Friday afternoon I found myself in a crowd of people chanting, “f*** the church.”
I bit my lip. I adjusted my sunglasses, cracked my neck, kept my sign in the air.
How did we get here?
A woman stood on the stairs of city hall, telling the story of a priest who raped her as a child and a church that did nothing.
How did we get here?
On the opposite corner a smaller group was praying, singing Amazing Grace, standing at a careful distance from the women surrounding me. They were quiet, calm, dignified.
On my corner, in our circle, there were tears. Our sorrow spilled from the sidewalk, our rage flooded the streets. We were not quiet. We were not calm. But peaceful protest carries inherent dignity.
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This morning I rushed into church, desperate for worship, prayer, confession, and communion. My head has been full of words to share since Friday morning, when I learned about the Supreme Court decision. received a panicked text and screenshot from a friend. But I’ve written too many words I’ve wished to take back, and I knew these words were too heavy, too complicated, too important to write without a firm grounding in Love.
Coincidentally, our scripture this morning was Mark’s story of Mary, Mary Magdalene, and Salome at the tomb. These women were faithful witnesses of Jesus’ death, burial, and resurrection, an important piece of the wider gospel narrative of Jesus’ affirmation of women in particular and the vulnerable in general. Again and again, the gospel writers chose to include women, often by name, in the story of Jesus’ time on earth. He healed women, discussed theology with them, included them in his parables, welcomed them into his group of disciples. In each of these actions, Jesus lifted women from their traditional roles as mothers and property and established them as full participants in his kingdom. He addressed them as people, not as wombs.
Why, then, has the Church allowed itself to be co-opted for political gain, for a cause that insists a woman’s life, dreams, thoughts, and emotions lose importance when she becomes pregnant? Millions of women understand Jesus only as part of an institutional religion that seeks to restrict their freedoms and right to self-determination.
I will not pretend that I know when life begins, whether at conception, at birth, or somewhere in between. Neither prayer nor medical education has made that clear. However, my prayers and my education led me to stand in front of city hall on Friday, to silently grit my teeth through “f*** the church” yet proudly shout, “abortion is healthcare!”
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While I don’t believe that abortion is an ideal solution to the reproductive health issues and inequalities that our nation faces, I believe it must remain an option in order to uphold the health and worth of women. Why?
The decision to overturn Roe v. Wade will inequitably affect those who are already most vulnerable to poor reproductive health outcomes.
Demographic data shows that Black and Hispanic women are overrepresented among those who get abortions (1). Black women already have high maternal mortality rates due to structural racism, and when more Black women are forced to carry pregnancies to term, more will die.
49% of patients who get abortions live below the federal poverty level (1). As access to abortion is restricted across wide regions of the U.S., these patients may lack the resources to travel for care. Women with more resources will be able to travel to receive safe abortions while those without the resources to do so will deal with the consequences of unintended pregnancy—or, as history shows us, the consequences of unsafe, self-induced abortions.
Restrictive abortion laws ban safe abortion, but these laws are associated with increased abortion-related mortality rates; i.e., when women are unable to access legal abortions, more women die from abortion-related causes. This difference is evident between countries and within countries that have changed their laws over time (2). Women who are desperate to maintain control over their lives and bodies may often resort to unsafe, self-induced abortion.
Restricting abortion access comes between the physician and the patient, impairing a physician’s ability to make decisions in the best interest of the patient. Abortion is healthcare, and for many women an abortion can be life- or health-saving. Provisions allowing abortion only when there is “danger to the life of the mother” delay care as providers scramble to make sure the healthcare they are providing is not a crime. Clinical ethics demand that physicians put the interests of the patient above one’s own self-interest. Will this fiduciary duty now result in the risk of prosecution and imprisonment?
I’ll admit the last couple of years have made me more of a cynic than I’d like, but I hold on to the faith that we all have the power to make our world more just, more loving, and more kind. Today, reflecting on the stubborn hope of our group of women in front of city hall, I might even call myself an optimist.
We are failing to prioritize one of the highest risk groups in the state.
U.S. COVID-19 vaccine distribution is well underway, and I’m hopeful that we’ll soon see the positive effects of the massive campaign. In South Carolina, more vaccine doses (399,830) have been administered than the number of official recorded COVID-19 cases (394,153).1,2 We remain in Phase 1a1, which includes health professionals, long term care facility residents and staff, admitted hospital patients 65+, and all adults age 70+.3 One similarly high-risk group is missing from the South Carolina vaccine distribution plan: adults with developmental or intellectual disability living in community-based group settings.
Community residential facilities (more commonly known as group homes or supervised living programs) are not formally included in Phase 1a or 1b of SC’s plan.** Phase 1c includes “people age 16 and older with certain underlying health conditions” listed by the CDC, but the only intellectual or developmental disability on that list is Down Syndrome, which means that many with disabilities will be excluded from Phase 1c as well.3,4 Despite the omission of community-based residential facilities, some facilities have obtained vaccines for their residents and staff, as evidenced by the inclusion of several community training homes (a type of group home) on the latest data released by SCDHEC on Moderna vaccine allocations.5 The issue lies not in the complete exclusion of these facilities from the vaccination campaign, but in the absence of clearly defined policy guaranteeing all group homes equal access to vaccines. I suspect this is a federal issue as well as a state issue because the federal government is managing the long-term care vaccination program.1 The Biden Administration recently released the National Strategy for the COVID-19 Response and Pandemic Preparedness; this plan specifically includes people with disabilities as a high-risk population.6 Hopefully improved federal focus on the disability community will lead to defined policy that improves community facilities’ access to the COVID-19 vaccine.
