Category Archives: Public Health

My work and the craziness that goes along with it.

No One Asked Me…

I was fortunate to receive my COVID-19 booster shot today. I got on a pharmacy website this morning and by late afternoon had the vaccine in my arm. There was no expense to me, and the entire process took longer to drive to the pharmacy (1 mile away) than to schedule or receive.

It was very simple.

Here is where it get’s less simple. This weekend, my husband and I spent a few days in rural southeastern Arizona. We love this area of the state namely because it is so quiet. The sky is as dark as you’ll find in the United States, with the Milky Way visible to the naked eye. It is a 180 degree change from our go-go-go lives in the Phoenix area. The internet and TV are unreliable. The patio, stars, animals, local wine, and quiet fill our time.

We spoke with a few folks who live in the area, including the man who owned the guest house where we stayed. Without telling us their politics, every person we spoke to mentioned having to make significant changes to their lives due to vaccine requirements. One was a border patrol agent who would be required to get the shots in December. He’s putting his house on the market and quitting his job. Another mentioned also quitting his job and finding a new profession to work around mandates.

I’m guessing my more liberal public health (and other) friends won’t agree with me on this take, but this all has me thinking about how strange vaccine mandates are. Let me be clear: I believe in vaccines as one of the most effective public health tools available, behind clean drinking water and seat belts. I want people to be vaccinated because I don’t want them to get sick, and I don’t want our ailing healthcare and education systems to crumble.

And yet, it seems antithetical to American values to require an employee (government or otherwise) to have a vaccine. Yes, I fundamentally understand why it would improve our COVID rates if all Americans were required, but at what expense to our liberties?

I am not convinced that requiring people to be vaccinated will do anything more than increase the divide in our nation of us versus them. The vaccinated versus the unvaccinated. The right versus the left. And increasingly, the wealthy versus the poor, educated versus the knuckle draggers. This sort of thinking is bleeding into other areas of my professional life where I see people who previously would have been interested in constructive conversations to resolve disagreements rather than throw their hands in the air and huff, “Uggg! You’re one of them.

Them? Aren’t we all in some form or fashion one of them?

I know the idea of a seasoned border patrol agent (teacher, solider, nurse) walking away from his job and selling his home does not in any way make my life safer or healthier. And aren’t we all essentially still children? When told you have to do something or else, what is your first reaction? Mine is to come up with an immediate list of all my other options.

The biggest failure by the American public health system (all the way up to the White House) is the lack of clear communication about the pandemic and the vaccine. Tell people why it is in the best interest of their American spirit to be mindful not to get sick, to wear masks, to be vaccinated. Share details of the investigation of where the disease started, and how the government is protecting us from this happening again. What policy have they changed and why? Let’s also talk about the real side effects of these vaccines. To just blindly say they are safe and don’t make you feel rotten is false. Yes, they are safe for the vast, vast majority. And yes, they may make you feel like you’ve got the flu for a few days post-vaccine. And yes, they are the most effective tool we have to beat this thing as a specie. And yes, the right to say no is as American as apple pie.

To convince those in the no category to join us in the yes, we need better tools than tweets and mandates.

-KDW

Spinning on the Dance Floor

I started a new job mid-August. I’m still working in both government and in public health, but for a new agency and in a new area. I’d worked in suicide prevention across the state for nearly a decade, and it was a great time to be involved in this field. There were a handful of new laws passed that brought much needed attention to helping individuals access behavioral health services, safely store firearms, methods to remove unnecessary medications, etc.

In a nutshell: we actually saw progress. In public health school, professors said time and time again, “You can spend your career on an issue and maybe, maybe you’ll see some improvement before you retire.” Public health is often a game of patience. You have to tell yourself every day that the work you’re doing does matter, as incremental as it often seems.

But with suicide prevention, we saw a school staff training mandate go into place, new collaborations with other state agencies, and Veteran groups having meaningful (and much needed) conversations about how to help their community get into substance abuse treatment and get guns out of homes when there is a crisis.

