Blog 15 - An Inspirational Woman - Lillian Carter

I don't think about risks much. I just do what I want to do. If you gotta go, you gotta go. ~Lillian Carter~ Every time I think that I'm getting old, and gradually going to the grave, something else happens. ~Lillian Carter~ If I had one wish for my children, it would be that each of them would reach for goals that have meaning for them as individuals. ~Lillian Carter~ Some of my young classmates probably don’t know who Lillian Carter is – she died before many of you were born. She was the mother of President Jimmy Carter and somewhat of a “character” in her time, doing her own thing and speaking her mind without much consideration for what other people might think. She was born in 1998 in Georgia and in 1917, at the age of 19, she volunteered to be a nurse in World War I (without any nursing training!) but the military nurse program was cancelled and she didn’t go. She completed her nursing degree in Atlanta in 1923. Her family disapproved of her career choice, but she forged ahead with it anyway, then met and married her husband in 1925,after her graduation from nursing school. She defied social norms by welcoming African American neighbors into her home and she provided medical care as a nurse practitioner (at times illicitly!) for both African American and White employees of her husbands business and for the community of Plains, GA. She was a liberal social activist who worked for desegregation in a time and place where that point of view was highly irregular and unpopular. In 1966, at the age of 68, she applied to the Peace Corp, and after a psychiatric evaluation, she was accepted and was sent to India for 22 months, where she worked as a nurse to those who were desperately poor and sick, including those with leprosy. “Miz” Lillian was greatly loved by those she served all her life and she loved and supported each of her children no matter what road in life they chose to travel. She left a legacy of service and an example of determination to do what she knew was right, no matter what the opinion of those around her. It’s people like Lillian Carter who help me know that “age is just a number, and old is just a state of mind.” As she said, “I don’t think about risks much. I just do what I want to do. If you gotta go, you gotta go.” REFERENCE: Wikipedia. Lillian Gordy Carter. 28 September 2010. http://en.wikipedia.org/wiki/Lillian_Gordy_Carter

Blog 14 - Finding balance

“Don’t ask what the world needs. Ask what makes you come alive, and go do it. Because what the world needs is people who have come alive.” Howard Thurman, American theologian. Finding balance in our lives is critical if we are to be happy, contented and fulfilled. Many women spend years striving and struggling to meet the expectations and goals of society and of other people, then wake up one day and find that their own goals and dreams were entirely different than those they fought so hard to realize. The first essential step to finding balance is to define what is most important to YOU personally. That might be a college degree, or masters or doctorate, or being a stay-at-home Mom with a large family or maybe having a successful and lucrative career – or maybe all of those things. The critical part of this step is to make it personal, not allowing others to define what is important to you. When the step of defining what’s important is finished, then make a plan and a timetable – this can be very detailed or more general, based on what is comfortable for you personally. Another important way to maintain balance is to learn to say no to requests that will cause you to be over-committed. Agreeing to do things that we don’t have time or energy for (or a passion for!) is a major cause of frustration, fatigue and imbalance for most women. Women should also make sure that there are periods of time in their schedules for personal renewal. The amount of time you allow for this is very individual – some women require more than others. This personal renewal time might be for reading, hobbies, a pedicure, a walk, watching a TV show or just spending time alone or with a friend. Another important step is to pursue intellectual renewal – a refreshed mind is an energized and balanced mind. Lifelong learning will keep each of us young and strong. Spiritual renewal is also important – this is very personal and individual for each woman, because each of us is spiritual in different ways. I have a personal relationship with Jesus Christ and I pray and meditate often, but others may find this spiritual renewal through different avenues. This important thing is to add this step to your quest for balance. As a woman who has been through many phases of life, I would just encourage each of you, as you seek balance, to define what’s important to you, then live your dream and wear your passion every day, making sure that the dreams and passions are your own, NOT those someone else may have defined for you.

