"All for Health"

I'm on a community health list serve that focuses on improving health world-wide. This is something I got today from Jose Miguel and Luz Stella (2 people I have never met, but who work with a group called MAP international)...it's a little long, so skim it if you want :) It is most relevant for the improvement of health overseas, but I thought it was interesting for us here in the US as well in the middle of some major health reform. I don't want to get into a political blog here, but I like what he says, and think of most of it can apply here. Health in a wide definition of the word has to come from people's own motivation. Disease can be treated by doctors, but overall good health must be something people decide to pursue on their own and that I as a physician can never achieve for someone without their own help.

Over some delicious Thai food last night Aaron was grilling me on various questions about experiences with educated patients vs uneducated, compliance issues etc in relation to a paper he is writing. After attempting to answer his questions with my limited 5 months of doctoring experiences, I was telling him that I had spoken with one of my attendings about possibly getting involved in some school violence research she is doing and Aaron asked what school violence had to do with health. To me it has everything to do with health. I think the writing below helps sum up why we as pediatricians think everything has to do with health -- violence in schools, nutrition, disease prevention, self esteem, sleeping habits, grades, parenting habits, disciplining and so much more. Health is not just a narrow topic that deals only with disease but undermines how you can experience life.

"We are more and more convinced that health cannot be purchased, donated,
provided or "delivered". Health is a social process given by the capacity
for full self-actualization as individuals, families and integrated
communities (according to the will of God) in the various bio-psycho-social
aspects, in a self-sustaining manner without jeopardizing the conditions
which would allow successive generations to experience this fullness.
Comprehensive Health is a social process which enables individuals and
societies to gain control over health determinants and adapt dynamically to
their environment, engaging in the transformation of all those factors which
prevent the entire society from living in harmony and justice (with each
other, with God, and with the various physical, biological and psychosocial
ecosystems), without experiencing progressive conflict (or disease) and
without the presence of high risk of damaging their state of health if this
lifestyle and these ecological conditions are maintained. This is a new
paradigm no focused on "health services delivering" but on facilitating self
empowering process in communities to gain control over those health
determinants. CHWs play a key role making this a reality. Health is a
journey manifested in a dynamic process of self-empowered families &
communities gaining control over an integrated web of health determinants
that enables them for the construction of meaningful and sustainable
families and society.



This new paradigm of understanding health and development requires new ways
of approaching the way in which people see their own problems, fears, dreams
and desires, and how they can assume full responsibility in the direction of
their own history. Diagnosis and planning processes cannot continue to be
made from an outsider's perspective. True development and true health is a
matter of people, and not only health services or the measuring of
statistical data about biological, economical, or production phenomena.
History has shown that significant sustainable community development happens
only when local community people have developed the capability and
responsibility to invest themselves and the resources in the effort of
building their own well being. Communities have not been built from the top
down or from the outside in. Communities are the fruit of their own
intertwined processes and the ability they develop to care for themselves
and to proactively dialogue and interact with other communities or cultures
(but keeping the power to maintain their own identity and control of their
own history). Each society throughout history constructs a set of concepts,
beliefs and unstated assumptions about life, their society and the universe
that constitute a particular worldview for that specific group. People's
worldview is one of the most critical lenses through which they view
reality. It is the frame of reference for their thoughts and actions and
for the assumptions about how the world is and ought to be organized. God
knows very well each cultures and context and God can rise in each setting
committed people to make Jn 10:10 a reality in their families and
communities. Our responsibility is not to go to solve problems, but to go to
facilitate local people to assume responsibility on God's mission for their
land and contexts. CHWs that have tasted God's love and commitment for life
become very effective facilitators in the transformation of communities
worldviews, a critical element for behaviors modification.

The traditional goal of "Health for All" needs a new approach of "All for
Health" in which the "priesthood of the believers" can be embodied
constructing healthy environments, healthy behaviors and healthy policies
that allow nurturing and sustainable conditions for the coming generations.
CHWs are the facilitators of local movement to achieve this.
Self-empowerment allows self-agency and co-agency processes of local
communities assuming responsibility for their own health, wellbeing and
history. When impoverished communities discover "we are the people we have
been waiting for", new children, new families, new local organizations, and
new communities will rise."
Hope you stuck through it all...some good stuff in there :)

Established

Established, originally uploaded by a b franzen.

The week before last I was outside reading on campus since it was such a nice day. As I was walking, I passed what I think was a tour group on campus. One of the guys saw that I had my camera with me and asked if I would take his picture, which, of course I did. It just cracked my up because not only did he have me take his picture, and not only did he pose for it, but he jumped up on this low ledge in preparation for the picture. All amusing considering the fact that I am a stranger to him and he will never actually see this picture.

That building behind him is the backside of the building that I spend most of my time in. Someday I will post a picture of it and you can slowly, piece by piece, picture what things may look like around here.

Political Wordle

Tomorrow I am giving a riveting lecture on 'unobtrusive social research methods.' Avoiding most of the content that may give this observation more legitimacy, (what would be the fun in making a legitimate generalization, anyways?) here is one of my examples...

Below are the word clouds (made at wordle.net) for the presidential inauguration speeches back through Clinton's first round (ordered from newest to oldest). These are essentially word usage frequency counts, bigger words are used more often. The change from Bush #1 to Bush #2 is very interesting in terms his focus. Also, it would seem that the dem. guys have a bigger focus on active things: today, time, now, work, must, new, and generation look to be popular. Bush looks to focus more on national identity kind of stuff: story, nation, country, promise, common, freedom, courage, citizens, character, liberty, history, cause, free, hopes and so on. This is pretty interesting (i think). It doesn't mean, necessarily, that Bush didn't care about being active and taking care of thing, nor that the Dem. guys didn't care about national identity. It could be that the way they communicated and envisioned this in action was different, but they thought they were doing the same thing. Who knows.