I felt proud to leave when I did. The team is doing great work. We saw substantial decreases in youth suicide (41% one year!) and the partnership were in place for success. Plus, there were days when I would come home utterly spent. I wasn’t a clinician, but there were more than a handful of times when I came home from work having counseled someone who’d just lost a loved one to suicide. Those phone calls were the absolute worst. (Second worst was trying to help families connect their suicidal children to almost non-existent child psychiatry resources. Want job security? Study child psychiatry.)

It was hard, hard work. But it was also very rewarding. I was sad to leave my state agency, where I’d worked long enough that the systems and people felt second hand. The leadership was great and I didn’t have any reason to go other than I was ready for a new challenge.

And while being somewhat intentionally vague because it isn’t good form to go into work details on a public blog: I am loving my new challenge. It’s a much bigger job in a smaller region. Our team focuses on homelessness, domestic violence, and other social service outreach. It is the first regional policy focused position I’ve held, and the idea we could make regional changes to help the most vulnerable makes me want to do cart wheels down the street.

The business books and mentors would say, “never show your vulnerabilities in a new position.” To some extent, I agree. I’m not interested in complaining or looking foolish to the team I manage. However, showing vulnerabilities makes us human. There is only so much faking it till you make it. And getting into this new job groove, including a commuting routine, has felt like someone asked me to dance to a slow song and now I’m stuck at a rave and can’t find my way out. It is a go! go! go! pace, which is quite the change from working from my couch for 18 months. We are all feeling it. The dogs aren’t getting the same amount of attention. The meal planning isn’t as consistent. The garden is not being planted for Fall.

But, nearly two months into this new dance, I’m starting to anticipate the steps. This hasn’t come without some frustrating falls and missteps, to continue the metaphor. Today, I feel less dizzy. I’m paying more attention to exercise and what I’m eating to keep my brain sharp and ready to go. And of course, I’m loving having the opportunity to wear dresses again. I had been living in work blouses and shorts to meet the Zoom criteria. But the new gig is more dressed up and there is something about the clothing making the man. I never thought I’d enjoy wearing a suit, but I so do. Most days I’m in my fancy office by myself on the floor. (Most folks are still virtual.) But it still feels good.

While the Peace Corps didn’t go as planned, it did introduce me to the needs of the poor in a new way. And from that, I knew I wanted to study public health. How fortunate I am to have found a field where the work remains fun and a challenge.

In the Trenches

Garden update

 

Lately, I’ve been spending time with the homeless, and those on the edge of homelessness. I’ve also been spending a lot of time at public forums and community events discussing substance use services available in our community.

None of this is terribly interesting. However, this week, while standing outside eating hot dogs and drinking black coffee with a group of homeless people at a health fair, I saw the situation differently. There were likely 100 volunteers at this event. Many of us work in health care in one form or another. There was also a large group of LDS missionaries, volunteers from the evangelical church where the event took place, and retirees.

Those who came to the event for help, including several large African refugee families, were paired with a volunteer. They walked with their volunteer through the varying stations to seek the services they needed. There was HIV testing, a shower station, a clothing room, a barber and even a veterinary station for those with pets. The largest lines were at the Social Security and Motor Vehicle lines to replace lost identification cards.

For hours, I watched volunteers and their paired family or homeless individual meander through the maze of services. The volunteer would start with a map, and several hours later would often walk by holding a huge bag of clothing and fistful of papers. One of the African women, with a roly poly infant tied to her back, elegantly wrapped her family’s bundle in a brightly patterned west African wax fabric that matched her long skirt and placed it on the crown of her head. She couldn’t have been five feet tall, but she cut quite the presence walking through the event.

