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By Reza Ghadimi
12/10/2018 ( v4 - N43 ) Wishing for Sore Thumbs.
An old story goes something like this; a man lost a leg and was sad about it, later he saw someone with no legs and thanked God for his one leg. When I was serving in the US Air Force, I had the good fortune of working with Dr. Eugene Thomas O'Brien who became a friend and mentor to me for many years. Dr. O'Brien was a hand surgeon. One of the best there was. His composed and peaceful mannerism, calmed many chaotic and frustrating situations and his meticulous work and surgical techniques usually had marvelous outcomes.
Once, I was helping him apply a rather bulky dressing to a patient's wound in our clinic's large cast-room. I felt that the dressing was overdone and said; "This sticks out like the proverbial sore thumb." He quietly tapped me on the hand and pointed to the patient behind me. I turned to see another patient of ours who had lost both hands in an explosion in Vietnam. He held his bandaged arms up and in a chocked voice said; "Boy, how I wish for sore thumbs right now."
The world we live in is getting more complicated and while many call for protectionism and conservation of core values, others would like to see globalization and universalisation as the solution. Recent events in France, UK, North Africa and Eastern Europe leave us scratching our heads. In the middle, the average person is confused and lost on whom to follow and what to believe. While masses in one area are dying from famine and hunger, they seem to live in comfort in other parts of the world. But the current protests in wealthy countries reveal that its not rosy there either, adding to the deepening of the chasms of disparity. This is making many to sacrifice much in the hope of changing their shortcomings. This chaotic environment is leaving many injured, sick and ill-treated, making the job of us healthcare providers more difficult. Because of all the confusing quagmire of the world we live in, it is imperative that we (healthcare providers) do our job without prejudice and intolerance. It is important that we do not create sore thumbs in people with no hands.
12-1-2018 (v4 - N42) Uniting the Divided
"History is a sort of tangled web of contradictions. …" said Robert Service, Professor of Russian History at Oxford University.
Because obviously, we don't learn from history, and no time in our history have contradictions been more noticeable than now. I suppose that we have the internet and the social media to thank for it. This tangled web of contradictions becomes more confusing when our leaders are the ones contributing to its propagation.
In the last century, after many wars, conflicts and global changes, many nations united in the hope of eliminating misunderstandings and confusion during conflicts and finding a way for an agreeable resolution. The UN Charter was signed on October 24, 1945, and the EU was founded on November 1, 1993, the African Union was founded on May 26, 2001, the Union of South American Nations signed their charter on May 23, 2008, - just to name a few. All to bolster the economic and political standing of their region. Ideas that make sense in philosophy and ideology, especially in today's mobile and interactive world. Yet the last few years have seen the demise of these principles. The meeting of the G20 going on right now in Argentina is a testament to this madness. It seems that the leaders of G20 members, have come to dismantle the whole unity of our world, rather than strengthen its accord. The real confusing fact is that these are the very countries that worked so hard to unite us in the first place. If history has taught us anything is that nationalism and individualism lead to disparity, which leads to disagreements and conflict.
No place does these contradictions cause more problems than in the task of providing healthcare. Our patients are suppose to be race-less, nationless, and classless human beings with a medical problem. We are not to judge them, but care for their health. It is hard however, to act and be neutral when they are forced to come to us, carrying race, nationality, legality and class flags. Such conditions prevents many from seeking help. Still at times, they risk coming to us at great expense to themselves, often to seek help for a loved one. I once cared for an illegal migrant who brought her sick child to be seen (read her story here). Her apprehensive and anxious state disturbed me so much that I was concerned about her safety. Yet I could not recruit any help for her, due to her lack of trust in me. Today there are many people like her and their suspicion of everyone is causing major problems. The squalid conditions, under which, many live, adds to the dilemma. Consider the possibility of someone among them contacting a contagion and out of fear of getting caught, refusing to seek help. The infection may become a full-blown pandemic, spreading to the general population before we become aware of it.
Telehealth, Telemedicine, and Tele-education could help curb much of these shortcomings. Only if those in power allow it to be implemented properly. Healthcare providers can demand it from their government to remove political hurdles from healthcare environments and allow us and our patients to keep the population healthy. After all, the last thing we need is to deport an individual with a serious contagion across a border to unsuspecting masses. It is cheaper to care for healthy people than sick - regardless of their legal status. Lets start uniting our fractured societies by caring for the sick and the injured - it is a humane thing to do!
11-21-2018 (v4 - N41) Happy Thanksgiving
From our families to yours
HAVE A WONDERFUL AND
BLESSED THANKSGIVING
In the spirit of the occasion, we leave you with this
prayer from our Native Americans;
The Mi 'Kmaq
Creator, open our hearts
to peace and healing between all people.
to provide and protect for all children of the earth.
to respect for the earth, and all the gifts of the earth.
to end exclusion, violence, and fear among all.
Thank you for the gifts of this day and every day.
11/10/2018 (v4 - N40) Refugees for Congress
Perhaps the best reason for running for US Congress was given by Ilhan Omar of Minnesota, the first refugee ever elected to Congress;
"I did not expect to come to the United States and go to school with kids who were worried about food as much as I was worried about it in a refugee camp."
Unfortunately, that is the state of the economy for many people in developed countries as well as the developing ones. Which portrays the confusing state of our world. What makes it even more perplexing is the fact that so many politicians seem to be totally disconnected from this reality and cannot even relate to it. This Escherian duality and parallel and disjointed veracity feeds the fires of discontent and restlessness.
M.C. Escher was an artist and philosopher who marveled at the possibilities of the duality of the world, and of life itself. He believed that there is an opposite to everything and every situation. That while one person may live in total chaos and gloom another can live in the same world and under the same situation and circumstances but be totally content and happy. So it is that people are often caught in the ironic situation of being represented by those who cannot fathom their predicament or understand it.
Whether it's the inability to find food, medicine, proper healthcare, or shelter - no matter the place - the end result is suffering. Yet, through the use of the internet, one can see the availability of all that is out of reach.
Making the job of the healthcare providers evermore difficult is the fact that even when medical care is available, it is often too costly for many. Which brings us back to the confusing state of today's politics. The new elections in America and around the world (like Brazil) are giving new hope to people on one side of the spectrum, while making the other side upset, adding to the polarization. But the true reason is that with so much conflicting information, most people don't even understand the issues and are just taking sides.
If we are to truly appreciate the predicament of people in the many camps around the world, we must first be aware of it in our own society. Then perhaps we can understand the plight of others. And here is where refugees, like Ilhan Omar can teach us a lot!
11/1/2018 (v4 - N39) Two Dollars for a Dream?
Money in hand, they stood in line by the hundreds. To buy tickets of chance. A chance to dream for a few days or hours of hope of becoming rich.
It is human nature; I suppose, to take a chance to improve ones life, destiny, future. Even the rich - those who don't need to - often take chances to increase their holdings, their prospects and their fortunes, by starting new ventures, new businesses, new investments. So it is understandable to see that when the future is uncertain, opportunities invisible, and prospects stagnant, leaving the tentative for a chance of better would be justified.
Sacrifices made by athletes, sports car drivers, aerobatic pilots, explorers, mountain climbers and the like are all testament to the audacity of mankind in the dream of improving their skill, art and life. At times even at the cost of their health and life. I once witnessed the tragic death of an aviation friend, when he flew his aircraft into the ground at an air-show. He flew his aerobatic maneuvers close to the ground. Many of us objected to his carelessness. But he used to say that his audience was on the ground and so he needed to be close to them. On the fateful day he was about to finish his air-show with a loop. We all gasped as he entered the loop too close to the ground. On the role out, he ran out of air-space and flew into the ground, coming to stop with a frightening thud. I ran to him, but as I got close, slowed down to catch my breath when I saw him sitting in the open cockpit smiling. I thought that he had miraculously survived the crash. But as others and I reached him, the reality reached us that he was not with us anymore.
The many abandoned pueblos of the Native Americans of the Southwest are also a testament to the search for a better life. Despite the incredible resourcefulness used in building them, when it came time to seek a better environment, they cast off all that work and security and migrated to new places in the dream of finding something better.
Healthcare is one area mankind takes chances. New medication, devices, treatment techniques, and new places to receive them are all evidence of the importance we place on it. In our profession, we have witnessed implausible advances in all aspects of the medical field. Whether it is DNA Specific Drugs, Robotic Surgeries, or Telehealth and Telemedicine. It is a wondrous and exciting time of history we live in. Many dreams are coming true, so its worth dreaming more, hoping more and taking chances for that betterness. Whether by starting a new job or venture, or moving to a new land or country, or spending two dollars for that dream of richness.
10/21/2018 (v4 - N38) Resiliency
The birds, this morning, massed on the tree above the water trough we keep for our animals. A large flock of robins announcing their arrival.
Fresh water is scarce in the mountains of America's desert Southwest - where we live. Watering holes of any kind attract all kinds of wild life. I can count on seeing wild horses, deer, birds, wasps and bees visiting the trough through out the day. On one occasion - awhile back, a rather large tarantula stopped over for a drink. This morning's congregation noisily took turns quenching their thirst, while others kept a worried eye for our cats. When resources are in short supply, all creatures - man and beast will take chances to survive. We should remember that a shrinking watering hole attracts more needy not less. Denying them what they need is a transgression.
The resilience of mankind, however, has always found ways to overcome adversity. Optimism dictates to be persevering of our ways and work toward improving and correcting deficiencies. A news bit last week got my attention that truly shows this resiliency. "A program called, "Superhero Boost", pairs children with disability with designers and engineers to create custom prosthetics, like an arm that shoots glitter or plastic snakes, and shows that anything is possible. The program empowers kids by helping them create 'superhero' prosthetics. In the process they learn some pretty cool tools and technology (like 3D printing, robotics or AI), and working alongside professional designers, engineers, and makers opens up an entire world of possibilities that was unknown to them."
