Tag Archives: #healthcare

A Shot In the Arm Against COVID: On Record With Gavin Newsom

After one of the most challenging years of our lives, there’s a light at the end of the tunnel—the COVID-19 vaccines are here, and my administration is working to ensure that no community is left behind.

The COVID-19 vaccines are safe and effective. They are our best hope to end the pandemic. Getting a COVID-19 vaccine is free, even if you’re undocumented or don’t have health insurance.

After the federal government authorized the use of the vaccines back in December, our own Western States Scientific Safety Review Group confirmed that the vaccines are safe. The Panel includes nationally acclaimed scientists, many from California, with expertise in public health.

Although supplies of the vaccine are limited right now, we’re working in close partnership with the federal government to get more vaccines into the state. And we’re working hard to build a system for swiftly and safely vaccinating Californians with equity at the forefront.

While the supply of vaccines is constrained, we’re prioritizing vaccines for the Californians most at risk–including healthcare workers, individuals 65 and older, and workers in education and childcare, emergency services and food and agriculture. That means grocery store workers, restaurant workers, farmworkers, those who work in food processing facilities and many others may now be prioritized. And we’re working to ensure that the communities most impacted by COVID-19–so often the communities of color and essential workers who have been sustaining us through this crisis–can access the vaccine.

We’re investing in community-based organizations and partnering with trusted messengers who have been providing critical services and information to California’s diverse communities during the pandemic so that they can help educate, motivate and activate people to get vaccinated when it’s their turn. We’re also building messaging through a public education campaign, creating in-language content with cultural humility and meeting Californians where they are—literally, through the mobile vaccination sites that have deployed throughout the state to community centers, places of worship and health clinics.

Vaccination sites are being set up throughout the state, and we’re working closely with community partners to make sure that vaccines are distributed to those who have been hit the hardest by this virus.

You may see people in uniform or police protecting vaccine sites. They are here to help Californians get vaccinated and are not immigration officials.

The federal government, under President Biden, has confirmed that they will not conduct immigration enforcement operations at or near vaccine sites or clinics. You should not be asked about your immigration status when you get a COVID-19 vaccine.

Also, your medical information is private and cannot be shared with immigration officials. And, vaccinations do not count under the public charge rule.

All Californians can sign up on myturn.ca.gov to be notified when they are eligible for a vaccine. Eligible individuals in several counties, including Los Angeles, San Diego, Fresno, and San Francisco, can also use My Turn to schedule an appointment, with more counties expected to begin using My Turn for scheduling in the coming weeks. My Turn is also accessible via a toll-free hotline at 1-833-422-4255. Operators speak English and Spanish, and third-party interpretation is also available in 250+ languages. You can also ask your physician or your pharmacy about scheduling an appointment.

After you’ve been vaccinated, it’s still important to wear a mask, wash your hands often and continue to stay six feet apart to protect others in your community who have not yet been vaccinated.

I encourage every Californian to get vaccinated as soon as it’s your turn. Together, we can end the pandemic.

Gavin Newsom is the Governor of California, formerly Lieutenant Governor of California, and Mayor of San Francisco. Governor Newsom is married to Jennifer Siebel Newsom. They have four children: Montana, Hunter, Brooklynn, and Dutch. Newsom has been a pioneer on same-sex marriage, gun safety, marijuana, the death penalty, universal health care, access to preschool, technology, criminal justice reform, and the minimum wage, which has led to sweeping changes when his policies were ultimately accepted, embraced, and replicated across the state and nation.

This article was first published by Ethnic Media Services.

Why Should You and I Care About Palliative Care?

Sukham Blog – A monthly column focused on South Asian health and wellbeing.

My wife’s oncologist recommended a palliative-care consultation during one of her checkups. This was the first time we heard about it and my wife, subsequently, received beneficial palliative care alongside her ongoing treatment for cancer. Since then, I’ve continued to learn more about palliative care and how it helps patients living with various kinds of serious illnesses. I’ve also realized that most people know very little, or are misinformed about palliative care. We need to understand this relatively new medical specialty; it can do a lot for us and our loved ones in the event of a serious health issue. 

Palliative care is specialized care for people living with a serious illness. It is a type of care focused on providing relief from the symptoms and stress of different kinds of serious and chronic, progressive illnesses, and is provided in addition to, and concurrent with, ongoing medical care. It supports the patient’s ability to feel better while undergoing treatments which could be intense and sometimes not well tolerated. The goal of palliative care is to improve quality of life for both the patient and the family.

To palliate is to make something – for example, a disease or its symptoms – less severe or unpleasant. Palliative Medicine is relatively new. It has its roots in the work of Cecily Saunders and Elisabeth Kübler-Ross in the 1960s. The term Palliative Care was coined in 1974 by Dr. Balfour Mount, a surgical oncologist at The Royal Victoria Hospital in Montreal, Canada. It was recognized as a field of specialty medicine in Great Britain in 1987, the same year that Cleveland Clinic started the first Palliative Medicine service in the United States. It became a board-certified subspecialty of medicine in the United States in 2006, just 15 years ago.

Let me repeat: Palliative care is specialized care for someone living with a serious or chronic progressive illness, focused on providing relief from the symptoms and stress of the illness, to improve quality of life for both the patient and the family. It is based on the needs of each individual patient and can be provided at any time during his or her illness, along with the treatment he or she is already receiving, regardless of the prognosis, expected trajectory of the disease, or age of the patient.

What, specifically, does palliative care do? It provides relief from pain, nausea, constipation, neuropathy, shortness of breath, or other side effects and symptoms caused by the illness and/or treatment. It helps when patients and their families have trouble coping with the illness and are anxious, depressed, stressed, or fatigued, and enables them to better carry out their daily tasks and do the things they want. Palliative care can also improve the quality of life for both the patient and his or her family. 

What is meant by quality of life? That depends on the patient! He or she defines what is important at that moment and in the future. The palliative care team works with the patient and his or her family to understand what’s important and what matters most to them, and takes that into account to formulate a treatment plan and provide the best possible support to help realize those goals.