There is a space between the homeless and the volunteer. In that space—or trench—rests the ashes of days past. For many of the homeless folks we spoke to, this included mental illness and substance use. What I would have guess also rested there nested among their current health struggles was a childhood plagued with unkindness. Physical and sexual abuse. Divorce. Poverty and the corresponding hunger that can prevent a child from ever being able to catch up developmentally with his or her peers.

Painting with a broad brush, on one side of this conversation stood a volunteer who likely had enough education and privilege, his job allowed him to take the day to be at the event, or enough paid time off to do so. On the other side, stood a man whose dentures and wallet were stolen. He wore new-to-him clothing, and was freshly showered after his haircut. The man, whose face was creased with the heavy wrinkles of a person who lives outside, tried explaining to his volunteer and to us how difficult it is to maneuver the Medicaid system in Arizona for dental benefits, and how difficult it is to live without teeth. He keeps choking when trying to eat.

We were able to get him a replacement ID card for his health services, but he didn’t qualify for the small dental service we could offer him. Frustrated, but grateful for our efforts, he scrunched his brow and went to the next station. His volunteer just nodded to us and followed behind.

We spend all of our time and efforts as a culture and nation pulling at weeds that won’t stop growing, rather than thinking about how to plant new seed.

If we want to make significant positive change in substance use, homeless, domestic violence, poverty, etc., we have to take better care of our kids. We have to reform the foster care system so no child is ever abused once already suffering the loss (temporary or permanent) from his/her birth parents. We have to spend more time feeding hungry people and loving those who need our compassion, not our judgment.

 

Let’s Talk About Suicide

Community Gardening

One of my roles is work in suicide prevention. In the last two years, I’ve learned there are few families in America who haven’t been touched by suicide — and this is especially true if you live west of the Mississippi. There is a western wave of violence theory; in a nutshell: there are a lot of guns west of the Mississippi.

I’m not getting into a gun debate here. I am going to share a few insights that I hope may help one of you read.

  1. You’re not alone. Lots and lots of people (most Americans, actually) will experience depression at some point. Some 80% of suicides are related to depression. You may have visited that dark place where ending your life seems more reasonable than sorting out the problems at hand. The good news in all of this is there are lots of resources, and you can remain anonymous if you want to.
  2. People who attempt suicide and survive are not doing so “for attention.” They are hurting, and they need help. Judgments of their behavior do not help. Let’s be thankful they’ve survived.
  3. Talk therapy is gold for suicidal individuals. Sometimes, a person may also need medications to help right the chemicals in their brain. Similarly, sometimes diabetics need insulin. There should be no societal difference in how we decipher the pharmaceutical needs of our physical and behavioral needs.
  4. Community is critical. The most successful suicide prevention program in Arizona pairs senior volunteers with home-bound seniors. These pairs become friends. Now, a person who wasn’t able to leave their home has a friend coming over at least once a week to check in. Just that has been enough. The program hasn’t had a suicide yet.
  5. Suicide, regardless of age, race or sexual preference, etc., happens because of isolation. A person may feel alone in a rural community, or in a bustling high school. Loneliness is public enemy number one in suicide prevention. We are creatures who need friendship. Once a suicide has been committed, individuals might have to contact services such as suicide cleanup Spokane to dispose of the blood or bodily fluids in order to avoid getting diseases.
  6. The largest group of individuals dying by suicide in America are white men aged 65 and older by gun. If you have a man who meets these criteria in your life and you are at all concerned, please remove any guns or prescription drugs from the home until you can find him help. Be it North Carolina or arizona gun laws, almost all states in America permit individuals who are above 21 to apply for a gun license. But under federal law, people who constitute harm to themselves or others are called prohibited gun possessors’. Therefore, if you know someone who falls under such a category, do report and get them the required treatment facilities.

Some great resources:

  • Teen Lifeline pairs kids with kids to talk about tough things, including suicide.
  • Your state behavioral health system. It may not be perfect, but they should have resources available for both substance abuse and suicide prevention. These often go hand in hand.
  • Safe Talk. This is a two day class that trains anyone age 18 and older how to recognize concerning behaviors and make a safe plan. Your municipality should be offering this course.
  • The Area Agency on Aging. The AAA will have community resources regarding suicide as well.

