October 24, 2011

Food and health

Those who garden teach us how to work at the future.

A recent gift from a friend's garden.
I’m from a family of southerners who in moving to the city did not abandon their roots. I grew up with a small garden of tomatoes, peppers, and greens in the backyard, which cannot compare to the vast produce of warmer, well-cultivated countryside farms. Family and friends making visits to Georgia and South Carolina would return with tasty varieties of sweet potatoes, collards and other delights including my favorite chow chow, a vegetable relish of green tomatoes, cabbage, peppers and spices.  Chow chow is a condiment that works well with greens and/or beans.  I grew up loving vegetables on my plate with few exceptions. I’m getting back to these dishes including updates for favorite recipes see “the goodness of kale” at the end of this post.  I also support food grown within reach from backyards to local farms.

Food provides the nutritional value that we need to be healthy.  A great meal often involves tasty food, good company and time to share.  Food Day provides an opportunity for reflection to change the way we eat and think about food. The grave health statistics for our nation include rising rates of childhood obesity, diabetes and cardiovascular disease all have some remedy with improving the access and availability of food so that healthier choices become easier (and tastier) choices.

National and local activities are taking place to build awareness and mobilize.  We should be encouraged with opportunities to “eatreal” supporting healthy, affordable food with a real focus on local availability. Food Day principles for changes in food and health include:

1.     Reduce diet-related disease by promoting safe, healthy foods.

2.     Support sustainable farms & limit subsidies to big agribusiness

3.     Expand access to food & alleviate hunger

4.     Protect the environment and animals by reforming factory farms

5.     Promote health by curbing junk-food marketing to kids

6.     Support fair conditions for food and farm workers

There are many national and local events taking place, today. Learn more about Food Day at www.foodday.org.

The goodness of kale

Kale is a hearty leafy green loaded with vitamins and minerals. Kale is good food for you and tasty too.  Here are a few of my recipe suggestions:

It takes about 2 lbs of cut (remove some of large stems) for 4 servings.  Wash greens thoroughly in cold water. 

Garlic and kale greens
Add 5 cloves of garlic to 2 tablespoons of olive oil in a large skillet. Heat on medium begin to add greens once garlic starts to cook.  Add ½ cup of chicken stock, 1 teaspoon of hot pepper flakes and cover tightly.  Let simmer for about 20 minutes.  As greens wilt toss them a few times.  Optional:  Serve with warm corn bread. Add slices of cooked chicken-apple sausage or kielbasa.

Kale and white bean soup
Follow directions above and add an additional cup of chicken stock, one 16 oz. can of white beans and 1 cup of fresh sliced mushrooms.  Let simmer for about 20-30 minutes in total.

Kale chips
Preheat oven to 350 degrees F. Spread cut and washed (pat dry) kale on a cookie sheet. Sprinkle lightly with coarse sale and drizzle with olive.  Let cook 15-20 minutes until crisp. Serve warm or cold.  Great crunchy snack or add flavor to a salad.

Olive oil in these recipes adds flavor and also aids digestive absorption of the many vitamins and minerals found in kale.  There are lots of varieties of kale to choose from, curly green are most abundant.   These dishes will take you through the winter as the frost and chill actually improves the taste of the dark green earthy goodness found in kale.

The Center for Science in the Public Interest is a non-profit watchdog and consumer advocacy group convening Food Day, a nationwide campaign with individual and organizational sponsors.

October 18, 2011

Occupy Health

The occupy movement has reached more than 1,000 cities in the U.S and around the world. In her provocative blog post “What Think Tanks Owe the People in the Park,” Janice Nittoli asserts:

“It's never been the task of the people in the park to come up with the ideas.  It's their job to call attention to injustice, to demand that the powerful be held accountable, to just plain get angry at massive inequity.  It's the job of others to articulate an action plan for thinking progressives - and not just by repeating the same ideas that we had five, ten or even 15 years ago.”  

High rates of unemployment, foreclosure crises, homelessness, looming national concern about the economy, children living in poverty, educational gaps leaving too many left behind is moving young people to the street, too. The sick and the aging are living longer lives with fears and realities of financial ruin more grim than the end of life. While health professionals and institutions are facing burnout and closing doors. 

"Foreclosure is not just a metaphorical epidemic, but a bona fide public health crisis. When breadwinners become ill, they miss work, lose their jobs, face daunting medical bills — and have trouble making mortgage payments as a result." 
                                                                            —Pollack and Lynch, New York Times op-ed

Health is more than the absence of disease or cure. Health is about well-being and the quality of our lives. “Doctors for the 99% has become the name for an informal group of health activists who have set out to support the occupation.” A recent post by Dr. Matt Anderson offers a moving multimedia story about #occupy health professionals and organizations.

Last Saturday night, my commute was interrupted. The subway system rerouted trains, I had to get off and leave the station at Occupy Times Square (aka 42nd Street) to reconnect at another station located a few blocks away to reach my final destination. My short walk in the dazzle of Broadway’s flickering lights and bustling crowds included a brief occupy encounter, an experience that stirs my hope.

The twitter hashtag #OccupyHealth offers context to consider medicine, health, and health care. We should be inspired to imagine new possibilities for such a time as this. Huge drifts in differences have not always been offered with civility. Rising injustices leading a spirit of inequity should push us to listen, think, engage and act accordingly. 

October 14, 2011

Making House Calls: A Story for Primary Care

A community doctor allowed me the privilege of bearing witness to his private practice by providing a training ground for early lessons in the practice and art of medicine. 