I used the phrase palliative-care team.  Care is provided by a specially-trained, multidisciplinary team that typically includes doctors, nurses, medical assistants, social workers, chaplains, and other specialists. This is because palliative care extends beyond a patient’s physiological and medical needs and addresses other factors that may be affecting their quality of life, including psychological, spiritual, and social needs. These needs vary from patient to patient. In addition, they can vary over time for a given patient.

Needs could include: help with figuring out what medications should be taken and when; thinking things through, and weighing options when faced with decisions on a suggested next step in treatment; help navigating the complexity of a large hospital when referred to different specialists or when various tests are ordered. Sometimes stress can overwhelm the patient, caregiver, or another family member, and they could benefit from having a caring listener, or just a hand to hold for a while. The costs of treatment are a huge concern for many of us, so the assistance of a qualified individual to sort through financial questions might be valuable. When serious illness brings up existential and spiritual questions, trained chaplains could provide answers, solace, comfort, and a compassionate presence. Nutritionists who understand the patient’s diagnosis and condition can help address dietary concerns.   

Palliative-care specialists treat people living with many types of serious and chronic illnesses, regardless of their age, stage of the disease, and whether or not they are still receiving curative treatment; these include cancer, congestive heart failure, chronic obstructive pulmonary disease (COPD), kidney failure, Alzheimer’s, Parkinson’s, Amyotrophic Lateral Sclerosis (ALS), and other life-limiting diseases. Pediatric palliative care is an upcoming specialty. During the current pandemic, it’s an essential part of treatment for those who have contracted COVID-19.

Many confuse palliative care with hospice and believe a recommendation for palliative care implies the patient has a condition that will imminently end his or her life. This is not correct. Palliative care can be very useful for those managing a long-term illness. Quality research provides evidence that the early introduction of palliative care provides all the benefits described above, and results in fewer hospitalizations, a reduced burden on the family, and greater satisfaction overall. Hospice is a form of palliative care for those patients judged to be approaching end of life – and typically have six months or less left to live – who decide to focus on comfort instead of prolonging treatments.

Most private insurance plans, as well as Medicare and Medicaid, cover palliative-care services in hospitals and nursing homes. However, you should always consult with your insurance provider to understand your coverage in detail.

I hope this has helped you better understand Palliative Care and dispel any related misconceptions. 

Mukund Acharya is a regular columnist for India Currents. He is also President and a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area that advocates for healthy aging within the South Asian community. Sukham provides curated information and resources on health and well-being, aging, and life’s transitions, including serious illness, palliative and hospice care, death, and bereavement. Contact the author at sukhaminfo@gmail.com

Sincere thanks to Drs. Neelu Mehra at Kaiser Permanente, and Kavitha Ramchandran & Grant Smith at Stanford Health Care – Palliative Care Physicians who have contributed greatly to my understanding of Palliative Care.

With sincere thanks to Trung Nguyen at Pexels for the use of her beautiful photograph.

The Launch of Sandhya’s Touch

We are delighted to announce the launch of Sandhya’s Touch, a non-profit organization whose mission is to improve the quality of life of people dealing with chronic or serious illness. We do this by supporting projects that provide services, support and care that ease the burden of suffering for these patients and their families, and by sponsoring community education and outreach events that will result in better care and outcomes in such situations.

Dedicated to the memory of Sandhya Acharya who confronted cancer with amazing resilience and grace while bringing joy and support to her loved ones every day, Sandhya’s Touch forms partnerships with organizations and institutions in the community to meet its mission and objectives.

Two projects have been funded as of this launch date, a third is under active consideration, and four more projects are in the pipeline.

Please visit sandhyastouch.org for more details about our mission, leadership, partners and projects.  We welcome grant requests from established community organizations and institutions for projects that align with our mission. Projects must directly support people and families dealing with serious and chronic illness to improve the quality of their lives. For more details on how to apply, contact us at  info@sandhyastouch.org.

Your contributions will go a long way in helping us fulfill our mission and fund new projects. Please make a generous donation before year-end by going to the Donate page on our website!

Sandhya’s Touch is a 501(c)(3) non-profit organization registered in the State of California. All donations are tax-deductible to the extent allowed by law.

Dharavi slum in Mumbai

India’s Low COVID Death Rate Is Puzzling

Though the COVID-19 crisis hit India hard – over 9 million cases have been reported and more than 138 thousand people have died  – the mortality rate from COVID-19 is inexplicably lower compared to other countries.

For instance, while the US leads the world with more than 14 million cases and over 276 thousand deaths, according to the John Hopkins Coronavirus Research Center, India accounts for only 10% of deaths globally and has the highest number of recovered patients of COVID-19 at 94%, even though its coronavirus caseload is second only to the US.

With such a significant share of the world’s coronavirus cases, shouldn’t COVID-19 have been more devastating in India?

Krishnaraj Rao

“Then again it has not,” announced Krishnaraj Rao, an investigative journalist from Mumbai, India, at an EMS briefing (November 20) on the pandemic.

“Something strange has been happening within the Indian subcontinent and neighboring regions,” said Rao. “For some strange reason our mortality rate per million is one eighth and our total cases seem to be in the region of one sixth per million.”

As COVID-19 began its inexorable spread across the world, the WHO recommended safety precautions to protect against the virus – physical distancing, wearing a mask, well ventilated rooms, avoiding crowds and close contact, and regularly washing hands.

But in an outcome that has puzzled epidemiologists and scientists alike, India seems to be experiencing a low mortality rate from the coronavirus, stated Rao, despite the crowded conditions in which many urban Indians live.

A large proportion of urban dwellers in a developing country like India lack access to adequate healthcare facilities and maintain poorer sanitation and hygiene practices which are known to be responsible for a higher incidence of communicable diseases.  So the virus was expected to have caused many more deaths in densely populated communities in India than it has.

Urban Indians are ‘badly housed,’ explained Rao, using Mumbai as an example to explain why crowded Indian cities offer a fertile petri-dish for catastrophic coronavirus outbreaks.  “I would say that close to 60% of the population of urban India lives closely packed together in slums.”

In a metropolis like Mumbai, home to over 20 million and India’s largest city, nearly one million people live cheek by jowl in Dharavi, one of the world’s largest slums.

“Houses are no more than two feet apart. Each house is no larger than a 10 by 12 room,” said Rao.

Each home houses about 10 to 12 people, closely packed together. It makes social distancing nearly impossible, while access to basic hygiene essentials, including toilets and hand washing are limited.

