Life: a sexually transmitted, fatal condition

Life: a sexually transmitted, fatal condition

sunset

Life is a sexually transmitted condition that is invariably fatal.

That well-phrased truth – often attributed to British author Neil Gaiman – led off a talk not long ago at San Francisco’s Commonwealth Club by Atul Gawande, physician and author of, most recently, Being Mortal. Gawande’s message was all about being mortal, and facing that inevitable death in advance. In other words, if we mortals could please just admit our mortality – and talk about what we’d like our final days/weeks/months to look like – much good would result.

This writer has been on that soapbox for several decades.

Gawande and his interviewer, University of California San Francisco professor Alice Chen MD, spoke of the need for shared decision-making, shifting away from the paternalistic ‘doctor knows best: here’s what we’re going to do for you’ attitude to the physician giving information and involving the patient in making choices. But their decision-making would still put the doctor first and patient second. This writer respectfully disagrees.

Atul Gawande
Atul Gawande

In response to a question from the audience, Gawande agreed that “a patient with unbearable suffering should be given the option to hasten death.” But he followed this perfectly rational statement with an irrational comment: “every hastened death is a failure of the medical system.”

Give us a break.

The medical system needs, at some point, to confront this reality: Life… is invariably fatal. The medical system cannot forestall anyone’s death forever. The medical system cannot protect, absolutely, against unbearable suffering. Compassionate physicians across the U.S. are recognizing this fact, and increasingly backing the legalization of aid in dying for the mentally competent terminally ill.

Gawande, Chen and countless others are proponents of palliative care, an excellent, relatively new segment of care in this country. They would have us believe that palliative care is the be-all and end-all of end-of-life care, and they oppose the option of legal aid in dying. Palliative care, an option many choose, is a fine addition to healthcare. It can keep pain to a minimum and often insure comfort; as a last resort, palliative sedation can render the patient essentially unconscious for whatever hours or days remain until death comes.

But it is a cruel myth that palliative care, or even the best hospice care, can guarantee anyone will slip peacefully from good life to gentle death. Pain, indignity, discomfort and distress are part of the process; some of us don’t want much of that.

Legal aid in dying, the option to choose at what point to let invariable fatality happen, is the only guarantee. It’s an option that we should all have.

Russia-Ukraine Conflict in One Fast Hour

Foreign Affairs 101:

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Ukraine Majority Language Map

If it’s possible to condense the incomprehensibly complex Russia/Ukraine conflict into one coherent hour, Matthew Rojansky can do it. Rojansky, Director of the Kennan Institute and an expert on the region, proved that in a recent presentation at San Francisco’s Commonwealth Club. A listener who blinked could miss a paragraph, but Rojansky’s fast-paced illustrated lecture had most of his audience too engaged to blink. What follows is an abbreviated summary of the presentation.

Yanukovich estate
Yanukovych Estate

For openers, Rojansky explained that Ukraine, under now-deposed leader Viktor Yanukovych, was “a society absolutely primed for revolt. A few years ago,” Rojansky said, “I moved to Kiev with my family, (finding) Yanukovych one of the most corrupt politicians in history – and that’s saying something.” Illustrating his point, Rojansky showed slides taken during his time in Kiev including views of some of Yanukovych’s perks: a heli-pad; a palace with gold, jewel-encrusted design, 3-lane bowling alley, billiard room, private floating pirate-themed restaurant reported to have cost a few billion dollars – a rather definitive picture of excess. Rojansky also mentioned the stuffed lion guarding a corridor leading to the nail salon and spa, and a collection of exotic cars and animals. It was not just personal excess, he said, “there was government corruption on a grand scale.”

By the fall of 2013, Ukranian citizens were tiring of this. A peaceful protest known as the Euromaidan began in the square Rojansky and his family could see from their apartment window. “It was surreal.” Public sentiment favored closer connections to Europe, Rojansky said, but Yanukovych instead signed an agreement with Russia’s Vladimir Putin. Thus began the increasing protests fueled largely by social media, with help for the needs of Euromaidan solicited via constant Facebook postings.