If someone in your life is hurting and considering suicide, please speak up.

~K

Antelope and Coyotes

Peach Springs and Seligman, Arizona

 

I’d been invited to this small community in northern Arizona because of suicide. Children were dying, by their own hands, and no one knew what to do.

It’s a community, a family really, of no more than 500. There is a health clinic, a school, a Boys and Girls club and a few other buildings in town. The Grand Canyon isn’t far and the plateaus, on early mornings, have antelope and elk and deer and coyotes.

Peach Springs and Seligman, Arizona

 

The people organized a medicine walk. We’d gather children and visit six fire keeper homes, each with a camp fire built in their front yards. Upon arrival, the head of household said a prayer over the children, adding sage to the fire. The pungent smoke enveloped the crowd, including the visitors like me on the periphery. We waved the smoke over us, leaning one by one over the fire. We pushed the smoke over our heads and down our backs and to each corner of the sky — sending the healing smoke to the four directions.

We pushed the unhealthiness looming over this community up and out, to be floated away by a high, strong wind.

Peach Springs and Seligman, Arizona

The prayers and songs reminded the children how valuable their lives are. Bullying by text is the new enemy; kids are being taunted by others. Told to kill themselves. Told they aren’t worthy.

The elders reminded them all otherwise, and that they are all family. The bullied and the bullies are one — and quite literally from one genetic pool made smaller by each death.

Peach Springs and Seligman, Arizona

Peach Springs and Seligman, Arizona

Peach Springs and Seligman, Arizona

In addition to the traditional healing, we will add clinical and educational resources — ways shown to prevent suicide. My wish is that we can provide hope.

~K

Bean Soup

Meal planning from spring

I didn’t think when I studied public health a dozen years ago I’d end up spending my days in homeless shelters and learning how to prevent people from killing themselves. Or hotly debating public policy, budgets and political leanings. Happily, here I am, mired in a career that keeps me my curiosities piqued.

Last week, I spent time with researchers from California who were visiting a local homeless shelter. We discussed startling rates of LBGTQ youth who end up in homeless shelters (25%) and try to kill themselves. The basic understanding is kids are not accepted by their families for their sexual preferences, run away, end up in homeless shelters and some feel further isolation — turning to suicide.

How do we stop this? Or the deaths of the 40,000 Americans resorting to suicide annually? I am not certain, but I have a few ideas. It seems most suicides are the result of loneliness. How do we better outreach those feeling isolated and provide the necessary care to give them another day?

Meal planning from spring

We are fundamentally created to live in community — to be around those who nurture our ideas, call us on our bullshit, and make us want to be better. Show me the person who tells you he’d rather be forever alone, and I’ll show you someone with pent-up anger  and a proclivity to send bombs via the USPS.

Meal planning from spring

With a bit of time and CDC funding, hopefully we’ll be able to come up with interventions that work. Perhaps something as simple as providing a support group for LBGTQ youth at homeless shelters in Arizona could help. We’ll see. It is one of many exciting projects on my professional plate.

And the photos of my pantry? Sometimes when it feels like I cannot control a thing in this world (See: Isis, those 47 Senators and their Iranian kowtowing, polar bears drowning in the arctic, wrinkles, more wrinkles, the number of children in foster care, those new wrinkles) — I clean and organize. While everything else seems to be spinning, the pantry is clean, meals planned and garden weeded.

Some days, hope and energy for new solutions and bean soup is what we have. This is enough.

~K

 

 

 

 

Doubtful Canyon

Yesterday, I was awake before the neighborhood chickens. I dragged Nelson around the block before heading north and east, driving past Four Peaks just as the sky was beginning to show the first light of day. The saguaros near Roosevelt Lake stood sentry, and by the time I reached the Mogollon Rim at some 6000 feet, a heavy fog clouded the vista. Through the mist, I could make out a few homestead fires on the forest floor, some 2000 feet below. The silver smoke rose in twisting spirals, winding its way upward toward the heavens — and the stream of cars on 260 heading to eastern Arizona.

