On parenthood

 A good friend of mine, a 39 year old woman we'll call Samantha, recently told me that her daughter is pregnant. For some context, Samantha's background is important here.


Samantha is a hard working woman who has made her share of mistakes in her life, but is certainly under no illusions about her responsibility to herself and her children.  She married early and the marriage produced 3 kids, ended soon after the third child, and she found herself alone and without support. But she took charge of her life as the kids got a bit older, got licensed and opened a daycare center, and moved to a very nice Chicago suburb so her children could have a better education and be be exposed to a different way of life than she was exposed to.  When you meet Samantha, you have no choice but to like her. She's a very nice person with a bubbly personality, very straightforward in her approach and doesn't have a pretentious bone in her body.  I say this but again, she has made some decisions that she herself has admitted were ill considered but who hasn't?

Her first daughter graduated from a nice suburban high school last year, and I asked about her. I, perhaps a bit presumptuous, asked about her daughter's college major, her plans, her current summer work experience situation.  Then again, I take that back. It would not be presumptuous of me to ask about college plans if I was talking about a Wall Street executive whose kid graduated from Andover.  Anyway, Samantha instead told me that her 19 year old daughter is  pregnant, living at home, and has no concrete plans.

My reaction perhaps betrays my feelings about teenage pregnancy and/or unplanned families.  All kinds of studies and data support my worst fears. Inability to control your reproductive life, teen pregnancy, academic failure or stunted academic progress, limited potential, low expectations, and the worst, repeating cycle. It repeats itself in the next generation.  This daughter, in my opinion had a good example in her mother's attempts to provide a relatively comfortable life for them. She went to a high school where most kids graduate and move on to college.  She had a mother who did all she could to provider for her and siblings. And still...pregnant at 19, a boyfriend who has no prospects or plans.. So my friend Samantha is about to be a grandmother--I could barely say it out loud--at 39.  I asked Samantha how this could have happened.

First, she did not want to put her daughter on birth control once the daughter confided in her mother that she was sexually active.  She felt it would be tantamount to condoning her behavior.  Samantha admits this might have been a mistake but she is not sure.  The daughter does not want to consider the alternative to having the baby, she's very conflicted. But at the same time, no job, a bad situation and all she has is her mom who is already working hard to take care of the other two teenagers, and her own mother (grandmother to the 19 year old).  The mother of the boyfriend is useless: she has 7 other children from an unknown number of fathers. Samantha all of a sudden finds herself in the middle of a messy life she had worked quite hard to avoid and protect her children from.

I am sure anyone can come up a long list of things Samantha did wrong during the years but as someone who knows her, while her life is quite different from mine, I can say that she leveraged resources she had to make something out of almost nothing. I expected dramatically different outcomes from her own children given her efforts to raise her them well.  While there are no guarantees, I do wonder if there is any control parents have in ensuring their children make the right decisions, from a position of power and self-control rather than succumbing to whatever chance might throw at you.

The splintering and the abandoned

I just finished reading Disintegration: The Splingtering of Black America, a wonderful book by Eugene Robinson. Eugene Robinson is a Pulitzer Prize winning journalist with the Washington Post and I read his columns regularly, and I often watch him on MSNBC as well.  But being a talking head and writing a good book require somewhat different skills so I approached his book without any preconceived notions (I hope).

Without going into too much detail, Mr Robinson basically explores the history of American American economic progress, with a focus on the period that mattered a lot--the 1960s forward.  Remember, the laws that codified the second-class status of black people in the United States were dismantled in the 1960s, and before this it was exceptionally difficult to work around Jim Crow and its spawn around the country.  Any and all progress after Reconstruction was halted and rescinded by Jim Crow in the early part of the 20th century.  Anyway, the splintering of Black America into four groups namely, the transcendent, the emerging group [split into multiracial and immigrant], the mainstream, and the abandoned is insightful in an of itself.  Black people, for better or for worse are often considered a monolithic group, and there are differences which are highlighted to some degree in this book.

