Thursday, February 11, 2010

Once more unto the breach, dear friends, once more...

The game is truly afoot, dear friends, and with just a couple weeks until the "Health Care Summit" on February 25, I urge you dishonour not your mothers, follow your spirit and upon this charge cry 'Give us substantive health care reform!'

The breach that needs filling today is not the gap in the wall of Hafleur but the gap in health care access, cost and quality. What I'm asking you is über-simple: contact your state representatives and the media and show them your mettle. One website allows you to do both with a couple clicks and you can use the following letter as you see fit, or compose your own, to tell them just what you want them to do.


I am writing to you as a member of [INSERT YOUR COMPANY or ORGANIZATION NAME] because today offers a special opportunity to make history through the passage of substantive and intelligent health care reform. We believe that today we have come too far to turn back and that many lives, not just elections, will be lost if we do not make changes to the way health care is accessed, paid for, regulated and researched in our country. The stakes may never have been higher.

We believe in giving the best evidenced-based medical care that money can buy, and giving it so that it helps the greatest number of people. We believe in a fair and compassionately regulated system that guarantees every member of our society a minimum level of care and services while still encouraging the best that innovation and research has to offer.

In short, we believe in the following fundamental areas of reform and we believe that a majority of rational and compassionate Americans like us would agree to their necessity:

Prevention… we believe that an ounce of prevention is worth a pound of cure, and costs less too. We need to support and expand primary care, preventative care as well as community-based and home-based care.

Research… providers need to be free to do what is best for the patients that they know best, but they deserve to have the best guidelines, protocols and clinical research possible to help guide them in their decisions. We support Evidenced Based Medicine which means more high quality and unbiased comparative trials and research. More longitudinal meta-anayses. More safety studies. This is a job for someone like the NIH, not drug companies or groups that have vested interests.

Choice… people should be able to choose their doctor and should have at least several insurance plans available to them. This is not the case in many areas of the country or with many employers, which is why we advocate for public options and national exchanges where individuals and groups can shop for insurance plans in a regulated and fair market.

Cost… there will always be a finite amount of resources. The question is how they are allocated. These decisions should not be driven by profit, but from a public health perspective of what will do the most good for the most number of people. Currently there are insurance companies telling providers what they can and cannot do, we believe these decisions would be better made by public health officials. We also need out of pocket caps for policyholders because there is no point in having insurance if you can go bankrupt when something goes wrong. Finally, we need to lift the yearly caps for insurance companies because there is also no point in getting chemotherapy for cancer only to die of a cold because you passed your yearly limit.

Accountability… taking care of people is a serious responsibility and all aspects of the system need to be held accountable. Nevertheless, punitive malpractice suits may not be the best way to do this. We need to put an end to defensive medicine by reforming malpractice law. National oversight and regulation of hospitals, payers and providers is a better way to enforce policy, set best practices and create accountability.

Access… the best health care in the world is all for naught if there is not adequate access to it. This means starting with giving access to the millions of uninsured, but it also means guaranteeing proper access to the basics of a healthy lifestyle: fresh fruits and vegetables, clean air and water, reproductive services, and education about age appropriate diet and exercise.

Because we hold these ideas to be vital to the very survival of our health care system, economy and moral fiber as a nation, we urge you to take action now!

We urge you to pass a substantive, intelligent and compassionate health care reform package that includes the fundamental issues described above.

Respectfully yours,
A concerned and voting citizen


Tuesday, February 2, 2010

Ethiopia 2009--super Gobez!

Debbie and I are going to spend the holidays warming up under the African sun, or at least that's the plan. This is also my "meet the parents" trip. No pressure, but Debbie's high-school friends used to call her dad "the General". I've already met several of Debbie's aunts and cousins here in the city and I'm hoping that their preliminary reports will have helped laid the ground work for the coming encounter. Debbie has not been helping things by telling me about all the things I should watch out for in terms of etiquette, like standing up when her parents enter the room, not talking with my hands in my pockets, not licking my fingers, and how elders from the village might spit on us as a sign of respect--and this is exactly what happens to Debbie when she is getting her personal blessing after St. Gabriel's, though the man spits towards her hands that he is holding rather than on her head or face...

