Less for More or More for Less?

American health care remains a very complex and heavily divided subject. I’ve been wanting to make this post for a while and have been trying to gather my thoughts enough to write it concisely and accessibly, so please bear with me.

As a transgender man focusing on health care and social work, most people that I’ve spoken to that know I’m trans expect that I’ll work specifically on trans health issues (there are plenty, after all). While that’s an interest of mine, I have no desire to be pigeonholed and there’s also this: I sought out a career in social work because there are millions of people in this country from all kinds of backgrounds and identities who lack adequate health care. In the United States, health care is an extremely lucrative business, with health expenditures making up 16.9% of our GDP in 2011 according to World Health Organization statistics – nearly double the median of other industralized nations (8.7%). We spend a lot more per capita, too. But we rank 17th or 16th (depending on whether you’re looking at males or females) on life expectancy compared to those other nations. Generally what the data says is that we spend a lot more and get less.
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I have my own story. I was 22 and I lived in Detroit and I was temp-to-hire, without health insurance for a couple of months but healthy enough. I don’t get sick very often, I reasoned, and I’m a careful driver and I take good care of myself. I had lower back pain but it could wait. Then a couple of days before Christmas the pain suddenly worsened, the backs of my thighs and my pelvic area started to go numb – the only way I can describe it is that my skin and muscle was so numb that I could feel my bones, and I felt like they were floating on sacs of fluid when I sat down. It was terrifying. I went to the ER that night, but the doctor was convinced that I had a pinched nerve – and I’m sure the fact that I couldn’t afford to pay for an MRI out of pocket didn’t help, either. She sent me home. Two days later on Christmas morning I couldn’t walk or go to the bathroom and so we went back to the ER.

The short version of this story is that my illness is very rare and serious and required a surgical operation the next morning. I remained in the hospital for a week and the bill was exorbitant, close to a hundred thousand dollars. The hospital’s charity wrote off two-thirds. There was no physical therapy (I couldn’t afford it and my insurance didn’t cover it) and payment for the medical equipment I now required would have to come out of pocket. Acquiring Social Security Disability is a lengthy process since frequently the applicant has to appeal at least once, and my prognosis was uncertain. I would be in recovery for at least a month, so the temp-to-hire position I was in simply let me go.

I declared bankruptcy and I recovered as best I could. I found work at a McDonald’s in Detroit and boiled my catheters over and over again to sanitize them because at $90 a box, thirty were all I could afford. I worked with food service workers who coughed and sniffled through their shifts when they were sick because they couldn’t afford the time off and didn’t get sick days, and people who snuck out to smoke weed on breaks because it was cheaper than their pain medication or anti-anxiety meds. This is American health care.

This was over six years ago now, and I’ve had health care and had my needs seen to for the past four or so. Still, throughout my graduate social work experience I keep seeing ghosts – patients with catastrophic illnesses who put off seeing a doctor as long as they could because they couldn’t afford it, patients who work through their illness or injury because they can’t afford to be sick, and patients in chronic pain from fractures because they can see physicians at a free clinic but can’t afford the X-rays or MRI or corrective surgery. I’ve also met countless patients who are using social services because they were bankrupted following an illness of themselves or a family member.

The reason the loan closet at the ALS Association is an important service is that there are gaps in Medicare coverage, and there are a lot of assistive devices Medicare and Medicaid simply don’t cover. If you end up requiring a power wheelchair after Medicare has already paid for a manual wheelchair, you’ll be paying out of pocket. For someone who can no longer work, this is an incredible burden, and for someone who might have been previously uninsured or underinsured waiting over the months for their paperwork to process, it’s almost untenable.

When we consider the prevalence of ALS (or any disease), we must also consider those who can’t afford to visit doctors for the initial diagnosis. This happens.

I suspect the Affordable Care Act and Ohio’s Medicaid expansion will have a palliative effect on a lot of these issues, though to what extent remains to be seen – and even then, there are still a lot of gaps. Based on the coursework and research I’ve done I’ve become convinced that a universal single-payer health care system is the way to go, but getting there is tricky – and if it happens, it’s a long way off. So what do we do in the meantime?

Well, there’s cost-containment, for one, and rebuilding the system. The Affordable Care Act brought coverage to millions and on a local level, Columbus Public Health has a good outreach program – though it could always be expanded further. But I think one of the best things we can do as citizens is to be aware of the data, and help others learn more. There are a lot of people who remain convinced that we have the “best health care in the world,” when the data points to that not being the case – and we can only hope that greater public awareness can help us bring change.