There are many population groups at high risk for complications from COVID-19. This makes vaccine allocation a complex issue, but recent studies have made it clear that adults with intellectual and developmental disabilities must be prioritized. A study of almost 500,000 adults diagnosed with COVID-19 found that those with developmental disorders were more than 3.06 times more likely to die from the infection than the those without developmental disorders, and those with intellectual disabilities were 2.75 times more likely to die than those without.7 The increased risk of death for those with developmental disorders was higher than for any other studied risk factor, including lung cancer. This study was conducted among privately insured patients, so it may not be completely generalizable to patients living in group settings, who are often covered by Medicare or Medicaid. However, it is probable that adults living in group settings are equally, if not more, susceptible to COVID-19 complications.
With this information about increased mortality risk, it would be reasonable to include this group in Phase 1c along with other adults at increased risk of death or disability due to COVID-19 infection. However, adults living in community-based facilities face additional challenges that I believe should place them in Phase 1a along with other adults living in traditional long-term care facilities. In both community training homes and supported living programs, adults with disabilities are in frequent contact with staff and roommates. Unlike an adult living independently with a condition such as hypertension or diabetes, adults in community facilities have little control over who they come in contact with and what those contacts have been doing. Community training homes have shift-based staff that ensure 24-hour care, introducing multiple contacts with the “outside world” each day for the house’s residents. Beyond that, each resident may participate in therapy, day programs, or outside visits with relatives. All of these outside contacts are certainly necessary, but they also increase the risk of infection. Once COVID-19 is introduced into the home, it can spread quickly in the same way it does within a family living in the same household.
Adults living with developmental and intellectual disabilities are at an increased risk of dying from COVID-19, and those residing in community-based facilities are unable to fully reduce their risk of contracting the virus. Consider the ethical framework published by the CDC to direct vaccine allocations:8
Maximize benefits and minimize harms: Adults with developmental and intellectual disabilities are more likely to die if they contract COVID-19, and those living in group facilities are unable to completely physically distance.
Promote justice: the disability community has been harmed in the past by health policies that did not respect the inherent value of lives lived with disability.
Mitigate health inequities: by failing to explicitly include community facilities in vaccine allocation strategies, facilities without the resources to obtain access to the vaccine will be left behind.
Promote transparency: with no explicit policy to include community-based residential facilities in early vaccine distribution, the community does not understand why some facilities have received the vaccine and others have not.
What’s next?
I am planning to contact my representatives at the state and national level to encourage them to amend Phase 1a of vaccine distribution to include adults with developmental and intellectual disabilities living in community-based facilities. I will not be satisfied until it is clear that every facility has full and equal access to the COVID-19 vaccine.
I hope you will join me in advocating for just and transparent COVID-19 vaccine distribution.
** Since writing this blog post, I have located this webpage that lists community training homes as a part of SC’s Phase 1b. I believe this post remains an important argument for moving this population into Phase 1a and/or prioritizing adults in group homes within Phase 1b.
When I was little, one of my favorite parts of the day was bedtime, when I would lay in my big four-poster bed with my mom and sometimes my dad. We’d read together, and then my mom would sing to me. Not just one lullaby, but five or six before I’d let her turn the lights out. The night was extra special when she held up my Lammy as a puppet and had Lammy sing to me. There was a whole songbook in our hearts of favorite lullabies. One of the less frequent, but still cherished, songs on the setlist was “Jesus Loves the Little Children.”
Though I had never seen anyone who was red, yellow, black, or white, I was old enough to know that “white” meant people who looked like me, and “black” meant people who looked like many of my friends in kindergarten. The meaning of “red” I learned later, reading Little House on the Prairie, and the meaning of “yellow” as a teenager studying American history. The message of “Jesus Loves the Little Children” is an important one, and Jesus’ love for all people as unique reflections of His image is central to the anti-racist work that brings the church closer to true embodiment of the Holy Spirit.
However, every time we reference “Jesus Loves the Little Children,” saying or singing, “red and yellow, black and white, they’re all precious in His sight,” we are employing racial epithets. Clare Herbert Woolston, a Baptist minister, wrote the song to the tune of a Civil War battle march in the late 1800s.1 For some historical context, this is the same time period as the beginning of Chinese immigration to the West Coast of the United States and the racist, reactionary politics to limit opportunities for Asian immigrants, including the Chinese Exclusion Act of 1882, which excluded Chinese immigrants from legal immigration and naturalization on the basis of race.2 Native Americans were being massacred at the hands of the U.S. military as American settlers pushed westward and were denied citizenship and any related rights in the lands they had inhabited for centuries.3
The terms “red” to describe Native Americans and “yellow” to describe people of East Asian descent, when used today, reflect a history of the dehumanization of groups of people on the basis of race. “Yellow Peril” is the idea that the Chinese are a barbarian people intent on destroying Christendom.4 The term “redskin” was and remains a term laden with the stereotype of the “violent native.”5
It might be easy to dismiss a critique of “Jesus Loves the Little Children” as an exercise in political correctness. But is it not an exercise in love? To white people like me, who have never experienced systemic discrimination based on the color of our skin, maybe it does seem an unnecessary critique. But how can all the nations under heaven worship together while one of our worship songs uses derogatory terms to describe some of those nations? Giving up a cherished tradition like a song is uncomfortable. Maybe it feels like giving up another part of the Church you grew up with in a world where nothing seems the same as it used to be. But the Church was never supposed to be comfortable; it is supposed to be embodied Love.
I have seen so many church members come out in support of the Black Lives Matter and anti-police brutality movement over the last couple of weeks. This essay addresses some of the issues two groups of people of color have faced in American history; other groups, and especially Black Americans, have faced (and continue to face) similar and yet unique biases, prejudices, and discriminatory practices. We’re all learning, changing, and growing during this time. I’ve made a couple mistakes. I’ve seen a couple of other people make mistakes. We’re not going to get it right every time. Otherwise, why would we need grace?