Blog 13 World Health Organization calls for graphic pictorial warnings on tobacco packaging

"The World Health Organization (WHO) recently called for countries to provide (graphic) pictorial health warnings about the dangers of tobacco use." In May of 2009, WHO called for countries to require pictorial warnings on all tobacco product packaging to increase public awareness of the consequences of tobacco use. "Tobacco is the only legal consumer product that kills when used exactly as intended by the manufacturer(WHO)." In the United States, the FDA regulates and controls thousands of products that have been shown to be harmful to people who use or misuse them. However, despite incontrovertable evidence that tobacco use kills, it is still available for purchase, with only minimal verbal package warnings - "smoking may be hazardous to your health". Smoking is the leading cause of preventable death in the US, causing 5 millions deaths per year, and yet availability of tobacco products is minimally regulated. Brazil, Canada, Singapore and Thailand all require graphic pictorial package warnings that studies have proven to have a positive effect on smoking rates in those countries. The tobacco industry lobby in the USA is very powerful and well funded, and because of it's political clout, efforts aimed at preventing new users and helping addicted smokers to quit are rendered much less effective. The new healthcare legislation should have included some very concerted efforts to control and reduce tobacco use. Instead of addressing the cause of so much sickness and death, the focus remains on treating the lung cancer, cardiovascular disease, stroke and many other chronic, debilitating and death-dealing illnesses suffered by smokers and those exposed to their second hand smoke. REFERENCE: World Health Organization (2009). Call for pictorial warnings on tobacco packs. Retrieved from http://www.who.int/mediacentre/news/releases/2009/no_tobacco_day_20090529/en/index.html.

Blog #11 Breast Cancer in American and Africa

Breast cancer is the most commonly diagnosed cancer among American women, other than skin cancer. In 1975, the incidence rate for breast cancer in American women was 105 cases per 100,000 women and the mortality rate was 31 per 100,000. Radical mastectomy (a disabling and disfiguring surgery which involves the surgical excision of breast tissue and skin, underlying muscle and lymph nodes) was the treatment of choice. Clinical trials studying chemotherapy using multiple drugs and hormone treatment was in its earliest stages (National Cancer Institute). In 2007, the incidence rate for breast cancer in American women was 125 per 100,000 and the mortality rate was 23 per 100,000. Lumpectomy (preserving the breast) along with local radiation therapy was the accepted treatment for early stage cancers. Breast cancer susceptibility in several genes has been identified, leading to the opportunity for early warnings in women who carry these genes (National Cancer Institute). According to the National Cancer Institute, in 2010 there will be approximately 207,000 new cases of breast cancer diagnosed in the United States and about 40,000 American women will die from the disease. As noted above, the breast cancer incidence has increased by about 16% but the mortality rate has decreased by 26%, and life-saving therapies are more readily available. Mammography has become more sophisticated as well as more accessible. In the future, the use of cancer genomics will aid in the development of more targeted and less toxic chemotherapy treatments. This is good news for all of us. The story for women in Africa is very different. Breast cancer incidence in Africa is lower, but it when it does strike, it strikes at an earlier age and with greater virulence. The relative rarity of screening mammography and examinations results in more advanced disease once the diagnosis is made. Researchers have found that in African women, many breast cancers arise from a different type of cells than those of Caucasian women, and cancers arising from these cells have a worse prognosis, regardless of race. In Africa, most breast cancers strike women in their 40s. There is a great deal of stigma attached to a diagnosis of breast cancer in Africa, and women are often afraid of losing husband and children, and being ostracized by their communities. Common beliefs are that breast cancer is caused by unsavory personal habits such as wearing dirty clothing or tucking money inside a bra. Many African women believe if they see a doctor, their breast will be cut off and they will be dead within 2 years anyway. There is some truth in this because most cases are advanced at the time of diagnosis and often there is no follow-up treatment. Changing the course of breast cancer for African women will require massive education, overcoming common beliefs and superstitions and the development of early detection centers where mammography will be more available and affordable for African women. National Cancer Institute, 2010. Cancer Advances in Focus. http://www.cancer.gov/cancertopics/cancer-advances-in-focus/breast Science in Africa, April, 2005. Breast Cancer Findings in African Women. http://www.scienceinafrica.co.za/2005/april/breastcancer.htm

