keep canada canada, part 2: thank you, tommy douglas

"The personal is political."

That feminist axiom sums up the overall theme of this blog, and of all the activism I've ever participated in. Abortion, sexual assault, violence against women, war resisters: these are all events in people's personal lives that must also be seen in a larger social context. In our political work, we should never forget the personal, human side. And when we comfort and help people, we should always keep the political context in view.

Perhaps nowhere is "the personal is political" more obvious than in the realm of health care. When we suffer through an accident or an illness, it can't get more personal. Our bodies, the stuff we're made of, the shells that hold our selves, are hurting or in danger. Pain is frightening. It's debilitating. It hurts.

When we have health problems, our entire world changes. It changes us mentally, emotionally and socially; it changes family dynamics. No matter how well we cope, we are still forced to cope. Even if we deny and avoid health issues, we're still expending energy denying and avoiding, and eventually, inevitably, the body will win.

But what about financially? What if we simply can't afford to get sick?

What happens to people who can't afford health care? What happens to a society that allows people to go without health care? We know the answers. Lack of access to affordable health care one of the principal reasons the United States is falling apart.

* * * *

As you may know, we recently had a frightening bout with illness. Allan was in extreme pain, and we had no idea what was going on.

It turned out to be a kidney stone. I was relieved it was nothing life-threatening. He was relieved when his pain was treated! But the attack itself was enough to deal with. We didn't have to worry about how we would pay for it, or fight a bureaucracy to get treatment.

Here's a recap and update.

1. Emergency department treatment, pain management, plan for follow-up, prescriptions and instructions. (Waiting time: zero.)

2. Appointment with specialist. (Waiting time: five days, including a Sunday and holiday.)

3. Consultation with urologist, including on-the-spot x-rays. He thinks the stone has passed!

For those who like more information: The emergency-department CT scan showed the stone in the bladder. The severe pain was probably the stone entering the bladder. The doctor said that is the narrowest point; if the stone makes it into the bladder, it can make it into the urethra and out of the body with no problem. Good news!

4. Urologist orders some follow-up blood work and pee samples, to make sure all is well, and to make sure the stone was not a sign of underlying issues. Recommends follow-up with family doctor.

5. Out-of-pocket cost to us: $0. We have already paid for this with our taxes.

Thank you, Tommy Douglas! Thank you, Canada.

* * * *

Some months back, I noted to Allan that no matter how long he sleeps, no matter how late he wakes up, he always has a lot of trouble waking up, and always seems exhausted. We started talking about how tired he is, nearly all the time.

Allan has clinical depression and takes anti-depressants, and I was concerned this might be a return of symptoms. But he said it felt different than that.

My blog-friend M. Yass, in a different context, mentioned he had sleep apnea. I wondered if Allan might have it, too.

M. Yass wrote me a detailed email about his diagnosis, and how his life changed after getting help. It really resonated with Allan. I recalled how reading a personal essay about depression helped us recognize Allan's own depression, and began a life-changing process. Maybe this would be a similar process.

So:

1. Appointment with family doctor. (Waiting time: maybe a week, trying to schedule a convenient appointment.) Allan tells her he is always tired. She does a physical, orders blood work to rule out other possibilities, and suggests a sleep study.

2. Blood work normal, Allan does overnight sleep study. (Waiting time: a few weeks, with earlier appointments being offered, but declined for scheduling convenience.)

3. Another appointment with family doctor. (Waiting time: until test results were in.) Diagnosis: obstructive sleep apnea. Treatment: C-PAP machine used overnight to increase oxygen flow to brain. This seems like a really good thing to me - non-invasive, no medication with potential side effects.

While this is happening, of course we discover that many of our friends have sleep apnea and use C-PAP machines. Most of them attest to excellent results. Allan has also gotten some good information through sleep apnea forums online.

4. Appointment with specialist from sleep clinic, who explains the options. (Waiting time: negligible.)

5. Second overnight appointment, to test one type of machine and to determine the proper level he needs. Depending on the results, this may be repeated.

Cost to us so far: $0.

Our provincial health insurance will cover a certain amount of the purchase of the machine. Depending on the price, that may be about two-thirds. Since we are fortunate to have supplemental health insurance through Allan's job, that will pay the remainder. If we didn't have that, it would cost a few hundred dollars.

This amazes us. It thrills us.

We pay our taxes. We receive health care. We pay our taxes, others receive health care. And we receive the same health care as people who earn much more than us and people who don't earn as much.

Last summer, I was unemployed for the first time in my adult life. I still received health care.

If you freelance (as I do) or own your own business or work part-time (as I also do) or work without benefits, you still have health care.

Thank you, Tommy Douglas! Thank you, Canada.

* * * *

I realize that not every Canadian has had as positive experiences with their provincial health insurance as we have. People are waiting for hip replacements and MRIs, they can't find a family doctor, they want treatments that Health Canada considers experimental and won't fund. (I must note that if you do not have a family doctor, you can use walk-in clinics, which are easy to find, and free. Not as good as a family doctor, but you do have access to care.)

It is certainly not a perfect system. I can't imagine that such a thing exists.

But it's a very good system. It's sane, rational. It's egalitarian and accessible. It's responsive. It focuses on prevention. It focuses on patients. It costs less than health care in the United States because it runs without financial profit. The only profit is fostering health, because healthy people strengthen our society.

Canadians are always discussing and debating how to improve the health care system. And no matter how much the Fraser Institute tries to convince us otherwise, any politician who talks about dismantling the public health system is committing political suicide.

I'm not writing this because I fear Stephen Harper's Conservatives will destroy public health care. But the system is a very good one. We need more of it. More funding, more programs to attract doctors, more access, more upgrades. The system needs more public funds, and it needs protection from people who believe otherwise.

thanks and update

Thank you all very much for your caring and concern.

For those who don't read comments, it was a kidney stone, not his appendix. It's quite a large stone, 5 mm. Apparently, with a stone larger than 6 mm, a laser procedure is used to break it up. So 5 mm is large, but still small enough to pass on its own with the help of some meds and a lot of water.

At least that's what we know now. When Allan sees a urologist on Tuesday, we may learn otherwise. My sister, a nurse, said 5 mm is huge. Hmmm.

If anyone here besides me reads The Diary of Samuel Pepys online - or if you've read it the old-fashioned way, on paper - you know that Sam had a stone cut out and removed. And this in the days before modern surgical procedure and anaesthesia! Pepys vowed to celebrate the day of his survival every year for the rest of his life. So far he's done that, putting on a feast and gathering his friends around him. He even spent a lot of money having a special box made for the stone itself. (I told Allan we will not be doing that.)

Yesterday in comments, Tornwordo noted that Allan did not spend months waiting for treatment as some people would have us believe. Indeed, there was hardly any waiting at all, as Allan was triaged within minutes of arrival, then moved into an emergency department bed and treated right away. The doctors and nurses were terrific.

Many years ago, Allan had a horrific experience with poor pain management in a hospital. Without going into long details, I'll say that while in a hospital bed, Allan was in acute, severe, untreated pain for more than 24 hours, and simply told, This is all you're getting, so if it still hurts, too bad.

Had I not been there to advocate for him - and had I not had my sister to advise me and guide me through it - it would have been even worse. In reading and speaking to people since then, I've learned a lot about attitudes towards pain management, and why some health care practitioners are resistant to it.

So that earlier experience was in the back of my mind yesterday. Will I have to fight people to get proper pain medication? Will they believe his pain and treat it? What a relief - in more ways than one - to find that every doctor and nurse that saw Allan yesterday asked, How is your pain? On a scale of 1 to 10? Do you want more morphine? (Yes, please!)