Such ideologies abound around the world. All that is needed is a chance to put them to work. By providing the means and opportunities to the disadvantage, a prosperous world will be created. After all, the main reason people leave their homeland is in search of such prospects. If opportunities came to them rather than them going after it, there will not be a reason for migration. And if instead of selling arms to governments we empowered the people with knowledge and tools to care for themselves, we could witness a better world in transition. Doctors, scientists, architects, designers and engineers could be paired up with young people through Telehealth, Telemedicine, and Tele-education and provide them tools and the means to use them. Paraphrasing Superhero Boost's motto; by "Rethinking disadvantage as a great opportunity for rebuilding the society", many problems could be defeated.
10/10/2018 (v4 - N37) Columbus Day
Monday was Columbus day. A celebration of Americas founding. It was then in 1492 that the first immigrants arrived in the new world. The new world discovery became a source of riches and unlimited bounty for the explorers, their families, sires and countries.
Today the nearly eight billion inhabitants of the world are sweltering in some areas while basking in riches in others. It must be remembered that overcrowding and lack of adequate resources are the reason powerful nations have always overtaken the resources of others for their own use. But today many of the resources are depleted. Thus the need for people to seek refuge elsewhere, only to face humiliating and genocidal consequences.
In the past few years, Nobel Peace Prizes have been awarded to activists and advocates of the victims of these injustices around the world. People like Martin Luther King, Mother Teresa, Nelson Mandela, Rigoberta Menchu Tum, Malala Yousafazi, Jane Addams and others. This year the prize is awarded to two who have been on the forefront of these wars. Dr. Denis Mukwege, a Congolese physician whose been treating thousands of women who were victims of rape in Congo. Nadia Murad, a Yazidi human rights activist and a victim herself of the wars in the Middle East.
It is interesting that 17 of the Nobel Peace Prize winners were women - more than any other category, ten of whom were from the so-called developing countries and nine of which received their prize in the last 20 years. Two of the three youngest people to receive the Nobel Prize, received it in the Peace category. Listening to most of their speeches, the main concern they had was the health of the victims. The victims' fate and destiny lands them in such dire and inhumane conditions, sickness and disease follows them. While governments and international organizations struggle with their political and economical consequences, healthcare providers have to deal with their health issues on an individual and personal basis. Often treating that which cannot be dealt with under such conditions. Perhaps if those objecting to these people's plight could only listen to the snuffled cries of children, smell the stench of wounds in a burn ward, or see the emaciated body of a starving individual with their own eyes, they would see the situation in a different light. Our Nobel Peace Prize recipients have seen these conditions and tried to do something about them, only to pay for it with their lives or livelihood. Our world is crying, let's stop blaming and start helping. We have the technology with which to do it. We just need the wherewithal to do it. Telehealth, Telemedicine, and Tele-education can help, lets use it.
10/1/2018 (v4 - N36) The World and Healthcare
The state of the world, such as it is, demands better understanding and appreciation of the events. In the United Nations, as well as the United States many are beating their chest to the drums of protectionism and patriotism.
All through the presentations at the UN, we heard complaints and criticism about the injustices happening around the world. Whether it is the Rohingya, Syrians, Africans, Yemenis, Venezuelans or Central Americans, the refugee crisis is central to everyone's concern. Among the most alarming of complaints was the health status of these. The world still remembers the influenza of 1918, the deadliest in history that killed an estimated 30 - 50 million. It is disheartening that after a hundred years, not only have we not eliminated the cause of the world's core problems, we are contributing to it.
It was President Michel Temer of Federative Republic of Brazilwho said it best: "… There is a piece of the world in every Brazilian." That could be said about everyone of us in the Western Hemisphere. For unless one is a Native American, we are all immigrants or children of immigrants in this part of the world. We have come from Africa, Europe and Asia and brought a piece of it with us. It is this entropy that makes the Western Hemisphere such a desirable destination. For, not only does it open for us a new part of the world, it shows that the mixture of cultures can produce a stronger and smarter civilization.
On a personal note, I can assert that my experience has been that whenever opportunity had me work with people of other cultures, the gained knowledge was greater and richer.
Doctor Patel was an Indian general surgeon whom I worked with in Dominica - he used to chant (under lip) while operating. It created an immense atmosphere of peace in that room. Our anesthesiologist told me on several occasions that Dr. Patel's patients seem to be in a state of trance. Something he never saw when he worked with other surgeons.
After the civil war in Jordan, I was deployed there with the American Red Cross. We joined other groups of the International Red Cross. With them was a Swedish nurse who was a nun named; Mary. It was fascinating to watch the majority Muslim patients respect her to the point of reverence. They often said that she reminded them of Mary, mother of Jesus and felt at peace in her presence.
Although the prayers and religious beliefs of these people seemed to play a role, I feel that it was their genuine concern and care for the patients that played the big part.
As stated by the UN Secretary-General António Guterres: "It is time all nations, and all people live up to the words of The Universal Declaration of Human Rights, which recognizes the inherent dignity and equal and inalienable rights of all members of the human race. …"
Despite all the problems facing the world today, our technology of Telehealth, Telemedicine, and Tele-education provides us with plenty of tools to help our fellow human beings. Organizations such as American Telemedicine Association (ATA), UNM Project ECHO and others are at the forefront of this revolution. We can help support their efforts by talking with our government officials and educate them on the advances of telehealth and telecommunication and its use in helping our world.
9-21-2018 - (V4 - N35) - The International Day of Peace
Tomorrow, September 21st is The International Day of Peace. Established in 1981 by the United Nations General Assembly as a day devoted to strengthening the ideals of peace, both within and among all nations and peoples. In 2015 The United Nations Member States adopted the 17 Sustainable Development Goalsbecause they understood that it would not be possible to build a peaceful world if steps were not taken to achieve economic and social development for all people everywhere and ensure that their rights were protected.
Nothing in the world could be more peaceful than a healthy community, and nothing could show more peaceful intentions than caring for our foe's mental and physical well-being. Telehealth and Tele-Education make it possible to care for friend and foe by providing them the necessary means and advice without endangering our own people. Sharing medical knowledge to improve our enemy's health is a gift that cannot be ignored or underestimated. Furthermore helping them become literate and educated reveals our benevolence and peaceful purpose.
We the people of this planet must share it's resources equally and evenly. Only then; man's true potential for advancement and achievement will propel him forward to new accomplishments.
9-13-2018 - (V4 - N34) - Where Fortune Roams.
In the far west corner of Texas, in the city of El Paso, the campus of the University of Texas, El Paso (UTEP), majestically adorns the barren face of the Franklin Mountains. Built in Bhutanese Architecture, it invites all imagination to a profoundly spiritual state. As though the very notion of edification will bring one closer to God. Inspiring one to reach for that desirous unknown as an acolyte would, worshipping his promising deity.
Less than half a mile to the south, seen from the crime ridden, dusty and famine blown shanty houses of Juarez, Mexico, UTEP beckons onlookers proudly and invitingly. A clear picture of richness, fortune and progress. One can imagine a young teenager looking across the river, fence and highway at the picture in front, wondering and asking; "WHY?" For such fortune and opportunity are completely unavailable to him or her - so close, yet …
What do you tell a child full of life, when teacher, parent and Bible tells him that bettering himself is reaching for paradise. Yet his reaching gaze and outstretched arms find only the madness of mankind and barriers in front. For whether looking across Rio Grande, Mediterranean, jungle, or Sahara the unreachable indicates an empty and hopeless life ahead.
United Nations Census tell us that people under 25 make up 43 percent of the world's population, and 60 percent of the population of developing countries. That is more than 3 Billion people and a lot of restless energy. Consider that among them are a few of the like of Mozart, Einstein and Galileo. Perhaps even a few Hitlers, Pol Pots, or Idi Amins. So wouldn't we want to encourage the former and control the latter.
Yet disparities abound in our world as inequalities are often caused by the very people who close their borders. Discriminations have sparked discontent into raging fires of revolution and chaos. With every revolt, more people are displaced, become refugees and homeless. The increase of such masses, closes more borders, fences are strengthen and walls are erected. People are made lost and desperate, adding to the instability.
Such conditions sicken men, women and children - mentally as well as physically. So to us (providers) they come for help. For us, such disparities create a dilemma to which we are strained to find an answer. For, with our Hippocratic oath, we have promised "… to abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. …" Yet we too often find ourselves behind the same barriers.
The world's defense spending is about 1.7 Trillion Dollars. Just one percent of that could educate every child in the world. Our new technology can help us provide medical and educational help to everyone on both sides of the disparate and dispirited world. Fortunately Telehealth, Telemedicine, and Tele-education allows us to traverse rivers, walk through fences and climb over the walls of misfortune! We only need the courage to set aside our own prejudices and use it to help each other. Then maybe that half a mile won't seem so far after all.
9-6-2018 - (V4 - N33) - NOT SO EASY TASKS
We wish to thank our readers for their overwhelming support during our transition. What seemed to be a simple conversion, has been a daunting task. Which gives us a fresh appreciation of what technical people go through on a daily basis. When we first started our website, back in the 1990s, all we had to be concern with, was getting the HTML codes right. Today, not only do the codes have to be correct, the site has to be secured, has to be accessible by multiple devices, on multiple platforms and operating systems. Our initial belief was that it all gets done automatically - well yes and no. We thought that all we had to do was to write the content, and the process would take care of itself - well no, not exactly. So none of what we considered to be straight forward, was, and in fact it was not!
