Bill Nemitz: Latest LePage order a piece of work | The Portland Press Herald / Maine Sunday Telegram

Bill Nemitz: Latest LePage order a piece of work | The Portland Press Herald / Maine Sunday Telegram

I cannot write this blog any better than Bill Nemitz comments in today's Portland Press Herald.

Baby Boomers in Asia - Five Countries in 30 Days

Public Health and Infectious Disease Observations:  Five Asian Countries in 30 Days

            So, my husband and I thought we were 30-somethings again. We decided to trek around Asia, unescorted, for a 30 day and 5 nation vacation. 

Along the way, I made mental notes about the public health I observed. We visited Singapore, where my husband’s nephew and family live; and where the quality of the government run health care is excellent.  We noticed a marked change in the public health after we left the modern safety of Singapore. Third world countries like the two sites we visited in Viet Nam and two places in Cambodia appeared less focused on public health than what I observed in progressive Singapore. 

In Beijing China, I observed an interest in improving air quality and emphasis on hand washing in bathrooms and restaurants. 

Finally, Kyoto, Japan appeared to be as modern and focused on providing for good public health as any western nation, including the United States.

We planned an itinerary using frequent flyer miles.  Our intention was purely personal, but my nursing instincts drew me to pay attention to the public health of each country we visited.

Of course, I was also vigilant about our exposure to infectious diseases that are either prominent or endemic to Asia – like, Malaria, Tuberculosis or Dengue Fever. 

Additionally, we were aware of our risk for contracting intestinal disorders due to the variances in water quality common in Asian countries.   Obviously, we didn’t want to think about the risk of unexpected accident or injury. 

            Our local travel clinic in Brunswick was non-specific about special health risks we could be exposed to.  We received advice about having our tetanus immunizations updated.   Thankfully, our primary care physician provided a prescription of Ciprofloxacin (Cipro) in the event we needed help fighting off gastrointestinal or urinary tract infections. 

            Fortunately, our 30 day journey left us with beautiful memories and in reasonably good health given the exhaustive pace of our 5 nation travels. We never used the Cipro.

            Nonetheless, it’s a good idea to check the resources on the Internet before taking an extended visit to third world countries like Cambodia and Viet Nam. 

While I observed public health measures in effect in Asia, the effectiveness of initiatives and facilities to treat illness, infectious diseases or medical emergencies are not uniformly evident. For example, first aid or medical alert signage was noticeably not existent in the ancient Angkor ruins of Siem Reap, Cambodia; likewise in the Cambodian jungle where the 10^th century temple at Banteay Srie is located.  Both of these Cambodian tourist sites present challenging terrain for travelers who may be unprepared for the arduous walking required, especially in 95 degree humid temperatures. 

            A visit to China’s Great Wall was an unbelievable travel experience for tourists like my husband and me. Nevertheless, be advised about the difficult climb on ancient steps while touring this Great Wonder located outside Beijing.  Driving in Beijing is also a public health risk because there are too many automobiles and novice drivers clogging virtually all the city’s highways. 

            This is a summary of what I learned by asking questions while we took our tours:

·        Singapore – public health facilities are excellent.  Record keeping is current about the incidence of infectious disease.  Electronic body temperatures are taken of all visitors at immigration.  Immigrants entering with a fever are quarantined until illness is determined and/or treated.

·        Viet Nam - provides health care for citizens up to 6 years old.  If private insurance is unavailable or unaffordable for those over 6 years old, the patients must go to charity hospitals.  Air quality in Ho Chi Minh City in South Viet Nam appears to be problematic, as some people were routinely observed wear surgical masks while commuting in the city.

·        Cambodia -  appears to down play risks of Dengue Fever, Malaria and even the remote chance of finding an undetected land mine in some remote villages where tourists are seen hiking on jungle paths, like at Banteay Srei .  Building a tourist industry is the focus of improving the country’s poor economy.  Public health seems to be provided by Europeans and at some Swiss run hospitals.