Don’t be afraid to learn, grow, and change. Give grace. Receive grace.
The second verse of “Jesus Loves the Little Children,” as my mother sang it, went like this:
“Everything is beautiful, in its own way. Like a starry summer night, the world’s gonna find a way.”
Growth is hard. Change is hard. But we’re gonna find a way.
In every coming of age novel I’ve ever read
It seemed obvious which choice the main character should make
But here I am
Here we all are
In the middle of a Bildungsroman
(personal, national)
And every choice is consequential
(personally, nationally)
I used to get angry with characters who chose wrong
But now I understand
That you never really know which choice is the right one before you make it
The COVID-19 pandemic, as with all crises, does not affect all populations equally. For those living on the brink of poverty or extreme poverty, the pandemic signals oncoming food insecurity. Many women around the world are facing an intensified “second shift” with family members constantly at home: while still attempting to continue providing economic support, they are also taking up caring roles for children and the elderly. In America, racial and ethnic minorities face increased death rates from the virus, a symptom of a larger system of structural inequality. African and South American countries struggle to obtain resources to effectively fight the virus in a tightly constrained world supply chain, and they face special economic considerations due to largely informal economies. While many privileged citizens around the world take up new hobbies in their time of social distancing, many more are facing steep declines in their quality of life.
In some ways, this virus is uniting us: we’ve all seen the videos of New Yorkers and Parisians cheering for healthcare workers each evening, of children playing the violin for their elderly neighbors, and of volunteers delivering groceries to those in need.
But how has it brought our divisions into sharper relief? How has it revealed inequitable resource distribution? This blog isn’t one to read through, word-for-word (unless you’re really dedicated, I suppose). I’ve spent the last three weeks collecting all of these sources for a class project. If you’re interested in the effects of coronavirus on a specific country, you can look for it in my “Country Index” then “CTRL+F” the author’s name to read more and find the article link. If you’re interested in a specific topic or world region (I summarized articles about gender, the hunger crisis, U.S. racial disparities, South/Central America, Africa, and the Middle East/Asia), just scroll down and look through the sub-headings.
I hope you learn a lot about something that interests you or stirs your soul. I tried to find information from diverse authors about diverse situations. I know my perspective on this pandemic has been greatly enhanced by this project!
Country Index
Afghanistan
Rodriguez, L.
Brazil
Phillips, T.
Costa Rica
Kahn, C.
Dominican Republic
Dugan, C., & Porter, I.J.
Ecuador
Phillips, T.
England
Lewis, H. Spinney, L.
Haiti
Dugan, C., & Porter, I.J.
India
Spinney, L.
Indonesia
Rochmyaningsih, D.
Iran
Rodriguez, L.
Italy
Tolmay, S. & Morna, C.L.
Kenya
Kenyanjui, N. Searcey, D. & Maclean, R.
Mozambique
Beaumont, P.
Mauritius
London School of Hygiene and Tropical Medicine.
Nicaragua
Kahn, C.
Niger
London School of Hygiene and Tropical Medicine.
Nigeria
Adegbeye, O. London School of Hygiene and Tropical Medicine. Simeoni, C.
Norway
Spinney, L.
Senegal
Hautefeuille, M. Jabkhiro, J. Searcey, D., & Maclean, R.
Sierra Leone
Ahmed, K. Lewis, H. Umurungi, C.
South Africa
Beaumont, P. Budrick, Z. Tolmay, S. & Morna, C.L.
Syria
Ashawi, K.
Uganda
Dexter, D., et. al.
United States
Blackstock, U. Cohn, M., Ruiz, N., & Wood, P. Illinois Department of Health. Lewis, H. Rosen, Y. Schwader, M., & Sampathkumar, M. Tartak, J.C., & Khidir, H. Washington, H.
The WFP is reporting that already elevated levels of food insecurity at the end of 2019 are being exacerbated by the pandemic. Food shortages will be especially severe in countries that depend on oil exports and food imports, and among vulnerable populations including pregnant and lactating women, displaced persons, the elderly, and the disabled. In addition, food aid distribution is becoming more complicated as ports close and distribution sites are unsafely crowded.
In general, pandemics occur in times of great economic inequality, when the poor are more vulnerable to disease and the wealthy live more globalized lives. This was true, for example, in the Justinian plagues and the Black Death. Thus, they often cause social unrest. In 2020, these problems have been exacerbated by global lockdowns, which are more difficult for poorer and less educated groups to follow.
Lewis analyzes the gender-based problems faced by many women in crisis situations, drawing on evidence from previous epidemics such as Ebola and Zika, to predict problems women will face due to the COVID-19 pandemic; instead of focusing on biological response to disease, she specifically considers the unpaid economy of “caring” for children and the elderly, which predominantly falls on women. She uses her analysis to plea with the government for a more far-sighted coronavirus approach that accounts for gender disparities.
Tolmay and Morna analyze the ramifications of coronavirus on women’s rights in South Africa. Their most serious concerns include backwards movement in employment gains (as women are expected to care for the sick and less expected to continue working), lost income (as many women are employed in the informal sector), and decreased access to women’s healthcare, including pre- and post-natal care. As a result of these factors, they call for governments to use a gender-based approach to economic and preventive measures.
Umurungi argues that women working in the informal sector will likely face the largest economic burden from COVID-19. As a solution to this symptom of a bigger funding, she pleads for a reform of the international taxation system to better fund public and social services. Good governance via responsible collection and use of tax funds can be used to improve women’s education and legal participation in the workforce.