“There is only one public toilet per every two or three hundred slum dwellers,” explained Rao, highlighting the less than hygienic conditions in slums like Dharavi. “Face masks, social distancing…are close to non-existent. We take things like face masks, temperature checks and sanitizing very lightly,” he claimed.

“If it were a pandemic that was ravaging us because of a lack of social distancing,” asked Rao, why are the slums relatively less impacted than expected? And, despite overcrowding on the suburban railways, he adds, “the crisis has hit us less hard than anticipated.”

While epidemiologists attribute India’s low mortality rate to under-reporting, and even though Rao himself expected undercounting, he alleged that at least in Dharavi, there is no evidence of it. “I don’t see the bodies piling up in the streets… or the hospitals,”  nor has he noted any alarming rises in the body count.

Rao claimed he is voicing “a mainstream belief” felt across economic classes and demographics in India, that the coronavirus is not causing the high mortality rates that were anticipated.

In Dharavi, officials say that concerted public health efforts to trace, track, test and treat cases, have helped to contain community spread.

Now, recent research by Indian scientists seeking to explain why India’s death rate is so low, suggest that more Indians may be immune to COVID-19 because they live in unsanitary conditions which have created an unexpected shield from the virus.

According to one study, more than 70 percent of all COVID–19 deaths have occurred in high income countries like Italy, Spain, UK, France and USA. It hypothesized that more people died in richer countries with older populations, because better hygiene and safe sanitation practices lowered levels of immunity and made people more susceptible to the virus.

In another study scientists report, “It appears that countries with better health care, clean environment, clean food and water have higher COVID associated mortality, whereas developing and underdeveloped countries have lower mortality in terms of deaths per million population.”

Both research studies (not yet peer reviewed), suggest that in low GDP countries like India, lives of people in densely populated areas may have been saved because of poor hygiene and sanitation practices.  Unsanitary conditions and exposure to diseases from childhood may have increased their ability to ward off infections, and boosted immunity against COVID-19. Experts also suggest that the early lockdown and a younger population helped stave off a higher death toll in India.

The science is intriguing. Does greater exposure to a variety of viruses in the slums of low income countries provide a better level of protection against the coronavirus, than the overly sanitized environments of richer nations?

“Paradoxically, better sanitation leads to poor immune training and thus could be leading to higher deaths per million,” says the study. But it cautions that while the research offers a possible explanation, poor hygiene is not a solution to the pandemic.

India, and Dharavi in particular, may have pulled off a remarkable reprieve against COVID-19 for now. But the pandemic is far from over and science is still learning about this young virus. So, public health experts warn, SMS (social distance, mask, and sanitize) must remain the global mantra to keep Covid 19 at bay, until vaccines become easily available to the general public.

Meera Kymal is the contributing editor at India Currents.

photo credit: Baron Reznik

Rising Healthcare Costs Make Patient Care Difficult for Visiting Parents

U.S. President Donald Trump and presidential candidate, Vice President Joe Biden, are united by one issue at least – the rising cost of medication.   

This July, prices rose 3.1 percent on average for 67 drugs compared to the same period last year. GoodRx points out that the increases came on the heels of a 6.8% surge, on average, from January to June 30 of this year – manufacturers raise prices in January and July annually. And for many Americans, this means not filling their prescriptions. In a new poll by Best Health and the Global Strategy Group of 4,200 potential voters in Arizona, Colorado, Georgia, Iowa, Maine, Montana, and North Carolina, the main battleground states for the Senate, 22 percent of the respondents said they couldn’t afford medications prescribed by their doctors. More than a quarter (26%) said they or their family members were unable to seek treatment for a health problem in the last year due to cost concerns.

Rising costs have also affected another demographic – parents from India visiting their offspring. Thousands of older Indians have had to extend their stay as a result of travel restrictions amidst the pandemic earlier this year.

“My father is 75 years old and has had benign prostate hyperplasia (BPH) for about 10 years. His urologist made the very unwise decision to perform surgery for my father’s BPH right before he came to visit me. He’s been experiencing complications from that ever since,” says Dr. Debyani Chakravarty, a new mother and a faculty member in the department of pathology at the Memorial Sloan Kettering Cancer Center in New York. “I bought both my parents’ travel insurance but since these are complications from surgery, nothing is covered. I pay $300 per consultation with a doctor here, $300 for my dad’s cystoscopy, $100 for labs, and $200 for his meds so far. In Pune, their medication (alone) would cost at least ten times less.”

Another set of parents visiting their daughter, also a new mother in New York, were Sushima Sekhar and her husband from Chennai. Both had to postpone their return and were running out of their diabetes, blood pressure, and cholesterol medication they’d brought from India. 

Their daughter’s physician, Sekhar says, asked to see them in order to prescribe. “The consult per person was $250, quite steep,” she recalls. “In the meantime, we got the number of a COVID Tamil Task Team which was doing an unbelievably great service to stranded Indians here. They had chemists and doctors in their group. All we had to do was give them our Indian prescription, and they would find the equivalent generic low-cost drug, double-check with their doctors, (and issue us a prescription here). We kept them as a last resort because the price of meds, however low, was way too high when converted in Indian rupees – anywhere between five to fifteen times higher.”

Sekhar eventually succeeded in getting the medication couriered from India, after that avenue opened up following a lockdown there. 

But for many others, obtaining affordable medication in time without missing dosages would have been impossible but for voluntary groups such as the COVID-19 Tamil Task Team, and Non-Resident Indian doctors in the Telugu community. 

Dr. Saraswathi Lakkasani, a Telugu NRI doctor who is helping parents visiting from India.

“The federal government relaxed telemedicine rules (as a result of the pandemic), and I wanted to help these people stranded here. For one prescription to go out, we had ten volunteers working on it,” says Dr. Saravanan Ramalingam, a trauma surgeon in New York who helped launch the service. The initiative gained momentum after the group had a conference call with Shatrughna Singha, Deputy Consul General of India, New York, who was keen that Indian-origin doctors provide help to visiting older Indians in need of healthcare and medication, Ramalingam points out.  