For those interested, you can find the actual reports at the WHO’s website.

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Building a Path: Homeport to Tepoztlan

With Week 8 having come and gone I’m left wondering where the heck my summer went! I began the summer looking forward to 10 weeks of great non-profit experience and exposure to important people in the Columbus non-profit sector.  I am now finishing my summer trying to wrap my head around what this summer has meant for me and preparing for what comes next.

As I began to outline my final presentation about my summer experience I started making a list of everything I have learned.  What seemed like a simple task, turned into an endless list that touched so many different experiences.  As a recent college graduate who lacked a firm sense of direction upon graduation, my summer was supposed to provide me with further insight on where I want end up.  While I have learned a lot about myself and the different paths available to me, I find myself with too many options in front of me even less sure of which path to choose.  One of the most useful and reassuring things I have heard this summer is that there really is no such thing as a “non-profit career path.”  During one of the earlier learning sessions we heard from young professionals with hugely varying backgrounds.  Each of these young professionals and almost every non-profit employee I have met through my work at Homeport tells a different story of how he/she ended up in his/her position.  I don’t know what my path will be, but really who does until it’s already happened?

Another valuable theme of my summer has been learning that non-profits are not called non-profits because they are profit-averse, or somehow anti-business; non-profits are only named so because their primary mission is not profit.  Any organization needs profit and any successful organization must run like a business.  Homeport is the largest non-profit I have worked for with over 60 full-time staff members.  Homeport is what Mike Schmidt of Cramer & Associates, who we heard from during this week’s learning session, refers to as a more mature non-profit organization.  It has different departments and specific policies and procedures that help it run efficiently.  My work on Business Process Management is the first step in the organizations push toward documenting and streamlining its processes.  It’s exciting to be part of this first step at Homeport and to know my work will have an impact.

The skills I have learned this summer are ones I can take with me to any job.  I have learned how to organize and plan events, how to interact with volunteers and clients, and how to communicate processes in a way that anyone can understand.  I have been involved in both high level process writing and daily essential organizational tasks that are necessary in any organization.  I have learned that not all non-profit work is the glamorous, constant client interaction we often imagine.  There are so many behind the scenes tasks that are essential to the success and fulfillment of the organization’s mission.  I have learned so much this summer about so many different aspects of the non-profit sector, and about being a young professional.  I’m not sure this has quite been the goal-clarifying experience imagined, but I at least know where I am headed next.

In three weeks I will be moving to Mexico to spend a year working for a non-profit organization called La Jugarreta.  The organization fights for the right of every child to have a safe space to play where they do not have to worry about taking care of their family or selling things on the street.  I just found out my position this past week and the city in which I will be spending a year; I will be in the beautiful town of Tepoztlán in the state of Morelos just south of Mexico City.  I can’t wait to carry the things I have learned from my summer with Homeport into my next journey in Mexico.  Even though I don’t know my final destination, I am continuing to build my own path and discovering my journey.

The magical city of Tepoztlan, Mexico, where I will be spending the next year.

The magical city of Tepoztlan, Mexico, where I will be spending the next year.

 

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Coffee, Plastic, and Grocery Bags

 

            Earlier this summer when I would drive to work I started stopping at a local UDF or Starbucks to get my morning coffee. When I would go to UDF the coffee was cheaper than Starbucks but instead of walking out with my coffee in a biodegradable container I would walk out with a single use polystyrene cup that would have a usage life of an hour. While at Starbucks I would get a biodegradable container that if composted would return to the soil in the form of organic matter.

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            After watching the single use cups build up in the FLOW office I bit the buck and got a refillable travel coffee mug that is also recyclable. But still I wonder about the thousands of single use cups that are going to be thrown away each day.

