Showing posts with label Health Care. Show all posts
Showing posts with label Health Care. Show all posts

Friday, July 27, 2012

Problem-solving: a skill we desperately need

I've had the good fortune to live and work with people who have devoted themselves to solving problems. They are really the unsung heroes of our communities. They are the ones who fix the things that are broken in our systems or carve out new paths to bypass the old, dysfunctional ones. These people work in a variety of fields. I'm not just talking about those who work in healthcare, law, social work, or pastoral care. I'm talking about people in almost any field out there. Heck, I could even be talking about you.

MUCH ADO OVER NOTHING 
I've come to realize over time that people in general spend a lot of time and energy making much ado over nothing. We invest so much capital in symbolic battles against those whom we perceive as our enemies, and we do this in big ways and small ways. People who spend much of their free time gossiping about and undermining personal enemies do it. So do political parties and other large entities that thrive on creating controversy and provoking outrage. And these actions come at a cost. What they add up to, at the end of the day, are symbolic victories, but the real foundational problems remain in our communities.

EMPHASIZING SYMBOLIC VICTORIES AT THE EXPENSE OF TRUE SOLUTIONS 
You want some examples? Look at the state of contemporary American politics. More specifically, look at the kinds of legislation that American conservatives have been pushing for all over the nation in the past few years. I'm talking about those laws that focus on issues that conservatives consider to be key to the nation's moral fabric: abortion, contraception, gay marriage and civil unions.

If you happen to be conservative, you may consider these nationwide legislative victories to be a great accomplishment for your side. But there's one thing you should be worried about vis-à-vis this kind of legislation: It's the fact that the legislators making it happen are doing it as part of a cynical calculation. The idea is this: By achieving these symbolic legislative victories, they signal to the people who voted for them that they have done what they were put in office to do. They subsequently win the loyalty of their constituents, but they have absolutely no incentive to work on legislation that actually solves the biggest problems facing their communities (e.g. unemployment, the failing health care system, malnutrition).

Today, American communities battling poverty, health crises, and other long-term problems are not actually dealing with these problems. Not in terms of policy, anyway. The problems are not even on the agenda. And the not-so-funny thing is this: When problems are ignored, they do not vanish. In fact, they have this knack of growing bigger and bigger. An apt illustration of this is Mississippi, one of the poorest states in the U.S., where conservative legislative efforts have been focused on making the one abortion clinic in the state next to impossible to operate. In the meantime, the average Mississippian is struggling to make it from day to day, living in the margins.

If you're on the ground in these communities, the situation is very frightening. To use a Kenyanism, things are elephant (there's a huge catastrophe impending). You watch as the existing problems are compounded; perhaps you even know what is broken in the system and how to fix it. But you also know that any proposals you make for policy changes will come to nought. Only if your proposal stands to make somebody somewhere a fat load of cash will it see the light of day.

In Kenya, I see pretty much the same kind of inertia about solving problems. The symbolic battles fought in the media are often flimsily disguised battles about ethnic supremacy. Occasionally, they're about religious supremacy and morality. Many Kenyan politicians and religious leaders alike are highly vocal about these kinds of issues. They know that they are effective in rallying support, and 'consolidating the base.' And they are successful: For some reason, people gain tremendous satisfaction from boisterously supporting or opposing some cause or another, and don't seem to mind that their shouts and rallies do nothing to ease their lives. When all is said and done, the old problems persist in the community: poverty, chronic health issues, food insecurity, environmental degradation, and others.

LOCAL HEROES 
The people I consider heroes in this anti-pragmatic climate are the ones who live in our communities, recognize our problems, and put in the hard work necessary to solve them in their own small way. If they have private capital, they use it to put their ideas into practice. If they don't, they reach out to others in the community with similar interests and they leverage their resources to craft solutions. When they face obstacles due to political obstructionism, corruption, etc, they don't give up. They simply look for a way to bypass them. Their main aim is to solve the identified problem, not to get fame for it, and not to profit materially from it. So they labor on quietly, achieving little victories and making a big difference in the lives of some.

Their victories do not lie in reaching large numbers of people. Even if only a few people's lives are improved, the problem-solvers' achievements remain meaningful. They form a template that the rest of us can borrow from. We can learn from them: We can learn about the techniques they used and adopt their attitiudes. Hopefully, by adopting their active approach to life, we can solve some of our larger problems.

THE INSPIRATION FOR THESE THOUGHTS
These thoughts didn't come to me out of the blue. I've been pondering on them for a long time. Part of my motivation has to do with the work I have done as a volunteer, and my exposure to others who have volunteered in other contexts. Part of my inspiration actually comes from observing those religious and ideological communities that place a high premium on self-sufficiency (sometimes due to a history of persecution). Even in those cases where I disagree with their core teachings, I find that they have valuable attitudes and practices that have helped them to thrive. Some of the groups (broadly-defined) that come to mind include the American nucleus of the Church of Latter Day Saints and the survivalist movement in the United States.