Vasudevan Kothandaraman, an IT professional in New Jersey, helps to co-ordinate within a group of around 30 volunteers. The quality checks are stringent, he says, and prescription requests are routed through the app Freshdesk. Volunteers verify the Indian prescription and refer patients to a telemedicine team of doctors if required. A group sends the list to local pharmacies to find out if an American equivalent of the drug is available. If it is, the verification team, consisting of doctors, nurses, and pharma PhDs search for a cheaper, generic alternative. The prescription team reviews the process, and a doctor faxes a prescription to a pharmacy nearest to the patient’s home. “If the cost is really high, we provide them with GoodRx type of discount coupons,” Kothandaraman says. “We have issued 400 prescriptions (at the start of the pandemic lockdown).”        

Now, a fall surge expected by the Centers for Disease Control and Prevention could again intensify the struggles of older Indians visiting in the U.S., and those who have extended their visas to be with family. 

Doctors are standing by to help. 

“One Telugu lady, a mother visiting her family in North Carolina, had recurring urinary tract infection. She was stuck here because of the lockdown and had no clue where to go and what to do,” says Dr. Saraswathi Lakkasani, an internist who was recently awarded a fellowship in gastroenterology and hepatology by the New York Medical College. “I heard her medical history – she had co-morbidities – and prescribed antibiotics at a CVS Pharmacy close to her. Told her to drink plenty of water and some cranberry juice; her symptoms were gone within a week.”

Lakkasani pauses, adding reflectively: “She is an elderly stranger, she is talking in my language. It moves you.”  

Sujata Srinivasan is a business and healthcare journalist in Connecticut. Find her on Twitter @SujataSrini.

Featured Image by Harsha K R.

The New Normal For Seniors In A Post-Vaccine World

Imagine this scenario, perhaps a year or two in the future: An effective COVID-19 vaccine is routinely available and the world is moving forward. Life, however, will likely never be the same — particularly for people over 60.

That is the conclusion of geriatric medical doctors, aging experts, futurists and industry specialists. Experts say that in the aftermath of the pandemic, everything will change, from the way older folks receive health care to how they travel and shop. Also overturned: their work life and relationships with one another.

“In the past few months, the entire world has had a near-death experience,” said Ken Dychtwald, CEO of Age Wave, a think tank on aging around the world. “We’ve been forced to stop and think: I could die or someone I love could die. When those events happen, people think about what matters and what they will do differently.”

Older adults are uniquely vulnerable because their immune systems tend to deteriorate with age, making it so much harder for them to battle not just COVID-19 but all infectious diseases. They are also more likely to suffer other health conditions, like heart and respiratory diseases, that make it tougher to fight or recover from illness. So it’s no surprise that even in the future, when a COVID-19 vaccine is widely available — and widely used — most seniors will be taking additional precautions.

“Before COVID-19, baby boomers” — those born after 1945 but before 1965 — “felt reassured that with all the benefits of modern medicine, they could live for years and years,” said Dr. Mehrdad Ayati, who teaches geriatric medicine at Stanford University School of Medicine and advises the U.S. Senate Special Committee on Aging. “What we never calculated was that a pandemic could totally change the dialogue.”

It has. Here’s a preview of post-vaccine life for older Americans:

Medical Care

  • Time to learn telemed. Only 62% of people over 75 use the internet — and fewer than 28% are comfortable with social media, according to data from the Pew Research Center. “That’s lethal in the modern age of health care,” Dychtwald said, so there will be a drumbeat to make them fluent users of online health care.
  • 1 in 3 visits will be telemed. Dr. Ronan Factora, a geriatrician at Cleveland Clinic, said he saw no patients age 60 and up via telemedicine before the pandemic. He predicted that by the time a COVID-19 vaccine is available, at least a third of those visits will be virtual. “It will become a significant part of my practice,” he said. Older patients likely will see their doctors more often than once a year for a checkup and benefit from improved overall health care, he said.
  • Many doctors instead of just one. More regular remote care will be bolstered by a team of doctors, said Greg Poland, professor of medicine and infectious diseases at the Mayo Clinic. The team model “allows me to see more patients more efficiently,” he said. “If everyone has to come to the office and wait for the nurse to bring them in from the waiting room, well, that’s an inherent drag on my productivity.”
  • Drugstores will do more vaccinations. To avoid the germs in doctors’ offices, older patients will prefer to go to drugstores for regular vaccinations such as flu shots, Factora said.
  • Your plumbing will be your doctor. In the not-too-distant future — perhaps just a few years from now — older Americans will have special devices at home to regularly analyze urine and fecal samples, Dychtwald said, letting them avoid the doctor’s office.

Travel

  • Punch up the Google Maps. Many trips of 800 miles or less will likely become road trips instead of flights, said Ed Perkins, a syndicated travel columnist for the Chicago Tribune. Perkins, who is 90, said that’s certainly what he plans to do — even after there’s a vaccine.
  • Regional and local travel will replace foreign travel. Dychtwald, who is 70, said he will be much less inclined to travel abroad. For example, he said, onetime plans with his wife to visit India are now unlikely, even if a good vaccine is available, because they want to avoid large concentrations of people. That said, each year only 25% of people 65 and up travel outside the U.S. annually, vs. 45% of the general population, according to a survey by Visa. The most popular trip for seniors: visiting grandchildren.
  • Demand for business class will grow. When older travelers (who are financially able) choose to fly, they will more frequently book roomy business-class seats because they won’t want to sit too close to other passengers, Factora said.
  • Buying three seats for two. Older couples who fly together — and have the money — will pay for all three seats so no one is between them, Perkins said.
  • Hotels will market medical care. Medical capability will be built into more travel options, Dychtwald said. For example, some hotels will advertise a doctor on-site — or one close by. “The era is over of being removed from health care and feeling comfortable,” he said.
  • Disinfecting will be a sales pitch. Expect a rich combination of health and safety “theater” — particularly on cruises that host many older travelers, Perkins said: “Employees will be wandering around with disinfecting fogs and wiping everything 10 times.”
  • Cruises will require proof of vaccination. Passengers — as well as cruise employees — will likely have to prove they’ve been vaccinated before traveling, Factora said.

