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First Steps...

At the end of the commencement ceremony for the 2013 CT Health Leaders Fellowship, we were all invited to stand and take one step forward, symbolizing the first step of a thousand mile journey. It is a journey of eliminating health disparities. I had spoken earlier about being an equal opportunity activist, and that this journey was but one of many journeys I am on.

All of this came back to me in many ways this past week. Thursday night was the annual Nurse's dinner at the Community Health Center. One of the stories was of a 450 pound diabetic man who had fallen through the cracks of the American health care system. A care-coordination nurse tracked down his story and followed through to help him get bariatric surgery. He has already lost thirty pounds and with therapy, is starting to walk again after having been bedridden for over a year.

Later, we heard a little bit of her story, an immigrant from a war torn country, who struggled with diabetes and depression through school, but eventually became a nurse at CHC. The patient is on his journey of recovery, aided by a nurse who has taken difficult first steps in her journey to this country and her journey to becoming a nurse.

The story stayed in my mind Friday morning as I went to the funeral of a former classmate and co-worker of my wife. Emily was taken from us way to early, by complications from diabetes.

This week also saw important other steps in our life together as a country. The Supreme Court dismantled key parts of the Voting Rights Act, but it took away some restrictions on gay marriage. I watched the wedding ceremony streaming across the Internet where plaintiffs in the challenge to Prop 8, Kris Perry and Sandy Stier were married.

I read stories about Paula Dean and Rachel Jeantel and I thought about how much work still needs to be done before all people truly are treated equally in all states, no matter what their race or sexual orientation is.

I imagine that the 450 pound patient celebrated the first steps in his recovery as he sat back down and rested after the strain of those steps. Tonight, I go to bed emotionally weary, celebrating first steps, lamenting steps backwards, and mourning the death of a friend.

Health, Candidates, and Budgets

Slowly, the electronic devices recharge. It has been a long day. I think Foursquare may have congratulated me on the miles I traveled today. It does that too often. My first event of the day was an Institute of Medicine meeting, Achieving Health Equity via the Affordable Care Act: Promises, Provisions, and Making Reform a Reality for Diverse Patients. It was a thought provoking, jam packed day. It took place at the Mark Twain House and Museum. I've been to other events there, but this was the first time I got a chance to take a brief tour during the lunch break. I did not realize that history of publishing in Hartford, nor various aspects of Mark Twain's finances. It was an odd juxtaposition which I'm still pondering.

From there, I rushed to Orange, where the Ken Lenz declared his candidacy for First Selectman. I got to know Ken a bit during my campaign for State Representative, and I'm glad that Ken is running. He's a good guy and hard worker.

My next stop was the Woodbridge Preliminary Budget meeting. The turnout was light and there was little for comments. One person did ask about police activities beyond the motor vehicle information listed in the budget. I mentioned the What's New section of the police department website.

Now, as my devices recharge, I'll head off to bed and recharge my own batteries as well.

Rethinking the Borg

Yesterday, I stumbled across an interesting article, A Brain-to-Brain Interface for Real-Time Sharing of Sensorimotor Information. It goes into detail about how a sensor was connected to one rat's brain, and the experiences were transmitted, over the internet, to another rat who learned from the experiences of the first rat.

My science fiction enthusiastic brain went wild thinking about the possibilities. While the starting point is with sensorimotor information, I wondered what else could be transmitted. While the starting point was rats, I wondered what could be done with humans, or even, interspecies communications. What would it be like to experience the sensorimotor feelings of a horse galloping? Could this information be stored and played at a later time, perhaps as an educational tool? Could I become a better pianist or guitarist by playing back sensorimotor recordings of great performers? Could this be added to albums, so I could not only listen to a great performance, but experience the sensory feelings of the performer during the performance?

And what about the use in dealing with conditions like Parkinson's disease or Essential Tremors: Could a researcher gain insight by playing back the sensorimotor recording of a person with these conditions? Could playing back the sensorimotor recordings of healthy people provide some sort of therapy for people with these conditions?