·        Beijing, China – appears to be struggling to get a handle on how to implement public health initiatives like improving air quality and prevention of infectious diseases.  Nonetheless, public toilet facilities in Beijing were modernized for the 2008 Olympic Games.  Hand washing was encouraged in all public places.

·        Kyoto, Japan* – appears to be on par with Western nations regarding sanitation and infectious disease prevention.  Hand washing stations in public facilities were emphasized and centrally located.  As in Singapore, electronic body temperatures were taken during immigration checks and electronic finger prints were required before entry to Japan.

My recommendations, for those baby boomers who want to take up a back pack or fly from place to place, are to research the Internet before embarking on what could be the journey of a lifetime.  Asia is a fascinating cluster of countries to visit, but travelers should be prepared for variances in economies, public health and often challenging terrain.  

*Since writing this story, the 2011 Earthquake and Tsunami in Japan has caused extraordinary damage to the beautiful country we visited. Although Kyoto was not directly hit, the collateral damage must be devastating throughout Japan.  I am deeply sorry for the Japanese people at this time; but I'm confident their culture will not be set back by the horrific destruction caused by the catastrophes of a 9.0 earthquake, a tsunami and resulting nuclear energy plant malfunctions and fuel leakages.

WLBZ2.com | Bangor, ME | Bates College orchestra holds fundraiser for Japanese town

WLBZ2.com | Bangor, ME | Bates College orchestra holds fundraiser for Japanese town

My understanding is this concert sold out but benefit donation info is included in the article.

Japanese need disaster support and help - Maine Psychiatric Physicians suggest assistance

Readers have contacted me via facebook to say the images out of Japan are haunting them.  Victims of other disasters are understandably re-traumatized by the current images of lives lost and the dreadful threat of nuclear plant meltdowns in Japan.  Although attention is focused on the urgency of the immediate needs, the long term emotional impact of this disaster must also be realized.  This article is from today's Maine Medical Association weekly newsletter:

Maine Psychiatrists Respond to Those Affected by Japan Earthquake from Maine Medical Association Newsletter weekly update March 14, 2011:


"Anthony T. Ng, MD FAPA, Medical Director of Psychiatric Emergency Services at Acadia Hospital in Bangor, is a nationally recognized expert in psychiatric responses to disasters and traumatic events."
The Maine Association of Psychiatric Physicians (MAPP) joins all Mainers, Americans and the international community in mourning the tragic loss of life that occurred as a result of the earthquake and tsunamis in Japan.
We express our deepest sympathy to the residents of the communities affected by the catastrophe, as well as to our Japanese students and expatriates who live in Maine. We express our support to those who are still awaiting word on the fates of family members, friends, and colleagues in the affected areas. We also wish to convey empathy with those who are experiencing the effects of disruptions of social supports and destruction and loss of property. The grief associated with this disaster is universal, and touches all of our lives.  Psychiatrists, as part of the world medical community, reach out to those who are affected by all forms of disaster. 

Maine psychiatric physicians have an important role to reach out to our communities, including schools and universities that are hosting Japanese students, as well as those who work with these students.  In particular, psychiatrists and other mental health professionals may be called upon to provide treatment for individuals with particular vulnerabilities, including pre-existing mental illnesses, who might become more severely disabled without specialized care. At a broader level, health care and social service providers, and other responders in the community should be aware of strategies for helping to promote people’s psychosocial wellbeing and resilience and further reduce distress or harm to disaster victims. In addition, MAPP offers a reminder to parents, teachers and the media to limit children's exposure to upsetting images on the television and the Internet.