Eating/Shopping

  • Local eateries will gain trust. Neighborhood and small-market restaurants will draw loyal customers — mainly because they know and trust the owners, said Christopher Muller, a hospitality professor at Boston University.
  • Safety will be a bragging point. To appeal to older diners in particular, restaurants will prominently display safety-inspection signage and visibly signal their cleanliness standards, Muller said. They will even hire employees exclusively to wipe down tables, chairs and all high-touch points — and these employees will be easy to identify and very visible

Home Life

  • The homecoming. Because of so many COVID-19 deaths in nursing homes, more seniors will leave assisted living facilities and nursing homes to move in with their families, Factora said. “Families will generally move closer together,” he said.
  • The fortress. Home delivery of almost everything will become the norm for older Americans, and in-person shopping will become much less common, Factora said.
  • Older workers will stay home. The 60-and-up workforce increasingly will be reluctant to work anywhere but from home and will be very slow to re-embrace grocery shopping. “Instacart delivery will become the new normal for them,” Dychtwald said.

Gatherings

  • Forced social distancing. Whenever or wherever large families gather, people exhibiting COVID-like symptoms may not be welcomed under any circumstances, Ayati said.
  • Older folks will disengage, at a cost. Depression will skyrocket among older people who isolate from family get-togethers and large gatherings, Ayati said. “As the older population pulls back from engaging in society, this is a very bad thing.”
  • Public restrooms will be revamped. For germ avoidance, they’ll increasingly get no-touch toilets, urinals, sinks and entrances/exits. “One of the most disastrous places you can go into is a public restroom,” Poland said. “That’s about the riskiest place.”

  • This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

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AACI is here for you!

Founded in 1973, AACI is one of the largest community-based organization advocating and servicing the marginalized and vulnerable ethnic communities in Santa Clara County.
 
Our many programs address the health and well-being of the individual and advances our belief in providing care that goes beyond just health, but also providing people a sense of hope and new possibilities.
 
Our passion and expertise in caring for families and individuals always start with cultural sensitivity and compassion. We believe neighborhoods are stronger when we recognize and embrace the diversity around us and look after each other.
 
Current programs include behavioral and primary health services, substance abuse treatment, center for survivors of torture, shelter for survivors of domestic violence, senior center, youth programs, and community advocacy.
 
To learn more about our services, please visit us on the web at www.aaci.org or give us a call to schedule an appointment at (408) 975-2763.
 

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Who Gets Healthcare In The Pandemic?

“Where do you go for healthcare?” I asked a group of African American participants whom a local pastor had gathered together at a neighborhood church in inner city Dayton.

The year was 1990 and I was running community focus groups for a Wright State University School of Medicine pilot initiative to identify the healthcare needs and barriers among the city’s indigent population.

An elderly woman turned to me. “Honey,” she said, “I get into a tub of hot water and pray.”

I’m reminded of her response whenever the current healthcare crisis lays bare the inequities that continue to haunt the American healthcare system for communities of color.

The individuals in those community health focus groups of thirty years ago had no health care at all, a sobering fact that one participant drily summed up, saying, “You must be very dense to ask people in this community to describe their healthcare status.”

Many people in those inner-city communities, like the woman who sought relief in prayer, spoke of turning to religion, herbal teas or home remedies to find healing. When these failed, they went to local emergency rooms or trauma centers to find medical help.

It was clear from those conversations that those focus groups were the face of underserved minority communities who had little or no access to healthcare systems or providers. An unforgiving mix of financial insecurity and limited or no health insurance gave few if any, a chance at the healthcare services to which more privileged members of society had easier access.

But what quickly became evident, was that the community did not trust the healthcare system because they perceived the cultural bias within it.

“Everything boils down to economics,” said a participant. “Where the dollars are, is where the healthcare providers are.”

It appears that little has changed since then.

That cultural bias exists, said Dr. Tung Nguyen at an EMS media briefing on June 19, because, the ‘default position’ in the American healthcare system is that healthcare is designed to give medical attention to average, ‘default’ patients who happen to be primarily “white, English-speaking, employed and well educated.”

So, as a result of “building a public healthcare system that is based on a racist principle of what works for white people,” said Dr. Nguyen, minorities have paid a terrible price in the coronavirus crisis.

The pandemic has upended the health and lives of people everywhere, but in the US it has unmasked systemic inequities in the medical infrastructure that undermine how communities of color access their healthcare. Data  from the COVID-19 crisis is revealing the chasm between those who do and don’t get healthcare, and how race and ethnicity affects who survives or succumbs to the coronavirus.

Racial and ethnic disparities are “even more marked” in data examining COVID deaths, said Dr. Nguyen, a Professor of Medicine at the University of California (San Francisco). He was referring to a  Brookings Institute report which showed that Black and Hispanic/Latino people are experiencing some of the highest fatality rates from COVID-19, compared to white people.

Dr. Nguyen pointed out that in the age group 35 to 44,  “the risk of dying is ten times more for blacks and 8 times more for Latinx compared to non-Hispanic whites. For ages 75 to 84,  the risk is 4 times more for black and 2 times more for Latinx.”

The Brookings data also showed that among those aged 45-54, Black and Hispanic/Latino death rates are at least six times higher than for whites. In April, 70% of Louisiana’s COVID-19 fatalities were African American while in Michigan, Detroit’s primarily black tri-county area accounted for nearly 85% of the state’s COVID-19 deaths.

That trend was also confirmed by a recent CDC report showing that the coronavirus hurts racial and ethnic minority groups at higher rates across every age group.  The data shows that African Americans and Latinos are at increased risk of getting infected, being hospitalized, or dying from COVID-19. African Americans are 5 times more at risk, and Hispanic or Latino persons are 4  times more at risk from COVID19, than white persons.

The numbers don’t lie. Minority communities are getting hit hard and it’s time to reset the ‘default position’ in American healthcare.

America has approached public health the wrong way for years, argues Dr. Nguyen.  The healthcare infrastructure is wasteful.  Despite flaunting the most expensive healthcare system on the planet, a Commonwealth Fund study put the US at the bottom of 11 developed countries ranked on healthcare.

A John Hopkins report found that Americans spent more money ($9,892 per person) on healthcare but received a lower standard of care compared to other developed nations; ($ 7,919 per person in Switzerland) in 2016.

The US has the worst life expectancy among comparable countries. For example,, the United States ranks 29th in infant mortality and 26th for life expectancy, with an average life expectancy of 79 years among 35 OECD countries.