Matthew Rojansky
Matthew Rojansky at the Commonwealth Club 3.6.15

Initially, Rojansky explained, the movement was not political. But also thanks to social media – Twitter users began receiving messages letting them know they were registered as protesters – things quickly changed. And on January 16, 2014, the dictatorship laws were passed: No protests, no groups, no gatherings. The movement against abstract corruption became ‘Yanukovych Must Go.’ Things came to a crisis when someone gave the order to fire and all-out shooting began. Despite the European Union intervening to broker a deal in late February, Yanukovych escaped – with boxcars of treasure – though leaving behind the exotic animals still being cared for on his former palatial estate outside Kiev.

Soon came the time of “the little green men” in Crimea, a significant chunk of Ukraine on the Black Sea. Rojanksy explained that there have always been Russians in Crimea; the little green men wore Russian military garb minus the insignia, carried Russian weaponry, but Putin at the time denied they were sent by Russia.

Donetsk airport
Donetsk Airport

By May of 2014, Rojansky said, regions of Ukraine that are heavily Russian-speaking began to hold referenda to break away – not to become independent, but to become part of Russia. Things accelerated significantly with the downing of a Malaysian Airlines plane in July, 2014, and the ground war began. “This was not World War II,” Rojanksy explained, but guerilla warfare with terror tactics, firing on civilian buildings, the destruction of the once-beautiful Donetsk airport. “This is insane stuff.”

As to what Mr. Putin wants out of all this? Rojansky listed three main points;

1 – Domestic politics are life-or-death. If the idea that when regular people take to the streets life gets better catches on, Russians might say “What about us?”

2 – Putin has a major image issue. He’s the tsar. He is never wrong. There’s God, and then there’s the Tsar.

3 – Geopolitics are important. If Russia and Crimea get together, Putin’s bargaining power is greater.

Rojanksky characterizes Ukraine as being between a rock and a Russian hard place. The hard place is boosted by the fact that half the people in Ukraine speak Russian, and many more watch Russian TV with its decidedly nationalist fervor.

For now, Rojansky says the wise course is “Don’t show up giving out cookies. Get observers on the ground as fast as possible, and eyes on the ground on the borders. Watch to see if sanctions are working.

And in the very long term: “Ukraine matters. We have to help Ukraine defeat corruption. Things we can do include letting Ukrainians come here, and knowing about the region.” In the end:

“There are no easy answers.”

Disclaimer: This writer knows as little about Russia and Ukraine as a few long-ago college courses and one unforgettable trip from Moscow to St. Petersberg might suggest. But listening to Matthew Rojansky’s take on the current situation is enough to convince one to pay attention.

 

 

 

Good news, bad news for an old week

landscapeThe holiday-week news in review was a doozy. Good news (to most of us) about Cuban-American relations and climate change, bad news for Sony and internet security. Plus the relentlessly ongoing bad stuff: ebola killing off entire families in Africa, terrorists killing children in Pakistan, crazies killing innocents, and a total absence of politicians able to do much besides calling other politicians names.

It was all up for discussion during a recent “Week to Week” political roundtable discussion at the Commonwealth Club in San Francisco. Panelists included San Francisco Chronicle political reporter Joe Garofoli and columnist C.W. Nevius, and writer/attorney Melissa Griffin Caen, along with moderator John Zipperer, Vice President of Media & Entertainment for the Commonwealth Club. Despite the unfunny bad news, the group had a seriously good time dishing about Uber executive Emil Michael – and why not? Set aside the fact that his company sought to make good news (Everybody wants rides! Raise Rates!) of the hostage tragedy in Sydney, Australia, Michael first endeared himself to the fourth estate by launching a campaign to investigate unfriendly journalists. Then came the news about his suit against his landlord for sending a stranger repairman into the apartment to fix something Michael himself had complained of. Throw in Michael’s claim of being buddies with the police chief (quickly denied by the police chief,) the condo cost ($9,500 per month) and its reported amenities such as hot tub and private garden, and it’s altogether too much for any political roundtable to resist.

But the evening opened with good news. Salesforce founder/CEO Marc Benioff, the panelists say, is making news with his 1/1/1 integrated philanthropic model. One of the founding principles of Salesforce, the idea is to give 1 percent of profits, I percent of equity and 1 percent of employee hours to charity. For months, Benioff has been working to bring other tech firms into the plan, and it’s working. Often at odds with their new San Francisco community, tech firms and their employees are increasingly giving their time, talents and money back to help the less fortunate. And who knows? The bad will generated by the likes of uber-rich Uber folks could be outweighed by the goodwill of 1/1/1 programs.