Another note on our experience, perhaps the most important one. We were able to obtain proper treatment, and will have proper follow-up care, without worrying about the cost, and without having to fight for insurance-company approval.

What would yesterday had been like for a US family with a tight budget and no health insurance? You wake up one morning, and completely unexpectedly, through no fault of your own, you are in dire pain. You don't know what's happening, you need medical care. But in the back of your mind, the worry: what will this cost me? If I pay for this, will I be able to pay my rent or make my mortgage payment?

I am so grateful that I don't have that extra burden.

Every person in North America should be free from that same burden - and could be.

Every person on earth should be, of course. But at least in the GNOTFOTE!

ouch! and i mean the real kind of ouch

Is there something strangely fitting about spending the anniversary of the day we moved to this great country partaking of our publicly financed health care? Allan's in the hospital, in excruciating pain - and a lot of morphine. It seems to be a kidney stone, but we haven't gotten an exact diagnosis yet. It still could be his appendix.

This morning he had what he thought were cramps. When it got very severe, and he was sweating and nauseated, I said, come on, we're going to the hospital. Driving 120 km/hour on Hurontario Street - that's a first for me! Allan was hyperventilating the whole way.

Now he's got a ton of morphine in him, and it still hurts. The doc said she thinks of kidney stones as the male equivalent of labour pains.

Everything is going as well as it possibly could in the hospital. Except for the pain part. I just came home to take care of the dogs and do a few things, then I'm heading back. Hopefully he'll have the CT scan soon, and we'll come home with a lot of pain meds and a cranky but healthy boy.

JoS friends: we should probably thread at Ish's place or elsewhere. Thanks in advance for all your good wishes, which I know are on the way. Love you guys.

who: "social injustice on a grand scale"

I'm sure you'll see this in many places, but here it is again.

The World Health Organization's Commission on Social Determinants of Health has issued its final report, called "Closing the gap in a generation: Health equity through action on the social determinants of health".

The report makes it clear why massive numbers of people are dying of completely preventable and treatable diseases, around the planet and in our own backyard. Two words: social injustice.

Although the report tells us what we already know, quantifying the problem and identifying potential solutions are necessary steps on the road to progress.

People are dying early not only because of health gaps between rich and poor countries but also because of a lack of housing and clean water in wealthy countries like Canada, policy makers said in a report to the World Health Organization on Thursday.

The 256-page report, titled "Closing the gap in a generation: health equity through action on the social determinants of health" shows how the conditions in which people live and work directly affects the quality of their health.

The "toxic combination of bad policies, economics, and politics is, in large measure, responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible," the report's authors wrote.

"Social injustice is killing people on a grand scale."

The report defines social determinants of health are the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness.

In Canada, nearly 1.5 million people, mostly single mothers and children, lack decent family income, safe and affordable housing, suffer food insecurity and are vulnerable to violence, said the group's Canadian commissioner, Monique Bégin, professor at the School of Management at the University of Ottawa, and a former federal health minister.

Canadians may be proud that the United Nations voted the country "the best country in the world in which to live" for seven years in a row, but not everyone shares equally in that high quality of life, Bégin said.

"This report is a wake-up call for action towards truly living up to our reputation."

Food banks in Canadian cities, unacceptable housing, high suicide rates among young Inuit, and the uprooting of Kashechewan Cree community from the James Bay region in 2005 and 2008 because of unsafe water and flooding are examples of areas for improvements, Bégin said.

Health inequities are reflected in the differences in life expectancies between countries, and within countries, the report said.

A child born in Japan or Sweden can expect to live to 80 years, but less than 50 years in several African countries.

Within a rich country like the United Kingdom, the life expectancy at birth for men in the Calton neighbourhood of Glasgow is 54 years, 28 years less than that of men in Lenzie, a few kilometres away, the report said.

The commission's three recommendations to close the gap in a generation are:

1. Improve daily living conditions, such as nourishing mothers and expanding education to early child development.

2. Tackle the inequitable distribution of power, money and resources, for example between men and women.

3. Measure and understand the problem of health inequity and evaluate the impact of changes.

Canada, Brazil, Chile, Iran, Kenya, Mozambique, Sri Lanka, Sweden, and the U.K. have committed to improving social determinants of health equity, and are already developing policies across governments to tackle them, the commission said.

Examples in Canada include the Healthy Cities project that supports health promotion, Saskatoon's plan of action on poverty and the Calgary Committee to End Homelessness, Bégin said.

WHO news release, and the 2008 World Health Report, available for download.

more smart canadians calling out tony clement

Yesterday the Globe and Mail ran seven letters, all opposing federal Health Minister Tony Clement's wrong-headed stance on safe-injection sites.

I expected that today there would be a small flurry of letters from the other side. That's often how it works: news story, followed by letters from one side, followed by a second round of letters in opposition to the first round.

Today the G&M ran two more letters on the subject: one in support of Tory policy, which I will not link to, and an additional letter opposing it. In total, eight opposed and one in favour. When you consider that newspapers generally print letters, pro or con, in proportion to those they receive, this is significant.

Imagine if Federal Health Minister Tony Clement opposed providing coronary bypass surgery to all obese patients or respiratory medication to all smokers, because of the "moral" message these conditions convey.

We are left breathless at Mr. Clement's preposterous comparison of palliative care for treatable cancers to safe injection for substance dependence. In fact, safe injection is on the same spectrum of treatment as certain forms of life-prolonging (not lifesaving) chemotherapy. The big difference is the stigma and attitude ministers such as Mr. Clement bring with the Conservatives' campaign against people disabled by addiction.

As front-line physicians trying to improve the lives of people with addictions, it is discouraging that we should have to educate our government about the legitimate health-care needs of this population.

Thea Weisdorf, Philip Berger, Charlie Guiang and Chris Cavacuiti, MDs, Toronto

canadians respond to tony clement

The Globe and Mail ran seven letters today in response to Tony Clement's lecture. Here they are, with no editing.

As a physician listening to Mr. Clement speak about safe injection sites at the meeting of the Canadian Medical Association, I was embarrassed. It was clear to me that rather than looking at the results of these safe injection sites and determining in an objective, evidence-based fashion whether or not these programs actually achieved the desired results of harm reduction and improved health outcomes, Mr. Clement used this as a platform to launch his party's agenda in case of a fall election.

I hope the Conservatives have more to offer in any campaign than this fear-mongering dribble.

Suzanne Strasberg, MD, Toronto

*

Mr. Clement impugns the ethics and morality of physicians who support (or, as I do, work with) supervised injection. His statement introduces an element of rancour into a painful, complex debate already characterized by too much emotion and a lack of dispassionate inquiry.

The minister may legitimately, if shortsightedly, question the specific harm reduction practice of supervised injection. But he ought to resign if he cannot tolerate disagreement without personally attacking health professionals who, under challenging circumstances and with no help from his government, are attempting to relieve suffering of which he seems to have no understanding.

Gabor Mateé, MD, Vancouver

*

Mr. Clement is as ignorant about palliative care as he is about harm-reduction measures for drug addiction. As a palliative care physician, I take care of many patients with treatable forms of cancer. One would think that Mr. Clement would know that oncology and palliative care are not mutually exclusive. Many patients with "treatable" cancer have pain, nausea and existential angst that is best managed by a palliative care physician.

Is this really the right person to be making decisions on health care for all Canadians?

Glen Maddison, MD, Sarnia, ON

*

Between "in-and-out" schemes, allegations of Chuck Cadman payoffs, mistreatment of Afghan detainees, and who knows what else behind the opaque shield erected by what was supposed to be a government of greater transparency, federal Health Minister Tony Clement and other members of this government are hardly in a position to lecture professionals about ethics and morality (Supporting Insite Unethical, Clement Tells Doctors - Aug. 19).