Anthony T. Ng, MD FAPA, Medical Director of Psychiatric Emergency Services at Acadia Hospital, is a nationally recognized expert in psychiatric responses to disasters and traumatic events.  "People who have been affected directly and indirectly by disasters or traumatic events may experience an array of psychological or bodily reactions, including fear, anxiety, sadness, emotional numbing, sleeplessness, and various bodily ailments such as headaches. Reactions may also include distrust of others and a loss of confidence in themselves," advises Dr. Ng.  "As the world psychiatric community engages the challenge of reaching out to individuals in Japan, it will be particularly crucial that any supportive as well as therapeutic interventions appreciate and respect cultural variations in grief reactions and coping strategies.  It is important for health care providers and others to avoid defining as pathological normal stress responses in disaster situations. Many of these reactions are transient and may resolve. In some instances, however, it may be appropriate for affected persons to seek treatment for trauma-related emotional states."

Individuals seeking information or other resources are encouraged to contact MAPP at 622-7743. Also, the American Psychiatric Association and other organizations have helpful websites where interested individuals can obtain more information about coping with the mental health aspects of disasters.
http://www.psych.org/Resources/DisasterPsychiatry.aspx
http://www.redcross.org/en/
http://nctsnet.org/
http://www.pqmd.org/cms/japan_earthquake
For more information contact:
Anthony T. Ng, MD FAPA
Medical Director, Psychiatric Emergency Services
Acadia Hospital
Tel: 207-973-6345
Email: atng@emh.org
James Maier, MD DFAPA
Public Affairs Representative, MAPP
Email: maierj@mmc.org
Tel: 207-883-5420
Julie Keller Pease, MD DFAPA
President, MAPP
Email: jkpeasemd@gmail.com
Tel: 207-409-8621
Contact for questions regarding guidelines for donations of pharmaceuticals:
Stevan Gressitt, M.D.
Executive Committee, MAPP
Founding Director, International Institute for Pharmaceutical Safety
Email: gressitt@gmail.com
Tel: 207-441-0291
Contact for general questions about Maine Association of Psychiatric Physicians:
Warene Eldridge, Executive Director, MAPP
P.O. Box 190, Manchester, ME 04251-1090
Tel: 207-622-7743
Email: weldridge@mainemed.com

Beautiful Country Devastated - Post Earthquake Japan

Visitors to Japan "pre" last week's horrific earthquake and resulting tsunami waves were impressed by the country's organized beauty. Guests were treated to an orderly country.  People were polite to a fault. they were graciously efficient with time, resources, transpiration and energy.

Japan is the only country in the world to endure and recover from two attacks with nuclear bombs at the end of World War II.  It is completely unfair for this nation consisting of small group of islands to undergo yet another series of catastrophic events, this time by the destructive brutal forces of earth's moving plates along the Pacific Ocean's rim.

We visited Japan as a US military family in the 1970's, traveling to Tachikowa, Tokyo and Kamakura.  Just last October 2010 we visited the old capital city of Kyoto during our month long Asian tour.  My husband and I love Japan for it's simplistic beauty and friendly people.

Obviously, I join the people of the world in praying for the Japanese who are desperate in the face of a triple disaster, the 9.0 earthquake, the resulting force of the tsunami waves and now the breakdown of the country's nuclear power plants. Triple tragedies have happened in a country best prepared to withstand the powerfully significant events, yet the compounded forces of all of them occurring at the same time are overwhelming a grieving nation.  Thankfully, the US military is among the first disaster aid teams on the scene to offer assistance to the population who are dealing with water, food and power shortages.

I'm glad to say I've had the opportunity to visit Japan before March 10, 2011.  There is no doubt the Japanese will eventually recover from the combination natural and man made nuclear disasters now demoralizing the country's people.

Unfortunately, the Japan I will remember may not be the same during my lifetime.  As for the nuclear power plants, the double edged sword of risky energy sources driving Japan's economic success, I doubt these will ever again be functional, but I'm certainly not a scientist.

Worse, the nuclear waste these plants leave behind in the wake of the meltdowns will be a pox on the sculptured Japanese landscape for at least a generation, probably longer.

