Thursday July 30 - Looking Deeply into our National Health

Vietnamese Buddhist teacher Thich Nhat Hanh


National health care is very much in the news right now. I hope that congress can come up with a workable system that gives all Americans access to excellent health care. Our present system is, like almost every enterprise in this country, geared more to profit than to service. It is not so much broken as it is wrong. I think most Americans agree that something must be done to provide good health care for all the people.

In looking at the health care dilemma as with so many tough situations, I find it very helpful to follow the advise of Buddhist teacher Thich Nhat Hanh and look more deeply into the problem, to really sit with it quietly and contemplate. It seems to me the first thing we must see in this deeper look is that what we really want and need is not so much national health care as national health. The health of our people is poor and I do not believe that a national health care system as proposed in any of the versions before congress even begins to address our ill-health. Prevention of illness or maintaining health needs to be a top priority in each person's life and it should be the top priority of any national health care plan.

So why aren't we healthy or more bluntly why are we so sick? Let's just take one common disease, type II diabetes which is reaching epidemic proportions in this country. The Center for Disease Control says that 20.8 million people which is 7% of the US population has been diagnosed with type II diabetes. WOW! As a nurse I would bet that nearly every one of those 20.8 million people received some education with their diagnosis even if it wasn't optimum. They did hear, "eat less and exercise more". You even hear that on TV almost daily. For many people with this disease the cure is really that simple. Yet we all continue to overeat and sit around even when we know how bad it is for us. I want to point out that I certainly include myself in this "we" who struggle with over-eating and weight problems. My weight has yo-yoed for the last 20 years as I gain weight, then diet to lose the extra pounds and then gain them back again. As most of us, I love all kinds of food and tastes and experiences of eating. Let's just say that today I am on top of my addiction but tomorrow or even this afternoon is a still up for grabs. I know first hand how hard it is to keep up a healthy lifestyle. It is work and it takes a lot of support and intention. You could say, just like it takes a community to raise a child, it takes a community to live healthily. Almost universally I would say we do not have that kind of community in this country.

Two thirds of US adults are overweight with a BMI over 25 and one-third of those is obese with a BMI over 30. That means that less than one third of Americans is in the range of healthy weight, BMI of 18.5 to 24.9. Thus we suffer the health consequences of heart and kidney disease and diabetes. These statistics come from WIN - Weight Control Information Network which is from the US Department of Health and Human Services.

Since I was a nurse for twenty-six years and just retired a few months ago, I would like to share just one of my many experiences with this problem. For the last five years I worked as a home care nurse in one of the poorest counties in one of the poorest states in the US. Still many people here have health care provided through either Medicare or Medicaid programs. I don't think that a national health care system modeled on the present system of health care would change things very much here. I saw many, many people suffering the consequences of obesity and poor nutrition. So that I do not violate any one's confidentiality I will use a compilation of situations. But this story even though it doesn't represent one individual is not an exaggeration of what kinds of things happen frequently.

This man was relatively young by my standards these days, about 50 years old. He weighed over 300 pounds. When I saw him he had already had diabetes for 10 years which caused kidney failure requiring dialysis treatments three times a week at our local hospital 25 miles from his home. The usual cost estimate for dialysis is about $150.00 per session. Home care nurses like myself came to his home daily to do dressing changes on a foot ulcer that was refusing to heal. Some of the creams that were used on his wound cost over $100.00 an ounce. We continued to see him daily for over a year. Each nursing visit cost Medicare about $150.00. Since the foot ulcer was not healing he was started on hyperbaric chamber treatments weekly at a hospital 100 miles away. These treatments cost about $1000.00 each time.

During all of this time this man continued to overeat and disregard his elevated blood sugars, often stopping to have hamburgers, french fries and shake at a fast food restaurant on his way home from treatment. Due to his poorly controlled diabetes he also had significant heart disease and was hospitalized several times for heart problems. He finally had to have a foot amputation which again did not heal, so eventually they had to amputate his leg. He spent some months in a nursing home and then again returned home. Obviously by this time he was very ill. Yet he and his family continued to believe that if he could just get the right medical treatment he could get back to being active in his community. Eventually he ended up back in the hospital with pneumonia. He was put on a ventilator when he could not breathe for himself. Even after weeks his family did not want to disconnect the ventilator because of his wishes to have everything possible done for him. It was months before he finally died. A very sad story. Sadly also a very expensive story for the "health care system". The family's finances were used up early in his disease. Essentially his entire bill was paid for publicly. If this is the kind of health care Americans are expecting, I believe any national health care program will fail.

