Wednesday, April 1, 2015

The Wrong Way to Grieve on "The Bachelor"

There is no one single right way that people grieve a deep loss, neither in the midst of the sting of a fresh hurt nor in the subsequent days, months, and years.

On this season of ABC's reality show, "The Bachelor," there were two widows, one of whom became very controversial due to personality clashes with other women and due to famous lines, such as, "I am immeasurably blessed," and, "I love my story. My story is tragic, but my story is amazing," and, "My story is beautiful."

Of course, the interviews where these phrases came out were juxtaposed by editors with scenes of her sharing her story with the bachelor himself, portraying her statements and motives as manipulative.

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On more than one occasion, individuals articulated confusion, anger, and offense over her expressions and ways of dealing with her loss, some even questioning whether she had ever lost a husband at all. She just didn't act like someone who had lost a spouse.

Watching these interactions and comments made me feel truly sad and to me reflected a profound misunderstanding of grief and loss, regardless of what other conflicts existed in the house. I decided to write this blog post, not because everyone should care about what happens on "The Bachelor" (I'm embarrassed to admit I watched this season), but because this very public strife offers a chance for all of us to consider what it really means to walk with others through challenging times.

Having lost a few loved ones myself and having grieved over other situations not involving death - and perhaps more importantly, having had many friends who have suffered much more intense losses - one thing I have learned is that there is no one way that people grieve. There is no one right way to experience loss and no one right demeanor to express to the world, in the moment or years later.

Certainly, there are some ways of dealing with grief that may be personally destructive (and I would hope close friends would intervene if I went down one of those paths some day), but beyond directly harmful coping techniques, there is a very wide range of healthy ways people experience, express, and move through loss.

Just because someone does not look sad the way you expect them to does not mean they are not grieving. Just because someone does not use the words you would choose in such a time does not make their grief less real. Just because someone reconciles a loss to a greater significance in a different way than you would does not mean they have not experienced the grief profoundly.

I wish the best for all of the individuals who participated on this season of "The Bachelor." Each of us will experience losses in our lives in one way or another, and I hope that when those times come, we can be surrounded by loved ones who will understand that we are grappling in our own ways and will support us on our paths to healing, whatever forms those may take. And I hope that we too will be the kinds of friends who learn to walk alongside others who are grieving in ways that bring hope and peace.

Tuesday, March 31, 2015

First Trimester Experiences of the Mind-Body Connection

Matthew and I are expecting our first child in September 2015!

I am at the start of my second trimester (now 15 weeks along). Most surprising so far, never has the mind-body connection been more real to me than during my first trimester of pregnancy.

9-week Ultrasound
The first trimester was rough. I was tired almost all of the time (constant napping) and got sick to my stomach almost daily, sometimes multiple times in a day. Whereas television makes morning sickness look cute (like on the Mindy Project this season – just throw up in a drawer, smile it off, brush your teeth, and then enjoy intimate time with your partner right after), it was anything but cute in my experience.

My expectation was an hour of nausea a day or some fleeting moments, with most of the day being normal; my reality was more like a couple hours of feeling good on most days while just praying not to throw up in class or on mass transit the rest of the time. Doing all of the activities of normal life while feeling extremely ill all day and with very few people around you having any clue that you are suffering in front of them is pretty lonely and hard. My most memorable lesson from those months was that throwing up a raw apple – even a full hour after eating it – is so painful and chokes you so much that it can burst blood vessels in your eye lids and cheek bones. (And I learned that particular lesson twice.) I know it sounds pretty graphic, but it was my everyday experience until I recently started feeling good more of the time than I feel bad.

Although people kept telling me that it would soon pass, having never had a stomach flu or food poisoning for two months straight before, “soon” didn’t sound very soon to me. It was hard to see past the moment.

But the challenge was not just in the physical. The first trimester is a hormonally tumultuous time, which can make it emotionally challenging for many women already. However, I found that when I was physically ill, my ability to control my thoughts and emotions and to lean towards optimism was much more limited than on the days when I was feeling physically stronger.

Having a child was a planned event for us, so I was not prepared for all of the mixed emotions that would come along with it. Although we have both always known we wanted children and feel we are as prepared now as we are likely to be, I think we also both feel satisfied with our lives and marriage as they are without a child right now. I never felt like something was missing. Rather, the decision was more about wanting to open myself up to what God might want to do with and in me – the ways He might want to grow and change me – through the special relationship of parent and child and through the unique challenges that parenting brings.

Many people I know with children have expressed that it is the hardest thing they have done, but that they now feel less selfish, have realized they are capable of more than they ever thought, and have a bigger view of God and the world due to the experience. On my best days, these were the things that encouraged me and gave me hope.