North Eastern Arizona

This drive across Arizona toward New Mexico is forest and brush, high desert and hills. The neighborhoods vary from the odd trailer with a spray painted particle board address sign to multi-million dollar gated golf communities. I drove across several American Indian reservations too, some with flashy neon casinos.

With each curve, wash and bridge, there was a small green sign denoting the place’s name.

Whiskey Springs

Trout Springs

Doubtful Canyon

North Eastern Arizona

The last was apt. I spent 10 hours and nearly 500 miles on the road to reach a small rural community in eastern Arizona facing a suicide outbreak. I arrived midday to join colleagues and city officials to review death certificate data and talk strategy. In cities of all sizes, talking about taboo subjects is more about who you know than what you know. I approached the conversation quietly, listening to folks talk about what they’d heard.

How many? How? Where? Why? Related? Who knows? 

Is the word “suicide” being used?

As in many communities, this one has pockets full of the like-minded. There are racial, economic and religious delineations. Each is talking about suicide differently — including, for some, not talking about it at all. Trying to unweave this tangle of small town living is not my mission. Working with local leaders to bring representatives from each of these groups together to talk about what they are hearing, seeing and feeling? That’s the challenge.

And thankfully, I was surprised yesterday by the collaboration that has already taken root among faith and town leaders in the last month. There have been strides toward listening and understanding. There have been public conversations, including prayers around the flagpole, about suicide. People are talking about it, even if they don’t want to use the word.

North Eastern Arizona

Stigma hides in the shadows of social issues. It can be found in euphemism and feigned ignorance. It’s threaded through insensitive jokes and is used as a derogation.

There should be no stigma with ending suicide. It is possible.  Suicide is not “taking one’s life” or “someone passing away,” but the act of killing oneself — just as some 40,000 Americans did last year. (Ample more died of unintentional poisonings, single car accidents or had a failed attempt at suicide.)

North Eastern Arizona

While I was hesitant to attend these meetings yesterday, it was full of hope. I drove away incredibly pleased at the new motivation from many partners to work together to identify local resources for mental health.

~K

– If you have thought about suicide and would like to speak with someone — please call: 1 (800) 273-8255. Your life matters.

Juxtaposition

Condo 2014

As I do a few home repairs in my free time, I am entrenched at work in research on women in prisons. Specifically, I am reading about women who have substance abuse or serious mental illness and become jailed for whatever offense. The research isn’t great, and God knows the US has the highest rate of incarceration internationally.

A few facts that are really bothering me:

  • Half of all women incarcerated received substance use treatment or mental health treatment prior to being jailed. Half. As in: 50% of those women who are behind bars today have either a mental health disease, or a substance abuse issue. I would guess in other countries, these women would be in treatment rather than prison.
  • Those who experienced partner violence were four times as likely to engage in sex work and two times as likely to deal drugs.
  • Those who had a substance abuse issue were seven times as likely to get DUIs and six times as likely to engage in sex work.

I am attending a training next week about women jailed in our community, and how we can do a better job to offer services (mental health, substance abuse, community outreach) to prevent girls from becoming the next wave of women in prison. The solutions aren’t easy. They are drenched in politics, finances and let’s be honest: prisoners may be the least considered in the social justice arena.

But the problem is certainly clear.

Condo 2014

Have I mentioned how lucky I am to have this job? That I get to learn and think and brainstorm with some of the smartest policy folks in Arizona? It is fun, challenging and exhausting. And it provides plenty to think about as I’m painting and replacing light bulbs.

