getting my house in order

getting my house in order
it's a jungle out there

Tuesday, September 28, 2010

Cultural Sensitivity: Part II


Sorry ladies. Part II is not about Key Food Cindy

It's about Lead Head Christine.

Lead Head Christine is 3. She has a lead level of 54.

That's REALLY high. Anything over 5 is elevated.

We NEVER see lead levels that high.

54=decreased cognitive function
54 is high enough to cause lead deposits in little kid organs
54 can=brain damage

Christine has 2 older brothers. When her routine lead test came back so high, we checked them too. Their lead levels were 3 and 4.

Does she put things in her mouth? Does she eat things that aren't food?

Pretty much.

She doesn't look particularly healthy. She's got bad eczema and a constantly snotty nose. Her hair is kind of falling out in patches. She doesn't talk much and doesn't make much eye contact.

One could argue that she doesn't talk or make eye contact because she's been in the office 4 times in the past two weeks, and every time she's gotten poked.

First a fingerstick. 38. Then a repeat fingerstick. 32. Then out of her arm. 54. Then out of her arm again.

That's where I come in.

I'm familiar with the family. They are from Nigeria. I've always found the mom to be a little odd. The oldest boy is autistic.
The middle boy is not yet diagnosed, but I suspect he's on the autism spectrum as well.

Christine came in last Wednesday at 7pm with her father. The chart notes were confusing. We were really busy. I was in a rush.
Dad said we came in to get her lead checked again. I flipped through the chart and saw the report of 54.
I ASS U MEd it was a fingerstick and she was in for a venous confirmation as per Department of Health protocol.

In NYS, lead stuff is followed by the Department of Health. We routinely check kids at 10 months and 2 years. Abnormal results go first to DOH, then to us. The DOH goes in and checks the home environment to determine the source of lead exposure. Our job is to treat the kid appropriately, based on the kid's level. Treatment guidelines are determined by the state.

So while I'm waiting for the nurses to poke Christine yet again, I asked Dad some questions.
According to Dad, the Dept. of Health had checked the house. According to Dad, there was no lead in the house.
I asked about a backyard.
Does she play in the grass? Does she eat the dirt?
No, the children are never out there.

Short story longer-
Christine was not supposed to come in Wednesday evening for a repeat level.
She was supposed to come in Wednesday during the day to be admitted into the hospital so we could Get The Lead Out.

Seems there was a "miscommunication".

Once I sorted the whole thing out, I explained to Dad that we needed to put Christine in the hospital to start treatment.
It didn't make sense to admit her Wednesday night because we couldn't start anything until the morning anyway.
I told Dad to come back Thursday morning, and we'd send them to the hospital and start her treatment.
I signed the case out to Dr. A, who would see Christine the next day and get her into the hospital.

Friday I'm back in the office and check up on Christine. No show. They didn't come back Thursday.
She's not in the hospital Getting the Lead Out. She's still at home.
I get a call from Wendy the Lead Lady at the DOH. She's concerned that Christine is still in a lead filled environment and hasn't started treatment.
Wendy says all the windows in the house are full of lead dust.

????

Why did Dad tell me the DOH didn't find any lead in the home?

Short story even longer-
All the windows need to be replaced. They own their home. There are no government funds to assist with lead abatement. The Department of Health had made 4 home visits and explained to Mom and Dad that Christine needed to be hospitalized to initiate treatment and would not be able to return to the home until all the windows were replaced and the DOH determined the environment to be lead free.
Lead Lady Wendy was pretty confident that Dad had full understanding of the situation.

I get on the phone with Dad.
He's refusing to bring Christine in for treatment.
He's aware that this level of lead causes brain damage.
He's aware that every day that Christine's lead level remains this high, it's causing more damage.
He's aware that the damage is irreversible.
I start to get worked up.
He wants to treat her at home with supplements for a month, and then test her again.
I advise there is no way treatment at home will bring the lead down to an acceptable level. She will need hospitalization anyway. It will just be another month of brain damage.
He says that since we don't really know how long her lead has been high, another month won't make much of a difference.
He continues to refuse hospitalization. He is aware that he is ignoring our medical recommendation and the recommendation of the Department of Health.
I let Dad know that he will be hearing from someone else in our office and the DOH as well.
Nigerian Dad remains polite and respectful the whole conversation.
But he wants to do it his way.

I turned away from the phone to see 6 wide-eyed nurses, mouths all agape.
They had never heard me speak to a patient in that way before.
They couldn't believe that Dad was still refusing treatment for his child.
They were all in a tizzy.

I ran it past a few docs. You can only do what you can do. You made the situation very clear.
Frustration spoke the words stupid, ignorant, idiots, in reference to the parents.
not my frustration. other's frustration.i may refer to my ghetto moms as train wrecks, but i never call them stupid

Dad is not stupid. Nor ignorant. Nor is he an idiot.

I didn't get it.

I went home Friday and didn't think about Lead Head Christine for the entire weekend.
I had done all that I could do.