An eye opener for this old timer. At times I for one felt totally lost. Reminded me of the time a neighbor's backhoe developed a leak in the hydraulics. We lived way up in the northern part of the state with no technical expertise available except that of our neighbors. And if there was one thing they were all good at, was being expert in all things they knew nothing about. After all, all they had to do was disconnect the doohickey from the whatchamacallit and replace it with a new one, right? Wrong.
The confounded leaking hose was disconnected and the neighbor took it to the dealer in the big city - nearly two hundred miles away and came back with a new one and a whole lot of instructions. Mostly on what Not to do. The next day half dozen heads came together and started screwing and connecting and pumping and filling and whatever else seemed appropriate. I came home just in time to see the finale and watched in amazement as they all stood back proudly while our neighbor started the machine and with the first flexion of the arm, snapped the brand-new hose in half. Pressurized oil and curses went flying all over the countryside. And well you can guess the rest of the story…
Today with the internet, You Tube, Google Search and thousands of advisers, things should be easier. All we have to say is thank God for the young people at the support centers of all these companies whose sales people promise that you can do - whatever you are trying to do - in under one hour.
In medicine too, we have all had to deal with patients who came to us with advise from neighbors, relatives, etc. on how they should be treated and wanting to know why we are not listening to those sage recommendations. Which brings us to the concept of telehealth and telemedicine. Though expert counsel and guidance are available, many false ones float around the ocean of the internet as well. So it behooves us to be weary of what we say and who we say it to. Building a reliable platform for use by colleagues near and far is a lot more complicated than commonly perceived and expected. Best recommendation is to let the real experts do the consulting. Those in university settings or major healthcare institutions. We hope to guide our readers to the true authorities and professionals.
Our new website will be published by this weekend, and a new newsletter will come your way from that website. This is to serve the need and demands of our national and international readership and it will be in addition to the New Mexico Telehealth Alliance website and newsletter. Thank you for your patience and support.
August of 2018 was the transitional period to TH PULSE newsletter. Although the newsletter Volume 4, Numbers 27 to 32 were published, no articles were written for them. Thus the absent period.
7-26-2018 - (V4 - N26) - Fire and Storm
The morning mist hugged the face of the mountain, magnifying its hills and valleys. It was surreal as the rays of the morning sun found its way through the jagged peaks and through the mist. The high altitude temperature of the Rockies was comfortable, but with a hint that it was going to get very hot later in the day. Back in the house, the morning news revealed a frightening map of the world on fire. Wildfires burning across the Western US, Central America, Asia, Europe, Australia, and Africa. No continent seemed to be spared. Where there were no fires, rain, floods, hurricanes, tornados and typhoons were causing mayhem. Global Warming is fully at work and moving to change the very face of our planet. Yet there are those who claim that mankind has no control over the weather therefore is not responsible for its affect. Reminds me of a cartoon, I once saw; 'In a boardroom, around a large table, are sitting the board members. They all have business attire, but they are ostriches. The chairman of the board is saying; "There is a motion on the table and it has been seconded that we should all stick our heads in the sand!" '
Many seem to have the same sentiment about healthcare. Arguing that illness and sickness are part of life, therefore governments can't be held responsible. The barriers one faces in asking for affordable healthcare is always fighting for a budget and trying to justify and convince people about the importance of a healthy society. Its like fighting for flood control and fire prevention when everything is fine. But it is not till the water is filling the living room or fire rushing across the fence into the yard that we wish the provisions were there.
Today technology is making it easier for us to reach many, but availability of that technology is costly for many in the world. Still with a little help, Telehealth, Telemedicine, and Tele-education can spread healthcare affordably and profitably. We have the knowledge and we have the tools, with a little help we can navigate away from the fires and storm.
7-19-2018 - (V4 - N25) FIFA
Last weekend, like millions of people around the world, I was glued to the TV, watching the World Cup's final game between France and Croatia. The game was amazing and so was the commercial value of it.
The contagiousness of watching a sport game is universal. Different cultures and nations have their favorites, but the ubiquitous excitement they feel for it is unmistakably similar. Baseball, American Football, the Olympics' national competitions, boxing matches, sumo wrestling and others are a testament to the power of sport's attraction.
Of course, what makes it such a success is the teamwork that goes into it. The entire community or sometimes even the nation contributes to that teamwork. Business and people's participation at the games supports a multi-billion dollar tourism industry of it's own. Why so many people will travel long distances to join others in watching their favorite game is mind boggling.
Traveling through the Baltimore area once, I stopped at a roadside motel to rest for the night, only to be told that they had no vacancy. "Could you tell me where is the nearest hotel with a vacancy?" I asked the proprietor.
"You can try Philadelphia, or Washington!" was the answer.
He laughed at my surprise and said; "Preakness is in town, you are not going to find an empty room anywhere in the Baltimore area this weekend."
"What's Preakness?" I asked clueless.
"The horse races!" he said with astonishment at my ignorance.
I slept in my car in the parking lot of a Highway Howard Johnson that night. I was not alone.
I had a similar experience of sleeping in my car outside of Brands Hatch in Kent, England, during formula car races and a friend tells of the time she and her husband had to camp out in the local park while traveling through Aguascalientes, Mexico, during the Bullfighting competition week. Similarly, an uninformed traveler can expect to use the car as sleeping room the first week of October in Albuquerque, NM, during the Balloon Fiesta.
Now just think how wonderful a world we could have if we got this excited about our healthcare. Even a fraction of the excitement would add to the well being of us all, and with all the technology available to us, it would be at a fraction of the cost of establishing, providing and participating in these national pastimes.
Of course, I realize that it is the competitiveness of sports that make them so exciting and providing healthcare is not a competitive sport. But it does require and demand teamwork. That teamwork could be built upon. Luckily for us, Telehealth, Telemedicine, and Tele-education are great team building tools that can drastically reduce the cost of making our world a healthier place.
The means and resources for such a world are available to us. Unfortunately, the world around us seems to be unraveling at an alarming rate. We may not be able to change it, but as healthcare providers, we can assure that the service we provide is to the best of our ability and telehealth and tele-education are tools that can help our team achieve its goal.
7-12-2018 - (V4 - N24) - Women of Medicine
It is said that Ginger Rogers did everything Fred Astaire did but backwards and in high heels. Which proves that our female counterparts are much stronger than we give them credit for. Whether the masculine part of humanity likes it or not, this is true intellectually as well as physically. But it is a shame that they have to struggle to prove it.
In the medical profession women have contributed enormously. Many were of Latin heritage. Dr. Helen Rodriguez-Trias - whose birthday was July 7, 1929 - was one such person. Trías completed her medical studies at the University of Puerto Rico, earning her degree in 1960. She accomplished much in her life that has had a lasting effect in medicine to this day. She spent much of her medical career in Puerto Rico and New York. In 1974, she was revolutionizing the way women of color were being treated in this country. She took up practice at Lincoln Hospital in South Bronx, NY. At that time it so happened that I was going through my own residency at that hospital. Although - I am sorry to say - that I don't recall having crossed paths with her, I am sure that we did.
Another Latino woman doctor that I do remember very well, as she was instrumental in my decision to stay in the medical field, was Dr. Angela Ramirez. Also a female Puerto Rican physician. She was going through residency at Elmhurst General Hospital in NY in the 1963-66 time frame. I was a nineteen year old tech working in the ER. I did most of the x-ray development and casting of the patients. She was a surgical resident and appreciated the understanding of medicine that I had learned watching many doctors treating the patients in the very busy ER.
November 9, 1965 was a night I will never forget. Due to a glitch, the entire North Eastern US lost electrical power right in the middle of the rush hour. This New York City blackout was devastating and costly. Our hospital was affected as well and although we had a backup generator, somehow no one could get it to work. No power meant no x-ray, no elevators, no OR lights, nothing. Many of the injured had lacerations and other injuries that needed immediate care. Dr. Ramirez was the surgical resident on call that night. Flashlights in hand, I helped her suture many of these patients. Her cool and composed demeanor calmed the patients and helped us deal with very demanding situations. We worked all through the night and well into the next morning. She was very encouraging and under flashlights and the chaos around us, explained what she was doing and even let me put in a few sutures - my first real ones in the new world.
After her residency she moved back to Puerto Rico and I was drafted and entered the United States Air Force and moved to Texas. We lost contact but I never forgot her. Years later while serving on the NM Medical Board, I met a member of the Puerto Rican Medical Board at a national conference who knew Angela Ramirez and told me that she had settled in Mayagüez but was in very poor health. I wrote her a long letter and tried to make contact but never heard back. I fear that we have lost a very good doctor and educator.
Many more doctors like Trias and Ramirez have contributed to our profession - some I have mentioned below. Today Telehealth, Telemedicine, and Tele-education help us learn about these and other women of medicine and help them reach people around the world. We salute you and thank you for all your contribution and devotion.
7-5-2018 - (V4 - N23) - An Honor
It was Fathers Day, my birthday and my daughter's wedding, June was a busy month, time off was well worth it though - Family first!
Still word came last month that The American Telemedicine Association (ATA) had nominated/elected me to chair the 'ATA International Telehealth Group', - The world is waiting, get to work. I am honored and humbled by this and hope to meet this great challenge.
In considering the world, I find it amazing that millions of people of all races and nationalities, all have so simple and similar wishes, hopes, desires and needs. I don't think anyone is worth more than anyone else! We all have one set of eyes and ears, a mouth, two hands and a brain. Yet our hands, guided by eyes and controlled by the mind can craft magnificent objects, paint emotions, grow crops, play music, tighten screws on a bike, bridge or an ocean liner. Our eyes can gaze at the stars, read a book, stare down a microscope, glance at that passing beauty and even weep for a loss. Millions of talents, so many potentials and possibilities, only if given an equal chance.