J. N. Trott, Oakville

*

Your front page yesterday had two guys up on their high horses. One, Ian Millar, deserved to be riding high (Millar Soars To Silver At 61 - Aug. 19). Way to go, Mr. Millar!

The other, Tony Clement, should get off his equine perch. That way, we can show him the way to go, too.

Joan Summers, Montreal

*

This lecture comes from a senior representative of a party that is being investigated for election irregularities, has written a guidebook on how to disrupt parliamentary committees and has broken election promises (e.g. income trusts).

On ethical issues, I think I will trust my doctor.

John Steeves, Sussex, NB

*

I was disappointed that Mr. Clement, as the Minister of Health, chose not to see the vulnerable as patients. Instead, he chose to make them political targets and further victimize them.

I expect better of my government.

Mark D. Macleod, MD
London, ON

health care based on ideology, instead of health

Tony Clement, federal Health Minister and right-wing ideologue, is lecturing health professionals on ethics and morals, bringing his political judgements where only health decisions belong.

Health professionals who support Vancouver's safe injection site are unethical and immoral, federal Health Minister Tony Clement suggested on Monday.

"The supervised injection site undercuts the ethic of medical practice and sets a debilitating example for all physicians and nurses, both present and future in Canada," he scolded in an address to the Canadian Medical Association general council meeting in Montreal.

He called providing a safe injection site to drug addicts tantamount to offering palliative care to a patient with a treatable form of cancer.

"This is a profound moral issue, and when Canadians are fully informed of it, I believe they will reject it on principle," the minister said.

His comments come as the Conservatives have bombarded urban ridings in Vancouver and Toronto with ads, sent free using MPs' mailing privileges, that depict a discarded syringe and a headline that states: "Junkies and pushers don't belong near children and families. They should be in rehab or behind bars."

The campaign, in addition to Mr. Clement's remarks, shows the Conservatives are trying to make illegal drugs an issue that will separate them from other parties and influence key swing voters, especially women.

On Monday, Mr. Clement took issue specifically with a letter he received from CMA president Brian Day that stated: "There is growing evidence that harm-reduction efforts can have a positive effect on the poor health outcomes associated with drug use."

The minister retorted: "Is it true that supervised injections offer 'positive health outcomes?' I would not put it this way. Insite [Vancouver's safe injection site] may slow the death spiral of a deadly drug habit, but it does not reverse it. I do not regard this as a positive health outcome."

After the speech, Dr. Day said the "minister is off base in calling into question the ethics of physicians" and accused Mr. Clement of "manipulating medical ethics to make a political point."

Dr. Day noted that in a poll of Canadian physicians, 79 per cent supported harm-reduction measures, including safe injection sites.

"We have an opinion based on scientific evidence. The minister has come to a different conclusion," he said.

Carolyn Bennett, the Liberal public-health critic and a physician, was livid after the minister's speech.

"I've never seen such an offensive performance by a health minister," she said. "How dare he come to a meeting of professionals and scold them about their perceived ethical failings."

At Insite, a small facility in Vancouver's Downtown Eastside, drug users inject themselves while supervised by nurses and physicians, and receive counselling about rehabilitation.

Clean needles are provided, but drugs are not; the principal purpose is to limit the spread of infectious diseases. Insite was granted an exemption from federal drug laws in 2003 so its users cannot be prosecuted for drug possession.

The Conservative government has vowed to close Insite, but the facility won a reprieve this spring when the B.C. Supreme Court struck down parts of Canada's drug laws. Ottawa has appealed.

For the facts and news about Insite, see Keep Insite Open, written by Jen, a wmtc reader and commenter, who is also a friend of the War Resisters Support Campaign.

another abortion myth debunked

Here's an excellent post from Impudent Strumpet about how reproductive decisions work.

The Salon story Imp Strump links to is written by Lynn Harris, who I used to work with in the Haven Coalition. Lynn is the co-creator of Breakup Girl, among other things.

caroline arnold: abortion is about power

Caroline Arnold has an excellent piece about abortion rights in an Ohio newspaper, which I saw at Common Dreams.

Abortion: A matter of power, not God
By Caroline Arnold

The moribund Bush administration has proposed new Health & Human Services regulations that would cut off funds to health care providers who fired or refused to hire people who object to abortion or contraception for religious or moral beliefs.

Never mind that workers are already protected against such discrimination -- though it is not reciprocal: Catholic hospitals have no obligation to hire pro-choice workers or respect moral convictions about contraception or HIV.

Recently I've received comments about my views on abortion. I am always gratified when readers respond to the issues I raise, and often find their criticisms helpful in shaping my thinking. But I find myself unpersuaded by arguments that human life begins at conception and that abortion is therefore murder.

I can't accept, either as a matter of personal conscience, or of my commitment to my neighbors and the planet we live on, that we should invest scarce resources, argue endlessly and fruitlessly, and punish women, neglect children and forestall medical research in order to keep every fertilized ovum alive.

I believe we have more important things to do -- making sure children already born have enough to eat, medical care and education, and learning to live together without killing each other and consuming the planet we live on.

I don't think the abortion question is about religion, except insofar as most religious people think that God doesn't like it because it destroys a human life. What kind of a god worries about the destruction of some unviable human tissue but designs human reproductive systems with a 50 percent attrition rate? What kind of god gives males the choice to conceive a baby but doesn't give females the choice to reject it? What kind of god allows older children to starve so that younger ones may be born, or permits babies to be born to a life of want, violence and fear? Not one I want to have anything to do with. And I won't accept the "It was ever thus" argument about human frailty. Just because we humans have always done badly doesn't excuse us from trying to do better, for ourselves, because we are all one family.

That said, however, I have to retreat a step. I do have a kind of religious faith, pretty much defined by what it is not. The Skeptic in me demands that the utilitarian condition must be satisfied -- God cannot be less than as source of Goodness -- love, grace, fulfillment -- that is available to all creatures and living systems. But my Resident Mystic keeps insisting that a God worthy of human experience must be more than a bearded old man obsessed with sex and virgins, strewing goodness about while withholding it from sinners and showering wealth on entrepreneurial men, handing down Ten Immutable Rules for human behavior, torturing the wicked, and advising George W. Bush on how to conduct his war on terror. I believe we are called to imagine a God of Truth and Uncertainty, Beauty and Disorder, Joy and Loss, while we are challenged to love our neighbors and seek to live with them in peace.

But neither the Skeptic's God nor the Mystic's God speaks to me about abortion. Abortion isn't about God, it's about power. And it's not even about male power vs. female rights -- only whether a person is to be allowed to make decisions about her or his body independent of the rules of religion, society or the civic order. The prevailing mythology today is that women cannot be trusted to make the right decision or take responsibility for their bodies and must be forced to do so by law. Men are excused from responsibility because sex is "natural" for them. And Viagra, Cialis, and other male sex-enhancing materials are big sellers in our society.

What I don't understand -- but find infinitely galling -- is why anti-abortionists feel it is their right to despise my conscience, control my thinking, dictate my behavior, and criminalize a private medical procedure. I don't tell them what they can and can't do, or try to make laws or constitutional amendments to force their compliance with my beliefs.

The late John Seiberling was threatened in 1972 by Right-to-Lifers who claimed they would defeat him if he didn't vote to restrict abortion.

"Well, that's all right," he replied, "because if I can't vote my conscience in Congress, I don't want the job." He won (75% - 25%), he believed, because he stood up for his conscience.

