FFT: Don’t Dream Of Becoming A Doctor, Dream Bigger

If your dreams don’t scare you, they aren’t big enough.  -Muhammad Ali

Food For Thought: Don’t Dream Of Becoming A Doctor, Dream Bigger

Don’t dream of becoming a doctor! That is not big dream enough! Dream bigger! Dream of curing cancer and in the process become a doctor.

Since age 5 or 6, I dreamt of becoming a doctor. Why? I don’t know; perhaps, I desired to help people since that was my nature. Deciding my future at that early age paved a path that I was prepared to navigate. It made choices easy and the sacrifices expected.

When I became a doctor, dreaming stopped. I worked hard and got into the routine of living life: A working single mom raising two active, athletic boys. Also, after 20+ years in clinical medicine, I felt unchallenged. Patient care required minimal brain power and more clerical skills as the years passed.

I wasn’t prepared to leave medicine, wasn’t ready to be a patient and hadn’t thought about a future without medicine. The first few years of leaving medicine, I felt useless; my education had no value. I knew nothing but medicine. Here I was starting over at my age. It took years for me to figure out what I wanted. It wasn’t easy and took time. The earlier you start planning your future, the better your chances of success, happiness, and inner peace.

If your children are older like mine, remind them to dream big then dream bigger. When you remind them, it doesn’t matter if it seems impossible and they ignore you, continue to tell them anyway. They listen if you repeat it often enough. If your child comes up with something that seems impossible, don’t knock reality into them. Encourage them to dream even bigger. Have confidence they will figure it out.

For those lucky enough to have babies that’s the best time to start preparing your child to dream big by giving them the confidence to dream big and then bigger.  #DreamBig

Dream Big then Bigger
Dream Big then Bigger

 

Source of Images:  Pinterest

Evidence-based Programs: Answers But Not Proof or Solution

Evidence-Based Programs are Not proofs
Evidence-Based Programs are Not proofs

Evidence-based Programs:  Answers But Not Proof or Solutions

 

What are evidence-based programs?

Simply put, a program is judged to be evidence-based if it meets the following criteria:

  • Evaluation research shows that the program produces the expected positive results;
  • The results can be attributed to the program itself, rather than to other extraneous factors or events;
  • The evaluation is peer-reviewed by experts in the field; and
  • The program is “endorsed” by a federal agency or respected research organization and included in their list of effective programs.

 

Start with what we have! A glance at the National Registry of Evidence-Based Programs and other similar registries and best practices is enough to demonstrate that increasing disparities between disadvantaged and non-disadvantaged groups does not stem from a lack of evidence-based programs. Absent are contextual  measures pivotal to accurately assess effectiveness and appropriateness of evidence-based programs operating within diverse communities. We may have the answers to the wrong questions. Evidence-based is not proof of   effectiveness, safety or application of programs in diverse communities.

“Why are gaps or rather disparities increasing?” I propose the answer lies in the belief that using evidence-based programs guarantees effectiveness and desired outcomes, particularly if fidelity, reliability, and validity have been demonstrated. Some in public health still believe-evidence based programs replace the need for metrics. This is wrong!

Research  studies showed positive nurturing environments d from birth to 5 years old is critical to  formation of healthy foundations.  Healthy foundations increased the likelihood of successful, productive, and healthy behavioral and academic outcomes in adulthood.

Currently, educational outcomes are measured by indicators such as academic performance, standardized tests, graduation rates and college entrance rates. These metrics provide useful information, but not about healthy foundations or  how to improve future potential of children, particularly children from impoverished backgrounds. The tests show that disadvantaged groups (poor children) lag behind and have not benefitted from the science of our advanced technologies, thereby decreasing future potential and  increasing disparities in education, health, and social class.

 

Why Evidence-Based Doesn’t Work?

This is partly due to:

  • Lack of evaluative tools to  guide effective and appropriate strategic interventions that are scalable,  replicable  as well as form strong, agile customizable  infrastructures;

  • Academia’s insistence on fidelity when implementing evidence-based programs defies factual observations that one size does not fit all. Fidelity–loyal to protocol –ignores  nuanced cultural contexts of communities and members of each stakeholder.

    1. Fidelity in implementation unintentionally devalues a community’s culture by replacing with Anglo-Saxon culture;

    2. Acting against one’s beliefs and values without creating a rational narrative stresses the psyche and the body, triggering profound inner turmoil known as cognitive dissonance;

  • Evidence-based studies are based on evidence within a particular context, community  or environment.    Also, keep in mind most studies are short term.  The wide application of evidence-based studies to diverse communities does not assure desired outcomes.   For example, Headstart, one of the government’s longest running”successful”  programs for in-need pre-school children,  fades within one to two  years of starting school. Why? That research has not been done yet HeadStart expanded.