I would say Eugene Robinson is a member of the transcendent group, the group that has achieved great success in their work and economically despite great odds.  In this group, think Oprah, Barack, Vernon Jordan, Michael Jordan, Clarence Page. The list is long. He did a good job explaining what this group represents, and what their resources *both human and otherwise* truly represents in the broader society.  He's well connected and is part of this group.  But the description of the emerging group is a bit less compelling. It is possible that Eugene has less access and fewer personal connections to draw from. So, this story both from the immigrant and from the multiracial perspective needs to be told more fully by the people who can speak from this perspective.

The description of the abandoned, the poorest, least resourced, and in some areas the least visible haunted me.  Again, Eugene Robinson does not come from this world, and after Katrina anyone who bothered to look saw that the poorest black people in this country lived in some ways that were indistinguishable from the poorest of Lagos or Nairobi. What do we do about the increasingly desperate situation of the abandoned? What do we do about the poor high school graduation rates and illiteracy? The single parenthood at very young ages?  The increasingly desperate attempts to reach kids who seem unreachable?

I read this blog entry in the Atlanta Journal Constitution, Three babies and no high school diploma, and realized again how very difficult the task ahead is. As Eugene Robinson describes, young people having children is a decision that makes complete sense in the world of the abandoned, but in the larger world beyond the confines of their neighborhood, it is an albatross that limits one's progress.

Looking forward to better leadership in Nigeria? Don't hold your breath.

 A few days ago, the Nigerian Public Health Network posted a synopsis of the presidential debates’ discussion on the public health sector.  The debates featured all major candidates except the current president, Goodluck Jonathan who is also a candidate. He was the only candidate who deemed it more important to campaign than to participate in a debate of the issues of the day.

Mr. Jonathan’s absence is a separate issue from the quality of the responses when candidates were asked about their vision for the health sector—particularly in the face of striking physicians which has had terrible consequences to date.  Since I did not watch the debates, I relied on clips and a partial transcript.  The responses, in sum, were shallow, poorly constructed, and at times indicated that the candidates had not given any serious thought to the issues at hand.  It bears repeating: presidential candidates had not given any serious thought to health issues in a country with the following statistics for 2005-2010. 

Country	Life expectancy at birth (how many years can one expect to live, on average)	Infant Mortality (infant deaths per 1000 live births)	Under 5 yrs old mortality (deaths under age 5 per 1000 live births)
Nigeria	47.8	109.4	187
Cameroun	51.0	86.9	144
Cote d’Ivoire	57.2	86.8	123
Brazil	72.3	23.5	29

Even among African countries, Nigeria is at the bottom of the list of a myriad measures of the public’s health status.  And yet, not only does the current president (also a candidate) skip a presidential debate, the ones who showed up gave miserable answers to how they would address problems the country can ill-afford to ignore.  But I digress—I actually didn’t mean to focus on public health exclusively here. 

As we all watch the events unfold across the Middle East, what I feel like I’m witnessing is a call for change. Except it’s more than a call, they are essentially revolutions in the making. What makes it so powerful is that they are occurring in a region of the world where one would least expect such monumental shifts in the status quo. Egypt? Tunisia? Libya? Major agitations in Syria, Bahrain, even Jordan?  Granted the more successful revolts have happened in countries with stronger national identities i.e. Egypt.  However, these developments have proven --yet again, that anything is possible.  

But who--if not a dictator who knows of the certain outcome of an election--can elect not to participate in the presidential debate process? Who chooses to ignore the voting public if they know their election rests upon how they respond to the pressing concerns of the day? On the other hand, what people continue to put up with the miserable numbers on child and infant mortality, economic insecurity, motor accidents, and lack of infrastructure? Who puts up with their leaders’ total lack of vision about how to improve the lot of the many not just for the select few? Who puts up with these things year after year after year? 