Blog 9 The dieting roller coaster

“Jane” is a 41 year old woman who struggles with her weight and her body image. As a young child, she was quite thin, being very physically active and having a normal appetite; however, as she entered puberty, she grew rapidly and became overweight. She was never obese but was uncomfortable with her size and shape, which soon became her major focus in life. Food was never a control issue or point of conflict as a young child, but her mother was thin and Jane always wanted to look like her. Jane’s mother was very supportive (she had been chubby as a young teen also) but she too was obsessed with weight, size and conforming to media-hyped body images. Together they were quite a pair. As a senior in high school, Jane went on a strict diet, lost about 50 pounds and exercised strenuously (she was an athlete in high school) – Jane feels she may have bordered on becoming anorexic. She said she had a lot of thoughts about making herself vomit after she ate because she had a friend who was bulimic, but she never did that. Her parents were divorced and her stepmother made constant comments about Jane’s size while her father never commented or supported her – so she thought he felt the same way her stepmother did. This just fueled her extreme dieting and exercise but no matter what she did her stepmother never had a positive comment. As she matured, she had a number of extreme weight fluctuations – she would diet until very thin, then gain all the weight back plus more. The weight gains seemed to correspond with her being content with relationships with men and the extreme dieting corresponded with periods when she was not involved with a man. After she married, the same pattern continued – happy equaled a heavier weight and times of marital struggle equaled extreme dieting and exercising. Jane has a high stress job which requires a lot of hours and she has children involved in lots of sports and activities as well, so she does not spend much time cooking or planning meals. She is always trying the next new “miracle” diet to lose weight rapidly. She knows her diet and uneven physical activity are not healthy but she feels trapped in the cycle. I asked about her goals for a healthy future and she responded that she knows that her future depends on better habits but she still searches for the “magic bullet” of weight loss.

Hormone Replacement Therapy - my choice

At the age of 30, my left ovary was removed due to a benign tumor. At 40, I had a hysterectomy due to fibroids, endometriosis and adenomyosis. I was adamant that the surgeon leave my one remaining ovary as I did not want to go through surgically induced menopause at 40 - I was really frightened at the thought of weight gain, hot flashes and looking and acting like an old woman. My doctor strongly advised that I have the one remaining ovary removed because of my history but I insisted and he finally agreed. Because of the one working ovary I didn't need to take HRT and the recovery was uneventful, as were the next 8 years. When I finally did start menopause, at 48, I elected to take HRT for hot flashes, night sweats and a host of other typical menopausal symptoms. I also had osteoporosis and the HRT was to treat that also. I took the pills for 7 years at which time my doctor advised that I stop them. I did, but at a price. The hot flashes, insomnia, "brain fog", etc returned. I chose to use some over the counter herbal remedies which did help some and after a couple of years, I was feeling comfortable again. And of course, the OTC remedies did not help the osteoporosis. I began taking Actonel, a medication to treat osteoporosis, but stopped due to the development of esophagitis. I'm not sorry I took HRT - it made a difficult time of my life more bearable and it did put off the worsening of the osteoporosis. I only take calcium, vitamin D, fish oil and a multivitamin now, and half a children's dose of benadryl at night to help with sleep (recommended by my ICU nurse daughter!). I am aware of the risks associated with HRT, but I think I would still take it if I had to do it over again - just maybe not for so long. I am opposed to taking prescription meds except in the most demanding of circumstances. I believe natural health is the way to go and it is working for me.