Disparities can wreck havoc on a soul and discourage even the most devoted. Whether one is lost in a bottle, smoke or a syringe, finding the way into clarity is easier said than done. When the only means of income is leftover coins in a payphone or on the sidewalk and after your family is murdered, your home burned, your very existence ripped apart, it is hard to understand why your rich neighbor - who knows you, wont lend a hand. Its not that many of us don't care, rather it is because we have become numb to what surrounds us. But there is nothing new about this.
In Florence, Italy stands Piazza della Repubblica, a nineteen century reconstruction of the old city. On the west side of the plaza stands the porticos with the triumphal arch, called the "Arcone". On the top of the Arcane, an ostentatious inscription reads:
L'ANTICO CENTRO DELLA CITTÀ
DA SECOLARE SQUALLORE
A VITA NUOVA RESTITUITO
(The ancient center of the city / restored from age-old squalor / to new life)
Apparently the city center of Florence became home to the homeless and transients who abused it. The city fathers then decided to run everyone out, demolish and rebuild a wider and modern plaza, with the above dedication.
Sound familiar? Today too, many major cities around the world face the same problem with the homeless, poor, and unemployed members of their society. But instead of solving the underlying civil failure of their community, they chase the unfortunate out and spend money restoring the area that eventually will attract new groups of the same.
Unfortunately the political atmosphere of our world is polarizing people and our wonderful communication technology isolates us further. The ever increasing poverty in many parts of the world forcing many to migrate for economic reasons thus making it more difficult to separate the needy from the political refugees. All of which makes the work of healthcare providers more challenging yet urgent. Luckily, Telehealth, Telemedicine, and Tele-education help us provide for many without getting blinded by all the political hot air.
6-7-2018 - (V4 - N22) - Commencement
Last weekend celebrities of all kind were invited and gave commencement speeches at colleges and universities across the country. Some praiseworthy ones were quoted by the media and broadcasted to the world. In my humble opinion, no other profession deserves to praise its graduates more than those in healthcare. For, not only do we have some of the longest and most arduous curriculums, the end of our schooling is truly the beginning of our learning life.
We encounter thousands of people with countless problems, complaints, concerns, and questions. People reveal the most intimate and personal predicament to us - total strangers - and expect us to resolve them. Encounters and expectations are usually proper and within the realm of our training and experience. But they can also be unrealistic, comical, dim-witted, profane, and even devious. Yet we are asked to be impartial, professional, non-judgmental, unbiased, and helpful. A lot to ask from an individual, even with years of experience, never mind a novice or an inexpert. Still, there it is and we have to deal with it and not get burned in the process.
Along the way, the experience and knowledge we gain is priceless and thus behooves us to pass it on to others. Sharing this information enriches everyone, the student as well as the teacher. The more we share, the more we gain.
If there has been one thing that I have learned in all my years of working in healthcare, it's the value of listening. Patients often tell us what is wrong with them, and in more times than not - even how to treat them. All we have to do then, is confirm their diagnosis, start or continue their treatment and charge them an office visit. Nothing will make a practitioner more likeable than good communication and in contrast bad communication will cost us. In the many years I served on the NM Medical Board, I noticed that the number one complaint against practitioners was lack of proper communication. Almost in every instance, the practitioner did everything correctly and the patient was treated properly. But the procedure was not communicated well and the patient left confused and dissatisfied. So I tell all my students; "Make your patients like you! People who like you won't sue you!"
The good Lord has given us one mouth, but two ears. If we listen twice as much as we talk to our patients, we will be a great practitioner and have no problems. Telehealth, Telemedicine, and Tele-education makes listening easier and good communication possible, even for lousy communicators.
5-31-2018 - (V4 - N21) - Memorial Day
Last Monday was Memorial Day, when we remembered all those who gave their lives to defend our country.Along with commemorating our veterans, many communities have started certain revelries and festivities that have become traditional and even a custom to them. One such activity was started back in early 1980s in the resort town of Red River, NM. I was running a small clinic in that town in the late 70s and early 80s and as a Vietnam era veteran myself was happy to witness the beginning of it all.
Following the death of their son, U.S. Marine Corps First Lieutenant Victor David Westphall III, Jeanne and Dr. Victor Westphall decided to build a memorial in his honor and the fifteen men that died with him near Con Thien, South Vietnam on May 22, 1968, and the Vietnam Veterans Peace and Brotherhood Chapel in the mountains north of Angle Fire, New Mexico was erected. The Chapel was dedicated on May 22, 1971, the 3rd anniversary of the death of their son. It was the first major memorial created to honor the veterans of the Vietnam War and inspired the establishment of the Vietnam Veterans Memorial in Washington D.C., which was completed over ten years later, in 1982.
In circa 1982, a group of veterans and motorcycle enthusiasts made a pilgrimage to the site to honor their fallen comrades and visit the one of a kind memorial. Since there are no amenities in the immediate vicinity of the memorial, the bikers continued on to the resort town of Red River - about 20 miles deeper in the mountains. Somehow the word got out in that era of no internet and many more made the trip the next year and every year since, so that this Memorial Day event is now attracting thousands of bikers every year to Red River and Angle Fire - about 20,000 attendees was the estimate for this year.
Although I no longer practice and have not done so in Red River for many years, the event brings back many memories. I am happy to report that, the clinic I started in 1979 is still in operation there.
The nearest hospital to Red River is in the Town of Taos, 40 miles away. In those days my consultations were done by a simple phone call and my ability to describe my predicament to a colleague on the other side of the call. Today all is changed as Telehealth, Telemedicine, and Tele-education can provide an accurate description and picture of any potential medical issue. Today the town of Red River is not much bigger than it was then, and tens of thousands of motorcycle riders can challenge the resources of this small community and as is the nature of this group, one can bet that skirmishes will occur and the expertise of whomever is running that clinic will be challenged. But now they can get help from experts in centers much further than Taos.
5-24-2018 - (V4 - N20) - May is Mental Health Awareness Month.
Since 1949, Mental Health Awareness Month has been observed in May. Yet the rate of the problem is on the increase. Despite all the rhetoric, no adequate resources are allocated to this national tragedy. On the contrary, many social, economic and political conditions have added to the underlying source of this crisis and it is affecting all classes of society. Many veterans returning from the wars we are fighting around the world, face unprecedented challenges, resulting in PTSD that is not effectively addressed or cared for.
Our politicians downplay the importance of the crisis and claim that the government is not responsible for the problem so it should not be liable for it. The acuteness of this calamity peaked in the 1980s when a large number of mental health hospitals and care centers were closed and their patients discharged into the streets. Many became homeless and out of necessity resorted to a life of petty crime just to survive, ending up in our prison system - costing the tax payers more than it would have cost to care for them in a mental health facility.
The mental health crisis has increased the suicide rate among our citizens. According to the CDC's National Center for Health Statistics (NCHS), there were 44,965 recorded suicides in 2016, up from 42,773 in 2014,. On average, adjusted for age, the annual U.S. suicide rate increased 24% between 1999 and 2014, the highest rate recorded in 28 years. White Americans are more likely to commit suicide than black Americans. But a new study finds that the opposite is true for children. According to a paper published in the journal JAMA Pediatrics, black children between the ages of 5 to 12 years old are roughly twice as likely to take their own life than their white counterparts.
This dilemma touches all levels of our society. Even our own profession is not immune as about 400 doctors commit suicide every year. To deal with this predicament, experts like; Rachel Pruchno Ph.D. suggest that we should bring back the mental asylums. But the very negative connotations attached to the concept of an asylum, turns everyone off. Yet the issue is not the place for mentally ill people rather the negative stigma attached to it. We need adequate resources to treat people with mental illness. We need psychiatrists, psychologists, and social workers. More inpatient facilities and integrated outpatient therapies so that people with mental illness are not homeless or imprisoned. We need to overhaul these infrastructures, not to eliminate them.
In this restructuring, Telehealth, Telemedicine, and Tele-education can play an enormous role. The majority of these people can be treated effectively with simple supervision by a professional. By involving family members, many could be managed at home. With a little direction, family practitioners could care for a good percentage of them in their office. And the more serious cases could be cared for in institutions run primarily by well trained midlevel and auxiliary healthcare providers. Telehealth, and Tele-education could be the solution to a major part of the mental health crisis.
5-17-2018 - (V4 - N19) - Then and Now
The aroma of coffee, tea and tobacco use to fill the air in the coffee and tea houses around the world from Hon Kong to Istanbul to Madrid to San Francisco. Young men, in their tight attire showed the muscled bodies to the passing girls who pretended not to notice - but did.
At times, music escorted the smoke out into the street, teasing passersby to pause and look. It was a carefree life for most of the world. All the young and old cared for was to enjoy their drink and smoke, speak softly and cast a sideways glance at that last beauty that just swayed by.
It was so, till someone in a faraway place decided that he needed more for himself, his country, his religion, his ideology or philosophy.
We need to help restore our world so our young can enjoy a cup of coffee again while checking each other out. Where there is a home for them to return to. At the recent ATA18 meeting in Chicago, it was very evident that many are weary and concerned of the uncertainties facing our world today. The attendance at this meeting was somewhat less than previous ones. Many reasons were given for it. But I sensed that it had to do more with the political atmosphere surrounding our world. There was a definite feeling of unease in the way people talked in hushed voices, and paused before answering questions. I am old enough to have seen conditions like this before and never did they end well.