  • Finally, without appropriate metrics and allowances for context, health is not measured nor is the long-term impact or harm of many well-intended social programs.  As well-intentioned as the missions of social programs, most are ineffective at best.

Causing harm, oppression and creating new issues  for those without safety nets were not issues anticipated by researchers.  Many brilliant minds still  reside in a tunnel.    Evidence-based studies  and best practices do harm simply by not  understanding or appreciating the impact or POWER of  diverse cultures.

 

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With the above in mind, imagine living in a community struggling to survive without basic needs—a food-insecure community lacking shelter where safety is of huge concern, not because of crime but because of local police departments.  In 2012, about 50 million Americans fit the description of food- insecure with 8.8 million children living in food-insecure households.    Mistrust and fear are high in communities struggling to survive.

 Maslow Hierarchy450px-Maslow's_Hierarchy_of_Needs.svg

Maslow’s hierarchy is a good starting pointing in understanding the stages of fulfillment of human needs. The bottom needs are essential to move up the hierarchy. Basic physiological needs—sleep, food, water, sex—are essential for survival. The next level includes security, safety and employment.

Keep the above in mind as you imagine the following scenario. A new program distributing information about obesity comes to your community. You unknowingly fall into a high-risk group. Considering Maslow’s hierarchy, would obesity be high on your priority list if food and safety are also concerns?

Unfortunately, most programs operate on the presumption that a community’s priorities are similar to those of researchers. When programs do not work, this apparently flawed assumption ignores the tendency of social workers to double down  and  request  more funding.

Suggestions:

Please, Please, Please No more spending and no more programs hatched in petri dishes, please! Social problems are complex adaptive problems that require all parties at the table, feeling discomfort while totally invested in the outcomes. Integrating appropriate metrics with social programs not only guides strategy but can be educational and a tool to build trusting relationships within communities for future collaborations.

A system-of-care approach determines the needs of children and their families within communities, based on a number of factors including a community’s own resources.  Community members form  core infrastructures germane to a programs’ success and longevity; as well as facilitate development of  culturally appropriate metrics (which improve  compliance)  to guide evaluation, implementation and outcomes. Engaged communities collaborate with researchers to  facilitate adoption of    cultural-contextually appropriate solutions. Interestingly, if one looks and listens, successful solutions with desired outcomes already exist within communities.

 Evidence-based studies are tools to help communities carve their own solutions.  They are not THE solutions.

References:

1.  SAMHSA National Registry of Evidence-Based Programs and Practices

http://nrepp.samhsa.gov/

2.   Cognitive dissonance

http://en.wikipedia.org/wiki/Cognitive_dissonance

3.   What Is Cognitive Dissonance?

http://psychology.about.com/od/cognitivepsychology/f/dissonance.htm

4.   Definitions of Food Security

http://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security.aspx#.U-DWLvldV8E

5.   Food Security in the U.S.

http://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us.aspx#.U-DV4vldV8E

6.   Food Security

http://www.who.int/trade/glossary/story028/en/

7.  Research Review Evidence-Based Programs and Practices: What Does It All Mean?

http://www.evidencebasedassociates.com/reports/research_review.pdf

8.  Evidence-based medicine

http://en.wikipedia.org/wiki/Evidence-based_medicine

9.  About Evidence Based Programs

http://www.projectenhance.org/aboutevidencebasedprograms.aspx

the 10 things you’ll learn by the time you’re a teen

I learned a few things I had forgotten and cannot think of anything to add to the list. Great Article!

The Success of The War On Drugs on Education

The Success of The War On Drugs  on Education

Part 2 of Prison Reform Benefits Education Reform

 

Was the war on drugs successful? At one time, many believed that blacks were criminals, and I started to fear my own people. The power of the media in creating illusions should never be dismissed.

The war on drugs (WOD) neither reduced drug overdoses nor drug ingestion. WOD harmed innocent children and their families by depriving children of education and placing them in toxic environments (prisons) where they were physically abused and sexually molested (by the United States government).

Over sustained periods, violent environments lacking support produce toxic stress. Toxic stress is a well-established risk factor for both physical and mental illnesses; stress is a major factor underlying the pathology of chronic medical conditions.

Toxic stress compounds pre-existing risk factors in children, as much as four to six times over children with similar risk factors who are exposed to stress, but have supportive adult networks and are not exposed to prison.