Either way, the difference in their focus in their speech is interesting....

Obama

Bush's #2

Bush's #1

Clinton's #2

Clinton's #1

passion x skills x opportunity = hot spot!

found on: http://50topmodels.wordpress.com/

I was looking around for a diagram of Bourdieu's theory of habitus and social fields and stumbled upon this one (not his, by the way). it is from this awesome blog that corresponds to a book (that is only in German right now) of the 50 best diagrams. Anyways, i like this one a lot. I have always liked to see people doing things that they love even if it is not the most profitable thing for them to do. There are few people out there, i would think, that actually are in the center of this diagram. Often i think we get sucked off 'course' into sectors where possibly some of our passion is lost as a result of an immersion in an overabundance of opportunity, or something like that. Anyways, it is an interesting thing to think about in terms of life decisions and an evaluation there of.

Space

Space, originally uploaded by a b franzen.

The last few days I have been thinking a bit about ecology. I think that space is a hugely important thing in our lives that we rarely stop to think about. How we are shaped as people is almost inseparable from the space in which we find ourselves. Our cognitive structures develop as a reflexive response to the space and time in which we are. This can, in a very real sense, constrain thought and choices of action, while not determining them. Expanding horizons takes on a while new meaning that way!

Anyways, this is a picture of one of the 'reading rooms' here at Baylor. Sometimes I start to be less productive in my office here so I will rotate around campus, and this is one of the places that I like to go. The decor is all what I would think classic southern decor as being. This space has an impact on me.

Last night when I was riding the motorcycle back to B's place, there were so many interesting smells. It got me to thinking about how much less of life we are able to experience merely by being in a car and not traveling in some other way. It is true you can put the windows down, but it is still significantly different than on a motorcycle. In general, everything is experienced in a completely different fashion when on a motorcycle. That 'space' has an impact on me.

The other day Sara and I were talking about being in TX a bit (small bit, and I got to thinking about it later). Being in TX is very good for what we are doing. I am less sure that TX is as good as other places for us. This space has an impact on us.

BearDowns!

BearDowns-6, originally uploaded by a b franzen.

This last week there was a relay-bicycle race on campus, called BearDowns. It is a 30-mile relay race. Each team was a team of four, and each person went for 1.4 miles before changing. It was totally awesome, and I hope that we can get a team together for it next year (if they do it again that is). Also, it was after the sun went down, just to make it that much cooler.



It was pretty fun to watch as well because it was a short loop, so you always get to see something going on. It was also kind of funny to see them change out riders. All teams only use one bike, so the change-out can get interesting. The one rider usually hopped off and let the bike keep going while the other person would hop on it. As you can imagine, just like passing a baton, there were some fails - all them more crazy to see since it is a bike and not a baton!

Firsts

It is a strange blessing and burden to deliver bad news to someone. Today I had to tell a family that their 4 month old child had cystic fibrosis (inherited disorder mainly affecting the lungs and GI tract/pancreas that has no cure and has a current average lifespan of 36). It was really the first time I've had to deliver bad news to someone. I guess the news could have been worse...i didn't have to tell them their child had died, or had cancer with a poor prognosis but it is still bad news. An answer, yes, which is nice as for 2 and a half weeks we really didn't know what was going on and felt like we were getting no where fixing their child, but no one truly wants an answer of an illness without a cure with a lot of morbidity.

It really is a privilege though to get to care for these patients and play an intimate part in their lives and the lives of their family. I hope as I go through residency I get a little less awkward in talking to families, but today went as well as it could. A humbling thing to have to break news like this. Just makes me realize too that I wish all my patients had the comfort of ultimate faith in God and His plan at tough times like this (and non-tough times too!) and sadness knowing that most don't and wondering how to actively make my faith a more active part of my interactions with families.

On a positive note, day off tomorrow!!! A long run with a friend, hanging out with my hubby once he gets back tomorrow afternoon, and some much needed house and car cleaning before gearing up for working ALL weekend (Saturday AM to Sunday noon....). Weather has been beautiful though, finally enjoying the Dallas sun and warm weather when others are getting snow :)

Late Night Cures

Late Night Cures, originally uploaded by a b franzen.

I thought this would be a fitting photo for today. I was here at the office 'till fairly early this morning. For some reason it is inevitable that I have a full book and a paper to write on Wednesday nights.

Common Grounds is one of the coffee shops right by campus here. It is a pretty sweet little place that is a cool place to study and is kind of trendy. It has all the signs of a 'socially progressive' joint, but interestingly enough, they sell all of their stuff in Styrofoam cups. Weird. Anyways, the coffee is not too shabby.

Shade Tree

Shade Tree, originally uploaded by a b franzen.

So there has finally been a bit of a break in the rain around here. Over the last month and a half or so, we have had more rain than the typical yearly average. Each time it would rain there was flooding around as the ground was all saturated. The Trinity River outside of Dallas hit a high water mark (for now) of 30 ft.

This is a picture of probably one of the nicer quads on campus here. It is right outside of the building that has our offices in it. There are huge pecan trees all over and many of them have these swings on them. I didn't really notice when I was taking the picture that you could see this as well, but those bushes there spell out 'BAYLOR BEARS.' They are just starting in this picture, but right now around those bushes are these awesome bright yellow flowers blooming. I am glad for a no-rain week. I was going into motorcycle withdraws there!