Since 1990 there has been a 76% increase in type II diabetes in the age group of 30 to 40 year olds. So how many more people are there each day who live out a variation of the above story? And why? The most obvious answer to me is that we have become a nation of addicts. We are addicted to over-eating and unhealthy food. This is one of the big problems that I believe a true national health care program would address. How can we get back to health? In the quote below from his book Living Buddha, Living Christ Thich Nhat Hanh is speaking about drug addiction but I think his words apply to the problem of any addiction that is causing us harm.

"Drug users know how destructive their habit is, but they cannot stop. There is so much pain and loneliness inside them, and the use of alcohol and drugs helps them to forget for a while... trying to stop the drug traffic is not the best use of our resources. Offering education, wholesome alternatives, and hope, and encouraging people to practice the Fifth Precept ( this is a precept on mindful consumption) are much better solutions. To restore our balance and transform the pain and loneliness that are already in us, we have to study and practice the art of touching and ingesting the refreshing, nourishing, and healing elements that are already available. We have to practice together as a family, a community, and a nation. The practice of mindful consuming should become part of our national health policy. Making it so should be a top priority..."

At first glance like most of this gentle teachers words, they seem too simple, almost child-like. But on deeper consideration, I believe there is much here for us to consider. What would it mean to have a health care system that offered "education, wholesome alternatives, hope and encouragement" to practice a precept of mindful consumption? What would it mean to make mindful consuming a "top nation health priority"? How can we learn to practice "the art of touching and ingesting the refreshing, nourishing and healing elements that are already available."? These are discussions that our communities need to have. We can not just leave it to our congress people. It is clear that they are influenced by corporations with their zeal for greater profits. This is another case where that old bumper sticker hits the mark, "If the people lead the leaders will follow." We each need to take responsibility for our health and make a contribution to the health of our community. Maybe the politicians will see the light some day but we can't count on it. We have to start creating the health we want for yourselves and our communities.

Of course I clearly understand that we cannot prevent all illness and we are not guilty for getting sick. Poverty and violence in one's life take a tremendous toll on a person's health. We don't have complete control over the quality of our air, water or our food or the predispositions of our genetics. But we do need to take some personal responsibility for those many aspects of our health and our nations health over which we have some control. In our society it seems like blasphemy to suggest that our body is not our own. Individualism is one of our gods. But just listen to a little bit different view again from Thich Nhat Hanh in his book The World We Have.

In modern life people think that their bodies belong to them, and they can do anything they want to themselves. "We have the right to live our own lives", they say. The law supports such a declaration; that is one of the manifestations of individualism. But according to the teachings of the Buddha, your body is not yours. Your body belongs to your ancestors, your parents and future generations. It also belongs to society and to the other living beings. All of them have come together - the trees, the clouds, the soil, everything to bring about the presence of this body....Keeping your body healthy is a way of expressing gratitude and loyalty to the whole cosmos, to all ancestors and to future generations. If we are healthy everyone can benefit from it...

You may not agree that your body is not our own. But I think everyone can agree that if we are healthy everyone can benefit from it. As I think about this new way of approaching health, I realize how many of the essential questions and issues are not individual but are questions for the whole community. Should we let corporations profit from selling soda and candy in our schools or serving our children milk laden with growth hormones and antibiotics? How can we support our local growers and farmer's markets which provide us with healthy food? What should we serve at our community gatherings? How can we support people who need to make changes in their lives to get more healthy? I would like to see real health taught in our schools, in our hospitals and clinics, our churches and community centers. Obviously the questions and issues are far-reaching and many, but we need to start talking and making some changes. Since our president is pushing for national health care reform maybe we can also talk about real lasting reform and the deep questions we need to address in order to achieve an acceptable level of national health.