First thing Monday, the nurses asked me if Christine had been admitted.
They had all worried about her the entire weekend. They couldn't understand how parents could be so negligent. Didn't the parents care? Did they want their child to have brain damage? If my child had a lead that high, or anything that serious, I'd do anything to fix it. Didn't they understand?

The parents totally understand. I'm thinking we don't understand.

Then I get a call from DOH Lead Lady Wendy. She had spoken with the Regional Director of No More Lead Heads/Get the Lead Out. The first priority was to get Christine out of the home. Second priority was treatment.
DOH Lead Lady Wendy was concerned about the extent to which we are responsible for getting Christine out of the home and in for treatment.
Turns out we're uber responsible. Like call CPS responsible.

Fuck. I HATE calling CPS.

Something wasn't sitting right.
I know these parents care about their kids. I know they are not negligent.
hmmmm....

Maybe Nigerian Dad needs a Man to tell him.
I bring this up with DOH Wendy who says you know... we were wondering the same thing... our lead team is all women... and he's always been very polite, but...

So I get Man Dr. B to call Dad. Man Dr. B says all the same things I did. But with a deeper voice and a set of cojones.

Does anyone know how to say balls in Nigerian?

NOLA, you out there???

Lo and behold, 3 hours later Christine is checked into the hospital to Get the Lead Out.

sigh

Dad's replacing all the windows himself. Christine's lead is down to 20 now.
She can't be discharged from the hospital until there is a DOH approved lead free environment in which she can stay.
Dad says none of his family or friends will allow the DOH in to their homes to give their lead-free stamp of approval.

sigh

OK. So I know NOTHING about Nigeria, historically or culturally. shame on me.
But let me tell you, I didn't worry about Christine and her family until we forced them to hospitalize her.
I don't like telling people what to do. Sure, I can be bossy. But I try very hard not to be.
I try to educate and offer options and make recommendations, and let folks decide on their own what's best for them and their kids.

This kind of socio-medical hegemony? Potential threats? Like we're gonna call CPS if you don't do as we say? eeek.
It makes me feel yucky and kind of sick to my stomach. I don't like invading people's personal space like that.
And I think we are all entitled to make our own decisions.

I wonder how Christine's parents felt. We come in and tell them their home is unsafe. Their daughter has to go.
They have to spend thousands of dollars to fix their house and get their daughter back.

sounds like extortion. or kidnapping. or ransom.

Like I said, I don't know anything about Nigeria. I don't know anything about the conditions in which Christine's family lived before coming here. I don't know what this kind of ummm... invasion... may conjure up for them.

Our current culture puts children first in a way that no other culture has. At least that's what I've heard.

My only reference to anything African is The Poisonwood Bible. and that's the Congo....again... shameful...
I just have the impression that in places where life is so damn dangerous, you don't sacrifice the whole family for one kid.
The Man might not put his job, or savings, or home, or other children on the line to save One.
Here, we'll loose our house, our savings, our kidneys.
We'll spend a fortune for specific in vitro DNA matches to make a baby to be a donor for another child who needs bone marrow or organ transplant.
We'll sacrifice the health and well being of an entire family to focus on the tragedy of One.
That's the way we do it here.

So. I feel guilty for manipulating Dad to get Christine the treatment she needs.
I don't know what kind of financial strain or ill will our actions have precipitated.
The three year old is better off.
The nurses feel vindicated and smug.
Christine's Dad is still changing out the windows.

I just have a stomach ache.


Friday, September 24, 2010

Cultural Sensitivity: A three part series

We have one grocery store in our town. It pretty much sucks. Its a Key Food.
In NYC, Key Food=ghetto grocery. Over priced and poorly stocked, it has stayed in business because they accepted WIC and food stamps. For several years, I'd do small shopping there instead of driving 15 minutes for a quart of half n half and a loaf of bread.
I always hoped it would come under new management and get an extreme grocery makeover.

And lo and behold, it did.

I guess it was bought by a family or maybe friends/business partners. A bunch of men.
I noticed better produce. I noticed more variety and organic stuff. I noticed the place was way cleaner.
They put in new freezer cases and more pleasant lighting.
The change was noticeable.

I also noticed the new owners. Middle Easterners. Just keeping it real, folks.
Could be Saudi. Could be Iraqi or Iranian. Could be Jordanian or Palestinian.
How do I know? And, honestly, why would I care?

I wouldn't. I don't.

I had noticed women assumedly wives and children coming into the store.
The women wore traditional dress. Heads covered. Arms and legs covered.
They drove minivans.

Whatever.

Like I said. It didn't make a damn difference to me.
Until one Sunday evening a few months ago when I unexpectedly got my period.

The 2 drugstores in our town were already closed. Key Food was the only place open.
I looked up and down the aisles. No tampons.
There was a section filled with every brand, size, and absorbency of pad manufactured, but no tampons

Seriously???