In Maryland in general and Baltimore in particular, Black community members make up a larger proportion of COVID-19 cases and deaths than they do of the general population. However, there is a significant data gap, as this data mainly comes from public labs (private labs are not yet required to report race). Perhaps the most significant reason for this disparity is long-standing health inequity and socioeconomic/structural factors that affect health. Coronavirus disparities are an acute-on-chronic problem. Black community members are unable to access primary care regularly, and in the midst of this crisis are more likely to be working “essential” jobs in public spaces where social distancing is more difficult.
Dr. Uché Blackstock, an Emergency Medicine physician who founded “Advancing Health Equity,” discusses the effects of implicit bias and structural racism on the Black American population during the pandemic. She specifically highlights inadequate access to testing, underestimated pain and suffering leading to inadequate care, higher rates of comorbidities, and a strained relationship with the healthcare system as factors leading to higher mortality rates in the Black population.
Illinois Department of Health announced new cases on March 27th, 2020, broken down by race and ethnicity; they reveal the heavy burden of disease carried by black Americans.
Community leaders in isolated Alaskan Native villages are imposing strict travel limits. While they are following the same practical reasons as communities across the United States and around the world, a history of outsider-introduced outbreaks influences these decisions, as well. For example, the 1918-1919 flu killed almost 200 Alaskan Natives in Nome after the disease was introduced by the S.S. Victoria.
This article discusses how indigenous and native populations of America are abandoning their settled areas that do not have adequate cell and internet service to move to areas where they can access the internet as the societal infrastructure moves online. Geographical, financial, and societal problems have prevented adequate service and caused a “digital divide” between native populations’ rural roots and their newly adapted urban community.
This opinion piece argues that Crisis Standards of Care, as released by many states to ration critical resources in the event of shortage, will worsen health disparities. This is because historically disadvantaged populations including black and Latino patients have high rates of comorbidities currently found to be associated with coronavirus death. In order to prevent this, the authors recommend including only major comorbidities with known short-term prognosis impacts in the standards of care, tracking demographic data, and ensuring that committees establishing standards of care are diverse.
Failure to maintain current malaria prevention and treatment measures in many African countries could increase 2020 malaria deaths to rates last seen at the turn of the century. The WHO recommends maintaining malaria-focused health programs, with some modifications for social distancing and testing patients with COVID-19 symptoms for malaria in endemic areas to ensure the proper treatments are administered. Several sub-Saharan African countries have committed to continuing their malaria programs during the pandemic.
Because COVID-19 is reaching dangerous case numbers later in Africa than in most other world regions, many African nations are entering the global pool of demand late, when the supply chain is already heavily constrained. For many nations, the problem is not a lack of money for medical supplies, but a lack of bidding power. Thus, in many situations, nations are uniting for increased power (for example, the African Union is bidding as a single entity). For nations without the economic power to purchase materials, the problem is medical supply hoarding on a national level.
In the week preceding April 23rd, the African continent experienced a 43% increase in coronavirus cases. However, this is likely an underestimation of case numbers, as the director of the African CDC, John Nkengasong, admits that testing capacity is very limited. Imperial College London has modeled a continent total of 300,000 to 3 million deaths (between the best and worst case scenarios). South Africa (with strict social distancing guidelines) and Egypt currently have the highest numbers of cases.
Dexter, D., Simons, D., Kiyaga, C., Kpata, N., Ntoumi, F., Kock, R., & Zuma, A. (2020, April 23). Mitigating the effect of the COVID-19 pandemic on sickle cell disease services in African countries. The Lancet Haematology.https://doi.org/10.1016/S2352-3026(20)30122-8 (Links to an external site.)
Though in Europe, Southeast Asia, and North America, the SARS-Cov-2 virus mainly kills the elderly (due to increased pre-existing conditions), the epidemiological pattern may be different on the African continent, as these younger populations often have pre-existing conditions including HIV, hypertension, and sickle cell disease. Countries with a high burden of sickle cell disease may see especially high morbidity and mortality, as respiratory viruses often cause pulmonary vaso-occlusion for sickle cell patients. Thus, resources should be used in such countries in order to identify and isolate high-risk sickle cell patients.
In some ways, African nations seem better protected from and prepared for the coronavirus, especially after dealing with other epidemics (such as the West African Ebola epidemic). As a result, some American immigrants are remaining in the countries in which they live instead of returning to America. They remain for legal, economic, or family reasons, though as the disease begins to take hold in Africa, there are worries about the strength of the health system.
A summary of mathematical modeling (not yet peer-reviewed) by Kevin Zandvoort and Christopher Jarvis demonstrates likely effects of various mitigation measures in the African countries of Niger, Nigeria, and Mauritius (chosen as examples due to their age structures as the youngest, median-age, and oldest countries, respectively, on the continent). “Shielding,” an uncommon idea during this pandemic in higher-income countries, involves placing the elderly and other high-risk individuals in sheltered communities via home swaps and relocations. Other effective measures according to these models included self-isolation and moderate levels of social distancing (social distancing isn’t feasible at more extreme levels due to weaker economies).
In Kenya, the informal sector (including market sellers, artisans, mechanics, and porters) makes up more than 80% of the workforce. During the COVID-19 pandemic, informal workers will face decreased demand for goods, problems with childcare, and decreased supply of materials. Where work does continue, social distancing is impossible and there are few opportunities for proper hand hygiene. In the short term, it will be helpful to provide masks, gloves, and hygiene stations to informal workers to prevent the spread of disease. In the long term, governments should prioritize city planning that provides proper resources to informal workers.
Adegbeye describes the barriers to effective coronavirus control measures, including social distancing, in Lagos, Nigeria. She especially mentions the difficulty of staying in one’s home due to unreliable power and water, the importance of the informal sector, and shared housing and sanitation facilities. Essentially, social distancing is a privilege for those with the socioeconomic means to do so, both in Nigeria and abroad. Ultimately, the community mindset of Nigeria demands a set of new solutions designed for the Nigerian setting.