Table 1 List of High Risk Behaviors

Risky behaviors include and are not limited to:

1.  Increased risk of drug and alcohol abuse;

2.  Increased risk of suicide;

3.  Increased risk of violence;

4.  Increased risk of sexual infections, pregnancy and molestation;

5.  Increased risk of homelessness;

6.  Increased risk of poverty;

7.  Increased risk of Mental Illness; and

8.  Increased risk of re-incarceration.

Again, I repeat: public schools are the main pipelines to prisons. School-to-prison pipelines are massive problems in communities of color. Zero tolerance, racial profiling, and school-to-prison policies relegate school discipline to prisons. Children who act out are considered difficult to teach, consuming scarce and valued time. What else can overworked teachers and educators working in understaffed schools do with children considered as “trouble-makers?”

Public schools and private prisons expose inner-city children with risk factors to distasteful mixtures of human depravity, bondage, and isolation, as well as unnecessary cruelty, violence, torture, sexual molestation, humiliation, physical abuse, and death. In the United States of America, children with behavioral issues are treated in prisons regardless of their age, diagnosis of mental illness, and lack of appropriate comprehensive evaluation. How effective has that been?

A study of 35,000 former Chicago public school students (4), completed by Anna Aizer of Brown University and Joseph Doyle Jr. of the Massachusetts Institute of Technology, showed:

Unsurprisingly, going to jail as a kid has “strong negative effects” on a child’s chance to get an education. Youth that went to prison were 39 percentage points less likely to finish high school than other kids who were from the same neighborhood. Even young offenders who weren’t imprisoned were better off; they were thirteen percent more likely to finish high school than their incarcerated peers.

 

More surprisingly, given that prison is supposed to deter crime, going to jail also made kids more likely to offend again. Young offenders who were incarcerated were a staggering 67 percent more likely to be in jail (again) by the age of 25 than similar young offenders who didn’t go to prison. Moreover, a similar pattern held true for serious crimes. Aizer and Doyle found that incarcerated youths were more likely to commit “homicide, violent crime, property crime and drug crimes” than those that didn’t serve time.

These findings are particularly troubling given that kids are often sent to the criminal justice system for relatively minor offenses.

The prefrontal cortex of a child does not fully develop until around 25-30 years old. Incarcerating children for mistakes – such as drug possession or bullying – teaches the wrong lessons, stunts personal growth, and exponentially increases baseline risk factors for children. Prisons create more risk factors and ensure children fail by limiting their paths to one of darkness, without opportunities for light, often ever again.

Children cannot communicate their feelings as well as adults, so they do what children do best: act out.

Public schools, soon to be charter schools, are similar to private prisons, cataloguing children by name, rank, and future potential inmate ID. Public school pipelines to prison are well-funded, lucrative, and powerful alliances that exploit children, families, and communities by turning the lights off on brighter futures while damning innocent children to lives of deep psychological pain.

Are teachers and educators listening to their customers? What are children telling teachers and educators? Few teachers take time to listen or inquire, and we have few indicators to measure student satisfaction with education.

Are teachers better educators with children in prisons instead of classrooms? How can teachers and educators create positive school climates?

How much does the average inner city class size shrink due to imprisonment of students by the end of the year? What is the impact of these policies on other students?

A system of care approach that applies Big Data is a scalable and fully customizable model for making education relevant and appropriate, leading to healthy, productive children.

Our culturally diverse country makes one-sized education to fit all communities unpalatable and irrelevant for many cultures. A system of care approach empowers communities to set priorities around needs of children and their families while employing resources within the community.

A system of care approach is one of many collaborative approaches to education and metrics that empower communities through community participation and engagement.

Armed with Big Data, education and law enforcement will be more responsive to communities, which will be more informed… I hope.


 ***

References

  1.  What Is IDEA?

http://www.ncld.org/disability-advocacy/learn-ld-laws/idea/what-is-idea

  1.  What is a System of Care?

http://www.thefamilygateway.net/supports-services/system-of-care/what-is-a-system-of-care/

  1.  United States Citizens Justice Database 

https://failuretolisten.com/2014/07/01/united-states-affluenza-and-genocide-online-database/

  1.  STUDY: Throwing Kids In Jail Makes Crime Worse, Ruins Lives

http://thinkprogress.org/justice/2013/06/17/2166481/study-throwing-kids-in-jail-makes-crime-worse-ruins-lives

  1. Prison Reform Benefits Education Reform  Part 1

 https://failuretolisten.com/2014/07/18/prison-reform-benefits-education-reform/

Prison Reform Benefits Education Reform

The above images are victims of organized partnerships  involving law enforcement, the justice system (judges) and private prisons

Prison Reform Benefits Education Reform | Part 1

 

Was the War on Drugs Successful?