But when I was leaning over a toilet feeling sick, or laying on the couch moaning, or sitting on mass transit just trying to make it to the other end, it was difficult to feel any connection to those encouragements. In those moments of sickness, the fear and negativity easily took over.
None of our close friends nearby have kids yet – they will not understand or will write us off as being unavailable now. The culture of parenthood here in the Bay Area is very different than what I saw growing up, and people seem to disappear into another world. What if I don’t want to be disappeared? Do I even have a choice living here?
Or what if it’s me that becomes a bad friend? Of course I will have less time, but I lead a busy life now and still try to make margin for important people. What if I lose all of my margin and the ability to be available to those in need?
Our families don’t live nearby. We will have no practical and familial support. This is going to be very lonely. And then there's the added downside that the going rate for babysitters these days is astronomical. How will we ever do anything just the two of us again?
My new career in public health is just getting started, as I will graduate with my MPH in May. Will anyone hire me while pregnant? Do I even want to work during the last few months of pregnancy? What if I take a break until the baby is a few months old and then employers don’t understand when I go to apply for jobs again?
My body is changing. Even the purposes of my body parts will change. I like the way they all function now and don't like the idea of having to share so much of me with a little dependent person. Not to mention the skin stretching and the organ smushing and all of the other fun things to come. 
I never had an overly warm and fuzzy view of having a baby in the first place. But I still want a family and at least expected the prevailing feeling to be happiness when our plans came to fruition. What is wrong with me that I feel so negative so much right now? I should be feeling something different than I am right now. There are people all over the world longing for what I have right now. I should be thankful that it happened so quickly and that God is blessing us with a child. Can all of these confused feelings really morph into a good and loving parent?
And perhaps the darkest place for me and the most prevailing thought of all: a baby will change our marriage relationship forever and change my life – but I truly like my life and my marriage right now. What if everything just goes south? Will it be worth it? What if after that six-month “hard period” that everyone talks about, we don’t rebound out of it into a healthy rhythm again? What if these are the last months of this great thing we now have, to be replaced by something mediocre?
I wish I could say these thoughts were fleeting, but they weren’t. They came and went in varying intervals, sometimes sticking around just for a few minutes and other times for a few days. And the sicker my body felt, the harder it was to cheer up or listen to other voices. The body is so deeply connected to the mind and spirit, so intertwined, that I could not separate the experiences of the two. Many tears were cried during the first trimester, both over the pain in my body and the confusion in my heart and mind.

Today, going into my second trimester, I feel like I am in a better place than I was for most of the last couple months.

Sharing honestly with close friends has made a big difference. An extremely supportive, understanding, flexible, and sacrificial husband has made a big difference. Spending time in prayer and scripture has made a big difference. And in a very real way, not throwing up every day (just some days) for the last couple weeks is making a big difference, too.

Today, I have been optimistic about our growing family. I have thought about the ways I want to savor and enjoy this time, instead of wishing away the days and weeks. Today, I remember that billions of people have entered into parenthood before me, that God promises never to forsake me, and that He will lead me through challenges in whatever way He knows is best for me. That gives me reason for hope and peace in this time of change.

Friday, March 20, 2015

Big Soda and the Open Truth Now Campaign

Full disclosure: I drink soda every now and then, and I really like it! Sometimes I even sip on soda to calm an upset stomach. But knowing it is unhealthy, I try to limit my intake.

Recently, on my morning Bart commute, I have been seeing signs like this one, which reads, "Big Soda says open happiness. What's happy about diabetes?"

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The Open Truth Now campaign, led by Youth Speaks Inc. and UC San Francisco's Center for Vulnerable Populations at San Francisco General Hospital, is riding on the heels of Berkeley's historic passage of a one-cent-per-ounce soda tax to keep the anti-soda train going.

The soda tax passed in Berkeley with a wide margin, despite millions spent by the beverage industry to prevent it, while a similar two-cent-per-ounce tax measure lost in San Francisco (with 55% of voters in favor, not enough for the 2/3 margin the measure required). While public health supporters of the measures pointed to evidence that even a small tax changes behavior (more than education typically does), many opponents felt the tax was an example of ineffective overreach by an overly controlling "nanny state."

The Open Truth campaign is now tackling the issue from a direction that many opponents to the law advocated - reaching not for our wallets but for our brains, by educating the public about critical media consumption and the health consequences of sugar intake.

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According to Dr. Dean Schillinger, "Americans' sugar consumption has tripled over the past 50 years. And sugary drinks are now the No. 1 source of calories in the American diet — and a major contributor to Type 2 diabetes. Just one 12-ounce soda has about nine teaspoons of sugar — more than the recommended daily maximum for adults and more than three times the daily maximum for kids. Just one to two sugary drinks a day increases risk for Type 2 diabetes by 26 percent."