But let's start at the beginning, our trip really begins in the Dulles airport where we are stuck for over three 3 hours. We’ve already avoided a blizzard in New York and this delay makes a long trip seem even more punitive. It’s funny because as we were walking through the terminal we overheard a boarding announcement explaining that the airport is really busy so the flight to Cancun would be using a temporary boarding gate. We find, however, our Ethiopian Airlines flight at the far end of the terminal all alone with several empty gates around it. It’s almost as if it has been quarantined here so other flights or airlines can go about their on-time business without being affected. As these things go, there is no clear reason why we are not boarding the plane that is sitting right there. At one point they announce we are waiting for “the boarding agent to bring a document” which could mean anything or nothing, then later they claim we are delayed due to the weather. The runways are clear, however, and the flight to Cancun is long gone, so go figure. The pilots and crew do not seem phased and sit in a cluster chatting or napping in the corner. We are still in DC, but somehow we are already on African time.

Speaking of African time, Debbie has always had her own sense of tardiness. She is never late for court, but misses our fourth or fifth date because she was taking a three-hour shower. It's what I call DST (Debbie Standard Time) or what Polly Platt might call quark-chronics. Here in Ethiopia, things definitely move at their own pace. When we wake up at 3:30 pm (yeah that's right, I said it) it is actually 9:30 pm Habesha or Ethiopian time. So if you ask someone when they are coming over to fix the plumbing, for example, you may need to clarify whether you are talking about Habesha or Ferengi time--not that it means they will arrive à l'heure, of course.

One explanation for why Ethiopia has it's own clock is that because it is so close to the equator, days are generally 12 hours all year round (and nights as well), so Ethiopians got into the habit of counting the hours from sun up to sun down, which is about 6 hours different from what the folks in Greenwich would have you believe (sometimes six hours less, sometimes more). There are also 13 months in the Ethiopian calendar year and a difference of about 7 or 8 years in the date, depending on whether you arrive before or after the Ethiopian New Year in September. This embassy webpage provides a good explanation of it all and how it came about.

When you talk about Ethiopia, Western people often think of two things: famine and coffee. True besides coffee exports, the Ethiopian economy is based heavily on subsistence agriculture which makes it vulnerable to crop failure and famine, but in spite of this, or perhaps because of this, Ethiopian culture practically revolves around eating. It is considered almost insulting, for example, to go to someone’s house and not eat seconds or even thirds. I’ve learned this the hard way as Debbie’s aunt locks eyes with me and then slowly extends a finger back towards the buffet table. Blurp. The trick is to start low and go slow. Don’t put too much on your plate, eat slowly and always have something on there. Because an empty plate is apparently a sign for give me another large helping in the Horn of Africa.

The story I love the best about Debbie’s mom, who is definitely one of the kindest, sweetest women on earth, involves her passing me the bread basket one night. This was about day 8 or 10 of the trip and I have just gotten over being sick. I’m almost grateful for my flu, however, because I haven’t eaten anything for like 24-hours and my stomach is no longer feeling like a packed canon. I’m trying to reach for a small piece of bread but somehow the basket keeps moving and my hands find themselves over the biggest piece in the basket. When I finally realize what is going on, I look up to see Debbie’s mom with a huge smile on her face. So sweet.

Ethiopian food is definitely delicious, and fun to eat too! Ethiopians love meat, but they also have a lot of vegetarian options. The Ethiopian Orthodox Church prescribes fasting, eating vegetarian, twice a week as well as for extended periods around Christmas and Easter. What makes Ethiopian dining really fun is that you get to eat with your hands. The idea is to use the flat crêpe-like bread called injera to gather up a mixture of stuff without getting any on your fingers (thus the proscription against licking one's fingers).

The meat in Ethiopia is also worth mentioning. I think it has something to do with its local and non-industrialized raising and processing. Whatever it is, it’s really flavorful and delicious. This wonderful meat experience is called tibs (pronounced with a sort of retroflex ‘t’). Basically, it’s a large side of raw beef (it’s really cow or carcass still at this point) hanging behind a counter that you have the guy slice for you. They take away the kilograms that you order and return with a plate full of steaming fajita-like tibs that you can dip in spicy mustard or berberé sauce. It melts in your mouth. In fact it was so good, we went back again the next night (see the video for more tibs action).

Another unique thing about Ethiopian cuisine is the butter. When I first visited Ethiopia, my friend’s host family showed me these huge blocks of butter and explained how they got them from their hometown outside the capital and how they would store in the cupboard for months or years. That doesn’t sound good, I thought, but I was wrong, because the butter is clarified, like ghee from India, so it really doesn’t spoil because the organic fats have been removed during the clarification process.

One of my favorite Ethiopian traditions around eating is what’s called a gursha. A gursha is when you grab a bunch of tibs or wet-ever (wet or sometimes wot is another yummy dish so that’s a transliteration pun) and then feed it to your guest or loved one. It’s very sensual and very fun. Kind of like when the bride and groom feed each other the cake at the wedding, except Ethiopians do it all the time.