“The reason is that we spend money on the wrong things, and we are wasting money for the outcomes we get,” explains Dr. Nguyen.

Public health should focus instead on factors that contribute the most to low life expectancy, such as “ income equality, low levels of education, exposure to violence, along with other key determinants like employment, housing and food security, and climate change.”

“These are the proper topics for public health to work on in the future” he suggests.

Going back to normal after the pandemic will depend on making effective structural changes to the patchwork  US healthcare system. It will be a Herculean task to reinvent the healthcare infrastructure after the COVID19 crisis, but the future of American public health must ensure that race and ethnic disparities inform its outcomes.

By 2045, non-Hispanic whites will no longer be the majority, so spending money on the ‘wrong things’ and looking at health disparities as an afterthought “will not work as a path to the future,” Dr. Nguyen advised.

“My slogan for this is that there is no health quality without equality.” He recommends addressing the disparities in the healthcare system first to raise the quality of care.

He pointed out for example, that metrics for healthcare quality which look at disparities, only work when the metrics are broken down by race and ethnicity.

“So, if an average healthcare metric like “the number of people with hypertension who have blood pressure control,” is not broken down by race and ethnicity, it becomes meaningless because it only represents an average for everybody. In the future, national measures for quality will need to report it by race and ethnicity to have value.

The pandemic has exposed how racial and socio-economic disparities affect access to healthcare in 2020. If advances in medicine and healthcare practices in the last thirty years remain out of reach for every American, just as in1990, then the fragmented healthcare system is unfair and outdated. It’s certainly unworthy of the hefty price tag attached to it. The future health of Americans is in jeopardy unless we build a public healthcare system that switches the ‘default position’ of who gets healthcare, from white, to one that reflects the changing face of multi-ethnic America.

“As the saying goes, we shouldn’t waste a good crisis,” urges Dr. Nguyen. “Some good needs to come out of the pandemic.”

Meera Kymal is a contributing editor at India Currents

Photo by Adli Wahid on Unsplash

 

 

Using Patient Stories To Mentally Survive As A COVID-19 Clinician

Dr. Christopher Travis, an intern in obstetrics-gynecology, has cared for patients with COVID-19 and performed surgery on women suspected of having the coronavirus. But the patient who arrived for a routine prenatal visit in two masks and gloves had a problem that wasn’t physiological.

“She told me, ‘I’m terrified I’m going to get this virus that’s spreading all over the world,’” and worried it would hurt her baby, he said of the March encounter.

Travis, who practices at the Los Angeles County + University of Southern California Medical Center, told the woman he knew she was scared and tried to assure her she was safe and could trust him.

Asking many questions and carefully listening to the answers, Travis was exercising the craft of narrative medicine, a discipline in which clinicians use the principles of art and literature to better understand and incorporate patients’ stories into their practices.

“How do we do that really difficult work during the pandemic without it consuming us so we can come out ‘whole’ on the other end?” Travis said. Narrative medicine, which he studied at Columbia University, has helped him be aware of his own feelings, reflect more before reacting, and view challenging situations calmly, he said.

The first graduate program in narrative medicine was created at Columbia University in 2009 by Dr. Rita Charon, and the practice has gained wide influence since, as evidenced by the dozens of narrative medicine essays published in the Journal of the American Medical Association and its sister journals.

Learning to be storytellers also helps clinicians communicate better with non-professionals, said writer and geriatrician Dr. Louise Aronson, who directs the medical humanities program at the University of California-San Francisco. It may be useful to reassure patients — or to motivate them to follow public health recommendations. “Tell them a story about having to intubate a previously healthy 22-year-old who’s going to die and leave behind his first child and new wife, and then you have their attention.”

“At the same time, telling that story can help the health professional process their own trauma and get the support they need to keep going,” she said.

Teaching Storytelling To Doctors

This fall, Keck School of Medicine of USC will offer the country’s second master’s program in narrative medicine, and the subject also will be part of the curriculum in the new Kaiser Permanente Bernard J. Tyson School of Medicine in Pasadena, which opens its doors July 27 with its first class of 48 students. (KHN, which produces California Healthline, is not affiliated with Kaiser Permanente.)

Narrative medicine trains physicians to care about patients’ singular, lived experiences — how illness is really affecting them, said Dr. Deepthiman Gowda, assistant dean for medical education at the new Kaiser Permanente school. The training may entail a close group reading of creative works such as poetry or literature, or watching dance or a film, or listening to music.

He said there’s also “real, intrinsic value” for patients because a doctor isn’t only being trained to care about the body and medications.

“Literature in its nature is a dive into the experience of living — the triumphs, the joys, the suffering, the anxieties, the tragedies, the confusions, the guilt, the ecstasies of being human, of being alive,” Gowda said. “This is the training our students need if they wish to care for persons and not diseases.”

Dr. Andre Lijoi, a geriatrician at WellSpan York Hospital in Pennsylvania, recently led a virtual session for 20 front-line nurse practitioners who work in nursing homes. Two volunteers recited Mary Oliver’s 1986 poem “Wild Geese,” which reads, “Tell me about despair, yours, and I will tell you mine. Meanwhile the world goes on.”

Sharing the poet’s words helped the nurses relieve their pent-up tensions, enabling them to express their feelings about life and work under COVID-19, Lijoi said.

One participant wrote, “As the world goes on around me I mourn seeing my aging parents, planning my daughter’s wedding, and missing my great niece’s baptism. I wonder, when will life be ‘normal’ again?”

Processing Fear To Provide Better Care

Dr. Naomi Rosenberg, an emergency room physician at Temple University Hospital in Philadelphia, studied narrative medicine at Columbia and teaches it at Temple’s Lewis Katz School of Medicine. The discipline helps her “metabolize” what she takes in while caring for COVID-19 patients, including the fear that comes with having to enter patients’ rooms alone in protective gear, she said.

The training helped her counsel a worried woman who couldn’t visit her sister because the hospital, like others around the country, wasn’t allowing relatives to visit COVID-19-infected patients.

“I’d read stories of Baldwin, Hemingway and Steinbeck about what it feels like to be afraid for someone you love, and recalling those helped me communicate with her with more clarity and compassion,” Rosenberg said. (After a four-day crisis, the sister recovered.)