The ads seen around San Francisco focus on youth and aim to expose the marketing practices that companies have used to target youth of color in particular. The posters allude to the serious increase in diabetes prevalence in recent years, pointing out that the happiness promised by advertisements has actually led to a scourge of illness in many communities.

In many ways, the message of these ads reminds me of the most effective anti-tobacco ads of several years ago, which I wrote about in an earlier post:

You can follow the Open Truth Now campaign on Facebook here:

What do you think? Is education, taxation, or both the best way to limit unhealthy consumption of sugar-sweetened beverages? Will the Open Truth Now campaign make a difference?

Sunday, February 8, 2015

What Is Public Health Anyway?

Now that I am in my last semester of my MPH program, I am often asked what I plan to do when I graduate. For the immediate future, the answer is, "I don't know yet! I need to start applying to soon as I get my capstone project done!"

But along with this question is often an undercurrent of confusion - and sometimes an openly voiced question - of what exactly public health is? I mean, I'm not training to be a doctor or a nurse. What do public health practitioners actually do?

The answer's complicated.

Public health can mean nearly anything. If something has any tie to health, you can bet there are public health professionals working on it. Many public health professionals are also doctors and nurses. But many others, like me, are not.

In general, I explain public health this way. Traditional medical professionals are generally concerned with treating an individual once you get sick or engaging in proximal prevention at the individual level (when you walk through their doors, they can tell you to eat better foods or take a pill to keep your blood pressure down to prevent further issues). Public health, on the other hand, is typically concerned with preventing disease in the population at large (or in a group of folks) by affecting health further "upstream," ideally long before any symptoms related to disease emerge.

For example, whereas a doctor may refer you for a mammogram to catch breast cancer early, public health would investigate what is it that puts some groups of people at greater risk for breast cancer in the first place? And what is it that affects breast cancer outcomes beyond the biology of the disease?

For example, if a large group of individuals do not have insurance and therefore cannot access doctors, how does that change the outcomes for that group and others in similar situations? Further upstream still, if they do not have insurance, why? What circumstances are contributing to lower rates of insurance in certain communities compared to others? Also, are there any experiences in the population at large that can be changed to lower rates of breast cancer itself? For example, if eating certain foods might decrease risk, why is it that some groups eat those foods and others do not? What are the cultural norms around food? What is the availability and quality of produce in a neighborhood? What is the availability of disposable income and time for that group to invest in healthy eating? Or what types of chemicals are found in one location that are not found in another which might increase risk of cancer? How are these exposures unequally distributed across neighborhood, socioeconomic, racial, and other lines? Or what is it that leads to greater stress and thus greater risk for disease in one community compared to another?

And then public health might ask, now that we have answered these questions and know there are differences in experience for different groups, which lead to differences in disease outcomes (what we call "disparities"), what can we do to improve the average experiences and exposures of the populations who are not achieving optimal health?

The answers to that question can range from vaccination campaigns that broadly affect rates of infectious disease, to economic development initiatives that aim to improve overall conditions in a neighborhood, to policy changes that limit toxin-producing industries from concentrating in low income neighborhoods, to organizing communities to campaign for changes that matter to them. Public health interventions can be Medicaid expansion or quality improvement of the patient experience or violence prevention efforts or reducing stigma and increasing health care access for a particular group of people. Public health can mean creating school gardens to increase vegetable consumption or teaching sexual education to students to lower rates of STIs and unwanted pregnancies. Public health can involve educating the public about the benefits of breastfeeding or campaigning for a new farmer's market to increase access to fresh produce or removing lead from buildings frequented by children. It can mean encouraging exercise programs in schools or limiting advertisements of unhealthful products or requiring restaurant employees to wash their hands after using the restroom or campaigning for equitable housing rules. Public health can mean increasing employment opportunities or teaching stress management classes or passing stricter laws about elder care abuse or requiring safety precautions in factories or creating emergency preparedness plans.

And, get the idea.

Public health can be almost anything that aims to prevent injury or disease and to decrease health disparities between groups. Public health also often involves research in how to do all of these things well and how effective our efforts really are at preventing disease anyway.

Ultimately, decreasing health disparities is what I want to do when I graduate! Exactly what that will entail is TBD, but I'll be sure to keep you posted!

Friday, November 28, 2014

Music Therapy and A Song for the Holidays

For Thanksgiving this year, most of our good friends were out of town. Luckily, we were still able to have three amazing friends over for turkey and stuffing and all sorts of other Thanksgiving goodies. Two of them were brand new friends who moved here only two weeks ago!