July 9, Thursday - Lesson #2

A rocky monster in Bomarzo Park, Italy, photo by Robert Fogliardi (click on picture to enlarge)

There are in life many things over which we have no control. In fact that might be the first big lesson that most of us need to learn. There are also some things in life, over which we are the only one who has any control. This may certainly be the second big life lesson. We all have our tendencies to either try to control everything or refuse to take control over anything. For much of my life I have been one of the former types, totally exhausted most of the time from trying to keep everything together. Believe me it's hard and most importantly, it doesn't work. One thing I have noticed from talking with my friends, control is a pretty common addiction

More than any other situation, being the mom of a son with mental health and addiction problems has taught me the lesson of letting go, not once but over and over again. I cannot ensure that he has a safe place to live, adequate food, or even that he does not kill himself in the process of satisfying his addictions. There is no bottom line, absolutely nothing to hang onto. Anything could happen and much of that anything has already happened.

I was first aware of his drug problems when he was twelve. He's now nearly forty. I could not even begin to tell the story of what he has been through. Note I did not say what "we" have been through. That's progress. He has been through scores of treatment programs, hospitals, jails and violent, horrific situations on the street. When he was younger, I felt as crazy as he was most of the time. As he got older, very gradually, I was able to create some space between us, to extricate myself from the craziness some of the time. I never stopped loving him. I just started noticing that nothing I did to help ever made any difference. It is a humbling experience not to be able to help your child. But by the time he was thirty-five I pretty much had it figured out and had my control impulse under control. Have you ever noticed that someone up there seems to be watching these things, so that as soon as you have one life lesson under your belt you get sent a package marked "Lesson #2"?

Lesson #2 in this case came in the adorable package of a baby boy. In other words my son who was barely able to navigate the world on his own, now has a child. This means of course that his decisions, however misguided, now affect not only him, they directly affect a little boy. When the baby was born, I rallied to help with essential needs. Now a year and a half later, they live one step from the street. I want my son to get a job and take care of his child. But I know this may not happen.

On Monday I am leaving for Minnesota to visit them. Since my "fix-it" mode of control is not totally dormant at this point, I started to think of ways I could help the situation. I spoke with my son about the possibility of his entering a treatment program to start the process of being a responsible dad. He didn't say no. So I made an appointment for an intake assessment at a facility that specializes in the treatment of mental illness complicated by drug addiction.

For a couple of days I went around congratulating myself for being a helpful mom and grandma. But that didn't last. Today my son called to tell me that he is not going to the appointment because he has been through a million treatment programs and what he really needs is a job, not a program. I tried to explain that he can't get or hold a job given his present state of addiction. He thinks other people won't notice. As we talked, I felt the old lesson come back. It is time to back off and stop trying so hard to control something over which I have no control. I could probably talk him into going to the assessment interview. But as soon as his addiction is confronted in the program he will be out of there. I'm pretty sure that this little dream of things getting better for my son and grandson is not going to happen in this way.

Letting go is hard, but not as hard as it used to be. Part of the difference is my maturity, a euphemism for aging. But also some of the difference is a benefit of my spiritual practice, especially silent meditation. Sitting in meditation, and continually letting go of thoughts as they arise is good practice for letting go in real life. Maybe that's why they call it "practice". Letting go of my plan to help seems easier than it used to be. I still have an ache in my heart, still a glimmer of hope that something good may come of this. But I am very clear that what I need to do now is to "let go, and let God" as they say in Twelve-Step teachings.

I came upon some appropriate words of wisdom in a little book that I have been reading over the last few weeks. Notes From the Song of Life by Tolbert McCarroll is a book of thirty short lessons. These lessons are meant to be read and contemplated one a day for a month. A few days ago the lesson was entitled "Detachment". So I went back today to reread it. Sure enough, the shoe fits:

To detach from your preoccupations is to have faith in the life process and to know that you are a part of it. Through detachment you do not forsake people and your environment. Detachment is a means of connecting with them at a deeper level. For it is not people or things that distract you, but your desires. It is from these desires that you must learn to detach.
Desires are like demons. There are many demons, each with his own name and characteristics. Some are called respectability, security, superiority, control, recognition, stubbornness; all creatures from the hell of self-centeredness. These are the demons that separate you from people and life.