The War on Drugs was a successful war, but not on drugs. The War on Drugs was successful at imprisoning young black youths, removing them from schools and making schoolwork more challenging and frustrating for children who were already stigmatized.

Furthermore, imprisoning children destroys families by trapping them in a vicious cycle of poverty as well as vicious organized corruption involving law enforcement and justice departments.

This has created a cycle of ex-convict and delinquent youths robbed of their “manhood” while imprisoned, combined with women of low self-esteem (another story), trapping them in a world protected by environment toxins that inevitably leads to premature death, imprisonment, drugs, or unfulfilled dreams.

Society does not recognize its role. Every time a black youth ventures outside his invisible fence of concentrated poverty and gets harassed or murdered it has a profound and pervasive impact. Perhaps this is why such news is not covered – only black-on-black crime is covered. Until a few months ago, I had no idea of the magnitude of structural racism destroying families in communities of color.

Seen from the eyes of black youths, the world is not a hospitable place. Black youths ‌are viewed suspiciously and deemed criminals by society. Black youths and communities are aware of these beliefs.

Imagine Black youths out to have FUN yet can’t because white adults stare, show fear at their presence, stare past them, clutch their handbags, follow them in the store and even arrest when item are legal.

How would you feel if your children shared such experiences?

Black youths cannot go to a convenience store without being accosted, followed or watched by store staff. Perhaps some of this suspicion is justified, but most is not.

Solution: As adults: Show black youths the same respect you show other youths – start with a genuine smile – and be prepared to be amazed at the results.

Many children from communities of color lack exposure, making communication difficult. Definitions and non-verbal cues have different meanings for them.

 

Was the War on Drugs Successful?

The War on Drugs legalized racial profiling in the minds of police officers, law enforcement, and the justice department. A brief review of articles noted in the US Citizens database gleaned many established and new observations. Granted, these observations are anecdotal; therefore, these are areas for further investigation. Racial profiling targets black persons, especially black youths. Racial profiling equals police harassment, with attendant police brutality and violence.

The magnitude of the devastation caused by the war on drugs on communities of color added exponentially to the psychological trauma of slavery, chronic discrimination, and an inferiority complex.

Many communities of color live in a state of dysthymia or chronic low-grade depression with many folks feeling helpless and hopeless about the future. Many search for meaning through religion, others through gangs, and still others through living in isolation. Remember at least one in three families have a loved one in prison. That is disruptive and defeating.

The War on Drugs resulted in mandatory sentencing of poor drug offenders. For example, possession of five grams of crack – a cheaper form of cocaine – carries a five-year sentence, while cocaine carries a five-year sentence only if the equivalent of 5,000 grams of crack is in a person’s possession. Similarly, stiff sentences apply to marijuana, which is now legal in a few states and has medicinal uses.

The War on Drugs started in the Ronald Raegan era, and the privatization of prisons took off with the Justice Department collaborating with private prisons after Clinton reduced the budget for law enforcement and the Justice Department.

Since then, explosive growth in prison populations suggests that private prisons have successfully rounded up the criminals from the War of Drugs. However, that was not the case, and it was just a smokescreen of stereotypes. Closer inspection of data refutes that claim by the demonstration of disparities in the justice system and law enforcement.

Private prisons and the justice department have a lucrative partnership, paid for by taxpayers, as they arrest targeted individuals despite known innocence. These innocent victims, usually challenged in self-defense, are subjected to repeated adult bullying by police officers, correctional officers, judges, and prosecutors. They become the main pool or source of income for private prisons and judges.

One wonders if police officers and correctional officers are selected for their brutality and, perhaps, their affiliation with white supremacy.

NYC charges about $168,000 per year for each prisoner. This sum does not include benefits and other essentials. NYC does well, considering the accommodations at Rikers. States get more taxpayers’ dollars to warehouse prisoners than they get to help poor families. NYC get $168,000 a year for each prison. Let that sink in while absorbing the landscape of America the police state.

Could the above serve as an incentive or driver behind the rise in incarceration rates and prison populations? The United States is 5% of the world’s population, yet it has 25% of the world’s prison population—2.2 million prisoners.

If prisons are packed with low offenders, how is crime controlled?

Distrust all in whom the impulse to punish is powerful

Friedrich Nietzsche

My thoughts: Police officers take the easy way out to increase their stats and make themselves look like crime fighters; however, police officers surreptitiously frame innocent victims while leaving gang members undisturbed to wreak fear and oppression in communities of color. Police Officers choose victims rather than finding criminals.