The Silent Partner - HIV in marriage (film)

In 2004, one third of all new HIV cases in Uganda occurred in married couples. In Zambia and Rwanda, half of all new cases were diagnosed in married or co-habiting couples. In Sub-Sahara Africa, 22 million people are living with HIV/AIDS - 5% of the total population. In some countries, the rate is 1-2% but in others, such as Swaziland and Botswana, the rate is over 20% (AVERT). Most of these Sub-Sahara African societies are patriarchal - women spend their lives being owned, first by their fathers and then by their husbands. In order to prove their strength and manhood, men have multiple sex partners outside marriage and married women are powerless to practice abstinence or demand condom use. Women's health, and even survival, depend on the sexual behavior of men and for the most part, their behavior is reckless and without regard for their own health or the health of their wives and children. For married women, there are no alternatives - they are taught to ask no questions and make no demands for the sake of their children because husbands are the providers. They are taught to always say yes to their husband's demands - if they don't, they can be physically chastised. Cultural attitudes foster acceptance of marital violence - in Kenya, 43% of women report being the victim of sexual violence from their husbands. A recent law against sexual violence in Kenya excludes marital rape as a crime. One problem is that leaders who recognize the urgency of stopping this life-threatening behavior have not identified ways to reach out to the men in these cultures. Millions of dollars in international aid have been thrown at the HIV/AIDS epidemic in Africa but until Africans themselves take ownership of the problem and begin to address the cause of the continuing epidemic it will continue. Women cannot be empowered to take control of their health until men are educated about the extreme risks posed by their behavior and until they are taught to value women. REFERENCES: AVERT, 2009. Averting HIV and AIDS. Statistics. Retrieved from http://www.avert.org/africa-hiv-aids-statistics.htm___ Population Action International, n.d. Silent Partner-HIV in Marriage. Video retrieved from http://www.populationaction.org/silentpartner/about.html#film

State of the World's Children, UNICEF 2007

Despite the monumental gains in health practices and life spans around the world, women still die in the perinatal period (28th week of pregnancy - 28 days postpartum) at a horrifying rate. Many of these deaths are in developing countries where girls, some as young as 8 years old, are married to older men. Young girls' bodies are not developed enough to give birth naturally so many of them die during childbirth or shortly thereafter. In Niger, 1 in 7 females will die in childbirth. Quite often the infant dies also. Keys to reversing this horror story include education, of children and their parents, and fostering empowerment of women to decide their own destinies. When women are educated and empowered to speak for themselves, they begin to demand resources for their children and everyone wins - children, mothers, families and communities. Gender equality is critical to child survival everywhere. Men in patriarchal societies must be taught that women are valuable and that preserving women's health is paramount to the survival of the society. REFERENCE: UNICEF, 2007. State of the World's Children 2007. Retrieved from http://www.youtube.com/watch?v=z8qXlhk2ig0&feature=player_embedded#!

Blog #5 My thoughts on having children

I have some very strong opinions about having children, some of which are not popular with feminists who feel that a woman should be able to have it all - career, marriage, children, social life. But as a mother to 4 children, now grown, I have a perspective that I didn't have when my children were young, and in that perspective, I see this truth - if you can't or don't want to raise your kids yourself, don't have them. The days are gone in which the primary purpose for all women was to marry and produce a family, no matter whether they wanted to mother a child or not. So why do we have children? Some women have children to please someone else - parents, inlaws or a spouse. But is that fair to a child - born because the mother wants to please someone in her life? I think not. Other reasons - to feel personally fulfilled, to fight loneliness or boredom, to have "something" that belongs to her...the list goes on. I think way too many women look at childbearing as a right, not a privilege and look at children as possessions, not human beings. I believe that once that life has been created, that mother has the RESPONSIBILITY to provide a loving and nurturing home for her baby, above all else. That child is entitled to protection, nourishment, guidance, love, understanding, dignity and nurture. Our world is full of throw-away children, conceived carelessly or for selfish reasons, so I believe that women who choose to remain childless should be congratulated for making a responsible decision. Pro-choice to me means one thing – we have the right to choose whether to become pregnant or to avoid becoming pregnant. Responsibility is the key. (Please note that I am not referring here to pregnancies that result from rape or abuse.)