One of my more recent inspirations was Dylan Ratigan, who until recently hosted a show that was part of MSNBC's daily line-up. It seemed to me that he placed a high premium on getting beyond partisan squabbles to discuss real problems and solutions. I don't know how successful a recipe that was for TV. Addressing real issues is hardly ever sensational enough to attract consistently high ratings. But I did take away from his show the urgency of pulling our heads out of the ground and getting to work. In the last installment of his show, he emphasized this philosophy and described his intention to continue working with those who were committed to developing solutions to the problems in their communities. He also wrote briefly about the same in one of his Huffington Post articles.

Another huge inspiration comes from Iran, via Mississippi: A description of a community health project that is intended to reach the rural poor. I've already linked to the relevant article above, but here it is again: These folks are working with very little institutional support, but their ideas are clearly solid. I can't help wishing that they could rally the support of local communities, especially churches, and mobilize the public to raise funds for their endeavors.

HARAMBEE: PULLING TOGETHER- A LEARNED SKILL
Working together to build the community is a learned skill. Some people are fortunate enough to be born in communities where this skill is taught. Others are born in communities where it is underemphasized. For those living in communities of the latter type, learning how to organize to solve practical problems is a godsend.

Reading about these kinds of communities makes me realize just how important effective community organizing is. We tend to think of community organizing as facilitating civic protest. But it can help communities achieve much more than that. Surely, it can help communities develop solutions to their healthcare problems. It can also help them educate families about healthy nutritional practices and sustainable living.

HOMEGROWN SOLUTIONS ARE BEST
One of the fundamental lessons I have learnt from my experiences and from others is that one's capacity to be an effective problem solver is drastically diminished if he/ she is an outsider to the community. How can one propose practical long-term solutions when he/ she hasn't lived in a community and doesn't know in precise detail what kinds of complications govern the community members' lives? This seems obvious. It also explains why the best solutions for community problems are homegrown solutions. One can't simply translate solutions wholesale from another community. They have to be tried out locally and modified to suit local circumstances. And for them to gain any currency in the community, they have to be seen to work for locals.

This is why I'm increasingly inclined to support the idea of people everywhere being more proactive in crafting solutions for their unique local problems using whatever resources they have at their disposal. Governments may help in some ways, but they can't do everything. In some cases, they don't do anything, not even the bare minimum that we have come to expect from them. As I write these words, I'm thinking about the annual floods and droughts in certain parts of Kenya (for example), and wondering at the fact that, even when these catastrophic events happen predictably, we still get caught unprepared. What can we realistically do in local communities to be better prepared for these kinds of crises?

To answer these kinds of questions, we need to take a close look at the social infrastructure we have. We need to look at the ways in which our communities are structured, see what kinds of social nets we have for people in times of crisis, and determine how to strengthen them. If the social net is the extended family, what can we (as individuals and families) do? If it is a local religious community, then let's work with that: what can we do? I'm interested in seeing religious activists spending less time burning boxes of condoms at rallies and more time building structures to support teen mothers who choose to keep their children, or to help AIDS patients who are stigmatized by their communities.

I'm also interested in seeing so-called tribal organizations investing their energy in mentoring young unemployed men and women and giving them internship opportunities, not indoctrinating them to hate others. How about villages? There's so much we can do, especially those of us whose communities have lost their most productive men and women to diseases such as HIV/ AIDS, TB, cancer etc. There is much more we can do to support the struggling families among us. We come equipped with active minds and bodies, so let's not wait for help from on high.

In the spirit of practicing what I preach, I intend to continue blogging about this subject. It strikes me that problem-solving is undermined when one has little or no access to information. So I'm going to make it a point to share any information I come across that has the capacity to inspire and empower others. Feel free to communicate with us if you have any ideas that you'd like to share.

This work is licensed to Rose Kahendi under a Creative Commons Attribution-Noncommercial 3.0 Unported License.

Sunday, April 8, 2012

On societal disapproval of young mothers

The blog post by toradora entitled "I'm Young & Pregnant, But I'm Certainly Not Stupid" is quite the read. In it, toradora describes people's reactions to the fact that she is a young mother.

Toradora highlights people's venomous comments and their condescending attitudes towards her. To me it's interesting to read her description of her experience because it confirms something that I have observed time and again: people are opinionated to the point of being offensive when it comes to parenting, even when they have no idea who they are talking to or what they are talking about. In the twinkling of an eye, absolute strangers can turn into "moral police," and proceed to lecture and insult hapless parents on subjects as diverse as breastfeeding, adoption and childbearing age.

Toradora's "sin," as perceived by the strangers in her story, is that she gave birth to her first child when she was 19 years of age. Now, in her early 20s, she is pregnant with a second child. She is quick to clarify that she does not fit the stereotype of a teen mom who "fell victim" to an unwanted pregnancy. Rather, she was engaged when she first got pregnant, and she and her fiance were thrilled about the pregnancy. Now, she and he are married, have a healthy child, are financially stable, and are looking forward to the birth of their second child. But they still are still subject to the disapproval of strangers and acquaintances who are convinced they know better.