Please share your thoughts… I am interested as I work on the database.

CHP-beating-with-test

Also please contact me by August 6 with feedback on the kickstarter campaign.

-Part 2 –

Prison Reform Benefits Education Reform | A System of Care Part 2

https://failuretolisten.com/2014/07/23/prison-reform-benefits-education-reform-part-2/

Albert Einstein: Quotes To Understand Life

Not everything that counts can be counted and not everything that can be counted counts.

-Albert Einstein

***

The most incomprehensible thing about the world is that it is comprehensible.

-Albert Einstein

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The value of a man should be seen in what he gives and not in what he is able to receive.

-Albert Einstein

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Education is what remains after one has forgotten everything he learned in school.

-Albert Einstein

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The true sign of intelligence is not knowledge but imagination.

-Albert Einstein

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Learn from yesterday, live for today, hope for tomorrow. The important thing is not to stop questioning.

-Albert Einstein

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There are two ways to live: you can live as if nothing is a miracle; you can live as if everything is a miracle.

-Albert Einstein

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3D print of Albert Eintein using: 3D printed head using ABS filament created in FDM printer.
3D print of Albert Eintein using 3D printed head from ABS filament created in FDM printer.

Photo credit:

The above 3D print of Albert Einstein presented by 3D2Go Studio at : http://www.3d2go.com.ph/blog/2014/07/17/3d2go-studio-presentsalbert-einstein/

Thank you  3D2Go Studio for your contribution.

***

 

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https://failuretolisten.com/2014/07/14/quotes-to-understand-life/

 

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There are two ways to live: you can live as if nothing is a miracle; you can live as if everythingis a miracle. Albert Einstein

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Sources of initial images: http://failuretolisten.tumblr.com/  https://plus.google.com/u/0/+AngelaRMCraneMD/posts

Farewell to Exclusivity and Tokenism

Krish_healthcropped

It is no measure of health to be well adjusted to a profoundly sick society.

~Krisnamurti

Yesterday, I was un-invited to an ACA event that day–apparently, Issued too many invitations and my presence irrelevant–Invitation one month ago and a second confirmation of attendance over 1 week ago….

I am disappointed!   This event attended and presented by the same people (and their protégés) is the biggest problem in medicine affecting medical care for everyone– perpetuating  vicious cycles of failed programs and ideas– The problem of  Exclusivity.  Exclusivity and diversity do not complement or work well with each other.   This mutually unique opportunity for  networking and leadership was  denied.    The problem with exclusivity is ACCESS.  Yesterday, I was denied access….unfortunately, this occurs often to people of color.  #POC

Harvard School of Public Health  did not practice what it preached.  I was prepared to teach  them:  Impart wisdom to the decision makers with formal authority.  Did they  not know physicians are important stakeholders?

Did they forgot my contributions to HSPH   during my first 4 months?

Did they  understand  how physically and emotionally ill I felt on returning to HSPH   following a 17 hour nightmare of cruelty and denigration  at Tufts Medical Center Emergency Department?

This culture says, who cares?  Diversity is paramount to appreciation and comprehension of   health.  Diversity begins with acceptance and comprehension of language.  Language is the means we use to communicate  thoughts, experiences and ideas –our cultures.  It is no measure of health when everyone has to adjust to a society that is profundly sick.

assimiliate-party12

The mindset of  medicine and public health is not diverse but rather stifling and very biased.  The  same voices in different roles. Essentially, the same actors and a few selected actresses wear different hats and hold all key positions of FORMAL authority.    This is called change and leadership.

Medicine does not value diversity and that is reflected in its culture and Continued Failure to Listen….resulting in lack of diversity along with increased morbidity and mortality of excluded groups.

***

Below is a letter that marks the end of my affiliation with medical care.

I will not attend this conference or any other claiming to care for patients when real patients are not represented and ….

Will there be People of Color presenting? The images do not show anyone like me. Last year I attended and enjoyed the conference but felt frustrated and disappointed by the lack of depth and diversity.

As I suspect the same, I will pass my ticket onto a colleague who is more your target. It is shameful medicine ( I will not say healthcare because there is nothing healthy or caring about our current system) remains exclusive even to the point of patient advocates.

I can’t be part of this atmosphere of exclusivity and tokenism.

It is no measure of health to be well adjusted to a profoundly sick society.

~Krisnamurti

Krish_no-health123

Krish_understand

When we talk about understanding, surely it takes place only when the mind listens completely – the mind being your heart, your nerves, your ears- when you give your whole attention to it. ~ Jiddu Krishnamurti

#quotes