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My UDF refillable cup

            Whether your cup is Styrofoam or biodegradable it is likely destined to spend most of its life in a landfill. The plus of a biodegradable cup is that if it makes it out in the natural environment it will decay before it reaches one of the ocean’s garbage patches. Unless you personally compost your compostable food items it will do little to effect the filling in of landfills. This is the same for any other “disposable” item you can think of. A larger problem than coffee cups is trash bags. Plastic bags mostly end up in the trash, and are so lightweight that they escape to our water ways.

plastic ocean

Photo from an Ocean Gyre

            Some local governments have taken action to fight plastic bags. In Washington DC, Montgomery County Maryland, many parts of California, and other sensitive areas have put a $.05 tax on a plastic bag, but have given you $.05 back if you use reusable grocery bags. Other countries have instilled similar measures to reduce the amount of plastic in both landfills and the environment. In china Styrofoam takeout has been banned and in Germany the manufacturers are required to collect it after use.

            In the book Cradle to Cradle by Michael Braungart and William McDonough the authors recommend that packaging and other single use items be designed with the end in mind. If you harken back to the stories of the milk man and deposits on glass bottles that were always refilled, then there is a blue print in place that some people even still remember.

            It will be hard to break our addiction to single use items, it really takes a personal commitment to eliminating the amount of these items that we use as they are in our everyday lives. But our local and county governments can help by placing the 5 cent tax on plastic bags, or by banning Styrofoam take out containers. It takes great awareness to try and buy things that our biodegradable and even more commitment to recycle and compost all that you can. Until government acts, use paper when you can and remember that travel mug for your coffee.

 

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Payoff

A lot of my work at the ALS Association finally started coming together at the end of last week. I started to receive calls back from durable medical equipment suppliers, who we plan to contract with to store the loan closet equipment. Currently, the issue at the loan closet has mainly been finding reliable storage, and historically the chapter has relied on donated space. I think at this point most places are moving towards paying for their space while receiving in kind services from the suppliers, such as new medical equipment or cleaning and repair for the existing equipment.

I was able to get a contract as a template from one of the other chapters in my first couple of weeks here, so now I’ve started to customize it to suit our needs. It’s been great to be able to contact other chapters in the organization who are doing similar work, since they’ve had valuable input and have been willing to share their resources. I think it’s one of the benefits of being part of a larger national organization, which is an experience I haven’t had before.

I also received code that I had requested from the software company that manages the software we use to organize equipment and customers. With it, the care services staff at the ALSA will be able to run a query to determine how often certain pieces of equipment are being used and when they were last checked out. This is vital because if we’re paying to store the equipment, we want to ensure that the equipment that we’re paying to store is being used and that we’re maximizing the space. Some staff members took some convincing for this step, but I think now that they’re able to see what the query does, they’ve realized how much work it will end up saving them in the long run. They’ll no longer have to move around and sort through equipment that they haven’t used and that customers don’t really need.

For the rest of this week and for the next week, I’ll be working on figuring out details and possibly finalizing a contract with our durable medical equipment suppliers. I can’t believe I only have two weeks left, but I’m proud of myself for staying on schedule and I’m glad that I’m starting to see all of my work pay off in a tangible way.

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View from the Top (literally)

This past week was full of wrapping up my two large scale projects and spending more time with the club members! I finished all of the Summer Brain Gain evaluations and assessments! I am currently working on a detailed guide on how to administer the post-assessments at the end of the summer, which will take place after I leave. Two weeks ago I was able to present the initial successes of the summer brain gain program. After spending so much time on the program it was a great way to concisely explain the program! I am excited to see how the program continues to grow in the upcoming years. The summer has flown by! However, between the evaluations, work with the TANF (Temporary Assistance to Needy Families) grant, the college trips, the trips to different corporations, I have gotten a great idea of what the Boys and Girls Clubs focuses on.

This past week I was able to travel to the Nationwide Insurance building in downtown Columbus as part of another “Career Launch” workshop. The event was quite successful! All of the children really enjoyed their time there and the staff members that interviewed and spoke with the club members were insightful, funny, and thoughtful. I can tell they really enjoyed taking the time out of their day to help our members professionally develop. I also learned a lot about the company. One of our members wants to be a sound engineer, and was unsure if Nationwide hires sound engineers. When the question was asked, someone from Human Resources immediately jumped in and mentioned that she just hired two sound engineers to run their audio/visual equipment and in-house auditorium. One of the students wants to be a pilot, and apparently Nationwide employs pilots as well! Needless to say I was thoroughly impressed with the visit and it was just another layer of the Boys and Girls Clubs that I was able to experience! The last visit in the “Career Launch” program is on August 7th with Huntington Bank!

 

View from the top floor of Nationwide!

View from the top floor of Nationwide!