Concisely, toradora sets the issue in context:

My grandmother was 19 when she was engaged, 20 at marriage and 21 when she had her first child. My mother was similar, as were most of my aunts and uncles and other extended family. When did it stop being acceptable for a woman to have children before a career if she wanted to? Or before 25 years old? When did it become unusual to marry young? I have qualifications. Several in fact. I'm married. I did all the things that should have made it "acceptable" for me to have a child. But people still see my age.


And that is the issue I must highlight today: How is it that, within one or two generations, our perspectives of life have changed so drastically? When did we become too narrowminded to recognize that it can, in fact, be normal for a young adult, 19 years old, to choose to get married and have kids, and to be matter-of-fact about it? I recognize that the statistics don't favor early marriages. I also recognize that many in their late teens make unwise decisions concerning marriage and raising families that quickly become untenable. But let's set aside the generalities and talk about individuals. Just because early marriage is unsuitable for many, it does not follow that it is unsuitable for all. Rather than stereotyping, why not set aside our prejudices and take people on their own terms?

Early marriage is a legitimate life choice when it is not the result of coercion or imposition by another, and when it is allowed by the law. This is especially the case in some religiously conservative communities, which recognize that it is unrealistic to expect the majority to abstain from sex until they are 29 or 30 years old. Mainstream society tends to prolong childhood into the mid-thirties and onward, indicating that it is not ideal to settle down and have kids until then. And this may very well be true for many, but it is not true for all. Some people are better off marriying at 32, some are better off not marrying at all, some are better off marrying at 19, etc. Assuming that one or another should apply to all people just does not comport with reality.

One of the unfortunate things about the prejudices that toradora highlights is that, when they manifest at the institutional level, they can lock people like her out of healthcare opportunities that, ideally, they should have access to:
So many times I had to fight to not be signed up for "young mother" programs instead of the mainstream programs. I don't have anything against these programs for what they are, but they were lacking in information, restricted, heavy on counseling and basic life skills, like hygiene classes. They were classes for the many young mothers in my community that simply "don't know." For instance the young mothers birthing classes went for two one-hour sessions and only covered a third of the topics that the mainstream ones did (which went for six two-hour sessions) -- and no, you could not take both. Because I refused the dumbed down class, I was refused all classes.
If anything, this is an indicator that one must be more thoughtful about how he or she approaches others' decisions on parenthood. Being well-intentioned is not enough, after all, we have all heard it said that the road to hell is paved with good intentions. Rather, one must also take pause and recognize that others are not mere statistics or pawns in some larger ideology; they are individuals with their own stories to tell.

This work is licensed to Rose Kahendi under a Creative Commons Attribution-Noncommercial 3.0 Unported License.

Thursday, March 29, 2012

Healthcare and ideology really don't belong together

The USA never ceases to amaze me. At this moment, a political battle is playing out in the Supreme Court that essentially pits the political right against Obama's health care plan. The biggest irony is that the 'socialized medicine' against which the right is fighting so hard is based on a conservative plan, proposed in the 1990s by a conservative think tank, and subsequently adopted by at least one conservative governor (Mitt Romney) in his state.

Perhaps history will prove me wrong, but I think this will turn out to be one of the biggest miscalculations of the political right. Inasmuch as "Obamacare" is not perfect, it is a vast improvement over what existed before. It gives more Americans access to affordable health care. Those who have not had the experience of being locked out of every possible insurance plan because they suffer from chronic disease or terminal disease may not realize just how revolutionary this is. The pre-"Obamacare" trend is not sustainable, especially since America has some of the worst health indicators in the industrial world, and these are getting progressively worse. As Americans become sicker, affordable health care is going to become increasingly necessary.

If 'true American values' continue to move towards the right, as they have been doing for the past 50 or so years, then Americans will wake up in a dystopian society some decades from today. Basic health care (including vaccination, prenatal and antenatal care) will be out of reach for the average person. Perhaps only 10% of the population will have access to fresh fruit, vegetables, meat and dairy products. The rest will have to make do on heavily-sugared and salted food products. It sounds very much like the USA is trending towards "third world" status. Those of us from the "third world" who have seen what zero access to affordable health care for the majority of the population means in practical terms know that there's nothing ideal about it. The strangest thing of all is that the American public will have voluntarily taken itself in that direction  because of its ideological investments.

I think the political right would have done better to embrace "Obamacare" as their original idea. After all, it did grow out of a conservative vision for expanded health care coverage. By contrast, a vision originated by the political left would have pushed private insurance companies out of the market and replaced them with a single insurer: the government. Seen from this perspective, many on the left could (and do) argue that "Obamacare" is too huge a compromise by the Obama administration to the right.

If the right had taken credit for "Obamacare" they would have had a more coherent platform to run on. They would have been able to paint "Romneycare," not as a blemish on Romney's record, but as a superior plan to "Obamacare." I have to wonder what lies ahead for American politics and American health care.

The best-thought out piece I have read on the American health care system lately comes from Fareed Zakaria: "Health insurance is for everyone". Its valuable for its comparative assessment of health care and insurance in different national contexts. David Paul's piece on the Supreme Court and the insurance mandate is also a good read.

This work is licensed to Rose Kahendi under a Creative Commons Attribution-Noncommercial 3.0 Unported License.