No tampons. No douches. No squirt up the hoo-ha stuff for yeast infections
I bought a package of pads and let a rant loose on Bruce

Chica, maybe they're just sold out
No way Bruce they don't sell them cause they think only one thing should be up there and it's not a tampon
Chica. I can't believe you just said that

I blame part of my rant on hormones. Some. Not all. I said it cause obviously I think it.

Last week Mia said mommy what does stereotype mean?
I tried to explain. She didn't get it

On Thursday she and I stopped at Key Food to get stuff for dinner.
Right at the front of the store, we saw a Big Middle Eastern Key Food Meathead Guy with his big paw around the neck of one of the Key Food cashiers. He was whispering right up in her face and wagging his left index finger and I could see the fingers of his right hand digging into her left cheek.
She was looking down at the ground, not moving a muscle.

If anyone local is reading, she's the super competent one with the pretty eyes and the Cindy Crawford mole

You know when you witness something so outrageously out of place that it takes a minute for it to register? We walked right past them and my brain refused to accept what I was seeing

It started to click when I felt the tension coming off the chick who was ringing us up. She visibly relaxed as soon as Middle Eastern Meathead Guy let Cindy loose.
The whole thing happened so damn fast. Mia and I took 2 steps out of the store and I looked at her and said
that didn't look right, did it?

No mommy. Not at all. how awesome is she?

I put the groceries in the car. Mia got in. I stood there in the parking lot.
Big Middle Eastern Meathead Guy came out of the store to collect grocery carts.
Is that him? Mia nodded yes. I still stood there

Mommy... What are you thinking? You have that look on your face. What are you going to do?

I'm not sure honey.

So what do you do? If I had intervened at the time, would she get the shit beaten out of her later? Would she get the shit beaten out of her regardless? I assume they have a relationship beyond employer/employee. If they don't can I go to the police? Do I boycott Key Food? What good would that do? Absolutely none.

I looked at Mia. For a million and one reasons I couldn't let her see me walk away as though what we saw was ok.

We forgot something.
Mommy, we didn't forget anything.
Ketchup. We forgot ketchup. You can't have meatloaf without ketchup.
Mommy. We HAVE ketchup.
I know we do honey. We can always use more.

We went back inside.
Cindy was in the little plexiglass kiosk with the cigarettes and lotto tickets.

Knock knock
Hi can I help you?
Are you ok?
Smile. Puzzled. Yeah I'm fine
She looks at Mia and looks back at me and reddens.
I'm ok
You sure?
Yeah. I'm sure

I have my own first hand experience with verbal and emotional abuse.
My guess is some of you know how lonely and isolating abusive relationships are.
I sure do.

Sometimes, most of the time, the loneliness was the worst part.

There wasn't much I could do. But I wanted Cindy to know that I saw and that it's not OK.

So I was am biased. I don't think that being Middle Eastern makes a man more likely to be abusive. At least I don't think I think that. Why would I think that?
Because "their" women are all covered up? Because they won't sell tampons?
Because what the fuck do I know?

The guy I allowed to abuse me was not Middle Eastern.

I know nothing.

It's all just an opportunity to try and figure out what the fuck is going on around here.


Tune in tomorrow for Part II


and I still hate Blogger cause I can't get the font size right

Thursday, September 23, 2010

blah blah blah and a lame attempt at posting








I'm still here.

I've visited everyone, but haven't commented.

I have a cold. Just enough to be an annoyance. I'm 2 days away from my period, so I'm a little blue. For no reason other than my damn ovaries. 
It should all blow over by Saturday.

sigh of relief

Life is just crazy these days. Not in a bad way, just in a busy way.

And I prefer to write about stuff other than the mundane-ity i just made that up of my life. It's not that there isn't a lot going on. There's a ton going on. 
Just stuff that I find boring to talk about. 
Or it's unbloggable.

It's mostly all good, though.

But still, I'd rather write about shit I experience that makes me think new thoughts or feel big feelings or brings understanding and maybe even tiny bits of enlightenment.

Last Thursday, I started a post about physical abuse and bullying.

On Monday, I started a post about the importance of being culturally sensitive.

Obviously, I didn't finish either.
Maybe I'll finish them this weekend.









*****


I was just interrupted by a knock at the door. It was Clark. 
We haven't seen her since the spring. She looks a little down and disheveled.  
We're about to have dinner
I sent her away.



sigh

*****





on a lighter note...








mia the love bug









the bug loves mia too



Sorry for the weird font size and spazzy margins and spacing. 
I hate this new Blogger edit thingy. 


Some changes just suck.


P.S. this post is entirely fucked up and the more I try to fix it the worse it gets.
Fuck you Blogger
Your fairy is called Columbine Icedancer
She is a bone chilling bringer of justice for the vulnerable.
She lives in mushroom fields and quiet meadows.
She is only seen when the bees swarm and the crickets chirrup.
She wears lilac and purple like columbine flowers. She has icy blue butterfly wings.