Nationwide Boardroom!

Nationwide Boardroom!

 

 

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Social Security and Worried Case Workers

I had my firsts “extended” stay at the social security office this past week. I went with the case worker Ahmed Kamil and we were registering a family of seven for their social security numbers and cards. The line was long as usual, but when we got to the social security worker’s booth, that is when things became difficult. Ahmed told me there are a few people at the social security office that know CRIS well and can get them through the process quickly, but the lady who served us had never worked with CRIS and did not “specialize” in registering people for social security. It took her quite some time to type each family member’s personal information, and just as I thought we were wrapping up a problem arises. The lady pulls the application for one of the younger girls, a quizzical look of doubt crosses her face as she raises an eye brow and asks, “why is this girl’s mother and father different than the other children’s?”

Ahmed calmly replies, “This girl’s parents were deceased and the family cared for her in the camps since she was young”

The lady announces “I’m sorry you can’t register for her card unless her original parents gave official guardianship to this couple” as if her assessment of the situation was finite and clear to everybody in the room.

I was irate to say the least, but Ahmed keeps a level head and attempts to explain to the lady that such documents don’t exist in the camps, or in Africa at large really, but the lady would not budge. Eventually she spoke to her supervisor and everything was squared away, but only after a 3 1/2 hour ordeal. Ahmed told me they run into these types of problems all the time and the high turnover rate means it is hard to have consistency, but the ones who have worked there a while understand the barriers and obstacles CRIS’s case workers deal with and speed up the social security registration process for us.

I have been working extensively with another group of 3 single Somali males who are all rooming together to lower their rent. Their caseworker Dahir is worried about one of the younger Somali guys who doesn’t seem to understand life in America yet. Obviously he is not expected to have a full grasp on life in Columbus seeing he has only been in the US for two weeks, but his priorities are out of place. Dahir thinks he does not quite understand that not everything is given to him like it was in the camps, and the guy is more concerned with getting a gaming device to play FIFA soccer than he is securing a job or paying his rent. I guess it’s the first time I realized younger clients can get so caught up with getting to America they don’t always realize the life adjustments and priority adjustments they will face in their new reality.

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How to Host 300 Children on a Field…in the Summer

Step 1. Secure a nutritious and delicious lunch for the kiddos, as well as dozens of volunteers and community partners to make the day run smoothly and enjoyable. Ronald McDonald is a popular invitee to have on the guest list.

Ronald McDonald

Ronald McDonald with kids at Children’s Hunger Alliance 2014 Summer Field Day

Step 2. Establish a dance floor complete with a DJ who knows all of the youngsters’ favorite tunes. If your CEO shows up, they will be more than happy to impart their cultural wisdom on him or her, so said CEO should come prepared with comfortable foot wear.

Mary Lynn Foster dancing with the kids

Our CEO, Mary Lynn Foster being taught new moves.

Step 3. Mobilize rotation stations to keep the kids moving and grooving. Activities can include having them dress in stylish attire and run in circles, transport water using a sponge, or flashing their creativity with arts and crafts.

A girl participating in a relay

Step 4. Help them perfect their golf swing, their basketball shooting and their soccer dribbling. Some kids may be more skillful than yourself. This is normal. To avoid embarrassment, refrain from participating and feign an age-related injury that their young bodies cannot relate to. My personal favorite example is to smack my knee and say something along the lines of “this old knee, after all the miles and miles I’ve put on her, she just can’t take it anymore…”

Boy shooting a basketball

Step 5. If you feel their energy is subsiding, introduce a little more competition. You can assign half the group to be predators (sharks are popular) and the other half as prey (minnows are the preferred snack of Selachimorpha) and watch the craziness ensue. If there is a relay of sorts happening, nothing charges kids up more than shouting “THIRTY SECONDS LEFT!!!” like you’re announcing the start of the apocalypse. Of course, this tactic is also effective when children are only competing again themselves, for instance in the number of sit-ups they can do.

Boys lining up to race 

Step 6. You want the kids to have a lasting impression of your afternoon, give them something to take home. Throwing buckets of water on them seems to be effective.

The kids insisted they didn't get wet enough at the Wet 'n Wild station.

The kids insisted they didn’t get wet enough at the Wet ‘n Wild station.

If you completed all 6 steps, congratulations! You’ve now made 300 friends who will never forget you.

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