~K

Veggie Challenge

I am participating in a veggie challenge at work this week. The idea was to encourage all colleagues to intentionally eat more veggies for five days. Each cup of veggies was scored at 2 points, while a cup of fruit was scored at one. (Couldn’t be easier to follow, right?)

I was shocked at how many of my coworkers at the health department sulked around saying, “But I HATE vegetables.” I am big believer as both a gardener and a cook that if you “hate vegetables,” you simply haven’t had them prepared well. A can of green beans can be soggy and gross, where as beans picked off the vine, sauteed in a bit of butter with almond slices and sea salt? Divine.

And of course, since this was a challenge, I had to win. I am fairly incapable of competing in things and not wanting to be the best. (It’s a sickness.) As such, I figured out ways to super size the portions of veggies my team was eating this week. How could we get in 2-3 cups of veggies at breakfast, lunch and dinner? Smoothies, salads and soups.

My favorite tools for eating more vegetables are the blender and the immersion blender. I like a good spicy punch of ginger and kale and apples for breakfast.

Veggie challenge

green smoothie

And I never met a blended veggie soup I didn’t love, especially if I had the time to roast a head of garlic to throw in the pot too. (The raspberries were dessert.)

Veggie Challenge

Veggie Challenge

Veggie Challenge

And slowly but surely, I’m getting D to try more veggies too. He adamantly does not like a few, which I can understand, but I appreciate his willingness to at least try others. Last week, to our surprise, he liked lima beans.

LIMA BEANS, PEOPLE!

I’m calling that progress.

Happy veggies trails to you,

K

 

 

No One Wins

Flower

May we learn from our past.

There is a new war pending. Well, new to us. Thousands of Syrians are dead at the hands of other Syrians, with both sides likely using foreign-made (and secretly supported) weapons.

War is shitty. It is shitty for the families who are there, whose children will always suffer PTSD and will never grow to be the adults they could have been. Those without constant nightmares. Those who don’t jump and cover at loud sounds. Those who remember what it was like before their neighborhoods were gutted, first by other neighbors, and then by foreign forces. Before they hated everyone involved — that time before the war, when the world was a laboratory for their dreams.

There are Syrians who are dying and quite possibly being gassed by their own government. We are paying attention, the cynical side of me says, because there are so many foreign interests involved in this matter. Not because there are families just like ours but with a different color passport dead and dying from this ridiculous injustice.

I mean, if injustice was truly our motivation, we’d do something about:

Southern Sudan, which is once again in turmoil. One of the newest countries in the world has a perilously fragile government, which cannot protect its citizens from tribal unrest.

Uganda and Congo, where armies of children are kidnapped, given drugs and led into disastrous battles with weapons they can barely lift. Some 5 million Africans have died in World War III. Collectively, we don’t care. When was the last time you heard anything in the news about the Congo? (5 million people is roughly the entire population of the State of Arizona.)

Zimbabwe, where don’t even get me started on the farce that was their most recent election — once again allowing Mugabe to rule. His people starve. His country falls apart by the limbs. But hey, the US is not interested in getting involved.

North Korea, where famine is widespread and folks are encouraged to eat tree bark when their hunger gets too out of control.

In Mexico, where the northern half of the country remains paralyzed due to fear of cartel beheadings. Speak up against the Mexican mafia? Your head will be delivered faster than DHL to the nearest family member.

Or hey, if I was going to get really high on my soap box, if the US wanted to address injustice — how about the 1 in 5 children in our country who go to bed hungry every night? How about the cycles of poverty we cannot seem to break, and the kids who end up suffering as a result? (We choose not to break these cycles. Hunger in America — unlike hunger in many other countries — is not a problem of supply and demand. It is a matter of political will. And hungry kids do not get to vote.)

War sucks. The ramifications will be felt for generations. Our men will die in Syria. Our tax dollars will be used to kill Syrians. Syrians will continue to kill Syrians. The Russians, Chinese and American war machines will continue to be fed.

I’d prefer to feed the kids in all of these countries instead.

~K