The Forum on Poverty was tonight at the Callaway Public Library. About thirty people including all the speakers were in there. It was nicely said and done. The speakers on Poverty were Cynthia Kramer, Lawyer and professor at William Woods University, Robin Acree of Grass Roots Organizing, and Brenda Rose of Central Missouri Community Action each spoke about their personal and professional experiences in with poverty. Then five people responded with respect to poverty as it relates to their belief system. There was a Humanist, a Buddist, a Catholic, a Moslem and a Pagan. The director of the Fulton Housing Authority aslo gave his perspective.
The consensus seemed to be that we each need to listen better and strive to do better for others. We need to try to see how issues look from the other person's point of view. And then we need to create a government that is more responsive to the needs of the poor. There was consensus that any faith or ethical way of living including caring for others directly and in asking ourselves, 'How will this action improve the lives of others?' each time we do anything.
Speakers each quoted their own favorites. Three stand out now, though others were just as good.
That person is not a perfect Muslim who eateth his fill, and leaveth his neighbors hungry.-Prophet Muhammed
"Inasmuch as ye have done it unto one of the least of these My brethren, ye have done it unto Me." Jesus
The personal is political.

Today I did flu shots at my small college. I gave shots to 75 people in an hour and a half. The whole basketball team came and got them at once. There was a line most of the time. It is good work. It is nice to be able to say I did this number. So much of what I do is not quantifiable.

I am working with a group which is organizing a forum on Poverty in America. This is described on a separate blog. There are about 12 different people invited to speak and it should be interesting. Here is a link to a blog with details:

Poverty in America Forum

I have been a facilitator with the Alternatives to Violence Project for just over a year. I go with another facilitator into a nearby prison and do a three day intensive workshop with inmates to get them thinking about their lives and how they can easily make their lives less violent. Some are amazing and really ready to change. All those attending are doing so voluntarily, so if they don't like it they can go back to what they are usually doing. We can only do workshops on weekends as they can't miss their routines Monday through Thursday. I created a web site for the Mid Missouri Alternatives to Violence Project Council and that's why I'm blogging now. I want to link this blog to the Mid MO AVP website.:
http://avp.missouri.org

No complaints, 21 days. I'm trying.

No Coplaints, 21 days.
A preacher named Bowen at a Kansas City Unity Church came up with this idea. Don't complain for 21 days. Why? Well, my life should get better if I don't complain. I will reframe the way I think and then be a happier person. And 21 days is the magic number as it has been shown to some psychologist (name not remembered) that it takes 21 days to develop a new habit.

If you don't like something, change it.
If you can't change it, change your attitude.
Don't Complain. -Maya Angelou

I love quotes and this one from Maya Angelou is great.

Here's the website:

http://ccunitykc.org/

So, why don't I try this?
I have actually been quite a critical person in my life. I was denied a raise a number of years ago because of my verbal complaints. My supervisor felt that my attitude affected the attitude of others around me and that if I stopped it, others would follow suit. I reallly don't know if it worked at that place. But I do have experience with cutting down my complaining.
I became much more selective about my complaining.
I didn't change the workplace environment, but I really tried. I tried making positive comments to people every day. Now several years after choosing to quit (perhaps taking May's advice-changing it) I am certain I am a happier person. I feel like I was scapegoated in that situation. I am still sad about what went on at that work place though. I felt we all had the best interests of our patients in mind but were not able to care for them to the best of our ability related to the environment created by management. So, my thoughts in this regard were not appreciated and I moved on. I left some hard working sincere friends and co workers. Most have also moved on as well though. Most of the patients who I really cared about were understanding, too. Retention was not high at that place.
I just re read the above paragraph and don't find any complaints. I was just explaining. If you disagree, please tell me.
I am trying this thing. I have a blue wrist band that says 'peace'. I've already moved it from one side to the other a few times. I will keep it up, though. I will try and see how long it takes.
This is one concern that I haven't seen raised in the things I have read:
What would Gandhi do? I mean if he hadn't asked the Bristish to go back home, where would the peaceful revolution that got India it's independance be? Was he complaining?
What I mean is: Can problems be righted without complaining?
If they can; I'm all for it.
Maybe I'm approaching this from a 'let's think this through' attitude and I need a 'let's do it.'
I'm a little skeptical about that number 21, too. How was that figured out? Who did the study that proved this? Did this researcher use good methods? Really, any number would be OK, but is this reason more valid that saying that the number 21 is mystical?
I think about the first time I took statistics (a few decades ago) and learned that one needed 32 subjects or items to study. Being in nursing, I would need to interview 32 people or have 32 pieces of data from people. Someone else could have data from 32 bugs or from 32 trees or 32 cars depending on their area of interest. Anyway, when I took statistics for graduate school 10 years ago; the magic number 32 (or was it 31, it could have been 31) had disappeared. One of the advances in statistics was that you could make statistics with any number of subjects. So that changed. How long before '21 days to develop a new habit' changes?
I gave up sucking my thumb when I was 11 years old in one week. That would be a different blog, though.
I just re read the whole thing. I don't see any complaints. If you see one, let me know, then move your wristband to the other wrist.
More soon on how this is going.