The final thing that has to be discussed is Ethiopian coffee. Ethiopian coffee beans are excellent (much like their Kenyan neighbors) and can be found all over the world, thanks for better or for worse to places like Starbucks. In Ethiopia, coffee is call buna and is often served as part of a ceremony that involves roasting, grinding and infusing the beans right there in front of you. As you drink it, frankincense is usually burnt giving the whole experience a magical air.

As I said before, we are a bit surprised with the weather during the trip, with bouts of rain and average temperatures below the usual 70s. Addis is at 7-8 thousand feet of altitude so one expects it to be cold at night. On several occasions, we light a fire in the living room and practice some traditional dancing--which involves a lot of shoulder action. I realize I look like a chicken on the video, but you’ll get the idea from watching the others.

Christmas is approaching and we are having some trouble finding an appropriate tree because 1) pine is not part of Ethiopia's native flora and 2) it is currently illegal to cut any trees down. This means we have to choose between a potted tree from the plant nursery--which contrary to what you might think has an incredible selection of flowers and plants, just not pine trees--or a fake one. We end up getting both, but the branches of the tree won’t hold the decorations so it will have to wait until next year. What a great idea, making it illegal to cut down trees like this. Why shouldn't everyone have a live tree for Christmas? It would be less of a fire hazard and much better for the ozone. After Christmas it could be a tradition to go out into the woods (or your backyard) and replant the tree, or you could just keep watering it until next year. Okay, I realize that the whole root thing would make it well nigh impossible to have a large tree, but maybe a few could still be cut down for municipal displays or the Rockefeller center type thing. I’m just thinking out loud here…

We are having our big Turkey and stuffing meal today, the day after Christmas. Mostly because yesterday was Friday, a fasting day. So we will be opening our gifts and celebrating today. Much like other Orthodox churches, the ceremonies here are quite long and elaborate. For the most part they are conducted in a language called Ge’ez which is an even more ancient language than Amharic and more directly related to the country’s coptic origins. Women, I am told, are not supposed to attend services if they are menstruating, and apparently when she was young ,Debbie was able to use this excuse at any old time of the month to get out of going to church and the men were none the wiser. These things do remain a mystery to most of us men, don’t they?

After Christmas we spend several days in Woliso, where Debbie's father was born. It’s about 60 km west of Addis. A small town with a church her father built in honor of his father who was a famous General under Haile Sellasie. In fact, when the Emperor was overthrown, Debbie’s family, like many in Ethiopia, had to flee the country for fear of retributions. This is why Debbie was born and raised in Rome. Her family still owns property in Woliso. The land and farmhouse go back several generations. Debbie’s uncle lives there and is turning the land into a proper farm with honey, apples, teff (the grain that is used to make injera), and of course tej which is a meady, honey-beer like drink that many households brew out back as it were. The stuff will put you down if you can keep it down, is all I’m going to say on that topic.

The 27th is Saint Gabriel’s, a big holiday in the Ethiopian Orthodox Church, and people come from kilometers around to chant and pray all night long and most of the day. The prayers are broadcast over speakers so the huge crowd that gathers around the church and that can't fit inside can participate too. It's a really beautiful moment and we don't want to leave. Several priests and the bishop, head of the local diocese, come over to the farmhouse after the ceremonies to break their fast with us. It’s a huge feast and celebration--you really have to watch the video to see what I mean. It is very interesting being in such a big crowd and being the only white person. Especially in a small town/village like Woliso, it makes you something of a spectacle--kind of like being Brad Pitt or Angelina Jolie for the day. You either get used to the staring (and sometimes pointing and touching), or you don’t. Every aspiring actor should give it a try.

There is also a village elder, who is something like 98 or 100 years old, who gives Debbie and her brother Gulu a personal blessing (this is when the spitting happens). The elder and priests mostly speak in Orominia (the local language of the Oromo region), and the translation of the blessing seems a little short compared to the length of the speech but apparently breaks down to telling Debbie and her brother that they should get married and have kids, by next year if possible!

It’s New Years now and we spend the countdown flipping between the French and Italian TV stations, both of which are airing their traditional réveillon galas. One features three 8 year-old kids covering bad Euro-pop songs and soccer highlights from several seasons back, the other decides to cut to a sponsor's logo with 30 seconds left in the countdown and spends half the time promoting the guest commentators' latest albums and tours. Thank god for the Champagne and Pandoro or I would be worried about Europe. 2010, woohoo...!