Article describing the spread of coronavirus in Senegal from March through early April. Pictures show sanitation measures at daaras and hospitals, a tailor making masks, binational couples remaining in Senegal, educational graffiti, quarantine hotels, empty shops and roads, and food aid distribution.
RBS Crew, a graffiti collective, is painting health education murals on popular Dakar streets in order to reach the illiterate population about the effects of coronavirus and the proper preventive measures.
Dakar, Senegal has a large population of street children, especially “talibés,” students of daaras (traditional institutions for teaching the Koran) who beg for food and funds to run the schools. With fewer pedestrians walking around the city and fewer businesses open, options to obtain food are few. Local non-profits are attempting to pass out food.
Though the structural adjustment period of the 1980s and 1990s destroyed the African public sector and weakened African economies, many African nations such as Nigeria retain their outlooks on the importance of public health in everyday life. Horizontal interventions that target health in general, instead of just coronavirus, will enable Nigeria to effectively combat coronavirus. The World Bank has opened up a loan program targeted to helping lower and middle income countries effectively fight the coronavirus; however, this neoliberal idea places African countries back in the cycle of debt to wealthier countries and harms their economies more than it helps them.
The Nicaraguan government has announced no quarantines or shutdowns, and officially reports many less cases of COVID-19 than its citizens and health facilities do. Surrounding countries are worried about the impacts of the uncontrolled virus in Nicaragua, especially as borders have not been closed.
Jair Bolsonaro, the Brazilian president continues to deny the seriousness of the COVID-19 pandemic, risking a massive surge of disease in Brazil similar to the one in Ecuador. Bolsonaro has fired his health minister and is favoring keeping the economy open in the interest of supporting the poor. While leftist politicians believe his mistakes may lead to his ousting or the election of a left-wing candidate in 2022, outside observers find this unlikely.
Many Venezuelans who had migrated to Colombia and Ecuador in search of work have now returned to Venezuela during the social-distancing-induced economic downturn. Venezuela has accepted those migrants but is keeping asymptomatic individuals in unfurnished transportation terminals, office buildings, and customs facilities that also lack basic sanitation. These conditions are not only inhumane; they also create a perfect situation to spread the disease.
Due to recent unrest that has halted tourism in Haiti, there are so far relatively few cases of COVID-19 in Haiti. However, the Dominican Republic, which borders Haiti, has more than 5,000 cases, and newly unemployed Haitian residents of the Dominican Republic are returning home. They are expected to bring the disease back with them, and many fear an epidemic akin to the 2010 cholera epidemic following the devastation of the January earthquake of the same year. However, with foreign countries and NGOs occupied with more local problems, Haitian non-profits and the Haitian government face the burden of care this time.
In Idlib, a rebel holdout in northwest Syria, hospitals and medical equipment are depleted following nine years of war, and 3 million migrants live in crowded refugee camps and makeshift settlements; these conditions make a devastating outbreak likely. A local group of engineers has designed a cheap ventilator, and they are hoping for funding and equipment from Turkey and aid agencies.
The Afghan Girls Robotics Team has designed a ventilator using materials from a Toyota Corolla, which would be mass produced for US $300 each if approved by the WHO and the Afghan Health Ministry. This is especially important in Afghanistan, which has only 300 ventilators but is seeing an influx of cases due to people fleeing the Iranian outbreak.
Rochmyaningsih presents an overview of the coronavirus situation in Indonesia, including a likely underestimation of cases by the government, spread from Jakarta due to migrant owrkers returning home (and potential increased spread with the Eid al-Fitr holiday), minimal lockdowns prevented by strict qualifications, and limited hospital and lab capacity for the country’s 267 million citizens.
This time three years ago, I was beginning to brainstorm
ways I would keep off the “freshman fifteen.” I’d go to the gym. I’d take up
swimming. I’d spend limited time in the dining hall. I’d just eat salads and
sandwiches at lunch.
I’ve gained twenty pounds since moving into my freshman dorm. But it isn’t the buffet-style dining halls, the constant supply of free food, nor the alcohol that flows freely on this campus.
First, my body demanded the space to exist as it was meant to exist. I fought it, and I lost, over and over again.
Finally, later, I allowed my body the
space to be.
Something they tell you in eating disorder recovery is that it’s okay to grieve what your eating disorder stole. I grieve the hours and days and years I spent trying to force my body to be so much smaller than it was ever meant to be.
College didn’t solve my eating disorder. Eating more won’t solve an eating disorder—I wasn’t technically malnourished before I started college, and I’m not malnourished now. If anything, college has been a place where I fail and fail again at maintaining whatever ideal diet I attempt to pursue, and it is those thoughts of failure and guilt that truly characterize, for me, what mental illness looks like.
This is a hard blog to write. I know most of my family and friends have no idea that the past few years have been such a struggle. The truth is that I only realized how intrusive food and exercise had become relatively recently. Only now, almost a year later, could I write about it. There is such a stigma surrounding both weight and mental illness. Combining the two creates a wall that seems almost to almost block out the sky.
Hopefully this blog takes a brick or two out of that wall.
13.2% of women have a diagnosable eating disorder by age 20. Many studies say men face a similar risk. What drives your relationship with your body? Do you seek some arbitrary ideal number? Is food one of many ways you’re seeking perfection and order? Do you find your identity in comparison with others? Do you spend more time planning meals and exercising than doing something you love?
Visible ribs are not a criterion for seeking help. You wouldn’t look at a sprained ankle and say, “it’s not bleeding, so it doesn’t need a bandage.” The same goes for any other mental illness. Don’t be afraid to speak up for your own needs—and, just as importantly—don’t be afraid to notice and address the needs of others.