Once again we are looking into a deep chasm between those who believe that human governance is a matter of blind obedience/uncritical acceptance of sacred or secular laws and authority, and those who believe that we must govern ourselves from individual conscience and shared values.

I don't know if the latter is even possible on a planet now largely owned by private corporations, bristling with nuclear weapons, overpopulated with hungry, hopeful masses, and overheating by the desires and habits of men.

I do believe that if it is to be done at all, we humans -- male and female, all ages, colors and beliefs -- will have to do it ourselves. We can't expect a deus ex machina, Grand Plan, or U.S. president to save us.

We don't need more fascist regulations that override individual conscience on abortion. As we choose a new president and administration we do need honest elections, and candidates of conscience who will help us generate the laws and processes needed to stop killing and torturing humans already born, and start addressing the apocalyptic challenges of an endangered species on a threatened planet.

patient dumping without borders

From the front page of today's New York Times.

High in the hills of Guatemala, shut inside the one-room house where he spends day and night on a twin bed beneath a seriously outdated calendar, Luis Alberto Jiménez has no idea of the legal battle that swirls around him in the lowlands of Florida.

Shooing away flies and beaming at the tiny, toothless elderly mother who is his sole caregiver, Mr. Jiménez, a knit cap pulled tightly on his head, remains cheerily oblivious that he has come to represent the collision of two deeply flawed American systems, immigration and health care.

Eight years ago, Mr. Jiménez, 35, an illegal immigrant working as a gardener in Stuart, Fla., suffered devastating injuries in a car crash with a drunken Floridian. A community hospital saved his life, twice, and, after failing to find a rehabilitation center willing to accept an uninsured patient, kept him as a ward for years at a cost of $1.5 million.

What happened next set the stage for a continuing legal battle with nationwide repercussions: Mr. Jiménez was deported — not by the federal government but by the hospital, Martin Memorial. After winning a state court order that would later be declared invalid, Martin Memorial leased an air ambulance for $30,000 and "forcibly returned him to his home country," as one hospital administrator described it.

Since being hoisted in his wheelchair up a steep slope to his remote home, Mr. Jiménez, who sustained a severe traumatic brain injury, has received no medical care or medication — just Alka-Seltzer and prayer, his 72-year-old mother said. Over the last year, his condition has deteriorated with routine violent seizures, each characterized by a fall, protracted convulsions, a loud gurgling, the vomiting of blood and, finally, a collapse into unconsciousness.

"Every time, he loses a little more of himself," his mother, Petrona Gervacio Gaspar, said in Kanjobal, the Indian dialect that she speaks with an otherworldly squeak.

Mr. Jiménez's benchmark case exposes a little-known but apparently widespread practice. Many American hospitals are taking it upon themselves to repatriate seriously injured or ill immigrants because they cannot find nursing homes willing to accept them without insurance. Medicaid does not cover long-term care for illegal immigrants, or for newly arrived legal immigrants, creating a quandary for hospitals, which are obligated by federal regulation to arrange post-hospital care for patients who need it.

American immigration authorities play no role in these private repatriations, carried out by ambulance, air ambulance and commercial plane. Most hospitals say that they do not conduct cross-border transfers until patients are medically stable and that they arrange to deliver them into a physician's care in their homeland. But the hospitals are operating in a void, without governmental assistance or oversight, leaving ample room for legal and ethical transgressions on both sides of the border.

Indeed, some advocates for immigrants see these repatriations as a kind of international patient dumping, with ambulances taking patients in the wrong direction, away from first-world hospitals to less-adequate care, if any.

"Repatriation is pretty much a death sentence in some of these cases," said Dr. Steven Larson, an expert on migrant health and an emergency room physician at the Hospital of the University of Pennsylvania. "I've seen patients bundled onto the plane and out of the country, and once that person is out of sight, he's out of mind."

. . .

Medical repatriations are happening with varying frequency, and varying degrees of patient consent, from state to state and hospital to hospital. No government agency or advocacy group keeps track of these cases, and it is difficult to quantify them.

A few hospitals and consulates offered statistics that provide snapshots of the phenomenon: some 96 immigrants a year repatriated by St. Joseph's Hospital in Phoenix; 6 to 8 patients a year flown to their homelands from Broward General Medical Center in Fort Lauderdale, Fla.; 10 returned to Honduras from Chicago hospitals since early 2007; some 87 medical cases involving Mexican immigrants — and 265 involving people injured crossing the border — handled by the Mexican consulate in San Diego last year, most but not all of which ended in repatriation.

Over all, there is enough traffic to sustain at least one repatriation company, founded six years ago to service this niche — MexCare, based in California but operating nationwide with a "network of 28 hospitals and treatment centers" in Latin America. It bills itself as "an alternative choice for the care of the unfunded Latin American nationals," promising "significant saving to U.S. hospitals" seeking "to alleviate the financial burden of unpaid services."

Many hospitals engage in repatriations of seriously injured and ill immigrants only as a last resort. "We've done flights to Lithuania, Poland, Honduras, Guatemala and Mexico," said Cara Pacione, director of social work at Mount Sinai Hospital in Chicago. "But out of about a dozen cases a year, we probably fly only a couple back."

Other hospitals are more aggressive, routinely sending uninsured immigrants, both legal and illegal, back to their homelands. One Tucson hospital even tried to fly an American citizen, a sick baby whose parents were illegal immigrants, to Mexico last year; the police, summoned by a lawyer to the airport, blocked the flight. "It was horrendous," the mother said.

You should be able to read it with a free login.

For the reader who asks, "Why should anyone in the US pay for this man's health care?", I reply with a question of my own. Why can't a country that has spent $648 billion* subduing and occupying two foreign countries - the eventual cost of both invasions may eventually total three trillion dollars - provide health care to anyone who needs it?

It's not as though the bed once occupied by Mr. Jiménez automatically goes to a needy US citizen. Only those who can afford it.

Also note "medical repatriation" is not limited to illegal immigrants. Legal immigrants can get the boot, too.


* By my partner's calculations, that comes out to: $22,222,222 every hour, or $370,370 every minute, or $6,172 per second since October 2001.

the u.s. war on women continues

The US's war on women has not stopped. It hasn't even slowed down. The woman-haters and fetus-lovers continue to chip away at women's rights, human rights - and modern life.

I had been seeing various scary posts on reproductive rights blogs for a few weeks, when James sent me this, from Ezra Klein's blog. Klein references this post from the main American Prospect blog.

The Bush administration is circulating regulatory changes within the Department of Health and Human Services that would prevent health care providers from choosing not to hire ideologues opposed to reproductive rights (including distributing contraception). The regulations, which could go into affect in as little as two months, would also re-define abortion as "any of the various procedures -- including the prescription, dispensing and administration of any drug or the performance of any procedure or any other action -- that results in the termination of the life of a human being in utero between conception and natural birth, whether before or after implantation."

Wow. In the past, HHS defined abortion the way the American Medical Association does -- as the termination of a pregnancy after implantation of a fertilized egg in the uterine wall. This new definition is clearly meant to re-classify emergency contraception, and perhaps even ordinary hormonal birth control pills, as abortion.

This Wall Street Journal story is good, too, and includes some helpful graphics.

I got in touch with my friend KK, who I know originally from the Haven Coalition. KK is working at the Guttmacher Institute, the best source of information on sexual and reproductive health. She sent me this.

A potential new regulation from the Bush administration would greatly expand the scope of federal refusal rights for health care providers. The draft regulation, which was leaked to the media and advocacy groups on July 14, would allow health care personnel and institutions to refuse to provide or even tangentially assist in the provision of services that offend their religious beliefs or moral convictions.