But we are healthcare providers and can do our part by ensuring that our care is free of all encumbrances, impediments and prejudices. Ensure that organizations that represent us are a true embodiment of care and caring. Let us be worthy of ourselves, worthy of our patients and worthy of our profession.
Fortunately, Telehealth, Telemedicine, and Tele-education give us tools to reach the needy effectively and safely. Let our message to them be one of hope and compassion. Lets show the world that we care!
5-10-2018 - (V4 - N18) - A World of Need
Over four thousand attendees from around the world gathered in Chicago last week to network, listen, learn and teach at the ATA18.
It was a rewarding and informative trip. They came to share their stories, successes, challenges, visions, hopes, and wishes. To see telemedicine and telehealth used to bring healthcare to far corners of our needy world is very rewarding.
One noteworthy point that becomes very clear and emphasizes the need for our efforts is the universality of the need. From small isolated islands in the South Pacific with a small population to large countries in deserts of Africa and jungles of South America with millions, the need is there and it is dire. As the economies of the world gets stretched and environmental challenges increase, the healthcare needs increase. Especially so, for the poor and isolated people. Fortunately new technologies make it possible to bring help to these regions. Meetings, such as the one we just had, reveal these needs and more importantly the solutions to many of them.
It was rewarding to see so many from near and far attending the conference, not only to show their needs but more so sharing their ideas for solutions and collaboration. We look forward to another year of success stories.
4-26-2018 - (V4 - N17) - ATA18
We are on our way to Chicago to attend the ATA 2018 annual meeting. I hope that you will be there too. I will report on the meeting upon my return.
Thousands of interested people from around the globe are gathering in Chicago next week to connect and learn about telemedicine and telehealth. Many remote places in very poor countries are connecting through telehealth faster than most of the rural communities in our country. Lets learn and use telehealth in the best way possible to the advantage of our patients and ourselves. Telehealth not only can bring healthcare to the world, it can bring peace and prosperity as well.
As French President, Emmanuel Macron said in his wonderful speech to our joint Session of Congress yesterday; "Human rights, the rights of minorities and shared liberty are the true answers to the disorders of the world." If you didn't hear his speech, you really need to. Listen to his uninterrupted speech here.
4-19-2018 - (V4 - N16) - ATA18 - Come to Learn and Teach!
A friend once said: "whenever we return from these annual meetings, we feel hyped up with enthusiasm, fervor and excitement. Not so much from all the lectures we listen to or new products flashed in our faces, but rather from all the interest and passion we see in others. The way we learn new ways to use Telehealth, Telemedicine, and Tele-education in our community, practice and communication."
It is important to realize that these meetings bring the importance of Telehealth, Telemedicine, and Tele-education to the attention of thousands of practitioners, regulators and legislatures. But for us attendees, the biggest reward is seeing old friends and making new acquaintances to become future friends. Many from around the world come to share their stories, successes, challenges, visions, hopes, and wishes. From small isolated islands in the South Pacific with a small population to large countries in African deserts and South American jungles home to millions, the need is there and it is dire.
Where this excitement is seen the most is in the eyes of those from the rural communities, developing countries and torn up neighborhoods - whether from natural or human caused disasters. For the first time in a long time, we find actual possibilities in affordable patient care. I feel that not since the discovery of penicillin has there been such optimistic outlook in the way we care for each other, educate each other and learn. At a meeting not long ago, a doctor from a small island told me; "I am not afraid to ask questions any more." What a wonderful feat!
So I hope that we all go to Chicago with lots of questions and return with great answers. Even more importantly, hope to have answers to others' questions, share wisdoms and find a unified way to help our corner of the world.
4-12-2018 - (V4 - N15) - See you in Chicago?
We are just three weeks away from the ATA18, the American Telemedicine Association's annual meeting in Chicago. This year's meeting is going to be of special interest and importance in that much has changed at ATA's leadership and control. We will be seeing and meeting many new faces. Although they have all been carefully and judicially selected and are highly qualified and passionate, they are still new and need our guidance and input as to the direction this organization is going. So it behooves us to make our concerns heard.
ATA was developed to provide the means and knowledge of taking quality healthcare to the needy parts of our country and the world. That vision and mission needs to be maintained in our future planning. Although new technologies are needed to achieve our task, they should be tools used in the process of our delivery system not dictate it.
One area that has suffered greatly in the confusion of changes, is the international group. With all the discords, calamities, natural disasters, epidemics and pandemics, the world is experiencing, Telehealth, Telemedicine, and Tele-education should be on the front lines bringing hope and relief to the affected.
If you have decided not to attend this meeting, please reconsider. This meeting may decide the future direction for some of ATA's groups and your voices need to be heard. If you have registered and are attending, please plan to contribute to the many questions and requests that will be made by the organizers and leadership.
On the international front, there is a meeting of the International Group scheduled for Tuesday, May 1st from 9:30 to 11:00 AM at the McCormick Place, room E353C. If you are in anyway interested or connected to any international activity, consider attending this meeting and running for office. It will be especially important for our young members to get involved. This is a new world, a new century with many technological changes that the youth are more apt to understand and use. Please be that person and help us bring hope to the many needed areas of our planet. See you in Chicago!
4-5-2018 - (V4 - N14) - Instincts
The scorpion appeared from under the sack of beans and headed across the busy bazaar toward me. I was surprised that it escaped the many feet crossing the narrow passageway. I sheepishly smiled to myself and said; "Your luck will run out when you get to me" and slowly raised my foot to squish it. The old man sitting next to me placed his walking stick gently but firmly on my foot and pressed it back to the ground. I turned to him surprised; "The scorpion is the warden of the desert. You should not disturb it." He said with a stern, yet warm and gentle tone.
I was about eight or nine, in the bazaar with my grandmother, shopping. When she went into one of the stalls, I sat on the stone bench outside the store, next to the old man. His warm and fatherly voice calmed my questioning look.
"What if it stings someone?" I asked.
"It will not, unless it is threatened or disturbed. It is its nature to sting in self-defense. To hurt a creature who acts out of instinct is a sin."
Respect for the environment and the world around us is not something you learn from books. It is something that has to be woven into the fabric of life as we grow. My Grandmother use to carefully brush the crumbs off her dinner plate and place it into the garden, saying; "It maybe just a bread crumb to us but it is a full meal to an ant." Such reverence for all living things is vanishing from our cultures. Some feel that today's world of high rises is isolating us from our environment. Making us forget that hundreds of feet bellow our apartments, there is still a living planet supporting our very existence. We no longer value instincts, nature, or the need of others. But instincts are in every living thing, including us humans. Society, religion, and cultural ethics further demand certain actions from us. Sadly, today's world cares less and less for such values and has forced millions of people into circumstances beyond their control. And when they follow their instincts and teachings to protect themselves and their families, they are criticized or worse. Our information technology should make us more aware and caring of our environment not less. But unfortunately that does not seem to be the case.
Healthcare too is a necessity many seek when they are ill or injured. To deny them that help and allow them to suffer is inhumane, no matter which side of the fence they maybe.
Fortunately for us, Telehealth, Telemedicine, and Tele-education allow us to provide that needed help to many from the safety of our homes and offices. And maybe if they receive the help they need, they will not cross borders or climb fences. It takes so little to care.
3-29-2018 - (V4 - N13) - Lets Make ATA Worthy of the Nobel Peace Prize!
Last weekend hundreds of thousands of young people around the world marched on cities and towns protesting the unsafe world we live in. It is no secret that much of the perilous conditions are created by the political actions of the world leaders. A short study of history reveals that much of this chaos is the result of the nationalistic and hostile events of the last century. The ill conceived ideology of men and women in power, along with diminishing resources and increasing population are responsible for much of today's conflicts. So much so that many of these differences have exploded into uncontrollable warfare, displacing masses. In desperation many are fleeing their homelands in search of security, yet finding doors slammed shut in their faces, borders strengthened and walls put up. By labeling them terrorists, criminals, and illegal we justify our actions and intentions. This type of response however is not going to settle the plight of the homeless, nor is it going to solve their predicaments.
Adding to the ever increasing problems, the advanced technology of communication paints an unrealistic picture of a wondrous life behind the walls, forbidden to them. Sooner than later the compounded pressure of the masses will bring down the walls forcing countries further into conflict, war and devastation. With the unfathomable destructive power of today's weapons, we can be assured that there will be no winners.
Such environments sicken people physically and mentally. Politics aside, we as healers can show that there is another solution that can bring peace rather than calamity to our world. With the same great technology, we can open doors to possibilities by showing how we can care for our fellow man near and far. Though there are enormous problems, wise use of our knowledge can truly solve many of the differences. It has to start somewhere. Fortunately there are enough of us healthcare providers that we can make the difference and start the revolution of caring. Telehealth, Telemedicine, and Tele-education are just the tools such a revolution needs. Organizations such as ATA are in perfect position to lead the way in providing for humanity everywhere. We as members of these groups can be the catalyst needed to direct the course toward peace and harmony. As Mahatma Gandhi said; Lets "Be the change that you wish to see in the world."
Lets make ATA18 the start of "Healthcare for World Peace". Lets make ATA worthy of the Nobel Peace Prize!
3-22-2018 - (V4 - N12) - Happy New Year
Last Tuesday, March 20, 2018, at precisely 10:15 a.m. MDT, the sun crossed directly over the earth's equatormaking the day and night equal. . This moment is known as the vernal (spring) equinox in the Northern Hemisphere, and autumnal equinox in the Southern Hemisphere. Celebrated by many cultures as new year for thousands of years. It is not a religious celebration, rather it is a natural and cultural one of nature's annual beginning.