This summer I had the opportunity to swim in several ice-cold mountain swimming holes. My hair stood on end each time I entered the water, and the bone-chilling cold set my heart racing. The water was uncomfortable, but it restored my legs for more trail miles with a heavy backpack, and it made the humid North Carolina air more bearable–even if I shivered for the first few minutes out of the water, towel-less, sunning myself on big rocks.
I entered this summer drenched in spiritual sweat. I was bent over, wheezing, and red-faced from the effort I was making to avoid disillusionment with God, wrapped up in my disillusionment with the world, the Church, and the American political environment.
My time as a wilderness counselor at camp this summer was both literally and metaphorical, a jump into the frigid Linville River. I forgot to hold my nose. The Gospel rushed into my sinuses, undeniable Truth so ever-present it gave me a headache.
There wasn’t time–or cell signal–to be concerned with executive orders, judicial council proceedings, or minute theological disagreements while I taught high school girls how to set up rainflies, cook over camp stoves, and pack backpacks on the rim of the Linville Gorge. My calling this summer wasn’t to figure out which method of biblical interpretation was the correct one; it was instead to show girls the truth of who Jesus was and to understand that Truth for myself. I spent ten weeks teaching the very basic tenets of Christian faith: Jesus is the bread of life; the light of the world; the gate for the sheep; the good shepherd; the resurrection and the life; the way, the truth, and the life; and the vine.
And it felt good. It felt right. Believe me, I know the Lord is present in the everyday. But ultimately we’re called to an eternal mindset, not an everyday mindset. Recently my vision of eternity has been clouded because I can’t stop wrapping myself in all the everyday pain present in this fallen world. Jesus came that we may have abundant life–and for me, at least, abundant life is not closely following every headline and church disagreement, attempting to discern right and wrong.
I have not stopped and will not stop praying for and pursuing justice for all of God’s people, however He intends that to look. I know that as a straight, white, upper-middle class white woman, I have the uncommon luxury of spending time focused on the simple Gospel, suspending concern for the nuances of complex theology. But this summer I’ve rediscovered the reason I care so much for the future of the Church and the world: a good God came into this world to give me abundant life, and everyone deserves to know just how abundant life can be.
A Socioecological Analysis of Migrant Child Mortality in U.S. Custody
Author’s note: this is a formal research paper and my readers may not be accustomed to its technical style. I encourage you to stick with it–I learned a lot while writing this piece, and there is a lot to be learned from reading it.
As the social and political
situation in Northern Triangle countries worsens, more Salvadorans, Guatemalans,
and Hondurans are heading north to escape lack of access to quality education,
weak labor markets, natural disasters, violence, high rates of common and drug
crime, coerced gang recruitment, and trafficking of both people and drugs (“Key
Issues,” n.d.; Menjívar & Cervantes, 2018; Jonas, 2013). Many migrants travel
as family units or unaccompanied minors; as a result, thousands of children enter
or attempt to enter the United States at the southwest border each year.
Between FY 2015 and FY 2016, apprehensions of unaccompanied alien children at
the Southwest border more than doubled, and over the same time period
apprehensions of family units almost tripled. This shift occurred due to
increasing migration from El Salvador, Guatemala, and Honduras as migration
from Mexico decreased (“Southwest Border Unaccompanied Alien Children,” n.d.).
The United States immigration infrastructure is not equipped to handle large numbers of children entering the country without economic or social supports. Children may be placed in “iceboxes,” rooms at detainment centers that are kept cold and barren, in large groups. These rooms were meant for short-term detention (less than 12 hours) but are now used for upwards of 72 hours in many cases. Women held in these rooms reported overcrowding, family separation, inadequate medical care, extreme cold, no shower access, little food, and sleep deprivation (Cantor, 2015). Under current United States policy, family units are often separated, so many children are removed from crucial oversight and support. Unaccompanied minors may be transferred between multiple holding sites before a longer-term placement is arranged.
It is no surprise that the health of children who have arrived in the U.S. following dangerous journeys from unstable countries deteriorates quickly under such conditions. Within a single month, December 2018, two migrant children died in U.S. custody. Jackeline Caal, age 7, died from dehydration and sepsis, and Felipe Gómez Alonzo, age 8, tested positive for influenza B postmortem (DeYoung, 2019; Sacchetti, 2018). Although the American Academy of Pediatrics has set forth specific recommendations for health screenings of immigrant children, medically unqualified Customs and Border Protection agents perform cursory screenings for obvious physical ailments and may miss critical problems that would be evident to a medical practitioner (Baker, Li, & Steele, 2019). Comprehensive medical history and physical examination of each newly arrived child from Northern Triangle countries should be performed by a qualified medical professional with special attention paid to possible tuberculosis, Hepatitis B, soil-transmitted helminths, sexually transmitted infections, HIV, and Chagas disease. This paper will analyze the socioecological factors that contribute to health problems in immigrant children before and immediately after their arrival in the United States.
Socioecological Analysis
Pre-Arrival
Determinants
Children from Northern Triangle countries encounter many challenges prior to their arrival at the U.S.-Mexico border that may increase their risk of morbidity and mortality under the adverse conditions of Customs and Border Protection Custody. Malaria, Schistosomiasis, Hepatitis A, amebiasis, congenital syphilis, hemoglobinopathies, and metabolic diseases, uncommon in the U.S., are all common in Northern Triangle countries and should be considered factors in the health of this population even after emigration (“Providing care,” 2005). The presence of these diseases can cause further problems on the journey to the United States as children face heat exhaustion, dehydration, injuries, and skin parasites (“Health Needs of Vulnerable Populations,” 2016). These common physical ailments weaken children before their arrival in the U.S. and increase the chance of adverse medical events in detainment facilities.