Congress has enacted three such refusal clauses, starting with the Church amendment shortly after Roe v. Wade and most recently the Weldon amendment in 2004, which apply to some or all recipients of funding from the U.S. Department of Health and Human Services (DHHS). The Bush administration now asserts that the American public, including state policymakers and health care professionals, is uninformed of these laws and has displayed hostility toward the principle of religious tolerance that they purportedly embody.

As evidence, the draft cites state laws mandating insurance coverage of contraceptives, requiring sexual assault victims’ access to emergency contraception, guaranteeing access to contraceptives at pharmacies and allowing officials to intervene in hospital mergers to ensure communities’ continued access to services. The cases cited as problematic cover most of the major legislative victories by family planning and reproductive health advocates over the past decade.

As further evidence of the purported problem, the draft cites a finding from a 2007 article in the New England Journal of Medicine stating that 86% of physicians believe they are obligated to provide patients with information on all of their medical options, regardless of a physician's personal objection. Presenting this fact as a "problem" implies that this belief held by the majority of doctors stems from their ignorance of the supposed legal right to refuse, rather than from a conviction that they are in fact obligated, both legally and under the standards of their profession, to provide all information necessary to obtain a patient's informed consent.

The administration asserts that the regulation will raise awareness of current refusal laws and clarify their meaning, but in "clarifying" the laws, the administration is actually redefining and expanding their reach in several crucial ways:

First, the regulation says that "abortion" (participation in which providers have long had an explicit right to refuse) could be defined — by any individual or institution — to effectively include all hormonal methods of birth control (because these methods may act post-fertilization, although this is not their primary mode of action). For years, leading antiabortion groups and conservative lawmakers have been asserting that commonly used methods of contraception are in fact "abortifacients." Adopting this position would be a stark departure from precedent in federal rules and regulations and from the consensus of the medical community.

Second, it defines other key terms so that laws originally designed to apply to health care professionals such as doctors and nurses, who are directly involved with a given procedure, would now apply to any member of a health care institution's paid or volunteer workforce participating in "any activity with a logical connection" to such services. The new definition would encompass information, counseling, referral, clerical and janitorial work and a host of other activities.

Third, it asserts that a provision enacted in 1974 as part of a law governing federally funded medical research applies to all DHHS-funded health research and service programs. This interpretation opens the door for individuals to object to being involved, even tangentially, in a range of health care activities beyond reproductive health or to serving specific types of patients, such as single women, gays and lesbians, or teenagers.

Among other consequences, the regulation, were it to be adopted, could have a serious impact on clients' guarantee of access to a full range of services, information and referrals at clinics supported by the Title X national family planning program and on the ability of health care provider entities to employ staff members supportive of their institutional mission. Certification and enforcement mechanisms included in the regulation also appear problematic, potentially adding major bureaucratic hurdles for domestic and even international government and health care institutions and inviting harassment by private citizens and advocacy groups alleging "fraud" by providers against the government.

In the meantime, many reproductive health champions in Congress are calling on the administration to drop the idea of even proposing such regulations, including House Speaker Nancy Pelosi (CA), over 100 members of the House (both prochoice and antiabortion) and a group of 20 senators, including Majority Leader Harry Reid (NV) and Sen. Barack Obama (D-IL).

At the bottom of the Guttmacher story, there are many good links about the implications of these proposed regulations. Note they are not law yet. In typical fashion, the US government is trying to slip them through without approval, debate - or even public knowledge.

Many blog posts on this issue - more than I can find or link to right now - focus on the supposed "conscience right" of a health care provider to refuse care to a person's whose life he or she does not approve of. If you have links, please feel free to post them in comments.

This is the kind of thing we have to make a fuss over. A loud, long fuss.

Controlling one's body is a basic human right. The ability to control one's reproduction is the bottom line of women's equality - and of human freedom. I've been reading about slavery (more on that soon), and it strikes me how the most pervasive degradations often involved stripping people of their ability to control their own bodies. Forcing people to be naked in public. Branding. Yokes, chains. Rape. Forced impregnation. Forced abortions. Stealing children from parents. These were some of the methods by which slaves were forced into submission. The common theme is the violation of bodily integrity.

A woman who cannot control her reproduction is a slave.

denied treatment, they took their child home, and she died

A while back, I posted an ethics question about a confidence an online friend had shared with me. Wmtc readers gave me a good perspective and offered excellent advice.

Shortly after, the person in question gave me liberty to speak openly about what had happened to him and his wife. Turns out that's what he wanted all along.

Last September, our friend Andy and his wife Audra lost their two-year-old daughter, Fianna.

Fianna had a cold. Her conditioned worsened, and she was having trouble breathing. Her parents took her to the emergency room. Kaiser Permanente, the largest health insurer in the United States (net income, $1.3 billion), wouldn't approve treatment. They took their child home, and she died.

Andy wrote the story on a site where people chronicle horror stories about Kaiser Permanente: you can read it here.

I've always thought losing a child is the worst thing that can happen to a person. People survive, and they go on, because that's what people do. They even go on to have happy lives with their surviving family, or to create a new family. But I imagine the loss never goes away. And I can't imagine how much pain they suffer, every day.

I wish there was something I could do for Andy and Audra. Andy asked me to help publicize the story, so there it is.

* * * *

I actually did mention Andy's tragedy, although not by name, earlier on wmtc. About a month after it happened, I posted this.

Just among our little group [Joy of Sox community], one person is losing his wife to cancer because they could not afford adequate treatment and cannot afford to keep her alive any longer. Another lost his child because an HMO did not approve treatment, and sent the family home from the emergency room. Their two-year-old daughter died that night.

And those are just two people who have disclosed their tragedies to us. I can almost guarantee there are others.

Something about Cathy Baskin's story is here. If you haven't seen this video, please watch.

I admire Cathy Baskin, not only for being public with her story, but for relating it to the larger political picture. She's not just saying cancer is a tragedy. She's saying cancer treatment only for the wealthy is a crime, and we need health care for all.

Last we heard, Cathy was doing really well, which was wonderful news. But it doesn't change the larger picture.

Neither the Democrat nor the Republican candidate for US President supports universal, single-payer health insurance. Neither one of them supports removing profit from the health care structure.

* * * *

This was a big week in southwestern Virginia: health care week. Thousands waited for hours, some through the night, for their annual opportunity for health care, brought to them by a charitable organization.

They walk through the gates of the fairgrounds, give their most personal information to complete strangers and are ushered off for a battery of tests and procedures.

An expected 3,000-plus residents of Southwest Virginia and neighboring states are here through today for one reason -- to get basic medical care they couldn't otherwise afford.

A crowd began lining up in the wee hours of Friday morning for a coveted spot inside the fences at the Remote Area Medical clinic. Some would wait days for the free service. Some would never get in.

For the majority though, organizers and doctors said, this would be the only time all year they would get medical treatment of any sort.

Remote Area Medical, based in Knoxville, Tenn., has provided medical care for the poor and uninsured in the United States and around the world since 1985.

Since Friday, volunteer doctors, optometrists, pharmacists and dentists have been helping patients during 14-hour days.

Charles Sizemore, a 68-year old retired machinist from Wise County, got in line Friday about 2 a.m. for a basic physical and to get two fillings replaced.

Sizemore raised four children in the area but never had health insurance until he got Medicare when he retired three years ago.

"I wanted to," he said, leaning against bleachers where patients were being registered as the sun rose over the mountains. "There just wasn't enough money. I had to take care of my family, and I never made more than $10 an hour."

All his children have left the area for better-paying jobs, but he's too old to move, he said playfully.

Turning serious, Sizemore said, "I don't mean to be ungrateful. I'm glad RAM comes out and does this. But it's just damned sad that this is the only time most of the people around here are going to see a doctor. It's a damned shame."