In the zodiac, the astrological year begins as we enter the sign of Aries, which is around March 21st. Nurooz, which means new day, is still celebrated in Iran, Turkey, Pakistan and Afghanistan. Zoroastrians were one of the early cultures who started their year thus, it is a time of purification and setting one's intention for a new start. Even the western world celebrated spring as the new year till Julius Caesar changed it to Jan in 45 BC.
The Mayan Culture also celebrated the Spring Equinox for hundreds of years before the Spanish arrived. The pyramid at Chichen Itza on the Yucatan Peninsula puts on quite a show on the occasion. Built around1,000 years ago, the pyramid is designed to cast a shadow on the equinox outlining the body of Kukulkan, a feathered snake god. A serpent-head statue is located at the bottom of the pyramid, and as the sun sets on the day of the equinox, the sunlight and shadow show the body of the serpent joining with the head. Best seen in this video.
It is amazing how the news of fresh beginnings always cheers people up. Even people with chronic or debilitating problems hide their troubles under a smile. Sadly the political atmosphere of our world has not improved much in the last year. Many actually feel it to be worse and in more dire need of attention. Much has been said and little being done to remedy it. Still as healthcare providers, we can embrace the goodness many see on these occasional times and build upon it to give our patients the hope they need to carry on. Fortunately for us the technology at our disposal helps us deal with the grave needs of many seeking our help. Telehealth, Telemedicine, and Tele-education can help us keep conditions under control. Telecommunication can bring the needy and provider together without jeopardizing the resources of either. Organizations such as ATA can be a catalyst in addressing some of these issues. With telehealth, telemedicine, and tele-education, we can provide a great deal of assistance. So as we celebrate this new season and new year, lets keep our focus on the fact that seasons change and we can be hopeful that even after stormy days, calm and peaceful ones give us time to re-grow and rebuild and that is worth celebrating.
3-15-2018 - (V4 - N11) - The Infinity of a Constant
Yesterday, March 14 was International Pi Day. The mathematical constant that is the ratio of a circle's circumference to its diameter, approximated as 3.1415926535….. the decimal number goes on forever. Contained within its string of decimals is every number pertaining to man's life, history, nature and cosmos. And if the decimals are converted into letters, you will find every word that ever existed, spoken and written. All the infinite possibilities of words rest within this one simple circle.
In our bodies too, the ratio of our consciousness or psyche to our physical being could be said to have infinite possibilities. Our body goes where the mind tells it to. Our mind works by the demands of our soul/ consciousness/ intellect/ psyche - or whatever we want to call it. Our actions are dictated by our desires, wishes and wants which in turn are based on our intelligence, education, experience, and wisdom. The more of these combinations we use, the better will be the outcome of our deeds. The possibilities of our actions are infinite. The choices we make may depend on the advice of others, on our teaching, or on a variety of outside influences. But the end result is where we end up in our lives and what we have to live with. Limited knowledge leads to limited and fewer choices and actions, wiser decisions produce healthier and happier outcomes.
Healthcare gives us many opportunities to find answers to our medical and mental problems. Modern technology gives us newer and more advanced means of dealing with age old problems. Telehealth, Telemedicine, and Tele-education are keys to many of the new knowledge coming our way. Wise and intelligent approaches lead to better outcomes. There are many options to the constant of man's need and our technology adds to those options. Indeed it is a wonderful time of history we live in and if prudent decisions are made, a bright future will surely be ours.
3-8-2018 - (V4 - N10) - A Salute to Our Nurses
The rays of the sun coming through the open window of the hut, woke me. Looking around the unfamiliar surroundings, I rose on an elbow and smelled the coffee.
"Good morning", she said smiling.
I sat on the cot and smiled back, "what time is it, did I oversleep?"
"Oh no. It is five thirty, you are fine."
She looked clean, fresh, happy and full of energy, even in that early hour of the day. I wondered when she awoke or if slept at all. She kept her composure throughout the time we were there.
It was the first day of our four day visit to this remote mountain top community. I was there with three other providers. Two dentists and an ophthalmologist. I was to provide general primary care. The village was far from any medical establishment - a two day journey by horse and mule. The so called clinic we were to work out of was a two room hut run by two nuns, one was an RN. We flew in on a small aircraft. A follow up visit for our eye doctor and one of the dentists. A first for me and the other dentist. We saw over two hundred patients in those four days and could have seen hundreds more. Their appreciation and gratitude toward us was contagious, even by the ones we didn't get to see. I felt ashamed and guilty to leave after our short stay.
Our missionary nun/RN had been there for many years, providing spiritual as well as medical care to the many Indians living throughout the mountains and valleys. She knew everyone by name, their medical and social problems. Acted as interpreter, assistant, immunizer, phlebotomist, and above all else; nurse. In our absence, she would be a provider, midwife, and dentist as well till the next group of volunteers arrived - whenever that would be. I learned much from her on that short visit.
I have had the opportunity to meet and work with many nurses like her in my years of medical work. I learned more from them than all the schooling I got otherwise. Perhaps the greatest and most important lesson has been how to be compassionate in the face of adversity, care for everyone even when they themselves stop caring. How to teach while learning and learn while teaching. As Maya Angelou once said; "People will forget what you said, people will forget what you did, but people will never forget how you made them feel"
Today our world is in dire shortage of trained and dedicated nurses. Every country needs more of them - some more than others. Even here in our great rich country there is need for many more nurses. Philanthropists spend money on programs to provide healthcare to needy regions of the world but little on training nurses to deliver that care.
In this digital age of Telehealth, Telemedicine, and Tele-education we can do much more in helping our nurses deliver their wonderful care to everyone around the world. Whether in a hut on a mountain top, in a tent on the battle field, on the streets of a famine driven city far away, or a state of the art hospital in an American or European city, they need our support and appreciation. We salute our dedicated and caring nurses everywhere.
3-1-2018 - (V4 - N9) - Read Across America
"I heirt my nee" was the reason for his visit to our office, the young man wrote on his medical questionnaire, when he signed in. He was a senior from a top high school in our town. He had driven himself to our office in a new BMW - indicating that he was from a well to do family. I found him well dressed and exceptionally polite. But then it was that spelling.
Tomorrow is "Read Across America" day. A day established in honor of Dr. Seuss to motivate people to celebrate reading. It is a wonderful idea twenty years old. It is interesting to see it celebrated in this age of smart phones, computer tablets and electronic devices.
In our house, we didn't have a TV till my youngest was in high school. I was scorned about it by friends and neighbors alike. Some of my children would sneak over to the neighbor on Saturday mornings to watch cartoons. I was OK with it and pretended not noticing. We had the biggest library in the neighborhood, and so they became avid readers. . My wife and I read to them every night and they looked forward to it even in their teenage years. Thank God, today they are all educated and successful in their lives.
Among the many books we read was, of course those by Dr. Seuss. My favorite of his - one that I feel should be mandatory reading for all college students - is "Did I ever tell you how lucky you are?"
Just like the little boy in the story listening to the happy old man living in the Desert of Drize, many of us feel blessed for all that we do have rather than not. Health as well as wealth, education, freedom and security contribute to our overall happiness. Yet we take much for granted and that may make us malcontent and depressed, leading us to act irrationally and at times violently. Unfortunately our history is full of such incidents and it's getting worse. Recent school shootings are examples of such tragedies. Many feel that social media is a great contributor to this problem. Maybe so, but it also could be the unbalanced available information that is leading to the wrong choices our people make. Much could be said about that here but as our job is healthcare, we can start by practicing good and sound medicine.
Healthy people suffer less mental anguish and add to the overall well-being of society. Today the technologies of Telehealth, Telemedicine, and Tele-education help to bring the best practices to all corners of our world. By implementing them into our practice, we reduce much of the stress and anxiety in our own lives and that of our patients. Then maybe we can find time to read to our children and help them become balanced and intelligent adults. For as the "Purpose of Read Across America" indicates; "Motivating children to read is an important factor in student achievement and creating lifelong successful readers. Research has shown that children who are motivated and spend more time reading do better in school." And in life!
2-22-2018 - (V4 - N8) - The Special Olympians
We are now a week into the Olympics and athletes from around the world have proven their talent on the ice, snow, skis, blades, boards and snowshoes. Fighting the elements of wind, frigid temperatures and the like which of course is the intent and purpose of the games. It is one event in the world where everyone is glued to their viewing devices and cheering. Healthcare too raises merriment and liveliness when it gives worthy results. Sports and healthcare are very much intertwined. Sports keeps us healthy, medicine keeps sportsmen and women healthy. Research in nutrition, exercise methods, physical and mental care, attire and healthy living contribute greatly to the well-being of athletes and the rest of us too. And when something goes wrong and injuries or illness occur, healthcare providers are there to deal with that as well. Which brings us to yet another Olympian achievement. That of the Special Olympics where the people with physical handicaps prove to the world that disability is only the hindrance we allowed it to be.
Watching the Special Olympics is of great satisfaction when we see the marvelous achievements of the competitors. How they overcome their handicaps, shortcomings and limitations. Here too healthcare and medical technology often play a great role. Much of what is achievable today is due to breakthroughs in the healthcare devices. Telehealth, Telemedicine, and Tele-education provide the means to spread the knowledge of them to the world. Advances in many areas help determine whether athletes reach their goals, ambitions and aspiration. People like Beatrice Vio - an Italian fencer with no arms, or Junichi Kawai a Japanese blind swimmer, or Chantal Petitclerc a Canadian wheelchair track athlete and many others; Olympians all.