Closer to home, or at least to the heart of this non-techie writer, my friend Tara Culp-Ressler over at ThinkProgress.org posted a similar good news/bad news piece about the year of reproductive justice: “Six victories for reproductive freedom you may not have realized happened this year.” At the end of a year crammed full of legislative assaults on women, with newly-empowered anti-abortion lawmakers vowing to take us back to the dark ages – here is good news worth noting.

And all tiny tidings of joy are welcome.

Immigration Then and Now: Three families, three stories

PRELUDE: A contemporary story –

Maluki had what she thought was a minor infection in her chest. She took a couple of pain relief tablets. She is undocumented and uninsured. She had no access to a community clinic where she might have seen a doctor with no questions asked; no one in her suburban family had heard that such things exist. Within a few weeks Maluki was doubled over with pain and was rushed by a neighbor to an emergency room at a major public hospital two hours away.

Two surgeries later the 38-year-old mother of three will be out of work for a very long time. Her husband, partly disabled, works irregular hours when he can, leaving the family dependent on what money the teenaged children – all U.S. citizens – can bring in. The children still hope somehow to finish high school and attend college.

What’s wrong with this picture?

Almost everything, if you asked the five California experts on a recent Commonwealth Club panel in San Francisco. “Undocumented and Uninsured” brought together two heads of clinics where treatment is available to all and two others with unique insight and perspectives. Moderated by Daniel Weintraub, Editor in Chief and Project Director, California Health Report, the panel included John Gressman, President and CEO, San Francisco Community Clinic Consortium and Scott Hauge, President of CAL Insurance & Associates Inc and Co-Founder and Vice Chairman, Clinic by the Bay; Laurel Lucia, Associate Policy Specialist, UC Berkeley Center for Labor Research and Education; and Jirayut New Latthivongskorn, Co-Founder of Pre-Health Dreamers. They were looking at how the Affordable Care Act will impact immigrants unable to get health insurance, and what the healthcare future might hold for them.

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There are, by one estimate, 11.7 million undocumented immigrants in the U.S. Some have health coverage through their jobs, and a few have private coverage; but the vast majority of these are uninsured. The resulting costs, in human terms such as the case above, are inestimable; the costs in dollars are also significant. “If we get the patient into basic care for colds and flu,” said Gressman, “we save thousands in hospital care.” In California, care is widely available through publicly funded community clinics as well as nonprofits – the problem is in getting the word out and building trust. “We look at how to get the patient to care,” Hauge said, “not at anyone’s immigration status.”

While Gressman, Hauge and Lucia each brought extensive understanding of both the policy and the real-world details affecting healthcare needs of undocumented immigrants, it is the personal stories of Lucia and Latthivongskorn that illuminate the remarkable richness of our immigrant nation.

Nearly a century before she was invited to bring her expert knowledge to a Commonwealth Club panel, Laurel Lucia’s great-grandfather was a frequent speaker at the Commonwealth Club himself. Felipe N. Puente was memorialized in the Club’s Journal upon his death in January, 1951. He was, his obituary reads, “by far the most important personal tie between Northern Californians and the Republic of Mexico for nearly a quarter of a century.

“Commencing as a colorful revolutionary Mexican leader in 1917 (as Jefe de Transportacion for the late Revolutionary General Francisco Villa), he had for 25 years been a resident of San Francisco, with five children in our public schools, and the long-time Manager of the Mexican National Railways, San Francisco division, in the Monadnock Building.

“Although a railroadman by profession, his expert and sagacious advice was freely at the service of American travelers by sea, highway or air, and a letter from ‘el Puente de San Francisco’ (the San Francisco Bridge) as he was affectionately known clear down to the border of Guatemala, opened all doors in Mexico.” Great-grandfather Puente’s expertise reached beyond transportation to government affairs. In a Commonwealth Club speech broadcast over KYA Radio in 1942 he spoke of the importance of Mexican-American cooperation in the war efforts, citing cargo lanes and Mexican ores that were critical to the U.S. and quoting President Avila Camacho as saying, “Mexican soldiers are willing to shed their blood anywhere in the world where they may be needed.” His Journal obituary began and ended, “Adios, Amigo Felipe N.Puente!”

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Lucia missed out on knowing her notable ancestor, “but I was quite close to his daughter, my grandmother.” She had not, she says, ever made any connection between his immigrant status and her current work – as a Policy Analyst for the UC Berkeley Labor Center – which partly seeks to strengthen the safety net for those more recently arriving on our shores.