Hypertension, diabetes, glaucoma, diverticulitis, gout, cardiovascular disease, lung and breast cancers were among the most frequent of memorable cases that I recall from months that I spent one day a week observing patient care and providing administrative support — a premedical student’s dream. Office hours began in the afternoons and continued late into the evenings with overwhelming demand peaking during the winter months when cold and flu were on the rise. The office was open late because most of the patients worked full-time, but were often underemployed and/or underinsured and needed evening hour appointments. The small waiting area was always crowded, but most endured the wait with resolve because they respected for his commitment to care.  Patients knew that he would take the time to listen when it was there time.  This came through when they called for appointments and checked-in at the desk.

Patients usually lived within a five mile radius of the office, which was on the lower level of the doctor’s modest home, a few blocks away from my grandparents’ house.  He was their neighbor and physician, too. There were significant numbers of couples and intergenerational families in this patient population. I’d learn that most had been patients for many years. There was also an increasing number of new patients, who were always offered appointments near the end of office hours to accommodate more time as were the patients with complicated situations.

When illness loomed beyond his reach, the doctor helped his patients navigate a world of specialists and the hospital experience by managing expectations, explaining procedures and calming their fears while acknowledging the uncertainty. He held regard for and equipped caregivers, too.

A few times a week, the doctor made house calls to a few select patients with urgent care needs. I remember when he visited my grandmother when she had too much leg pain to get out of bed. He diagnosed her sciatica, gave instructions about rest, wrote a prescription and a note for work. Many years later he’d return to our home to see my grandfather for respiratory distress, the house call focused on helping our family come to terms with the pressing need for his hospitalization as well as to come to grips with the gravity of his condition. 

Physician house calls give a glimpse of the patient’s environment, lifestyle and dynamics that can go untold during history-taking. A vegetable garden growing on the side of the house may confirm some commitment to nutrition. Indoor odors with a hint of bleach may offer notes on cleanliness.  On the other hand, the smell of alcohol or tobacco may match symptoms visible in the chart. House calls offer a glimpse of the patient en vivo informing diagnosis, treatment and decision-making.

In this primary care practice setting, I gained a profound sense of the trust and respect necessary in the relationship between doctor and patient as well as the connection between community and doctor. 

I learned others lessons that I look forward to sharing in forthcoming posts.

N.B. Doctors providing primary care services deliver “definitive care to the undifferentiated patient at the point of first contact and [taking] continuing responsibility for providing the patient's care...Primary care physicians devote the majority of their practice to providing primary care services to a defined population of patients. The style of primary care practice is such that the personal primary care physician serves as the entry point for substantially all of the patient's medical and health care needs - not limited by problem origin, organ system, or diagnosis. Primary care physicians are advocates for the patient in coordinating the use of the entire health care system to benefit the patient.”
—American Academy of Family Physicians

October 01, 2011

In Memoria: Do Justice

Last month, my beloved great Aunt passed away after battling illness with the same kind of  spirit she took on to address the challenges in her life applying tenacity, courage and a good sense of humor.  I had the honor and privilege of writing her obituary. It was a time of healing, reflection and contemplation. Memories, pictures and inquiries with family and friends helped me move through a century of American history to offer a vibrant narrative on her struggle and strength in living out a meaningful life.   

Remarkably, my Aunt was a leader in our family and community.  She was a critical thinker, agitator, strategist and organizer who kept a close view of the world and hand in our lives encouraging resiliency, progress and love.  

As a young woman, she and my maternal family escaped the threat of harm by moving from a small South Carolina town on the boarder of Georgia to New York City.  During the 1940s many black families were making the same travel plans because Jim Crow left many realizing that flight was a better response to their fears than a fight because so much blood had already been spilled. I believe as her eulogist suggested that untold horrific stories of her encounters with discrimination and racism moved my Aunt to work after work and family responsibilities in the civil rights movement. She taught me lessons about what it means “walk humbly, love mercy and do justice” in a world that doesn’t seem to favor the empowerment of people of color. In her eyes doing justice involved working actively in the community and beyond for the sake of humanity.

While the legislation of the Civil Rights Act of 1964 outlawed discrimination against blacks and women, including racial segregation there was still work to be done for progress.  For example, prior to 1964 it was illegal for people of color to go to a hospital to receive medical care anywhere in the United States, very few places had colored hospitals. Many organizations continue the push for justice in education, employment, housing, health care as well take on the criminal justice system for the well-being of our society.  Since 1909, the National Association of Colored People (NAACP) has been pivotal in leading the way by addressing injustice. Today, the aim is to bring an end to the death penalty in the United States, you can join this cause at http://action.naacp.org/EndTheDP

“When in Gregg v. Georgia the Supreme Court gave its seal of approval to capital punishment, this endorsement was premised on the promise that capital punishment would be administered with fairness and justice. Instead, the promise has become a cruel and empty mockery. If not remedied, the scandalous state of our present system of capital punishment will cast a pall of shame over our society for years to come. We cannot let it continue.”
          —United States Supreme Court Justice Thurgood Marshall, 1990

I’ve come to understand professionally that lethal injections are not good medicine.  According to the Innocence Project, “seventeen people have been proven innocent and exonerated by DNA testing in the United States after serving time on death row.” I agree with the National Urban League statement “disparities and problems cast a long shadow of doubt over our criminal justice system.”

The state of Georgia shamefully executed Troy Davis on September 21, 2011 despite serious doubts about his guilt. But our fight to abolish the death penalty lives on.”
                                                               —Amnesty International

In fifteen minutes, execution by lethal injection ended the life of Troy Davis with too much doubt