In healthcare too we have Para Olympian caliber practitioners like; Dr. Gregory Snyder a physician in wheelchair, or Dr. Judith Ann Pachciarz who is deaf, or Dr. Cheri Blauwet who is an MD and a Para Olympian, or Dr. Tim Cordes who is blind. They are all inspirations to the rest of us. A long time ago I had an opportunity of working with a doctor who was a polio victim and in a wheelchair. In my young and ignorant way, I did not quite appreciate him at first. As matter of fact we use to give him difficult patients because they would pacify once they saw that their provider had more of a handicap than they. But over time I came to truly appreciate him and learned much about dealing with adversity. Handicapped healthcare providers are everywhere around the world. In many developing countries children with disabilities often become healthcare providers as they grow up. Many learn on the job to care for their friends and relatives with similar disabilities. Not all are educated by our western standard, yet the care they provide is invaluable and very much welcomed. We might chuckle at the notion of the blind leading the blind but I have witnessed it first hand. Once I was amazed to see a blind adult leading three blind children behind him through busy streets. Humanity demands caring for others and often it becomes a Herculean task for the care giver and receiver. So as we watch many of these Olympian's Olympians, we must be thankful for all they teach us in adversity and be appreciative for all that we do not have to endure to do our job. Maybe then we can have a better outlook of our daily chores.
2-15-2018 - (V4 - N7) - Healthcare Olympiads
Healthcare providers who, like athletes strive to improve themselves to the level of an Olympian give our profession the credibility it deserves. At the Olympics, the collective performance of the athlete is what makes it a world event, but it must be remembered that it is the contestants training and work that has earned them their place on the world stage. A tribute to the tenacity and resolve of their dream and vision.
The Olympics are one place where peace and harmony is demanded and permeates the very essence of the venue. It is where friend and foe gather to prove their mettle. History has proven that the process can also heal differences and create peace among adversaries. Indeed the tradition of the Olympic Truce or "Ekecheiria" dates back to the 9th century BC. During the Truce period, the athletes, their support teams and families, as well as spectators could travel in total safety to the Olympic Games and return home. As the opening of the Games approached, the sacred truce was proclaimed and announced by citizens of Elis who traveled throughout Greece to pass on the message.
Recently, International Olympic Committee (IOC) decided to revive the ancient concept of the Olympic Truce to encourage searching for peaceful and diplomatic solutions to the conflicts around the world and to create a window of opportunity for dialogue and understanding.
Healthcare is another area where peace is demanded in order to bring needed care to everyone. It too can be an avenue for resolution and reconciliation. To a Healthcare Olympian, a patient has no race, nationality, political or social affiliations, financial ability, etc. except where it's relevant to the patient's condition.
Today's technology can facilitate healthcare even more readily than before and add to the safety of the care. Telehealth, Telemedicine, and Tele-education can promote such endeavors. When disaster strikes a region, even sworn enemies are known to set aside their differences and lend a hand. When an earthquake recently hit the Iraq/ Iran boarder, The American Red Cross joined others to help. The Nepal Earthquake last April brought help from India, China, as well as many other countries. The list goes on and on. If we can set aside our differences during these times, there is no reason at all why they could not be curtailed permanently till a peaceful solution is worked out. To paraphrase Dr Jacques Rogge, 2007 IOC President: (Healthcare and) sport alone cannot enforce or maintain peace. But it has a vital role to play in building a better and more peaceful world.
2-8-2018 - (V4 - N6) - The Cusp of Change
Our world is changing. What comes out of this change will have profound ramifications on tomorrow's world. Historically major changes, as we witness now were done in limited or smaller arenas. Even in major offensives like World Wars I and II, Korea, Vietnam etc. it took days for news from home to reach us in the form of a newspaper or Newsreel. But today our soldiers around the world can witness the news from back home instantly. Even watch their family do the laundry or eat dinner on their smart phones.
No time in history has mankind witnessed global changes and even participated in it as we do today. Just tonight's news informed us of political upheaval in the Maldives, the coalition agreement reached in Germany's four month old elected government, the new offensive of the Turkish military forces against the Kurds, the unity of the North and South Korean Olympiads, the new government in Liberia, the mass migration of the northern South American population to Brazil, …. etc., etc.
Today's technology also reveals the many prejudices of history. Often history is written by the victors at the expense of the losers. But even when there are no clear sides, history tends to be selective about what was the story behind some major changes. The month of February is a good example of all that we celebrate and that we don't. For example we celebrate Presidents Day in honor of George Washington and Abraham Lincoln. But two other presidents were also born in February; Ronald Reagan on Feb. 6, 1911 and William Henry Harrison on Feb. 9, 1773.
Of the twenty seven Constitutional Amendments, six of them were ratified in February. Speaking of Constitutional Amendments, one may ask, If we are so proud of our Constitution, why the Amendments? The answer of course is that the Constitution served the people of its time, but as time changed, the new needs of people demanded changes to it. The changes did not make it better or worse, rather it just met the demands of the time.
Another very good example of what has changed is the Boy Scouts of America. On this day (February 8, 1910), Boy scout of America was established. The Boy Scouts began as a movement in England in the early 20th century. It took off in America almost immediately as a way to keep young men (as the Scout Oath puts it) "physically strong, mentally awake and morally straight." What is moral today would not even be fathomed a hundred years ago. William D. Boyce - the founder of the Boy Scouts of America would turn in his grave if he knew that today's Boy Scouts allows gays and girls into their ranks. But here they are, a change not conceivable a few short years ago.
In no place does change affect the people as it does in healthcare. We - the providers of healthcare should be aware and have a direct input on any changes made to our delivery system. For, after all the arguments are made and rhetoric shouted across the aisles, laws are passed and politicians move on to other matters, we are still left to implement those changes and care for our patients. And if the new rules create more of a hindrance than help, it will be on our shoulders.
Fortunately for us, the new communication technology makes it easy for us to express our opinions and have our voices heard. Telehealth, Telemedicine, and Tele-educational organizations along with other established institutions are usually present at congressional hearings. But they need to carry our voices with them. The more of us speak up, the louder their voices will be. Please lets stay alert to what is coming our way. Let American Telemedicine Association (ATA), American Medical Association (AMA), other professional organizations, and your state and local chapters hear your concerns. Help them make changes that we can live with. For the benefit of our patients and ourselves!
2-1-18 - (V4 - N5) - Black History Month
One interesting thing about politics is that you never know who you meet or when someone you know becomes truly important and famous. As one of the first PAs in New Mexico, I had my share of rubbing elbows with and arguing and even dancing with politicians. When I first moved to NM, not many people knew what a PA was and I had to fight to get recognized and eventually get licensed. But as destiny would have it, years later, I ended holding the very job of the first person I met at the NM Board of Medical Examiners (later Medical Board) - who told me that NM does not recognize PAs and I would never practice in this state. Not only did we manage to get legislative approval, years later Governor Gary Johnson signed into law to allow PAs to serve on the Medical Board and I was the first PA appointed to that post by the next Governor; Bill Richardson. The reason I am reminiscing this bit of history is to show how familiar we (PAs) are with people's unfairness and prejudices.
But back to meeting important people, when I served on the Medical Board we routinely attended the Federation of the State Medical Boards annual meetings. There we met and worked with representatives from other states and even countries. One such lady I had the honor to meet was Doctor Regina Benjamin from the Alabama Medical Board. Dr. Benjamin's history is most fascinating and enlightening. Born in Mobile, Alabama to a poor family, she had her share of tests and trials. In 1984, she was the first from her family to receive an M.D. She then worked as a clinician serving the fishing community of Bayou La Batre, providing much needed medical care there.
Dr. Benjamin became a true leader in her field, and was the first African-American woman and the first physician under age 40 to be elected to the American Medical Association's (AMA) board of trustees in 1995. She followed years later in 2002 with another big achievement, becoming the first black woman to lead a state-based medical society with her position as president of the Medical Association of the State of Alabama. And still yet an even bigger achievement as the first African-American female physician to get nominated and appointed to become the U.S. 18th Surgeon General in 2009 - appointed by President Barack Obama.
Dr. Benjamin is now back at her La Batre clinic doing what she loves. Over the length of her career, she has received many honorary degrees and awards, including the Nelson Mandela Award for Health and Human Rights and the National Caring Award.
So on this Black History Month, we take this opportunity to salute her and all African-American (and indeed all people of color) physicians, nurses and healthcare providers whose contribution can not be overlooked or forgotten. Thank you!
1-25-18 - (V4 - N4) - Legislators need our help!
Many state legislatures along with New Mexico are now in session. Our lawmakers need our input and help in deciding where to put the limited state money, or at least where not to cut it.
Telehealth, telemedicine and tele-education can help provide great education and healthcare for our people, statewide and nationwide. Many states have passed rulings in favor of the use of these technologies. Our legislators need to be made aware of the benefits it will bring to their constituents. Telehealth, telemedicine, and Tele-education will increase access to specialized healthcare in rural and underserved areas. Our legislators could use our expertise and would welcome help in dealing with the opposition.
In most states, the legislative process is broadcasted or webcasted. You can watch the NM Legislature in action via their webcast as well.