. . .

Teresa Gardner said the RAM event is vitally important.

Gardner is executive director of The Health Wagon, a nonprofit organization that provides health care for the uninsured and underinsured in Southwest Virginia. It is the local organizer for the RAM event.

"The main problem is that these people don't have access to even the most basic health care because they can't afford it," she said. "And those that can afford the insurance, or get it through their companies, can't afford to pay the co-pays or the prescriptions." [The story continues here.]

My brother, an oral surgeon, works with an organization that goes into impoverished areas and performs surgeries that local residents otherwise would not have access to. He's been to Kenya, Guatemala, Ecuador and several other places. He's told us harrowing stories about the conditions under which they work, and heartwrenching stories about the gratefulness of the patients.

I don't see a whole lot of difference between those stories and this one from Virginia.

study shows u.s. hardly united at all

Geography is destiny.

I think about this all the time: how where a person is born determines so much about her future. Poverty and the opportunity to leave it, education, health care - the rights and options of people with disabilities - freedom of personhood and conscience - reproductive freedom. Childhood! Having one at all, rather than being forced into a sweatshop, or sex work, or killing. So many basic human rights from which our lives flow are pre-determined by where a person is born.

This is a terrible fact. But why should this be true within one country? From The Independent, via AMERICAblog, via James, emphasis mine.

The United States of America is becoming less united by the day. A 30-year gap now exists in the average life expectancy between Mississippi, in the Deep South, and Connecticut, in prosperous New England. Huge disparities have also opened up in income, health and education depending on where people live in the US, according to a report published yesterday.

The American Human Development Index has applied to the US an aid agency approach to measuring well-being – more familiar to observers of the Third World – with shocking results. The US finds itself ranked 42nd in global life expectancy and 34th in survival of infants to age. Suicide and murder are among the top 15 causes of death and although the US is home to just 5 per cent of the global population it accounts for 24 per cent of the world's prisoners.

Despite an almost cult-like devotion to the belief that unfettered free enterprise is the best way to lift Americans out of poverty, the report points to a rigged system that does little to lessen inequalities.

"The report shows that although America is one of the richest nations in the world, it is woefully behind when it comes to providing opportunity and choices to all Americans to build a better life," the authors said.

Some of its more shocking findings reveal that, in parts of Texas, the percentage of adults who pass through high school has not improved since the 1970s.

Long ago, a wmtc reader tried to sell the idea that the US and Canada were the same. (He turned out to be a troll, temporarily disguised by his large vocabulary, but easily unmasked.)

When readers pointed to some basic differences between the two countries - health care, abortion rights, equality of sexual orientation - he argued that because those rights exist in some places within the United States, they therefore exist for the United States. For example, Vermont offers state-sponsored health insurance, therefore the US has universal health care. Abortion rights are secured in New York and California, therefore the US has reproductive freedom. Same-sex couples can marry in Massachusetts, therefore...

As I had been helping women from abortion slave states who came to New York City to terminate pregnancies, this argument blew my mind. Had this guy ever seen a map?

What good do abortion rights in New York do for the woman in South Dakota? What good does Vermont's health insurance plan do for a family in Mississippi? Technically, Americans are free to move to any state they choose. But can a family be expected to roam the country trying to meet their basic needs and secure their basic freedoms? Who will fund these travels? Where will their children attend school?

In a place where many people can't afford the fuel or child care necessary to hold a job, because minimum wage is still under $6.00 an hour, the knowledge that some other state might offer a better life is little comfort. The study mentions "an almost cult-like devotion" to the free market. There's also the cult-like devotion to states' rights - federalism, in US parlance - which justifies these inequalities and locks them in place.

In my work for reproductive freedom, I would often marvel, is this one country or not? A co-author of the report referenced above says: "Some Americans are living anywhere from 30 to 50 years behind others when it comes to issues we all care about: health, education and standard of living." I would have to say "not".

cheap shopping, health care and imperialism

Long-time wmtc readers may remember a discussion we had about Canadian perceptions of the US - of the positive variety - which I called cheap shopping vs. health care.

When I tell people I am from the US - not that I advertise it, but it tends to come up in conversation - reactions fall into a few different categories. Some people are happy and excited; they understand the difference between the two countries and why an American might choose Canada. Interesting conversations ensue. But one fairly common reaction repeats itself nearly verbatim: "Why would you want to move here? We all want to move there!"

I first heard this during an interview at an employment agency, and let me tell you, I was taken aback. I hardly knew how to respond in a way that would be appropriate for a job interview. I laughed, played it down and changed the subject.

Since then, I've heard it many times, mostly from co-workers, but also from Canadian-born neighbours and in other casual interactions. To generalize, I would describe the people who say this as apolitical, largely ignorant of and unconcerned with events outside their own lives, and superficial. People who live in their own little world of family, friends, work and shopping.

For background, you might like to read that post, plus readers' comments.

This recently happened again while I was getting my hair cut. The woman cutting my hair is Vietnamese-Canadian. Most of her family lives in the US or in Vietnam; she and her mother live in Canada. In our conversation, she sighed wistfully and said, "I wish I lived in the States."

I said, "No, you don't. Unless you're rich, it's not a very nice place to live."

She said, "Yes, I've heard that. It's the health care, right?"

I nodded.

She said, haltingly, "It's not... it's not free, right?"

Not free, yeah, you could say that. I tried to explain that health care is very expensive, and the more money you have, the better health care you receive. And the less money you have...

She nodded, but she seemed unconvinced.

Then I said, "You know, we pay about the same in taxes."

"What?" She was stunned.

I said, "That's right. Our taxes didn't go up when we moved here. They're about the same. Except now we don't have to pay our health care costs, too."

"Wow," she said. "I didn't know that. What do they do with all the money?"

I thought, thanks for the cue. "It all goes to the military."

She looked aghast. She said, "I didn't know that. Wow. Learn something new every day."

As I mentioned, this woman is of Vietnamese descent. I don't know if the words "United States military" strike a chord with her, but I hope so.

I'm reading Overthrow, by Stephen Kinzer, right now, so the US's misadventures in Vietnam are on my mind.

Today I read the chapter on Chile, when the US destabilized a democratic country, overthrew their president-elect (Allende) and installed a dictator (Pinochet). And I remembered that one of my former co-workers who was part of the health-care-vs-cheap-shopping discussion is Chilean-Canadian. Her parents escaped Chile right after Pinochet came to power.

Now, maybe these two women are completely apolitical, and living in the country that tore apart the homelands of their parents and grandparents wouldn't bother them. But maybe they're smarter than that.

How dangerous it is when people don't know their own history.

follow-up: u.s. poor suffering from tropical diseases

I'd like to draw your attention to an excellent comment from Epimetheus in this thread, about low-income people in the southern US having high incidences of disease found in Africa and Asia. Just in case anyone was interested in further discussion. Thanks.

u.s. poor afflicted by tropical diseases of africa, asia

From my "US turning in to third-world country" file:

Tropical diseases that ravage Africa, Asia and Latin America commonly occur among the poor in the USA, leaving thousands of people shattered by debilitating complications including mental retardation, heart disease and epilepsy, an analysis showed Monday.

The diseases, caused by chronic viral, bacterial and parasitic infections, disproportionately strike women and children and are largely overlooked by doctors, says author Peter Hotez of the Global Network for Neglected Tropical Diseases, part of Sabin Vaccine Institute.

Hotez says the diseases go untreated in hundreds of thousands of poor people who live mainly in inner cities, the Mississippi Delta, Appalachia and the Mexican borderlands.