Our hearts pour out to the Japanese people who are faced with challenges beyond comprehension as the world watches the events of March 10, 2011 continue to unfold.   Thank you US military for being there, helping the Japanese when you can.  Although there is no way to mitigate the destruction of the triple earthquake disasters, our US military presence is symbolic of caring Americans who pray for Japan's well being.

Maine Governor LePage - Why Did You Fire Physician Dr. Dora Mills? It's the Company You Keep

Disclosure - I have been honored to know Dr. Dora Ann Mills as a public health policy leader and as a neighbor in Brunswick, Maine.  She is respected for her advocacy on behalf of responsible public health policy and as an advocate for nursing, especially regarding the public health policies protecting Maine's women, infant and children.  Obviously, I blanched and nearly dropped my newspaper when, after returning home from a relaxing vacation in Rome, Italy, I read the headlines tucked into my mail slot.

Why did Maine's Governor Paul LePage fire Dr. Dora Ann Mills, the former state public health officer, as Maine's Medicaid director?  No rational reason was given. (Perhaps it was a political decision? Ouch!)

To Dora, I know numerous others in Maine join me in congratulating you on your professional response to the irresponsible action taken by the Governor LePage administration in your employment.

Especially concerning is the lack of recognition for your 15 years of service to Maine people and for your reputation throughout the nation, by those who know you, as a wonderful public health official.

Another question in my mind is how a new gubernatorial administration will fill empty high level Maine positions, several left vacant because of precipitous firings, in a way that will prepare the state and this Republican Party state house majority against an inevitable emergency? 

Examples:  Arizona's Governor Jan Brewer was understandably unprepared for the murder of innocent people during the shootings where Congresswoman Gabriel Gifford was shot in Tuscon.  Louisiana's Bobby Jindal was equally challenged when the British Petroleum (BP) oil rig exploded off the coast of his state causing an environmental catastrophe.  All state governors live with the risk of unwanted disasters happening during their administrations. We cringe in anticipation of a Governor LePage response if, God Forbid (!) something unforseen and horrible happens in Maine.

When the LePage administration fires key public policy people who have proven leadership during times of crisis, in my opinion, he puts at risk the health and welfare of Maine people by allowing political appointments to trump responsible leadership.  Firing Dr. Mills without having a replacement in place is poor management at best and, otherwise, an error in judgment. 

Governor LePage's advocates say he has a right to hire his own team.  Well, these rhetorical advocates better watch the words they continue to parrot to support the mis-steps by this inexperienced administration, because you are graded by the company you keep.

My thanks to Dora for keeping your cool during this uncertain time.  I apoligize for the LePage administration for not publicly recognizing the value of your leadership as a public health policy leader, as an outstanding citizen of Maine and as the mother of a wonderful family. Neighbors, friends and colleagues of Dora are proud of the company we keep.

Future of Nursing - Highlighted in Institute of Medicine Report (IOM)

Page 4 ANA Maine Journal February, March, April 2011
Initiative on the Future of Nursing: Campaign for Action

http://www.nursingald.com/Uploaded/NewsletterFiles/ME2_11.pdf
  
Panelists at the Future of Nursing program said the initiative’s final published report is similar to the 1910 Flexner Report sponsored by the Carnegie Foundation, credited with transforming the standards for physicians and medical education.

by Juliana L’Heureux, BS, RN, MHSA

Professional nurses are essential in the efforts to improve the nation’s access to quality health care, said Donna E. Shalala, chair of the Robert Wood Johnson Future of Nursing initiative.

Shalala spoke at the Nov. 30, 2010, Summit on Advancing Health Through Nursing, in Washington, D.C.

Shalala is the committee chair of the initiative that presented the report, The Future of Nursing: Leading Change, Advancing Health, at the Institute of Medicine (IOM) with the Robert Wood Johnson Foundation (RWJF).

Shalala served as secretary of U.S. Department of Health and Human Services (USDHHS) under President Bill Clinton.

She called for collaboration among nurses and healthcare colleagues to transform the nation’s healthcare system and to improve patient care.

