The C2S blog draws on the arts, the social and biological sciences to explore the many meanings of health and "dis-ease." Designed to be a locus where patients, their families and professionals can meet on a level playing field, it is the natural off-shoot of the Cell 2 Soul Online Journal. We encourage the submission of ideas, essays, poems, stories, humor, and timely reviews relating to the humanities and health care.
Around 25 years ago, I met the Balinese anthropologist and psychiatrist, Dr. Luh Ketut Suryani. She went on to establish the Suryani Institute for Mental Health in 2005, because, she said, “A large number of mentally ill people in Bali are essentially abandoned, permanently kept under restrains, chained or in makeshift cages by their families, or community (pasung).”
Indonesia spends less than 1 percent of its total health budget to mental health, uncommonly low even compared with other lower middle-income countries. It has only about 700 trained psychiatrists, roughly one for every 350,000 citizens.
Drs. Nova and Suryani have devoted their lives to improving the care and living conditions for Indonesia’s mentally ill. Pause for a moment to honor these two visionary women.
Dr. Luh Ketut Suryani
Dr. Nova Riyanti Yusuf
Here is a German language You Tube on "Bali's Dark Side." (Unfortunately, I can't find a copy with English subtitles, but the film can be viewed and appreciated even with the German narration.)
When is it ethical to design a health care system that caters to those who can pay?
An old Yiddish proverb runs: "If the rich could pay the poor to die for them, the poor would make a very good living."
Khawar Mann, OBE, a venture capitalist with the Abraaj investment group, travels around Africa scoping out hospitals to buy that seem likely to provide good returns on investments.
Private health care has been an interesting model in the U.S. which lags behind all other developed nations in outcomes. So why is the American system now envisioned as a viable model for Africa? Will this not just serve to widen the "health" gap between the rich and poor?
Mr. Mann says: "“Nairobi is a sweet spot for us. There is a big population that is growing. You have emerging middle incomes. And there is a massive need for health care.” (for those who can afford to pay in cash).
she misses bicycling, on the boardwalk, the salt air renewing, her hope of a perfect love, constant as the returning tide.
In Memory of Marsha Abrams, who bore the weight of MS with dignity and grace and brought warmth and love to her friends.
(Photo from Amaze Art Gallery)
Whitman at Last
The IV drips, drips as I read, Leaves of Grass, reclining on a plastic chair, under a frayed blanket, soft as a baby's touch.
Here on a street of rocks and stones, illness lies, a detour between life and death, where we become like Whitman, all of the same flesh, one with earth, sea, sky.
The poet, Shirley Adelman, is a mother of two, grandmother of three, a breast cancer survivor, a former college teacher, and a writer of poetry and prose. Her work has been published in academic, literary, and medical humanities journals in the United States, Canada, South Africa, and Israel. Most recently her work appeared in Jewish Currents, Blue Collar Review, and Kaleidoscope.
Goal: To help, empower and support all adults to prepare for their future and take the initiative to talk to their doctors and their friends and family about what matters most to them at life's end.
Contemplating one’s own death and doing some basic preparatory work is certainly not an easy task. However, the emotional, physical and the financial toll of not doing so is exorbitantly high. People who do not clearly document their wishes and preferences for care at the end of life are often subjected to futile medical treatments that they neither seek nor benefit from. Their families are burdened by the medical bills accrued from the numerous ineffective treatments many patients get at the end of life. In fact, a large research study showed that 62 % personal bankruptcies are due to medical expenses. Over 75% of the people who became bankrupt due to medical expenses had some form of health insurance (i.e., having health insurance does not protect you and your family from medical expense related financial crises).
Letter Project Tools:
What Matters Most Letter: This is a letter template that allows anyone to document what matters most to them and what treatments they want in the future. This tool is free and is available in print, as an online fillable form and as an iPhone and Android App in eight different languages.
Letter Project Advance Directive: This tool allows anyone to answer a few simple questions in English. When they finish and click print, the tool will send them an auto-filled valid advance directive document and a supplemental letter to their doctor describing their preferences for medical care at the end of life. This tool is free and is available in print, as an online fillable form and as an iPhone and Android App.
A brief article, Ask patientsWhat matters to you?” rather than “What’s the matter? by Sosena Kebede in the British Medical Journal is well worth reading.
“A lot of what matters to our patients is outside of what we can offer them as physicians, and our success in meeting their needs demands our ability to integrate our care with their lives outside of our hospitals and offices.” As an example, the Dr. Kebede recently “asked one of her patients what mattered to her, after attempted pain control did not alleviate her distress. In between tears, my patient told me about her hobbies and family. This gave a new perspective on patient care.”
"Whenever Heather entered a patient’s home for the first time, she knew that she was walking into a long, long, complicated story that she understood nothing about, a story that was just then reaching its final crisis"
This longish and moving piece follows a hospice nurse on her rounds in Brooklyn. It is worth a close reading.
Gavin Francis is a Scottish physician and writer. He was raised in Fife, Scotland, and now lives in Edinburgh where he works as a GP. His new book, Adventures in Human Being is a real keeper.
From the Guardian review: "It is grand, eloquent stuff, occasionally humorous, frequently moving, and invariably informative. In other hands, Adventures in Human Being might well have become cluttered with cliche, detail or sentimentality but Francis has a lightness of touch that helps him avoid these pitfalls. His use of quotes is sparing but erudite and his lack of self-importance – not a characteristic in his profession – is welcome. The end result is a thoroughly entertaining, provocative work."