Dr. Pamela Schaff (right) discusses narrative medicine in the Hoyt Gallery at the Keck School of Medicine of the University of Southern California, as Chioma Moneme, a student in the class of 2020, looks on. (Credit: Chris Shinn)

Close readings can also help students understand the various ways metaphor is used in the medical profession, for good or ill, said Dr. Pamela Schaff, who directs the Keck School’s new master’s program in narrative medicine.

Recently, Schaff led third-year medical students through a critical examination of a journal article that described medicine as a battlefield. The analysis helped student Andrew Tran understand that describing physicians as “warriors” could “promote unrealistic expectations and even depersonalization of us as human beings,” he said.

Something similar happens in the militarized language used to describe cancer, he added: “We say, ‘You’ve got to fight,’ which implies that if you die, you’re somehow a failure.”

In the real world, doctors are often focused narrowly, devoting most of their attention to a patient’s chief complaint. They listen to patients on average for only 11 seconds before interrupting them, according to a 2018 study in the Journal of General Internal Medicine. Narrative medicine seeks to change that.

While listening more carefully may add one more item to a physician’s lengthy “to-do” list, it could also save time in the end, Schaff said.

“If we train physicians to listen well, for metaphor, subtext and more, they can absorb and act on their patients’ stories even if they have limited time,” she said. “Also, we physicians must harness our narrative competence to demand changes in the health care system. Health systems should not mandate 10-minute encounters.”

Telling The Patient’s Whole Story

In practice, narrative medicine has diverse applications. Modern electronic health records, with their templates and prefilled sections, can hamper a doctor’s ability to create meaningful notes, Gowda said. But doctors can counter that by writing notes in language that makes the patient’s struggles come alive, he said.

The school’s curriculum will incorporate a different patient story each week to frame students’ learning. “Instead of, ‘This week, you will learn about stomach cancer,’ we say, ‘This week, we want you to meet Mr. Cardenas,’” Gowda said. “We learn about who he is, his family, his situation, his symptoms, his concerns. We want students to connect medical knowledge with the complexity and sometimes messiness of people’s stories and contexts.”

In preparation for the school’s opening, Gowda and a colleague have been running Friday lunchtime mindfulness and narrative medicine sessions for faculty and staff.

The meetings might include a collective, silent examination of a piece of art, followed by a discussion and shared feelings, said Dr. Marla Law Abrolat, a Permanente Medicine pediatrician in San Bernardino, California, and a faculty director at the new school.

“Young people come to medicine with bright eyes and want to help, then a traditional medical education beats that out of them,” Abrolat said. “We want them to remember patients’ stories that will always be a part of who they are when they leave here.”

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Hate Unmasked In America

“You are the most selfish f—ing people on the planet.”

I jerked my head to the left, where I saw a neighbor glaring at us from his driveway while unloading groceries from his trunk.

“Where’s your f—ing mask?” he said. “Unbelievable.”

 

Marigold Ganz, 3, wore this mask for five minutes outside and then threw it away. We haven’t been able to find it since. In the background is her grandfather, Jovit Almendrala, trying his own mask out for the first time. (Courtesy of Anna Almendrala)

My jaw dropped. I had just walked three blocks home with my toddler and my dad in our leafy, mostly empty Los Angeles neighborhood because my kid had thrown a tantrum in the car.

And we had forgotten our masks. Four days earlier, Mayor Eric Garcetti had ordered protective face coverings anytime we left home, not just when we entered essential businesses.

I pointed out my house to the neighbor to explain how close we were, just a few doors down from him. He cut me off.

“I don’t give a f– where you live, and I don’t give a f– what your reason is.”

Then my dad jumped in. “Sorry, sir, we forgot our masks. I’m sorry, sir.”

Still, the man didn’t soften.

“You should be sorry. And you should make her be sorry, too,” he gestured toward me. After a few more agonizing seconds, he dismissed us.

Our neighbor’s mask, by the way? It was off his face, hanging loosely around his neck. All the better to shout at us.

As a health care reporter, I had covered America’s evolution on masks as the coronavirus spread across the globe. Back in January, I wrote an article about why Chinese immigrants insisted on wearing surgical and construction masks in the U.S., even though it went against official health recommendations at the time. In February, I wrote about Asian families in California clashing with schools over whether their children should be allowed to wear masks in class.

At that time, Asian people wearing masks were targets for verbal and physical abuse. Attackers saw masks on Asian faces as signs of disease and invasion; people were punched and kicked, harassed on public transit, bullied at school and worse.

Now, of course, masks are the norm. And they’ve become more than just personal protection; they are symbols of courtesy and scientific buy-in. They have, to some extent, also become political signifiers. In a new poll from the Kaiser Family Foundation, 70% of Democrats said they wear a protective mask “every time” they leave their house, versus 37% of Republicans. (Kaiser Health News, which produces California Healthline, is an editorially independent program of KFF.)

After our verbal beatdown, my dad and I walked home stone-faced, and then retreated to our separate rooms to nurse our wounds.

I have no idea if the neighbor’s comments had a racist undertone. But it felt like the times in my childhood, first in New Zealand, then in a Bay Area suburb, when I had seen my Philippines-born parents, stunned and silent, get dressed down or humiliated by angry, callous white people. Now it was my 3-year-old daughter’s turn to see me dumbstruck. As I began telling my husband the story, I started crying so hard that I got a headache.

After my tears came reflection, and an attempt at empathy.

My neighbor was obviously scared. He was older, and potentially more medically vulnerable. His trunk had been packed with overstuffed shopping bags ― probably enough food for weeks, to avoid leaving his house.

He had just come from the grocery store, an enclosed space full of things and people that could potentially infect him. I understand the stress that comes with shopping during the pandemic.

Like many of us, my neighbor could be struggling with how to live in mortal fear of the coronavirus. And for him, at least that morning, that struggle got the better of him.

Later that day, I wrote the neighbor a card introducing ourselves. I apologized for making him feel unsafe and acknowledged that he was right about the masks. But I also said he had unfairly used us as a target for his fear and frustration, and I told him I was shocked and saddened he would treat a neighbor with so much hate. I haven’t heard back from him.