When I go for my visit to Minnesota next week I trust that there will be one less demon separating me from my son, my grandson and our life together for that time. All the problems will still be there. But I will try to be there too. That may be the best gift I can give them both.

July 3, Friday - Picking Blueberries

Necessary preparations include long-sleeved shirt, straw hat, sun lotion and water bottle. U-Pick-It farmer gives me two plastic gallon buckets with smiling instructions to pick all the purple from each bush that I start. I agree to his conditions.

Row on row of person-sized, evenly spaced berry bushes with wide newly mowed grass paths between the rows. At eight-thirty AM the sun, already warm, casts a west-sided shadow beside each bush. Two straw-hatted, early bird ladies already picking on the far end, voices barely audible. Snatches of conversation drift through the clear morning air, "good-old boy", "even he voted for Obama". Choose a row far from the talkers. Fingers move haltingly at first seeking the plumpest, most purple delights nestled among the unripe green berries. Notice the flawless blue sky, the still air, the creeping heat. Berries plunk! plunk! plunk! on the bottom of the plastic bucket.

Listen to birds singing and some noisy black birds stealing berries farther down the row. Sit down cross-legged in the grass to pick the lower berries. Bend, squat, stand, bend, squat, sit. Send out a little prayer for a cloud. Then notice that it probably isn't going to happen in such a clear sky. Change prayer request to a pleasant breeze. A little cool breeze passes by touching my face. Smile.

Endless picking, newly discovering that blueberries are quite small. There are thousands in a gallon. First bucket finally full. No, it can hold a few more. Fifteen minutes later, now it is full! Return to the car with over-flowing bucket of berries. Think about leaving. Then think about blueberries for breakfast all through the long winter. Decide to stay. Return to berry bushes with water bottle in hand.

Ten O'clock, shadows beside the bushes getting smaller, sun heating up. No birds singing just more squawks from the thieving black birds down the line. Suddenly remember that I have not yet tasted the berries. Internal conversation, "is it OK to eat the berries while I pick them?" Decide that everyone would do this so it must be OK. Pop a couple of the smaller ones into my mouth, saving the big ones for winter of course. Yum! There is nothing like the taste of blueberry. Memory of camping with my kids in Michigan and picking wild blueberries for our breakfast. Nostalgic for the days of camping with the kids.

Feeling a little heat sick. Picking more while sitting down and looking for that shrinking shadow next to each bush. Developing pride in "my" beautiful blueberries. After all this work do I really have to pay for them too? Think suddenly about migrant workers, all the people who pick our fruits and vegetables so that we can go into air-conditioned stores and buy them. There's so much we don't know about every piece of food we eat. It must be really hard work to pick in the heat day after day for hours on end. Vow to learn more about where my food comes from and be more aware of what I am buying at the store.

Return with my two full buckets to the farmer. We have a really fine conversation about the rewards and trials of small farmers. He tells me how he likes to try growing heirloom plants and unusual varieties but that it is hard to sell them at the Farmer's Market in Harrison because most people want the standard variety they know from the super market. He grew a great Austrian variety of pink eggplant last year but everyone asked for the purple kind they were used to. He said the pink variety was sweet and tender with skin that did not get tough. We talked about possible ways to educate folks about new varieties, maybe with recipes or even clandestinely slipping something new into their bag to see if they would try it and come back for more the next week. We conclude that America's food production and consumption is in a sorry state and that the work he is doing as a small local grower is very important. I pay for my berries and both of us seem quite satisfied with our morning.

Cloudless sky, bright sun,
blueberries hide from busy fingers.
Heart discovers the juice.

To learn more about our food and buying local check out some of these great sites:

LOCAL HARVEST where you can find a list of local growers near you

Animal, Vegetable, Miracle by Barbara Kingsolver and family

Small Planet Institute with Frances Moore Lappe and Anna Lappe

FOOD FIRST - Institute for Food and Development Policy