I’m sick, but he also gets that I cannot stand dirty screens. So, knowing that I would probably want to clean my desk today (which I desperately do), and, in particular, give a bit of extra attention to my monitors (which need it), he left the screen cleaner on my desk for me to easily find. I repeat, he is just that awesome.

We recently had a bit of a discussion in our local electronics Mecca about buying another bottle of screen cleaner so I wouldn’t have to rifle through his desk / office to find the bottle he bought. He thought I was being silly, which I was. But, I honestly don’t want to disturb his desk, not because I think it would bother him. But, because it would bother me (not him looking through my desk, but me looking through his). I know he doesn’t have anything to hide (nor do I). But, it’s ‘his’ space….and I don’t want to somehow taint it. (Silly, I know.)

So, deadline monkey has been firmly removed from my back, my tummie is now a bit more tolerant of things other than water, weak tea and crackers, and my desk is in thorough need of cleaning. But, most importantly and more consistently than anything else in my life, my husband is awesome.

Cancer sucks

At this moment, that’s all I’ve got: cancer sucks.

Several weeks ago, I learned simultaneously that one friend was just diagnosed with melanoma and a sorority sister of mine had just lost her battle with cancer.  That morning, all I could think was, ‘cancer sucks’.

This morning, one very close friend was rushing home to be with his father who has been fighting courageously to rid his body of leukemia. Then, this afternoon, another friend wrote to tell me that his mum — a woman very dear to me — lost her seven-year battle with breast cancer just an hour earlier.

And, again, all I can think is, ‘cancer sucks’.

I don’t think many of us are strangers to cancer any longer. It is so pervasive. Whilst most of my working life is occupied by the world of HIV, TB and drug use issues, I’d love to see us all live to see the day when cancer is no longer so common. Regardless of what type or system it afflicts, the simple word, ‘cancer’, has this ability to absolutely paralyze and arrest all other thoughts.

We’ve come a long way in terms of diagnosing and treating cancer. Perhaps its simple awareness; perhaps it is a combination of awareness, early detection and better, more aggressive treatment. Perhaps, I’m simply at that age when cancer affects more within my own social network.

None of that is particularly comforting at this precise moment. I’m sure that it holds absolutely no meaning for those family members my darling friend Rita left behind.

Here’s to all those fighting their own battles against cancer, to their family, friends and loved ones fighting right alongside them, and to all those grieving as a results of this horrible scourge.

Cancer sucks. That’s still all I’ve got.

[For Rita.]

Image by Becky Hilgendorf (pikesbabe on flickr)

Image by Becky Hilgendorf
(pikesbabe on flickr)

Water, water everywhere; not a drop to drink or use…

Not long ago, I was musing about how fortunate and privileged we are in our comfortable life here in the uber-developed North. Today, I’m realising just how incredibly privileged we are and how a mere 8-hour disruption is, well, disruptive to our normal routine and cushioned life.

First-world fortunate, indeed.

The story:

A few months ago, some maintenance men with clipboards and tape measures traipsed through our flat looking at the pipes in our kitchen and bathroom to determine how sound they were. They went to each and every flat in the building and we knew they would be carrying out this inspection well in advance. After the inspection, the decision was taken to replace the building’s entire plumbing and drainage system. Thus, the next few months will see loads of renovations taking place throughout our normally quiet and convenient life. All of the pipes and plumbing fixtures in our four-story, four-entrance apartment block will be replaced with shiny new pipes and fixtures. It all appears to be very well organised and orchestrated. And, we are given updates through our mail slots of impending disruptions and what to expect with plenty of notice.

Rather impressive, really.

The problem is that occasionally over the next several months, we will have no water nor drainage in our flat. Given that both my husband and I work from home, logistically, this is not quite ideal. A bloody nuisance when you think about all the various ‘functions’ which require drainage or running water.

Today — the first of those several days  — I’m truly astounded by how many tasks and ‘things’ require water and/or drains. And, I am so, so, so happy that it is for only 8 hours.

This also has me thinking about those who have no running water. And, those who have no drainage systems or modern plumbing.

UNICEF’s US-based website lists the following in relation to world wide stats on safe water and sanitation:

Water is life. Yet 768 million people do not have access to safe, clean drinking water, and 2.5 billion people live without proper sanitation. When water is unsafe and sanitation non-existent, water can kill.

Across the globe, nearly 4,000 children die each day from unsafe water and lack of basic sanitation facilities.

That’s quite staggering to me. The WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP) lists diarrhoea as the leading cause of illness and death. Furthermore, 88% of diarrhoeal deaths are due to inadequate access to sanitation facilities, together with the inadequate availability of water for hygiene and unsafe drinking water.

Water is life, indeed.

To understand the importance of having clean and safe drinking water and adequate sanitation and just how much water we use along with how easily available it is to us in the developed North, take a day to make note of your daily water use. It’s eye-opening to say the least.

All the various, seemingly meaningless tasks which at some point require running (or at least clean) water and functioning drains add up and add up quickly.

We stocked up on bottles and buckets of water yesterday evening and also put out a few refuse buckets for the kitchen and bathroom sinks, mostly to remind us not to use the drains. Despite having spent a fair amount of time either traveling in places where water was a luxury or inconsistently available, numerous camping expeditions when it was all about humping water in and out in my backpack, and the completely unpredictable water cut-offs in Moscow and on holiday in Cuba, I’m still struggling with this inconvenience. Because, honestly, for us in our relatively posh life in Finland, this 8-hour disruption is a mere inconvenience rather than a daily fact of life.

And, I am extremely grateful!

UN Water estimates that each person—each individual human living on this giant rock racing through the universe—needs 20-50 litres of water each day to meet their basic needs for drinking cooking, and cleaning. Here in Finland, particularly in Helsinki, those 20-50 litres can be accessed quite easily by opening up any number of water taps in our flat.

From brushing our teeth, to using the toilet, washing our hands, making coffee, rinsing our coffee cups or spoons to get the bits of grounds off of them, drinking water because we’re simply thirsty, to showering, and all of the various things we do throughout the day which mean opening up the water tap, water most definitely is life.

And, I’m looking forward to opening up those lovely, luscious water taps at 16.00 (or in an hour and 40 minutes).

Image from Save the Children Australia

Image from Save the Children Australia