There is something special and immediately bonding about chatting over a plate of comfort food on a special occasion. We look forward to many more meals over which we can get to know our new friends better while we continue to grow closer to longtime friends. The more the merrier!

One of our new friends shared that she trained in music therapy, so I took a moment today to read a little bit about how music therapy works. I am a newbie to all of this information, but from what I read, what many of us understand intuitively about music's ability to change our mood and even our whole day has also been proven empirically.

Music can affect both mind and body. Music therapy can change the speed of brain activity, relieve stress, lower blood pressure, and improve sleep. It can even help stroke patients in their movement recovery.

So in honor of our enjoyable Turkey Day and the start of the holiday season, I thought I would share one song that has touched me deeply, provoked emotion, and helped me relax this year.

Pentatonix competed on NBC's The Sing-Off. They, and all contestants on the show, sing a cappella, which means that their music is made with only their voices. That includes drum sounds and all - no accompanying instruments allowed! (Reminds me of my high school choir days!) After my favorite group, Afro Blue (see here and here and here), was voted off the show, I got behind Pentatonix, and they did not disappoint! I was constantly astounded by the innovative and rich sound that this group made with just five mouths. (To see them on the show, check out here and here and here. For some of their incredible a cappella work since, see hereherehere, and here.)!

And without further ado, below is the song I want to share today, Pentatonix' beautiful and touching rendition of a holiday classic, "Mary Did You Know?"

Wednesday, October 29, 2014

California Gold

I seem to be on a media kick with my blog posts lately. Here is another such post!

I have noticed on my Bart rides home that there is a new ad campaign in Berkeley encouraging residents to use their "green bins" to recycle food scraps, as well as soiled paper/cardboard. These can then be composted to enrich the soil, aka "California gold."

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Did you know that California produces about half of the nation's fruits and vegetables in our central valley region? For some items, such as artichokes and walnuts, it is as much as 99%! That's why we care about soil.

The ads are produced by Ready Set Recycle, a campaign in Alameda County to help people learn how to properly sort their refuse. They even offer prizes, like gift cards, gardening compost, and fresh  food boxes from local farmers, for engaging in certain activities that support learning to recycle.

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One tricky thing is that businesses in Alameda County can contract with private recycling companies, which may not follow the same rules as the curbside program. For example, where I work, a Starbucks coffee cup can be composted (green bin) and the lid can be recycled (blue bin). In other places, the lid may not be recyclable and would go to landfill.

So what does recycling and composting have to do with public health?

As it turns out, the environment affects our health! Things we do to and for the environment can have lasting impacts on our health. For example, according to the EPA, recycling can play a role in reducing GHC emissions, which are associated with chronic illnesses like asthma. For more information on waste disposal and public health, see here, here, and here.

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Does your town, county, or region offer large scale composting? How has it changed your thoughts about waste or the environment?

Saturday, October 25, 2014

Health Insurance Changes Behavior: Moral Hazard

This semester, I am a Graduate Student Instructor for the undergraduate course Public Health 150D, Introduction to Health Policy and Management. I am really enjoying working with the students and am having fun helping them learn about the U.S. health care system! Here is something they learn about in our class:

UC Berkeley requires students to have health insurance to enroll in the school. When many of my classmates started graduate school, they had previously been working in settings that did not provide benefits and had therefore gone without some health services for a period. Once they started school and had insurance through the university plan, they got very excited to use those services to the fullest!

New glasses? Check!
Teeth cleaning? Check!
Pap smear? Check!
Flu shot? Check!
Sore throat? Why not get it checked out? Can't hurt! Check!
Ski trip? I'll have to save up to go, but at least if I get hurt on the trip, I know I'm covered!

Did you know? This phenomenon actually has a technical name!

Moral Hazard in health care is the tendency to behave differently when you have health insurance than when you don't. It can include both engaging in riskier behaviors (because you know you have insurance if you get hurt) or using more services (because they are covered fully or in part by your insurance).

Furthermore, it turns out that the better our insurance coverage (lower deductibles, lower copays, lower coinsurance, etc.), the more services (and more expensive services) we are likely to use! (See publications on the RAND Health Experiment and other similar findings.)

The name "moral hazard" makes it sound like this is a series of bad or wrong choices. But that is misleading, in my opinion. Sure, insurance companies dislike it, and in some cases, moral hazard can involve over-use of unnecessary services. But for most of us who just want to take care of our health, it is actually quite logical to weigh the risks and count the costs when we make everyday decisions. If we can afford it, of course we want to get the services that might improve our health!

If you have never heard the term "moral hazard" before, you have just been introduced to one concept from PH150D: Introduction to Health Policy and Management. And now you know!