In many cases, he says, the infections cause disabilities that trap sufferers in lasting poverty. His analysis, called "Neglected Infections of Poverty in the United States," appears in the journal he edits, PLoS Neglected Tropical Diseases.

As widespread as the diseases are, few people in middle America have heard of them, and many doctors never think to check for them, says Carlos Franco-Paredes of Emory University Rollins School of Public Health, who was not involved in the analysis.

Franco-Paredes says the effect can be devastating: "If you have these infections as a kid, if you're anemic, your ability to learn when you go to school is affected. If you have these infections on a chronic basis, they can affect your ability to become a productive adult and support your family."

Hotez says it is a "disgrace" that diseases causing so much suffering remain at the bottom of the national health agenda.

"If this were occurring among white mothers in the suburbs, you'd hear a tremendous outcry," says Hotez, a microbiologist at George Washington University.

Franco-Paredes says the remedy may be as simple as screening minorities, immigrants and refugees and making sure doctors can diagnose and treat these ailments.

The article lists some of the diseases, their prevalence, and what populations they primarily affect.

Hotez is quoted as saying, "If this were occurring among white mothers in the suburbs, you'd hear a tremendous outcry." That's true, of course. Also true is that increasing numbers of former middle-class suburbanites now find themselves scrounging at the bottom rungs of the socioeconomic ladder, because their health-care needs wiped out their homes and their savings. So these issues are affecting ever greater numbers of Americans.

Not bad for the Greatest Nation on the Face of the Earth™, eh?

Thanks, as always, to my researcher-in-chief.

either margaret wente needs a fact-checker or the entire united states is a backwater

I usually avoid reading Margaret Wente, but this morning the Globe and Mail put her on the front page, so a bit filtered through. She writes:

It's right to honour Henry Morgentaler with the Order of Canada. He fought to make this country a better place for women, and he succeeded.

But those who either lionize or despise Dr. Morgentaler tend to miss the point. By the time he came along, the tectonic plates were well in motion. Hospital abortions had already been available for years – subject to approval by a medical committee. Dr. Morgentaler's achievement was to make abortion a woman's private choice, subject to no one's approval but her own.

Except for a few backwaters in the United States, safe, legal and accessible abortion is the norm throughout the Western world. It would be the norm in this country, too, regardless of Dr. Morgentaler's pioneering work. He's a symbol now, and the passions he arouses are the same ones aroused by Roe v. Wade in the U.S.

Emphasis added. And added and added. Here are your backwaters, Ms. Wente.

In 2000, 87% of US counties had no abortion provider. Thirty-four percent of women aged 15-44 live in those counties. Eighty-six of the US's 276 metropolitan areas had no provider.

Abortions in the United States cost anywhere from $400 to $4000, depending on the procedure. A first-trimester abortion costs more than a family on public assistance receives in a month.

Low-income women and girls often delay procedures as they try to borrow the money they need. (Not easy when most people you know live hand-to-mouth.) "Chasing the funds" - as it is known in the movement - often forces women into second-trimester procedures. Those procedures are more complicated, more risky - and much more expensive. It is not uncommon for women to carry an unwanted pregnancy to term because they cannot afford a simple first-trimester procedure.

These three states prohibit the use of any state funds for abortion whatsoever. They have refused to comply with a federal law requiring states to provide Medicaid funding for abortion in cases of life endangerment, rape or incest.
Alabama
Mississippi
South Dakota

These states fund abortion in cases of threat to life, rape or incest only. All must be proven in court.
Arizona
Arkansas
Colorado
Delaware
Florida
Georgia
Indiana
Kansas
Kentucky
Louisiana
Maine
Michigan
Missouri
Nebraska
Nevada
North Carolina
North Dakota
Ohio
Oklahoma
Pennsylvania
Rhode Island
South Carolina
Tennessee
Texas
Utah
Wyoming

These states will fund abortion where there is threat to a woman's life or health, rape, incest, and some other reasons, such as verifiable abuse or mental health issues. All require several court appearances.
Iowa
New Mexico
Virginia
Wisconsin

These states restrict abortion access by age, requiring mandatory parental notification or consent for minors. States are required to provide varying degrees of so-called "judicial bypass", meaning a young person can plead her case to a judge, who can then grant or deny her permission to obtain an abortion without parental notification or consent. Think about that one.
Alabama
Alaska
Arizona
Arkansas
Colorado
Delaware
Florida
Georgia
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Nebraska
North Carolina
North Dakota
Ohio
Oklahoma
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Virginia
West Virginia
Wisconsin
Wyoming

Every state not listed here has had parental consent or notification laws introduced in its legislature, which activists defeated, often by tiny margins. The mandatory judicial bypass clauses are also the result of court orders won by activism.

Before any parents reading this trot out the old "if my daughter was having an abortion, I would want to know" response, let's just say: of course. That's obvious. And if you want to know if your daughter is having sex, or fears she is pregnant, or needs an abortion, create a home environment where your children know they can come to you with any problem, and receive unconditional support and love, even if that love includes disapproval.

Many teens are not that fortunate. I know from first-hand experience that in a home where young people fear abuse, including one's parents in decisions about sex and pregnancy is simply not an option. For their own health and safety, girls must be able to obtain abortions without telling their parents, and no state law is going to change that.

These states require women seeking abortions to register, then wait 24 or 48 hours before receiving a procedure.
Alabama
Arkansas
Georgia
Idaho
Kansas
Kentucky
Louisiana
Michigan
Minnesota
Mississippi
Nebraska
North Dakota
Ohio
Oklahoma
Pennsylvania
South Carolina
South Dakota
Texas
Utah
West Virginia
Virginia
Wisconsin

On first glance, a waiting period may seem innocuous. But for a low-income woman who must arrange child care and transportation, and travel a long distance to an abortion provider, the mandatory waiting period means one or more overnight stays, all of which she has to pay for - and none of which she can afford. If she is trying to terminate a pregnancy against the wishes of an abusive partner, an overnight stay can be the difference between life and death.

State-mandated waiting periods are condescending and demeaning, as they assume women cannot think for themselves and are requesting abortions in some kind of momentary fit of non-reason.

Only procedures relating to reproduction are subject to mandatory waiting periods. No other elective medical procedures are regulated by such laws.

These states prohibit private insurance coverage for abortion.
Idaho
Kentucky
Missouri
North Dakota

These states exclude abortion coverage from state health care programs.
Illinois
Montana

These states have spousal consent or notification laws. All spousal consent/notification laws have been ruled unconstitutional, and are therefore unenforceable, but they remain state laws.
Colorado
Illinois
Kentucky
Louisiana
North Dakota
Pennsylvania
Rhode Island
South Carolina

Like the parental consent/notification laws, many more states have had spousal/partner consent laws debated and defeated in their legislatures.

* * * *

Ms Wente says: "Except for a few backwaters in the United States, safe, legal and accessible abortion is the norm throughout the Western world."

Does this seem like a "few backwaters" to you? Does it look like abortion is accessible in the United States?

Without access, the right to abortion is meaningless.

* * * *

All facts in this post are verifiable at these reliable sources:
Human Rights Watch
The Guttmacher Institute
Planned Parenthood Federation of America
NARAL Pro-Choice America
National Network of Abortion Funds
National Coalition of Abortion Providers
American Civil Liberties Union

Although I didn't use it for this post, Wikipedia's entry on abortion in the United States is quite good.

belated congratulations: henry morgentaler is a canadian hero

I was unable to blog about this when it happened, but I want to add my voice to the chorus of right-thinking Canadians who applaud Henry Morgentaler's appointment to the Order of Canada.

Dr Morgentaler should be a hero to everyone who values equality, personal autonomy and human rights. All the Canadian women and men who fought alongside Morgentaler are heroes, too.