Furthermore, migrant children experience multiple traumas both in the country of origin and throughout travel to the destination country. Flood and Coyne (2019) discovered that, in Europe, unaccompanied asylum-seeking children had often experienced torture (38.5%), food deprivation (37.2%), near-death experiences (55.8%), rape or sexual abuse (11.7%), forced separation from family (72.4%), and/or unnatural death of a family member (64.4%). As Guatemala, Honduras, and El Salvador are some of the most violent countries in the world not in active war zones—often with civil war-like conditions—it is reasonable to assume similar prevalence of traumatic experiences in youth traveling to the U.S. southern border. As a result of trauma, 61% of males and 73% of females in Flood and Coyne’s study (2019) had PTSD symptoms. PTSD and other mental disorders may have physical symptoms, and poor mental health is associated with poor physical health; thus, pre-arrival traumas may increase morbidity and mortality of child migrants.
At the more distal levels of the socioecological model, the failure of the wider international “community” to provide adequate food and water, medical care, and shelter is extremely dangerous to migrating children, whose bodies are more fragile than those of adults. As noted earlier, these deprivations lead to dehydration, heat exhaustion, and injury (“Health Needs of Vulnerable Populations,” 2016). Pre-existing dehydration, exhaustion, and injury make it more difficult for the body to fight infection when it occurs because of the pre-existing struggle to maintain a precarious homeostasis. Thus, weakened immune response may lead to sepsis more quickly than usual, or the symptoms of a more common illness (i.e. vomiting, common in children with influenza B) may be deadlier due to dehydration.
Public policy fails asylum-seeking migrant children as well. Restricted border crossing opportunities result in attempts to cross into the United States via dangerous desert routes (increasing the likelihood of dehydration and heat exhaustion), often using smugglers or traffickers (increasing the likelihood of traumatic experiences and mental health problems). Children face uncertainty and lack control over their experiences, increasing stress and its somatic symptoms and effects. Furthermore, the backlog of immigration cases waiting to be heard in the United States (and detainment of asylum-seekers within the United States while they await trial) gives many potential immigrants the idea that they will be allowed to remain in the United States if they are found crossing the border with a child. More children are brought along (or sent alone) on the dangerous journey to the United States with the hope that their presence may increase the chance of success and prosperity for the entire family.
Post-Arrival
Determinants
Several individual factors carried over the border continue to affect the health of migrant children after their arrival in the United States. The higher risk of several aforementioned diseases remains a problem, and in the new cultural context of the United States, traditional beliefs about health may affect parental decisions to seek treatment. At the interpersonal level, these traditional beliefs often go unacknowledged by physicians and healthcare workers, leading to animosity, distrust, and noncompliance with recommendations for care (“Providing care,” 2005). Loss of cultural context and known social structures following emigration may lead to acculturative stress and mental health-associated somatic symptoms. Furthermore, strained parent-child relationships following migration may contribute to poor communication about health, so that children become sicker before medical care is sought (D’Abreu, Castro-Olivo, & Ura, 2019). When healthcare workers are able to successfully reach and communicate with immigrant families and children, problems remain. Many American physicians are not used to diagnosing the unique illnesses and health problems faced by children from the Northern Triangle and may thus dismiss, misdiagnose, or incorrectly treat a child’s medical problem (“Providing care,” 2005).
Distally, the policy-defined organizational characteristics of U.S. Customs and Border Protection contribute to child morbidity and mortality. There is no assigned role to oversee child health and thus little oversight; when screenings are performed, non-medical professionals may only notice visible problems such as a rash and overlook hidden conditions such as dehydration. Detention centers are not meant to house children and provide little opportunity for healthy coping. The Department of Homeland Security does not specialize in health care, and it is not working with humanitarian organizations, nor the Centers for Disease Control and Prevention, which could both provide public health support. Alone, the Department of Homeland Security is inept in public health management (DeYoung, 2019). Lack of public health expertise is especially dire inside of detention centers, where overcrowding worsens the spread of disease (“Health Needs of Vulnerable Populations,” 2016). Children, who possess incompletely developed immune and stress response systems, may bear the brunt of infectious illness in detention centers, as in the case of Jackeline Caal and Felipe Gómez Alonzo.
Discussion
Child migrants are prone to illness while in United States custody due to high prevalence of diseases in the developing world; these diseases are exacerbated by the physically difficult journey north. Without sufficient, culturally competent care, morbidity quickly becomes mortality among members of this vulnerable population. A critical intervention to reduce both morbidity and mortality is the institution of comprehensive health screening of migrant children upon entry to the United States, performed by culturally competent medical professionals. Physicians, nurse practitioners, physicians’ assistants, and other professionals trained in differential diagnostics should perform a full physical with special attention paid to symptoms of common medical problems including tuberculosis, hepatitis, sexually transmitted infections, schistosomiasis, and seasonally relevant diseases. Professionals should be fluent in Spanish with at least rudimentary knowledge of some indigenous languages to facilitate effective communication with parents and children, or fluent medical translators should be present.
On a wider scale, reform of temporary detention is necessary. Crowded, ice-cold, bare, and windowless rooms constitute cruel and unusual punishment and are unacceptable for any amount of time and any population; children especially should not be subjected to these conditions. Separation of parents and children is unacceptable from the public health perspective; children cannot advocate for themselves medically and may be unlikely to report dangerous symptoms. Separation is traumatic and can worsen a child’s mental health status, increasing the likelihood of both psychological and somatic symptoms. Currently, the general conditions of temporary detention—whether the definition of temporary is 12 hours or 72 hours—increase a child’s risk for illness and death.