Book Reports

I have had the past week off from work as there are no students at my college and so no one to visit my little clinic. I had time to read two books about campus life. I have been working here for about a year and am still trying to find my way around.

My Freshman Year, What a professor learned about becoming a student by Rebekah Nathan, c 2005.

This book was written by an anthropology professor who spent her sabbatical year at Northern Arizona University taking freshman courses and living in the dorm. Her real name is Cathy Small. She is also a tenured professor there. The school is big enough that she could take classes and live in the dorm and not be recognized as a professor. Somehow, it was OK with the residence life staff to let a 50 something year old woman live with the other younger college students.

At first, when reading the reviews, I thought she must have been young enough looking to appear to be a college student (a thirty something looking 20.) But no, she just moved into the dorm and took classes and acted like that would be a normal thing for her to despite being the same age as everyone else’s Mom. I am the Mom of a college student, and I can tell you, I would be very curious if he told me that there was a middle aged person living in his dorm. I would wonder if dorm life seemed acceptable because she had just come out of a convent or prison. I would wonder if she had some personal interest in my college youth that I as a mother should worry about-sexually or cult recruiting perhaps. Maybe people in the western US have a more live and let live attitude.

Cathy Small got approval from the Institutional Review Board to conduct here research at her institution; she was limited in what she could say. The other students didn’t know she was an anthropology professor doing research on them and soshe didn’t feel that she could tell everything she saw or experienced. She did observational surveys on content of the white boards on their doors and the ‘graffiti’ in the women’s bathroom and formal surveys with individuals (saying she was a student) and reported this data.

I’m glad she was ethical enough to not report personal conversations; but the format was dry and stilted at times. Some of the surveys I do myself (like observations during meal time about who sits with whom and who just leaves with their meal to go.) Being on campus wasn’t the big revelation it seemed it should be. There was also no reflection on the changes she noted now from the days when she was an undergrad. That also would have been unprofessional; including her own life experience wasn’t the point. Well, I would have liked to know her personal thoughts and the compare and contrast between then and now. The book didn’t miss doing what it promised; it just had so much more potential.

My Freshman Year gave me a few insights about college life. I learned that students are career oriented; so that their volunteer/social life often revolves around careers and creating resumes. That doesn’t surprise me, high school students are encouraged to do extra curricular activities so that their college applications will look good. The next step would be resume and grad school applications. I wonder how much of that is that they are expected to talk this way or their true feelings. How often do we each reveal our true feelings?

The book was a good read; it started as many questions as it answered. I doubt that many students would find it interesting or informative.

I'm The Teacher, You're The Student: A Semester In The University Classroom
by Patrick Allitt, c2005.

This book follows a professor at Emory University through a spring semester US History class. It did do what it promised as it was more musings on being a professor and how one balances the need to cover the content, interest the student and be sympathetic to the developmental needs of the students. I was surprised that the professor had a line over which he did want to go into people’s personal lives.

His job is to communicate the class content. He happily met students to discuss course work; but was careful not to go any further. As a nurse practitioner I will at times have personal discussions with patients, who are now students. I am comfortable with listening to tales about how a student is getting along with family, friends and at school. If there were a health issue that required a visit to a residence hall or student apartment; I would do it. I didn’t consider that professors would want to keep a distance.

The course sounded great. Allitt has collected a mass of slides to illustrate the content and used music appropriate to each day’s lecture to start many classes. He challenged students to know where events occurred by having them label maps of the USA. He banned the use of the web for content in their papers (it is a history class- books would work.) He didn’t use a textbook but rather assigned a list of real books. These are books which may one day be re read and enjoyed again by his students. As an avid reader; this seems like an incredible gift.

He was not always satisfied with effort and skill of the students. He bemoaned their writing skills and their ability to present their thoughts in a cogent manner. He talked about helping them with perseverance and patience. And he did have several to brag about. He had me wondering how I would do in his class when I was a college student (forget that those studying nursing don’t get to take history classes) and how I would do now. I certainly am not succinct.

So, will reading these books help with my job at a small Midwestern college? I believe so. It is one of the amazing things about the USA: that the experiences of college youth in Georgia, in Arizona and the Midwest are similar enough to be helpful to this middle aged nurse practitioner. It was a nice break from medical and nursing literature. I do have two other new books, one about contraceptives for adolescents and the other a series of review articles about college health. They will be interesting, but not such light reading.

Happy New Year, dear and patient reader, soloNP.

Plan B-Emergency Contraception

I prescribe Plan B a few times every week. Young women who have had sex without using any form of birth control or who used a condom and it somehow failed come to see me. Sometimes, a woman will want it in addition to the condom because she has sex only once every few months and want another form of birth control besides the condom. As a form of birth control, it isn't the best, but better than nothing. Each time I prescribe it; I also have the opportunity to discuss more effective birth control methods, choices about when one has sex, concerns about sexually tranmitted diseases, general health issues and concerns about rape or assault. I find the opportunity very useful. I hope the young women appreciate our discussions as well. Sometimes it's a little hard to tell with college students.