 

Laurel Lucia with Moderator Weintraub

As for the other young person on the “Undocumented and Uninsured” panel, Jiryat New Latthivongskorn (hereafter identified by his familiar name, New) confesses to having been a little startled to hear himself constantly referred to during the evening as “the first undocumented student to be admitted to UCSF (the University of California San Francisco) Medical School.” But that is, in fact, part of his current resume, and a not insignificant achievement.

There were 7,453 applicants to UCSF Medical School for New’s class, out of which pool 490 were interviewed and 149 were accepted. The overall grade point average was 3.77.

New Latthivongskorn came to this country with his parents when he was 9 years old. His parents worked in Thai restaurants every night until 11:00. But whenever he tried to help, he said in an interview on KQED Radio last May, “the answer never changed. ‘Don’t worry, and do your job.’ My job was to get an education.” So far, he appears to have done his job quite well. New never considered the idea of being a doctor until one scary incident during his junior year in high school when his mother fell gravely ill and had to be taken to the emergency room. The family had, until that time, relied on a medicine cabinet full of remedies for colds and pain and a few old antibiotics from Thailand. But in the ER, when his mother couldn’t understand the doctors and they couldn’t understand her, New realized his job might be more than just a translator.

There are those, including a few who commented on the KQED program, who argue that anyone who is in this country illegally should simply be sent back to wherever he or she came from and until then should receive no benefits – and certainly no healthcare. That may, however, be an overly simplistic – not to mention cruel and unusual – answer to a very complex issue.

“Immigrants don’t come here,” New told the Commonwealth Club audience, “for free healthcare. They come here to escape danger or terrible conditions; they come here to work.” In short, to create a better life for themselves and their families, and ultimately to give back to the communities of their new world. That was definitely true for immigrant Puente a century ago, and is demonstrated by the hard-working parents of doctor-to-be New.

Other than the Native Americans who pre-date most of us, it would be hard to find many U.S. citizens whose ancestors didn’t have similar stories.

 

 

On being grateful – for rain & waterfronts

bridge in rain

(This essay also appears on Huffington Post)

“It’s not happiness that makes you grateful,” goes one of my favorite recent quotes (thanks, Joann Lee;) “it’s being grateful that makes you happy.”

Here’s to gratitude.

For one thing, it has been raining in San Francisco. That strange wet stuff that falls occasionally from the sky – but we haven’t seen in a very long time. A planned Commonwealth Club Waterfront Walk tour, which I had earlier volunteered to help host, was advertised “Rain or Shine;” and as it happened there was both. The rain dampened all streets but no spirits, and the beauty of the waterfront literally shone.

There is something mystic about a waterfront on a dark day: an ethereal quiet hanging just below the clouds, the call of a gull who could be from another world, the scent of newness.

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The waterfront in sunshine is brilliant and exciting; in rain it invites your imagination – and appreciation.

As with waterfronts everywhere, San Francisco’s is steeped in history: sailors and conquerors, longshoremen and adventurers. There is public art, and private beauty. Waterfront Walk guide extraordinaire Rick Evans covers a remarkable range of them in two hours:

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The rise and – literal – fall of Rincon Hill, once one of San Francisco’s famous seven, which overlooked the Bay until the city unwisely bulldozed a street through it in the 19th century and the sandy hill collapsed upon itself. (Earthquake and fire finished the job.) Today Rincon Hill is rising again, as gleaming steel towers. The buildings that survived earthquake and fire are other centerpieces of the walk, plus the monumental artwork on the waterfront that was a trade-off for Gap tycoon Don Fisher’s corporate headquarters building when it went up – insurance of unobstructed, breathtaking views.

Some of the beauty of many waterfronts, physical and informational, is manmade, as is true of this piece of San Francisco Bay. But every waterfront has its story, and its soul.

Rain or shine. A cause for exquisite gratitude.

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Bold Hope for the World’s Poor

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A Solution to Poverty?

If governments can’t solve world poverty, and nonprofits can’t make serious dents in it… can the private sector be the answer? With the help of you and me and major investors?

Mal Warwick thinks so. Warwick, co-author, with Paul Polak, of The Business Solution to Poverty, spoke recently at the Commonwealth Club in San Francisco about their conviction that the long-term solution to the ongoing tragedy of global poverty lies in coming up with answers that will pay off. Not just to suffering individuals, by helping lift them out of poverty, but to investors by turning a profit.