Which brings me to my point. Nigeria is a victim of her own democratic government charade. The government stands on paper as a democracy, but there is almost nothing democratic about Nigeria.  People have not had the right to self-determination for as long as anyone cares to remember. Even eventual political leaders are not really selected by free-thinking people in fair and free elections. Have you heard anything about the recent round of murders leading up to this election? It’s all a charade: but one can’t make the argument that they are being led by a dictator because of what’s on paper.  This, I believe has contributed somewhat to the silence about (and tolerance of) the egregious indignities citizens of this country have had to bear certainly in my life time.  Case in point: the statistics on health mentioned earlier.

Toughest places to be

I started off my blog with the desire to write about anything but health issues.  I wanted to write about fun things like film, fashion, books, recipes, high quality dark chocolates.  One month in, and I am struggling with that plan.  See, I like fashion, but I am not interested enough to blog about it.  I love chocolate but I am bored by the discussion of it. I don't see enough movies to have a constant stream of thoughts on them. I would probably never, ever, blog about recipes.

I am interested in health, and the social determinants of health.  What do I mean by this?  I am drawn to the intersection of education, housing, income, assets, neighborhood and community, air/water, race, sex, and policy and how they all impact our health.  So here's my plan: I will use this blog mostly to explore and highlight these issues in a non-academic, accessible, and meaningful way. This will be more or less the focus of the blog.

Of course, I still reserve the right to write about  non-health issues like Tina Fey's recent essay on juggling motherhood and career in the New Yorker (subscription needed).

Now, on to another post.

A show on the BBC called Toughest Place to Be sent an experienced midwife named Suzanne to Liberia to see how they practice midwifery in that part of the world. Suzanne was quite open to learn more about "natural birth" methods and how to improve her practice.  What she learned in Monrovia shocked her.  Women frequently suffered unbearably during the childbirth process--many babies and their mothers die of preventable causes.  One young woman, after a failed abortion using the "leaf of death," became septic, and died right before our very eyes.  She was 21 years old.  No family members were around.

Women, inpatients with various conditions shared the same ward with nothing but a curtain (in some cases) to shield them. Births occurred right next to a woman whose child may have just died minutes before, with what appeared to be a lack of sensitivity. But this--few resources, death--is a matter of fact here. Most heartbreaking of all, one Liberian woman with five living children (she had delivered a stillborn just hours before) begged Suzanne to take any of her children off her hands...she was struggling to feed them as things stood.



There are many video segments on Youtube.

Another segment of this show is of a London bus driver named Josh who was sent to Manila, Philippines to interact with his fellow bus driver, a Jeepney driver named Rogelio.  Manila is a city of about 20 million including its outskirts.  An unbelievable scene, when Josh went to visit a family in a house that measured 6 ft by 6 ft, revealed that the young woman had 13 children and a husband all living in the house. No one could quite stand up straight in this house. She described her repeated pregnancies (she's normally pregnant during the first birthday of the last child), and the difficulty it now posed as life had become impossible. As Catholics, she had long believed it was a sin to control her fertility. That decision had led her to a terrible bind-no food, no space, education for the children was not an option.  This is juxtaposed with Rogelio's wife who insisted early on birth control, and subsequent prayer for forgiveness.

In Liberia, you see standing water in most of the outdoor shots, filthy conditions outside the hospital, no medicines (no antibiotics for a septic patient) in the hospital, self medication in the most outrageous circumstances, stigma, poor training for some of the health care providers, poor transportation and no fans. In the Philippines, even in a 6 by 6 ft house, there's electricity, but lack of education, terrible infrastructure, extreme poverty. While I marveled at the shared ward in Monrovia, Liberia, there were shared beds--four women and their newborn infants--to a bed in Manila.

The common denominator: In both places, poorly educated women, arresting poverty, poor healthcare infrastructure and poor health, and family planing--in more ways than one--gone completely awry.