My dad spent the rest of that morning praying that the man didn’t get the coronavirus — lest he blame us and all Asians, forever.

Since that day, no one in my family has left the house without a mask on their face, and I’m anxious to train my daughter to wear one, although she resists it the way she has refused hats and headbands in the past.

We can’t stop noticing that most other exercisers and dog-walkers in our neighborhood ― all white ― fly past us without them. They don’t seem to worry about getting caught on the wrong side of whatever America happens to believe about masks on any given day. But my family can’t risk it.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Images (Courtesy of Anna Almendrala)

The Greying Population of India Hit with COVID-19

While parents left behind in India are terrified of COVID-19, their NRI children are impatient in a distant land to return back to them. We are worried about our loved ones staying far away. Recently, NRIs settled in US, UK, France, dealt with the rapid transmission of COVID-19. The nightmare of a rapid influx of positive COVID-19 cases among potential foreign returnees is petrifying and we must be wary for the most vulnerable populations in India.

In India, the number of working-age populations suffering from COVID-19 is substantial because of its large middle-aged populace, yet the elderly are just as likely of getting the infection, resulting in fatality; this is due to weaker immunity systems, presence of comorbidities, and slower recoveries from diseases.

A handful of research supports that 60+ people with pre-existing comorbidities like chronic lung, liver, kidney diseases, hypertension, cardiovascular illnesses, cerebrovascular diseases, diabetes, and those dependent on immunosuppressive drugs have a higher chance of COVID-19 infection than the rest.

According to the Center for Disease Control and Prevention (CDC), 80% of COVID-19 associated deaths are among more than 65 years’ age group, with increased deaths in elderly males. Thereby, it becomes a challenge to fight the disease for India where the number of the elderly population is close to the combined population of UK and Italy.

The Health Ministry opined in April that “8.61% cases are between 0-20 years, 41.88% cases are between 21 to 40 years, 32.82% cases are between 41 to 60 years and 16.69% cases above 60 years“. Simple statistics from the current population structure can establish the vulnerability of the greying population- about 8% of Indian population above 60 years’ accounts 17 % of COVID 19 patients; while about 62% Indians 20-60 years have approximately 73% COVID-19 cases. Hence, the elderly is at no less risk than the middle-aged to this novel disease.

India has a propounding 140 million (UN projection, 2020) 60+ population. Majority of the districts across India have 7-10% percent elderly. While, many districts of Southern states – Maharashtra, Himachal, Uttarakhand, Punjab – have more than a 10% elderly population (Fig1: a). Based on 2011 Census, our map indicates that many districts of Rajasthan Madhya Pradesh, Chhattisgarh, Orissa, Gujarat, Kerala, Andhra Pradesh, and Telangana have a high proportion of 60+ elderly who are disabled (seeing, hearing, speech, movement, mental retardation, and mental illness; Fig1: b). Districts with a higher proportion of elderly, especially disabled elderly, require special focus and regular monitoring in the framework of tackling pandemic.

Elderly Population in India, 2011.

(a) Proportion of 60+ elderly; (b) Proportion of 60+ elderly disable

Source: Based on Census 2011
Source: Based on Census 2011
disability-crop

 

Impacts on the elderly are layered. World Health Organization (WHO) has identified mental health as an integral part of overall health in correspondence with physiological, behavioral, and psychological wellbeing of older adults. Gerontological studies have established the association of inadequate social wellbeing and poor elderly health.

Proportion of Elderly Living Alone and The Prevalence of Different Diseases Per 1000

StateLiving AloneMental IllnessDepressive symptomsHypertensionDiabetesAsthma
Assam386.9020.80656.20252.8059.0080.10
Karnataka343.10117.40592.90237.90141.6072.10
Maharashtra341.505.40557.00179.0090.60110.10
Rajasthan378.306.10452.00142.9042.0078.60
Uttar Pradesh316.0028.20552.00133.6028.80100.50
West Bengal350.004.10567.30245.1067.3064.30
India341.0026.80554.30181.6065.7089.80

 

 

  Source: Calculated from WHO-SAGE 2007 Data

The long lockdown in India is vital to avoid burdening the healthcare system and to suppress the chain of transmission of infection. It is mandatory to take “extra care” of the elderly because social distancing may lead to depression, anxiety, and mental illness, especially among the elderly who are living alone and/or are disabled. The vulnerability of the elderly with less social support can escalate in instances of accessing medical support, transportation, banking, food access, etc.

Income, medical security, and social support are major challenges during and beyond the lockdown period. Although, the central government has announced some financial-welfare schemes and guidelines/instructions in the light of the COVID-19 crisis, the helplessness of the aged needs special consideration.

During this tough time, it is necessary for the government, stakeholders, social welfare organizations, and communities to stand in solidarity to provide the essential supplies (groceries, vegetables- fruits and medicines) to the elderly at their doorstep. We need to take precautionary steps to avoid infecting the older adults by sanitizing and frequently cleaning their belongings like, clothes, spectacles, canes, walkers, beds, toilets, chappals, etc. and encouraging them to get engaged in possible physical activities/works within the home.

In order to bolster our elderly loved ones, we need to assist them through social and mental connectivity. The void of connectedness can be minimized through phone, online calls, messages, or encouraging them to interact with friends/neighbors keeping a safe distance.  We all should stay connected with the aged while staying away to keep the world positive.

Subhojit Shaw is a doctoral fellow at the International Institute for Population Sciences in Mumbai, India (IIPS, Mumbai). His academic quest revolves around population aging, child health, and environmental health.

Aparajita Chattopadhyay with her two decades of teaching and research experience, has contributed well in the fields of public health, gender issues, aging, environment-development, and nutrition. She is a faculty of the International Institute for Population Sciences.

All views expressed are personal.

Heroes of War

Heroes of War 

Bracing themselves 

heavy armor

coat after coat

danger is principal.

 

They enter war

an invisible enemy 

the fiercest predator

with an unidentifiable weakness.

 

Their compassionate hearts

drive a noble sacrifice 

for the protection of lives 

they never knew.

 

Heroes they stand

knowing and holding 

the fear of 

surrendering themselves to defeat.

*****

Rashmika Manu is a freshman in high school. She enjoys writing poems, playing volleyball, and traveling. She visits India often and has a desire to help the poor and needy in the future.