It's our job to make sure their legacy does not unravel.

insite to remain open at least another year

Good news from BC!

North America's only sanctioned safe-injection site for drug addicts won a major court victory Tuesday, thwarting any chance of the federal Conservative government closing it down.

Mr. Justice Ian Pitfield of the B.C. Supreme Court granted users and staff at the popular but controversial facility known as Insite a permanent constitutional exemption from prosecution under federal drug laws.

Allowing addicts to inject their illegal drugs in a safe, medically supervised environment is a matter of sensible health care and they should not be under threat of being busted by police, the judge ruled.

In so doing, Judge Pitfield also declared that sections of Canada's drug laws against possession and trafficking in illegal narcotics were unconstitutional.

However, he gave the government until the end of June next year to redraft them in accordance with the Canadian Charter of Rights and Freedoms. The ruling is narrow in scope and not expected to lead to widespread loosening of the laws against heroin, cocaine, marijuana and other illegal drugs.

But it was clearly a stunning reprieve for Insite.

Friend of wmtc Jen is a long-time advocate for Insite. I'm hoping she'll come by with a comment or, if she'd like, a guest post.

immigrants everywhere are under fire

All over the world, people are scraping together whatever they have and leaving their homelands, seeking a better life.

It has ever been thus. My grandparents and great-grandparents were part of a mass migration from Europe to North America, masses of people hoping to find religious freedom and economic opportunity.

In the first half of the 20th Century, millions of African-Americans moved from the southern United States to the north, which might as well have been a different country at the time, creating a sea-change in US history.

Indeed, the United States and Canada were both founded by such seekers, first called colonists, then pioneers, later immigrants. (Leaving aside, for the present, the millions who were brought to the US by force, and the millions already there who were massacred or displaced.)

Since its founding, the US has never been particularly welcoming to immigrants, each immigrant group, now settled, trying to bar the next one from "their" country. But at various times in the country's history, the need for cheap labour shaped a more tolerant immigration policy.

Right now, if all the illegal immigrants in the US suddenly disappeared - as so many Americans seem to want - the entire economy would shut down. Not a meal would be prepared in a restaurant. Not a room cleaned in an office or hotel. Not a blade of grass would be mowed. Professionals couldn't go to work because they'd have no one to watch their children. You get the picture.

Vast populations the world over are trying to move from impoverished, resource-poor and repressive lands, to any place else. Any place they imagine they might be free, and not hungry. Many Americans think the whole world is trying to get into the US. Of course that's ridiculous. Much of the world is trying to get anywhere.

It can't be easy in the best of times, but right now, it's sheer hell. Anti-immigrant sentiment is on the rise in Canada and Europe, and raging almost everywhere else. Conditions are very bad - everywhere - for illegal immigrants right now. Only it's worse where they come from.

From OneWorld.net:

As thousands of immigrants to South Africa piled onto one-way buses home to escape widening anti-immigrant violence, civil rights groups in Texas deplored a new initiative they charge endangers the lives of immigrants and their families.

The new procedure would place U.S. Border Patrol agents at hurricane evacuation sites in the Rio Grande Valley to check the documents of those boarding buses, with the aim of ferreting out illegal immigrants. Those who can't produce citizenship papers would be put on separate buses, bound for deportation.

"This is a shocking and dangerous initiative, which will undercut the authorities' efforts to keep everyone safe during a crisis," said Janet Murguia, president and CEO of the National Council of La Raza (NCLR), an immigrants rights organization based in Washington, DC.

Karen K. Narasaki, president and executive cirector of the Asian American Justice Center, called the plan "unconscionable," since it may discourage immigrants from seeking protection during emergencies.

If immigrants fear evacuation and remain in place, the plan will endanger immigrant communities, as well as placing an additional burden on local agencies charged with evacuation, rescue, and relief operations, Narasaki added.

John Trasvina, president of the Mexican American Legal Defense and Educational Fund, pointed out that when emergencies strike many people don't have time to sort through their documents and bring them along. The Texas plan means that many U.S. citizens are likely to experience unwarranted harassment, he said.

Marguia announced that the National Council of La Raza has written to Homeland Security chief Michael Chertoff demanding that the new initiative be suspended immediately.

Coincidentally, the United Nations' special rapporteur on contemporary forms of racism, racial discrimination, xenophobia, and related intolerance, DouDou Diene, is currently on a U.S. fact-finding mission, although Texas is not on his itinerary. Diene's visit is being welcomed by civil rights groups around the country; a report should be completed by early 2009.

Xenophobia, defined by Webster's dictionary as "hatred of foreigners," is said to be behind the escalating attacks on Zimbabweans, Malawians, Mozambicans, Pakistanis and other foreigners in South Africa, along with the impact of sharp price rises for food and fuel.

Tensions over the presence of large numbers of foreign immigrants, which have simmered in the past few years and occasionally resulted in violence, boiled over last week, leading to at least 42 deaths when armed mobs attacked residents of immigrant neighborhoods and looted foreign-owned stories in Johannesburg.

The violence spread to Cape Town and Durban Thursday; at least one immigrant, a Somali, was killed.

Not unlike the United States, South Africans complain that immigrants deprive local citizens of jobs and absorb precious public resources.

A South African intelligence official Friday accused pro-apartheid elements of stirring up the anti-immigrant violence, suggesting a renewal of the pre-1994 alliance between far-right whites and Zulu workers to discredit the ruling African National Congress.

From the US:

Hundreds of legal and illegal immigrants in Arizona are being sent back to their home countries, sometimes against their will, for medical treatment because they lack insurance.

In some cases, the FBI and police, responding to allegations of kidnapping, have been called in to halt such forcible removals, according to patients' lawyers. In one recent case, a sick baby who is a U.S. citizen born to an illegal immigrant was being transferred by helicopter to a waiting air ambulance for a flight to a hospital in Mexico when Tucson police intervened and brought the child back to the hospital.

The forcible removals are the result of federal and state law mandating that only U.S. citizens and legal residents are eligible for Medicaid. As a result, state hospitals are pressured to transport noncitizens, even if they're legally in the U.S., at the hospitals' expense, back to their home countries, at a cost of up to $100,000.

The alarming scenario has come to light in recent weeks with the dramatic case of Sonia Iscoa Del Cid, a house cleaner in the country legally under temporary protected status, who woke up from a coma last week only to realize that she was going to be forced back to her native Honduras because she lacked insurance for long-term care. The case galvanized the immigrant community in Phoenix.

On May 9, hours away from being flown to a small hospital in Honduras, where Del Cid no longer has any family or friends except for an elderly father, her lawyer filed a temporary restraining order preventing the move. Family and friends raised money through car washes, and received significant financial assistance from dozens of trial lawyers in Arizona, to pay the $20,000 bond ordered by a local judge.

Groups like No One Is Illegal (Toronto, Vancouver, Montreal, UK) offer a different vision for the future.

No One Is Illegal (NOII) UK challenges the ideology of immigration controls and campaigns for their total abolition. We oppose controls in principle and reject any idea there can be "fair" or "just" or "reasonable" or "non racist" controls. We make no distinction between "economic migrants" and "refugees", between the "legal" and the "illegal". These are political categories invented by politicians. We campaign to break down these categories and support free movement for all and unity between all.

First, we must share the bounty of what we have, and welcome contributions from every human.

But the entire undeveloped world moving to the developed world is obviously not possible or practical. So until we view the world as one community and all people as humans - not identified by some accident of geography or birth - and address poverty on a global scale, these desperate attempts at immigration will continue.

We need all societies to be open to immigration. But in the long term, we need all human populations to be properly sustained.