Some Health and Medical related bills in the 2018 NM legislature
House Bills: HB16 (ABORTION DECRIMINALIZATION), HB44 (HEALTH PROVIDER CLAIM DENIAL & RECOUPMENT), HB45 (COUNTY & TRIBAL HEALTH NEEDS), HB75 ("BORN ALIVE" DEFINITIONS & MEDICAL CARE), HB76 (PARTIAL-BIRTH & LATE-TERM ABORTIONS), HB104 (RURAL HEALTH CARE TAX CREDIT CHANGES), HB107 (MEDICAID DD WAIVER SUPPORTS & SERVICES), HB145 (PHYSICAL THERAPIST ASSISTANT GROSS RECEIPTS), HM5 (FEDERAL LAW TO PROTECT MEDICAL CANNABIS), HM9 (EXPLORE MEDICAID BUY-IN PLAN), HM20 (HEALTH INSURANCE MARKET STABILITY TASK FORCE), HJM2 (LFC PLAN ON INPATIENT MENTAL HEALTH)
Senate Bills: SB2 (MEDICAID CHANGES), SB3 (EXPAND MEDICAID FRAUD CONTROL UNIT), SB4 (ASSISTED OUTPATIENT TREATMENT ACT FUNDING), SB10 (HEALTH PROFESSIONAL LOAN REPAYMENT), SB35 (OVERDOSE & MEDICATION COUNSELING), SB73 (BEHAVIORAL HEALTH SUPPORTIVE HOUSING), SB75 (MEDICAID & TAXPAYER FRAUD ACTS Changes), SB136 (NURSING COMPACT RULES), SB144 (HEALTH INFO SYSTEM INTEROPERABILITY), SB145 (HEALTH INFO INTEROPERABILITY FUND), SB161 (MEDICAL ASSISTANCE COVERAGE FOR AUTISM), SJM4 (OVERWEIGHT BACKPACK HEALTH RISKS)
1-18-18 - (V4 - N3) - Are We Ready?
The contentious political atmosphere of the day along with the recent incidents of false alarms in Hawaii and Japan is of great concern. Having lived as long as I have and seen many conflicts, raises an apprehension that we maybe heading for something very undesirable.
In the protectionism environment of our world, the gap between prosperous and deprived keeps growing. Such inequalities have sparked discontent into raging fires of revolution and chaos. With every revolt, more people are displaced. With the increase of such masses, nations feel obliged to close their borders, strengthen fences and erect taller walls, leaving people in limbo and desperate, adding to the instability.
Albert Schweitzer, who was born on January 14, 1875, in his long and historic acceptance speech to the Nobel Peace Prize Committee said that after every war, the writers of new rules;
"…. were obliged to regard themselves as the executors of the will of the conquering peoples."
"… The new order created after both world wars bears in its turn the seeds of a future conflict."
"… The most flagrant violation of historical rights, and indeed of human rights, consists in depriving certain peoples of their right to the land on which they live, thus forcing them to move to other territories."
"… What really matters is that we should all of us realize that we are guilty of inhumanity. The horror of this realization should shake us out of our lethargy so that we can direct our hopes and our intentions to the coming of an era in which war will have no place."
After that award, Schweitzer spent the rest of his life working to abolish nuclear weapons and obviously was unsuccessful.
The most eye opener in Hawaii was, just how unprepared the healthcare system is to deal with the potential threat. As healthcare providers we are no more ready to deal with such a calamity than anyone else. So it behooves us to think about such potential and plan for it - while praying that we never have to use it.
Fortunately Telehealth, Telemedicine, and Tele-education allow us to train and prepare those in the danger zones and in the unimaginable event - help them. It therefore will be a good idea for universities and major medical centers to create a taskforce to look into a plan to use telehealth in such an unthinkable event and train their staff in the use of it. It would also be wise for the American Telemedicine Association to devise such strategy. Telehealth, Telemedicine, and Tele-education can cross oceans, traverse rivers, walk through fences and climb over the walls of misfortune! Our new technology can help us provide medical help to everyone on both sides of the divided world and tele-education can school us all. By educating everyone, maybe we can reveal the calamitous consequences of such a nightmare and prevent it from happening.
1-11-18 - (V4 - N2) - What once was
On this day in 1838 a telegraph message was sent using dots & dashes at Speedwell Ironworks, Morristown, New Jersey. Samuel Morse and Alfred Vail collaborated in developing the telegraph. It is interesting that their story is reported as a forgotten history by Smithsonian. The First Transcontinental Railroad (built between 1863 and 1869) and the transcontinental telegraph lines were built simultaneously. It was the telegraph that made communication between two points along the railroad possible and expedite the movement of needed supplies and information. It shows how quickly do we lose touch of our past in this fast moving world.
Recently going through some old photographs, I found an aerial picture I had taken of Embudo Hospital (now closed) that brought back many memories and confirms how fast our history is lost. Back at the turn of the last century, the Presbyterian Church was serving the medical needs of Northern New Mexico with missionary doctors and was planning to build a hospital in the town of Peñasco. Legend has it that one evening, the local missionary doctor was called to help a woman having trouble giving birth and in distress. The woman's husband was at a friends house, drinking and upon return found out about the incident. In his drunken stupor, he became outraged that a strange man had looked at his wife - not with standing the fact that he had been a physician and had help deliver his child. The drunken husband found the doctor riding home on his horse and buggy and beat him mercilessly. After hearing the story, the church canceled the plan to build a hospital in Peñasco, and instead built it twenty miles to the west near the confluence of the Embudo River and the Rio Grande. For many years it was the only hospital north of Santa Fe.
In the early seventies, Presbyterian Medical Services (PMS) took over the administration of the hospital. Soon afterward federal grants became available for rural hospitals and PMS successfully bid and was granted a big chunk of money with which it also took over the running of the hospitals in nearby towns of Española and Taos. I happened on the scene in 1974 just before PMS decided that with these new hospitals, the one in Embudo was not needed and closed it. With that, an important piece of Northern New Mexico history was closed. The outraged community organized a board and we turned the hospital building into a clinic, which operates to this day - but that's another story.
In 1975, I took my girlfriend to see the newly released movie; "The Great Waldo Pepper" about an aviator of the 1920s. The movie touched a nerve with me. I had started flying in 1969 while I was in the service, but after my discharge due to financial reason, medical school, travels, etc. stopped flying. Leaving the theater that night, I felt an elemental passion awaken in me and felt the need to start flying again. On the way home we drove to an airport and sat in the dark in an old aircraft tied down on the tarmac and fantasized flying it. The next week, I drove back to the Santa Fe Airport and signed up for flying lesson refresher classes. Over the years, I went on to become a commercial pilot and have since flown to and from all kinds of places and seen many changes. Two of my favorites airports in NM have closed since and for the same reasons many rural hospitals have - urbanization of the wrong kind, financial burdens, government regulation to name a few. Today I can only recall memories by looking at pictures I took with a camera I can no longer use (no film), from an aircraft I flew from airports of a hospital that are all closed. What once was is gone, nothing that has replaced them even resembles them like the cars that replaced the horse and buggy the missionary doctor rode to see his patients, digital cameras that have replaced my SLR, shopping malls that have replaced airports, and closed hospitals that are not renewed at all.
New technologies however are providing us tools to serve our clientele. Perceptions and expectations of today's people look to futuristic type of solutions. In our field of healthcare Telehealth, Telemedicine, and Tele-education are such tools and solutions. I don't know whether these advances are making us spiritually poorer or richer. But if there is one thing that I have learned in my journeys is that our lives are molded, not by the knowledge that we gain but by the choices that me make! Lets hope our choices take us into a good future. Lets assure that while we use these wonderful mechanisms, we stay in human touch with those who come to us for help.
1-4-2018 - (V4 - N1) - Something New
The coat didn't fit him well but it was warm. The evening chill was exaggerated by the brutal wind coming off the lake. Snow, blowing sideways seemed to go right through all the layers of clothing. January in Chicago can be brutal. Which makes one ask; why would anyone build a city here?
I was on leave from my military station in San Antonio, Texas. A friend - from Chicago - had ask me to accompany him home for the holidays and to meet his family. It was my first trip to the windy city and despite the warm reception, the beautiful holiday decorations and the food - oh boy, the food, after eating breakfast, lunch and dinner at the military mess hall for months, the home cooked meals were most appreciated - I still looked forward to returning to the warmth of Southern Texas.
New years are for new things, experiences and hopes. It was my first year in the service and I wanted to see as much of America and the world as possible. So I could not say no to an invitation to Chicago. Driving through a lot of Texas, Oklahoma, Missouri and Illinois gave me an appreciation of our country's size. Along the way, the many people, representing many cultures, were too, an eye opening experience. Maybe it was the holiday season but our encounters were warm, welcoming and friendly. It felt good to be welcomed. In Missouri, the chill hit me hard. I had not come prepared for that kind of cold. A sign on the highway informed us of a military base close by, so I decided to make a detour and visit the Post Exchange and pickup an overcoat. It was well used in Chicago.
Over the years of work and travel around the world, I have come to realize one thing about America that no one else can claim. No one can ever say that Americans all look alike! The diversity of our people is second to none and the power it gives us is unmatched. Although there are some who find our mixture threatening, I find it strengthening. For, what is beneath the skin of our bodies are souls with great ideologies, cultures, wisdom, intelligence and customs that profoundly congeal our strength as a nation.
My profession as a healthcare provider has been another key ingredient of my interaction with many people. It not only provided me with an adequate living but showed me the beauty of mankind, its humanity, civility, passion and yes, occasional brutality. No other profession can bring people intimately close so quickly. There is much wisdom to be gained from these encounters. None more enlightening than how universally everyone wants to stay healthy. This overwhelming desire of people helps keep us in business, yet it should not be taken for granted nor abused. This same need has helped the industry of healthcare to flourish. Today more money is spent in healthcare than most other businesses. Telehealth, Telemedicine, and Tele-education further broaden our scope of practice but it should not isolate us from our patients. Rather it should help us get closer to more people and humanity. Still nothing compensates a human touch nor is more rewarding. Years later it is very likely that a tele-encounter will be forgotten but not a face to face act of kindness. Like the over size coat I picked up in Missouri and gave to a man in Chicago whom I found inadequately dressed - fifty years ago.
It is a new millennia, century and year. Lets wish for something new and encourage ourselves to be more humane and benevolent so the future writers remember us so. Happy New Year!!