Plan B has been in the news a lot. I'm not sure those who have opinions about Emergency Contraception really understands what it is and why it is used.

The Facts:

Plan B is an artificial form of progesterone. Other examples of hormonal birth control are the oral contraceptive pill, the contraceptive patch, the contraceptive vaginal ring and the shot that lasts 3 months. The latter is the only other common form that is only artifical progesterone. The rest are combinations of artificial estrogen and progesterone. All of these methods are safer than being pregnant, which is why women choose to take contraception. Pregnancy is wonderful and the outcome is outstanding, but the process of child bearing carries it's own risks.

Plan B or levonorgestrel prevents pregnacy by preventing ovulation and/or by changing the lining of the uterus so that a pregnancy won't occur. The second method prevents implantation of the egg. I believe that a fertilized egg which is not implanted and therefore not receiving nuturance from the mother is not even a potential life. I don't see any ethical issues here in terms of the potential for life.

The medicine itself is very safe. It may cause mid cycle spotting or nausea immediately after taking the medicine. There is no risk for heart attack, stroke, blood clots following a single ingestion of Plan B. There are no long term side effects. It is medicine and it has the disadvantages of: having to take it properly, expense and taking time out of a busy life to get the prescription. These are all issues for the young women who seek Plan B. They are deterents enough that most are motivivated to have another form of contraception in use before there is a need again.

The Big Deal, Two issues:

1.) Should Plan B be sold over the counter without a prescription?
2.) Do pharmacists have the right to refuse to dispense Plan B based on their own beliefs?

Plan B is a medicine that is essentially safe, works best when taken as soon after the event as as possible and using it properly is well explained in the package insert. I think the cost is sufficient to deter most young women from using it excessively or exclusively as birth control. According to Drugstore.com, it costs about $30.00 per package. Plan b should be over the counter, like it is in the state of Washington, in the entire nation.

Some pharmacists have chosen to refuse despensing Plan B based on their personal beliefs. I say they are poorly informed about the medication and about their professional responsibilities. They may have a personal belief regarding Plan B so that they don't agree with it's use. But that is not their job.

The pharmacist's job and indeed, professional duty, is to serve the client and to carry out the orders of the prescribing provider. Pharmcists should advocate for the client and question dispensing a medication that seems unsafe or contraindicated for an individual. For instance, pharmacists should be aware of medication allergies of their clients so that if a prescriber writes a prescription for a penicillin type medciation and the client is allergic; the pharmacist can question that prescription and intervene on the clients behalf in a positive way. This is professional behavior.

In dispensing medications, pharmacists are acting as the agent for the prescriber and following the prescription as written. As a nurse, I have done this plenty of times when working in the hospital. The doctor writes the orders, the staff implements them in the hospital. As a hospital staff nurse it is my responsibility to be certain that the orders make sense, and are prudent, and to question if I have any concerns. But, I also respect that the physician and hospital patient have a relationship and the patient has asked that physician to care for him by writing the orders. Sometimes, not frequently, but sometimes I have carried out orders that I didn't agree with. My disagreement may be as simple as my belief that appropriate treatment for a wound is different than the doctor's. Other times, I have had a personal disagreement with the whole plan of care. I have continued patient suffering by implementing curative treatments in a patient who, in my belief, was not going to be cured. In this instance, I can advocate for providing comfort care. If this is not the agreement between those who decide (physician and patient) it becomes my duty, as a staff nurse, to carry out their wishes and the doctor's orders. I am an agent for the physician in that situation. Other health professionals are responsible to carry out the orders of the person in charge. The person in charge is the patient and patients often turn this responsibility over to their physician. This is the system. In the same way, the pharmacist has a responsibility and a duty to carry out the orders of the prescribing person, even if in their belief they would never use that particular medication themselvses.

I will mention another class of medications that pharmacists don't refuse to dispense but they may not agree with the ultimate use of medications:
When dispensing Viagra and other medicines for erectile dysfunction the pharmacist may not agree with the context in which the individual is using this medication. Viagra-like medications may be used outside of marriage and at times in sexual relations that are not the standard male/female couple. The Catholic Church does not condone the use of any alteration to the natural way of conception. So,the use of viagra-like medications is not condoned by the Catholic Church along with its anti contraception stance.

The bottom line:

Plan B is safe as it is. It should be over the counter and the governmental authorities that are currently trying to block this change are just avoiding real work by their efforts to block Plan B being over the counter.

Pharmacists are a part of a team that provides health care to patients. It is their duty to do the part of the job that the prescribing provider asks of them. It is also their responsibility to make sure the medications are safely dispensed as ordered. It is not their job to decide that a certain medication should never be dispensed.

Phew!

That's my first blog adventure. I could spend hours refining this, but it's not the point. It is quite a rant, I have a lot of feelings about this issue. I have a lot of feelings about other stuff. I will save them for other future blogs and also try to do some lighter stuff, too.