The death of two children under United States custody in December 2018 was preventable and unacceptable; however, incidents should not have been unexpected considering the socioeconomic situation in Northern Triangle sending countries, the difficult trip to enter the United States, and the conditions at temporary holding centers in the American Southwest. While international interventions to improve conditions in sending countries may be too complex to be practical, the United States can improve medical care and oversight following arrival. These changes can mitigate the consequences of a child’s exposures in her country of origin and over the course of her travel.
D’Abreu,
A., Castro-Olivo, S., and Ura, S.K. (2019). Understanding the role of
acculturative stress on refugee youth mental health: A systematic review and
ecological approach to assessment and intervention. School Psychology International, 40(2), 107-127. doi:10.1177/01430318822688
DeYoung,
S.E. (2019). Time for Coalitions to Protect Immigrant Health. American Journal of Public Health, 109(4),
519. doi:10.2105/AJPH.2019.304959
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My brothers and I were each other’s primary playmates, day in and day out, from the time I began to play. My middle brother and I lived in a world of rich imagination, devising entire worlds out of the grove of trees behind our house and playing baseball with imaginary fielders. With my older brother, our play took on a more concrete quality.
Our favorite game as a little crew of three was “skiing”: Andrew on his adaptive, adult-sized three-wheel bike; me holding on behind in my blue roller skates, pushing the bike along when Andrew gave up pedaling (which was more often than not); and Glenn riding behind on a razor scooter tied to the bike with a jump rope. I can only imagine what the neighbors thought! We were the only ones who could master this unique sport, though we tried with friends again and again. Inevitably the friend roller blading would slide dangerously under the bike’s back basket or the razor scooter rider–our “skier”–would crash onto the grass (if they were lucky) or skin their knees on the curb (if they weren’t).
One of Andrew’s unique skills, then, is riding a bike just slowly enough to give the roller skater a job (pushing) and keep the skier from a certain fate of skinned knees. This was all before the bike became anxiety-inducing for Andrew. Now his skill set includes a surprising falsetto, an insane sense of humor, and recitation of the week’s weather forecast.
I would love to romanticize my relationship with Andrew, and I do have many beautiful stories to tell of growing up with him and of our current (almost) adult relationship. While I would never trade my childhood and family for anything, the truth is that being the sibling of a person who has autism is incredibly difficult. When I was younger, my wish on every coin that I threw into a fountain, every first evening star, and every birthday candle was for a “cure” for autism. This concept is a little funny to me now with a better understanding of the brain and of autism. It isn’t a malignancy to be cured, but a piece of millions of people’s identity and way of processing the world. In context, however, my wishes were not surprising.
I was tired of having shoes thrown at me in the middle of a meltdown, of quickly removing breakable things from view when anxiety levels began to run high, of hearing my mom called a bitch and jumping every time a door was slammed and having my parents lament unsuccessful IEP meetings and not going to Christmas Eve services because they were too overwhelming and seeing my parents’ broken windshields repaired over and over again. I was tired. I wanted to be a kid, I wanted to be the center of attention, I wanted to invite a friend over without worrying about how they would react to my brother if he was biting my mom and throwing the nearest projectile at the TV. I felt like I had no place to act out at home; it was just a fact of life that my brother Glenn and I needed to be calm and compliant to prevent a meltdown. I remember a particularly difficult year at summer camp, the summer before Andrew got a residential placement, when I seemed to be in trouble every day–I could act out without fear of creating a chain reaction, so I did.
My discomfort doesn’t compare with Andrew’s. His “behaviors,” as they’ve been referred to by outsiders throughout his life, upset him. They keep him from doing the things he loves—going outside, seeing big cities, flying in airplanes, and getting in the ocean.
I no longer wish that Andrew’s autism would be cured. Things are much more complex than that. I do pray we find ways to help him cope with his anxiety and obsessions so that he can do the things he loves. I pray we help doctors and dentists understand how to make their offices and demeanors welcoming and calming, so Andrew doesn’t face a higher risk of health problems. I pray our residential programs for people with special needs can be better funded–both to improve Andrew’s quality of life and to honor the people receiving barely minimum wage to provide round-the-clock care to my brother. I pray that we can make public spaces more friendly for him.
My parents love their son, and they deserve the opportunity as they transition from childrearing to empty nesting to focus more on building an adult relationship with Andrew and less on his day-to-day care, though of course with their incomprehensible love for all three of us, they seem to have a bottomless willingness to do so–just as they help me pay for and navigate mental healthcare (though I would like to consider myself an “independent” adult) or help my middle brother organize his finances (and he is an independent adult).
For World Autism Awareness Day, I could quote statistics about the increasing prevalence of autism, but you’ve probably already seen them, and you’re probably already “aware” that autism exists–so instead I’ve shared some real life facts about what autism actually looks like in my family: the good and the bad. I challenge you to step away from passive awareness and acceptance and turn toward action. Here are some ways you can help:
Look into ways to make your organizations–churches, schools, clubs, workplaces–more welcoming to people with autism and their families. Be aware of both the physical environment (sensory stimulation, crowds) and the social environment (reach out, accept others’ differences, provide organizational support).
Advocate for better funding of programs for children and adults with disabilities. Parents of children with autism shouldn’t have to cry in IEP meetings to ensure that their child continues to receive speech therapy. Individuals with autism shouldn’t have to spend years on the waiting list to get into group homes that help them live independently. Programs should exist that meet people with autism where they are–whether that be with work, recreation, or therapy. In South Carolina, this could look like state acceptance of Medicaid expansion!
Involve yourself in organizations advocating for people with autism and their families. The South Carolina Autism Society does great work in our state.
Make friends with people who are different than you and encourage those around you to do the same. Not out of pity, but out of genuine interest. Work to find common ground. We’re all human.
Change into a blue shirt for the rest of today and tell everyone you know that you’re “lighting it up blue for Autism” today. Don’t let a blue shirt be the end of your advocacy.
Excessive Ramblings 