Warwick’s audience included a variety of interested individuals familiar with much of the work already being doing by nonprofits whose funders tend to seek reward through humanitarian success rather than financial return. But major infusions of capital, Warwick maintains, will be needed to continue building the ladders people everywhere will need to climb out of poverty’s depths, and that will require – business solutions.

As a shining example, Warwick cited the treadle pump. It is a human-powered device, inexpensive to manufacture and simple to use, which enables farmers to multiply the yield of their land and thus, in many cases, raise themselves and their families out of poverty. It works as a business solution on a number of levels. Factories needed to manufacture the pump were set up in villages, providing employment for people there, village shops distributed them, workers were employed to drill the wells and financial institutions made loans for purchases.

The problem, Warwick says, was with marketing – radio, TV, newspapers and traditional advertising methods weren’t available. The solution? Roaming troubadors and a Bollywood movie.

Among the facts Warwick brought to light were: One billion people lack access to electricity. One billion people lack access to safe water. One billion farms are without irrigation. The 20 million people lifted out of poverty between 1981 and 2006 by international aid programs, Warwick says, are only a drop in the bucket to the numbers who continue to suffer.

“It’s possible,” Warwick says, “to create brave new companies” with the lure of “reaching at least 100 million $2/day customers.” Some of those companies already at work include Australia’s SunWater which is developing a variety of safe-water solutions, several businesses working toward turning organic waste into affordable charcoal briquettes, and SpringHealth, which is addressing the problem of contaminated drinking water.

If governments and nonprofits can’t solve global poverty, can businesses? It might take all of the above – plus you and me, ordinary citizens.

Hello again, woolly mammoths!

woolly mammoth

Woolly mammoths roaming the countryside, heath hens back in the fields, passenger pigeons swooping around in great clouds? Believe. Believe, specifically, in de-extinction.

De-extinction is not to be confused with Jurassic Park. It’s also not just dreaming, when the dream starts with noted visionaries Ryan Phelan and Stewart Brand. The two spoke recently at the Commonwealth Club in San Francisco, on the intriguing – and now very real – possibility of rescuing extinct species through genetic sequencing. Among the ethical questions they get most often, the two said is, “Aren’t you playing God?” And the answer is, no. “We are finding out the problem we caused, and un-causing it.”

God knew what He or She was doing all those millennia ago; but not all creatures were created equal. Some species have fallen victim to other species, ice ages and natural calamities, but the worst of the problems have come from – guess where – humankind. Thick formations of migrating passenger pigeons, once the most abundant bird in North America, were common up until the late nineteenth century. But their habitat and food were lost to deforestation, and finally they made too-easy targets for the shotguns that dropped them by the billions. Martha, the last known passenger pigeon (named in honor of First Lady Martha Washington) died on September 1, 1914 in the Cincinnati Zoo. Heath hens met a similar fate largely through their attraction for the dinner tables of humankind.

Phelan and Brand set out to un-cause these tragic losses to the planet through the Revive and Restore project, a part of their ambitious Long Now Foundation. Among Brand’s successful ventures are the Whole Earth Catalog, launched in 1968, organizations including The WELL, and books most recently including Whole Earth Discipline: An Ecopragmatist Manifesto. Phelan occasionally refers to herself, accurately, as “a serial entrepreneur.” The two married in 1983, and live on a tugboat in Sausalito CA.

Phelan and Brand devoted much of their Commonwealth Club presentation to an explanation – partly through sophisticated scientific/technological data and partly in down-to-earth lay language – of how the woolly mammoth might indeed be roaming the earth again in a matter of a few years. DNA, which reveals details about hair, fat cells and much else, has been recovered from frozen specimens of the long-extinct species and can now be sequenced with relative ease and speed. “The cost of sequencing is rapidly going down,” Phelan said. And scientific/technological expertise continues to go up. The final phase of woolly mammoth restoration will involve implanting a properly sequenced egg into the ancient animal’s closest living relative, the Asian elephant. And “we could get the woolly mammoth back in three years.”

For this writer, a hopelessly right-brained (myth or not) Art major, much of the scientific explanation defied easy understanding. But the possibility of taking a trip to the Arctic Circle to see these wondrous creatures actually walking the earth again?

Magical.