Blog #4 Designing effective birth control programs

In the article from the Module 4 supplemental readings, Sex Education Attitudes and Outcomes among North American Women, authors Monnica Williams and Laura Bonner examined the results of an internet survey of approximately 1400 North American women with a mean age of 19.5 years. Twenty-four percent of the participants reported one or more unplanned pregnancies and 13% reported one or more abortions. Those who received sex education from parents and schools reported fewer pregnancies and fewer abortions than other groups. Among those receiving sex education in schools, there were fewer pregnancies reported when education consisted of combined contraception and abstinence or primarily abstinence. Overall, the participants in this study indicated they were more satisfied with sex education from friends, books and the internet than that received from parents or schools, although apparently, from the results of the data, the sex ed received from parents and schools was more effective since there were fewer pregnancies and abortions in that group. This is a very brief overview of the study but the results could be used to design more effective sex education programs. Young women who feel comfortable with obtaining birth control information from sources such as the internet and books will most likely not put off looking for the information they need due to reluctance to approach a parent or teacher for that information. The data in the study showed that the most favored method of obtaining birth control information was from friends. Of course, if the friends are young and mostly uneducated about birth control, then it becomes a case of the blind leading the blind. I think a really valid way of disseminating birth control information, including abstinence as an option, is through peer education. There are always mature and capable individuals in every population group who can be trained to teach their peers and to refer them to other sources, such as reliable internet sites and books, if further details are needed. The peer educators would need to be educated to recognize situations which would require the involvement of an adult supervisor or parent and trained in techniques to guide that individual into seeking parent or teacher assistance. Finding creative options for effective birth control programs for young people takes educators with open minds and the ability to visualize future effective programs, no matter what methods it takes to get there.

Blog #3 HIV/AIDS __ making it even harder to be a woman

amfAR, The Foundation for AIDS Research (http://www.amfar.org/), is a nonprofit organization that supports AIDS research, HIV prevention, treatment education, and sound AIDS-related public policy. I remember in the early 1980’s when HIV/AIDS first made its appearance in the United States. I don’t remember this part, but according to amfAR, the media (and others) initially called it GRID – Gay Related Immune Deficiency, or “gay cancer”. We now know it was a mistake to tie the disease only to the gay population, but that was the early view of it. Although I have always been concerned about this health issue, it never really affected me personally until just recently when the 32 year old fiancé of my cousin’s daughter was diagnosed with pneumocystis pneumonia, an AIDS related opportunistic infection. He has full-blown AIDS, but never knew he was HIV+. He denies any IV drug use or homosexual contact, so it appears he contracted the virus from one of a great many casual heterosexual contacts during his twenties. So far, his young bride-to-be has tested negative for the virus, for which we are very grateful. But that doesn’t remove the grim fact that if he (and their relationship) even survives this crisis, their lives will be centered around living with and managing this diagnosis. On Dec. 31, 1981, there were 159 confirmed cases of AIDS in the US, with 121 deaths. Being HIV positive was an inescapable death sentence. In 1983, the CDC added a new member to the list of high risk individuals – female partners of men with AIDS. Also in 1983, there was a major outbreak of AIDS in both men and women in central Africa. In 1991, WHO estimated that there were 10 million people infected with HIV worldwide. In 1996, the U.N. estimated that 22 million people were infected. In 1999, despite somewhat less dismal news in the US, in more than 27 countries the HIV infection rate had doubled since 1996 and 95% of all HIV infected people lived in developing countries. At the end of the 20th century in the US, 23% of AIDS cases were in women but in sub-Sahara Africa, 55% of those HIV positive were female, most of whom still to this day have very little access to medical care or treatment. 2002 – worldwide, half of all HIV+ adults were women. 2004 – 15 million children had been orphaned by AIDS. Today, an unprecedented number of individuals are LIVING with HIV (good news) and more than half of them are women (bad news). The turbulent history of HIV/AIDS is relatively short and while things have improved for men, for women in developing countries the prognosis has gone downhill. In the US the story is taking a turn for the better because of the availability of preventive practices and drugs for treatment; unfortunately, in the rest of the world, the story is less than rosy, particularly for women and children. I am affected by the occurrence of AIDS in the US in a round about way and there is hope for survival. Globally, the HIV/AIDS epidemic lurks on every woman’s doorstep, and it’s still a merciless killer.