“There is not a more challenging time for health care than right now,” said Shalala in the program’s opening remarks. The presentation was also webcast to approximately 100 other locations in the nation including St. Joseph’s College in Standish, Maine.

“Nurses can and should play a fundamental role in transforming and improving health care,” she said.
The country’s more than 3 million nurses are vital in implementing and supporting the objectives set forth in the 2010 Affordable Care Act, the legislation that provides the most sweeping healthcare overhaul since the 1965 creation of the Medicare and Medicaid programs, according to the report. (For more information on the report, go to http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx or http://tinyurl.com/2brrusk)

Moreover, nurses were voted the most trusted healthcare professionals for eight years in a row, in a Gallop Poll reported by the American Nurses Association (ANA) on Dec. 9, 2009.
In anticipation of the passage of national healthcare reform, the Robert Wood Johnson Foundation and the Institute of Medicine launched a two-year initiative to respond to the need to assess and transform the nursing profession. “It’s time for nurses to step forward and take responsibility for the future of health care,” says Shalala.

Panelists at the Future of Nursing program said the initiative’s final published report is similar to the 1910 Flexner Report sponsored by the Carnegie Foundation, credited with transforming the standards for physicians and medical education.

A committee was appointed by the IOM to develop the RWJF-funded initiative on the Future of Nursing. The purpose of the joint IOM/RWJF effort was to report an action plan or blueprint for the future of nursing.
Five key action-oriented objectives detailed in the report are:
• Scope of Practice: Nurses should practice to the full extent of their education and training.
• Nursing Education: Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
• Removing Barriers to Practice: Nurses should be full partners, with physicians and other healthcare professionals, in redesigning health care in the U.S.
• Data Collection: Effective workforce planning and policy making require better data collection and information infrastructure.
• Fostering Inter-Professional Collaboration: Private and public funders, health care organizations, nursing education programs and nursing associations should expand opportunities for nurses to lead and manage collaborative efforts with physicians and other members of the health care team to conduct research and to redesign practice environments and health systems (The Future of Nursing: Leading Change, Advancing Health, 2010, S-9).
Additionally, five desired outcomes were cited to evaluate how the blueprint will be implemented:
• Establish leadership in the nursing community to help drive and engage in the Future of Nursing report’s recommendations.
• Raise the visibility for the Institute of Medicine (IOM) recommendations and expand a support base to include stakeholders from key sectors, including government, higher education, consumer organizations, health professionals and others.
• Further the discussion of the IOM recommendations and contribute to the analysis and understanding of emerging perceptions about the recommendations.
• Plan action steps and follow-up to provide further engagement beyond the Nov. 30 rollout meetings. Educate local and state media about the recommendations.
• Engage state lawmakers and/or key policy leaders to learn about the recommendations.
Affiliated groups in five states—California, New Jersey, New York, Michigan and Minnesota—were selected to participate in pilot programs for the measures recommended in the Future of Nursing report:
• California—Betty Moore School of Nursing at the University of California, Davis; California Institute of Nursing and Health Care
• New Jersey—New Jersey Chamber of Commerce; New Jersey Nursing Initiative
• New York—Institute for Nursing; New York State Workforce Center; New York AARP Executive Council
• Michigan—Michigan Health Council
• Mississippi—Mississippi Department of Budgeting and Administration; Nursing Workforce Center
Donald Berwick, M.D., interim director of the Center for Medicare and Medicaid Services (CMS), delivered a keynote speech in support of the IOM/RWJF report. He praised the Affordable Care Act and pledged to include nursing leadership during healthcare reform’s implementation.
Information about the Summit on Advancing Health Through Nursing and the entire report is available at www.thefutureofnursing.org.

Shalala’s video statement on the Future of Nursing is available at
http://www.thefutureofnursing.org/resource/detail/video-statement-donna-e-shalala
or at http://tinyurl.com/6hj3qdx.