Breastfeeding Nazis and The Fine Art of Health Education

 

image from Latch On NYC

There is abundant evidence that breastfeeding is best for babies. I profoundly wish that everyone would at least follow the American Academy of Pediatrics recommendation of breast feeding for at least 12 months. From personal experience, I know how little support mothers can receive (and actual DISCOURAGEMENT) especially in the African-American community to nurse their children at all, let only for a full year.

I am a breastfeeding cheerleader: Go Mother's Milk!

However, as a healthcare professional and educator, I have to caution against the dreaded Breastfeeding Nazi. (Yeah, I know some people are offended by the term. No offense intended.)

I have been an educator for many years and a nurse for a few years more. What I have learned from my students is to be a partner to them. Meet them where they are. Hitting people over the head is not a recommended educational technique.

To be professional, we have to remain empathetic and focused but refrain from investing our own emotions into a learning situation. Remain patient and help to remove barriers where you can. Encourage, don't browbeat. Remove your own ego and don't proselytize.

Yes, breast is best and it is a crying shame what we have allowed the formula companies to do to undermine breastfeeding around the world. At the same time, our job is to empower our patients not power over them. We should not sit in judgement of those who choose formula.

Unintended Consequences

  

“Everything must be taken into account. If the fact will not fit the theory---let the theory go.”
― Agatha Christie, The Mysterious Affair at Styles (from goodreads.com)

I've been thinking a lot lately about unintended consequences: The idea that often (always) when we make a change or take an action, there are unforeseen and unplanned for results. 

For example, a recent study of Amish children is seen to support the Hygiene Hypothesis which states that many allergies may be caused by children missing exposure to allergens. In other words, if the environment is too clean, then the immune system develops the "over-reaction" we know as allergic responses.

Another example that comes up often in my circles involves the No Child Left Behind educational policy. I have no doubt that the policy sprung from the sincere desire to improve education nationwide by emphasizing objective standards and student test results to measure progress. Alvin Granowsky, Ed.D., points out "(t)he type of pressure and rewards being placed on schools to have high test scores has resulted in an obsession with performance on tests... Classroom time previously used for learning, discussing, and exploring ideas is now spent focusing narrowly on content expected to be on the test or simply practicing test taking skills."

So the answer then, I think, is absolute adherence to the scientific method. We must hold off on absolute certainty in absence of overwhelming evidence. We must continue to learn and look for causation or correlation where they occur. As Ms. Christie states above, the facts (conclusions) must drive the theory, not the reverse.

Self-Evaluation

Overall, I would say that my blog became effective. At the beginning, it took me a while to get my content and design together. But with practice and learning from my own mistakes and the efforts of others, I feel that my blog has really come along.


I also appreciate the exposure to various tools that we learned throughout this quarter's assignments. It can be easy to fall back on the familiar if we don't seek out new tools, and I enjoyed the challenge of learning something different.


The feedback I received from my peers was very supportive with only a few design element suggestions. I did post a survey form with ten Likert-type items, but I only got one respondent -- I'm sure that was due to the poor timing of that post. The score I received tallied to a total of 48/50.


I would like to continue blogging both for profesional and personal benefit. Most of all, I'd like to thank Dr. Stoner and all my peers for their continued support!




Below is a TED talk on blogging:

I added a little background music. It's not perfect, but it is closer to what I wanted it to be...

You can view other aspects of the video plan here: http://bit.ly/LKheuw

Feedback Survey

HIV Prevention in Prisons

Photo of California State Prison Overcrowding

So Truvada, an expensive HIV prevention drug, has been in the news lately. It got me to thinking about our prison population.

I think I know the answer, but I wonder if Truvada will be made available to prisoners. I wonder if it should be.

How do we measure the costs-benefits to something like that?

Those behind bars are part of our community, and the vast majority will be released back into the population at large. It is short-sighted of us to endanger our own health because we fail to reduce the health risk of the incarcerated. 

At the same time, we have limited resources, so is our money best spent on expensive treatments for the "bad guys?" (How about we start with making something cheaper available, like condoms?)

Like usual, the issue is more complicated than that:

• There are other modes of transmission in jail other than unprotected sex. 
• We have to be careful in any drug therapy of fostering drug-resistance.
• Other diseases such as Hepatitis C and Tuberculosis may be even more widespread.

 So, again, how do we measure the costs-benefits?

Prevention, Prevention, Prevention!

This is my oldest daughter on her first trip to Disneyland. She was around 15 months' old. What you don't see in this picture is the nebulizer and other medicines in the storage under her stroller. You also don't see the scars on all four limbs and in her groin left over from her week-long stay in the Pediatric ICU.

She had been hospitalized overnight just before her first birthday for a suspected virus (RSV) and sent home with a nebulizer and albuterol. Despite repeated trips to the doctor's office, within a month she was back in the hospital and intubated for respiratory failure.

I can't even tell you how much the insurance company had to spend on her total care, but I do remember seeing one bill that was for Nursing Services that was over $40,000. There were so many points where the proper intervention would have made all the difference in this outcome. I am also sure that the proper prevention would not have put my baby's life in danger and would have saved the insurance company lots and lots of money. 

There is a current fight in Washington over paying for the extension of lowered student loan rates by getting rid of a preventative health fund provided by the Affordable Care Act

(Student loan bill fails as Senate gears up for protracted battle). There was one female politician -- I wish I could find her name and the quote -- who seemed to dismiss this preventative health fund as unnecessary. I found her stance outrageous.

At the same time, this post is not about ObamaCare, all right?

What this post is about is the importance of preventive care in improving patient outcomes and patient safety. We as a society need to emphasize prevention to optimize the state of our health care.

Of course, not all preventive measures are effective nor cost-efficient as Doctors Cohen, Neumann, and Weinstein point out in the February 2008 New England Journal of Medicine (Does Preventive Care Save Money? Health Economics and the Presidential Candidates). As with all evidence-based practices, we need to evaluate preventive medicine in an on-going fashion to identify what works and what doesn't.