Blog #2 My opinion about the current state of health care in the US today...

There is no argument any where in the world that we, as a nation, are privileged to enjoy the finest health care available in the world today. The disagreeable fact is that many citizens of the USA cannot afford to access this excellent health care; some through no fault of their own and some because they choose to purchase other consumable goods rather than health insurance. I have a unique perspective from both sides of this debate – I worked in the healthcare industry for 25 years and enjoyed very good and very affordable employer sponsored coverage during that time period. However, from November of last year through today, I have been unemployed and unable to pay for either COBRA continuation or an individual health plan. I am one of the uninsured. After some research, I discovered that I can make an appointment to visit a Parkland Community Clinic in my city and that I will pay according to my income level. This is available to anyone. I have a car so I can get myself to the clinic but if I didn’t have a vehicle, the clinic is located on a bus line. I recognize that transportation could be a problem for someone who is disabled or a mother with several children who does not have childcare support. Accessing available health care resources may not necessarily be easy, but it is available. The key is to educate individuals about the resources that are available to them and provide support in applying for services. I do not agree with the concept of universal free health care for all citizens regardless of income, but I do believe that every child should have easy access to health care from date of birth through the time that they complete high school. Many parents do provide health coverage for their children through an employer health plan or by purchasing an individual plan, but for those children who don’t have health insurance, for whatever reason, health care should be available. One option for school aged children’s health coverage that I believe should be expanded is the school based health center. There are over 1,000 of these clinics in operation in the U.S. today and 89 in Texas (Texas Association of School Based Health Centers.http://www.tasbhc.org). This is a workable alternative and I believe that if children received adequate care and HEALTH EDUCATION, there would be a corresponding decrease in chronic health conditions and a greater respect for a healthy body as they become adults. Health care reform is a massive multi-faceted issue that cannot be resolved all at once, but it can be resolved one step at a time.

Blog #1 HS3133

I am concerned about several women's health issues but the issue that is of greatest personal importance to me is healthy aging and maintaining personal productivity. Being 60 years old, single and having seen savings and retirement depleted by the economic downturn, it is doubly important that I remain healthy and able to be productive well into my "golden years". My concentration is on maintaining physical health (including the most effective treatment for osteoporosis, which I do have), strength and mental acuity, as well as life long learning and a love of trying new things and embarking on new projects and adventures. Healthy eating, physical and mental exercise and enjoying life each day (attitude!) play an important part in my plans for the future. I am definitely concerned about the availability of comprehensive health coverage for seniors as the recent healthcare legislation is implemented. I spoke with two women, one 18 years old and one age 39. The 18 year old is an athlete and related that she is concerned with maintaining physical strength and further developing her athletic ability- she would like to make her sport her vocation, first as a player and later as a coach. She is also concerned with "looking good, having lots of energy and enjoying life and friends, including guys". She said that she is concerned about how pregnancy and motherhood might affect her athletic ability and if she will be able to continue playing if she marries and has a child. The 39 year old is a married mother of 3 really busy children, is involved in a lot of civic activities and she works part time. She related that her main health focus right now is dealing with fatigue due to her busy lifestyle and not getting enough rest, which often leads to migraine headaches. She also deals with some depression and is looking for remedies for both that do not involve taking drugs. Another concern for her is how health coverage for her family will be impacted by the recent healthcare legislation. I have also become aware of another more global health issue that is of great concern to me - the very young age that a significant number of girls are becoming sexually active, some as young as 12 or 13. Aside from the obvious concerns of sexually transmitted disease and pregnancy, I am very concerned about their mental and emotional health as they enter into complicated relationships and encounters that they are not mature enough to negotiate without damage to self esteem and future ability to establish and maintain healthy relationships. I don't think more sex education is the answer - I believe we need to address the reasons that children this young become sexually active, one of which is lack of self esteem and self respect.