All of this, of course, is precursor to The Borg. What happens as people become more connected to a collective mind? The borg is portrayed negatively in terms of force assimilation, yet our society has always been based on collective experiences and action. The struggle between individual experience and collective experience is an age old struggle.

Last night, I went to see The Indigo Girls in concert in Northampton with my daughter who started her college career in Virginia. It was striking to think about the collective experience of young women around Northampton and how it compared with the collective experience of some of my daughter's classmates from the south. I wondered how many of my daughter's classmates sought to flee their southern collectives, not for more individuality, per se, but to join a collective that was more tolerant, more embracing of their individual experiences.

I remember, many years ago, gathering around a campfire, to sing songs. Singing around campfires is one of the earliest ways in which experiences were shared, in which the collective spread its common ideas. Yet even two decades ago, around the campfire, different modes of collective engagement were creeping in. Many of the songs we knew, we had learned on the radio, and not around previous campfires. The campfire itself, was most likely started using the remains of another way of sharing collective information, used newspapers. We shared our experiences from around the campfire when we returned to our homes and spoke with friends.

Last night, the individuals who had this shared experience had gained collective information other ways. They had listened to music online, perhaps sharing it online. The newspapers were largely replaced by sharing of news online. Perhaps the most striking change was the way the collective experience of the concert was shared. During the concert, people texted their friends. They called friends from their cellphones so their friends could listen in, or to leave a brief recording of the experience on their friends voicemail. Photographs and videos were taken, and I imagine, shared via social media.

As far as I know, no one had implements allowing them to have the same sensorimotor experiences as Amy Ray or Emily Saliers, yet this omission did not seem to lesson the very strong bond between the audience and the performers.

Progress marches onward and some day, perhaps, we will look back at how we have shared common experiences via pictures, sound recordings or the written word, as being as quaint as the gathering around the campfire many generations before. Yet we would do well to remember the words of John Donne, "No man is an island" and that each one of us should say, "For I am involved in mankind".

Testimony Supporting Senate Bill 366

Testimony Supporting Senate Bill 366, AN ACT REQUIRING LICENSED SOCIAL WORKERS AND COUNSELORS TO COMPLETE CONTINUING EDUCATION COURSEWORK IN CULTURAL FOUNDATIONS

Sen. Gerratana, Rep. Johnson, members of the Public Health Committee. I am writing to you today concerning Senate Bill 366, AN ACT REQUIRING LICENSED SOCIAL WORKERS AND COUNSELORS TO COMPLETE CONTINUING EDUCATION COURSEWORK IN CULTURAL FOUNDATIONS. My name is Aldon Hynes. I live in Woodbridge, CT. I am the Social Media Manager for the Community Health Center, Inc., headquartered in Middletown, CT and am a member of the Connecticut Health Foundation's 2013 Health Leadership Fellows Program. My testimony is based on my experiences with these two organizations, but I am speaking on my own behalf.

Every year, the General Assembly considers many bills. Those that move forward requires fiscal notes from the Office of Financial Analysis. It is my belief that every bill that moves forward should also require an analysis of its health equity impact: how does the bill effect the health of the people of Connecticut, and how equitably does it meet that impact?

SB 366 is a bill that I believe can have a positive impact on the health of Connecticut's citizens and do so in an equitable manner. The better informed Licensed Social Workers and Counselors are in the cultural foundations which affect their care of patients, the better the outcomes we can expect. In addition these outcomes are most likely to assist those from different cultures that experience health disparities, making such training important in achieving health equity. Currently, all staff, especially those in behavioral health, at the Community Health Center are expected to complete yearly cultural foundation training. The cost is minimal and the benefit can be great.

Therefore, I strongly urge you to support SB 366 and to consider all bills in terms of the health impact they have and how equitably they active this impact.

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Creating Better Health, Part 2

On Monday, I wrote a blog post entitled Creating Better Health trying to pull together themes from patient education, the e-patient movement, discussions at the Mayo Clinic Center for Social Media and the Learning Creative Learning class at MIT.

Tuesday, I had a meeting with people from a health care foundation to talk about messaging around health care. It struck me how much money and effort is spent marketing unhealthy products, and how little effort is really spent encouraging Americans to live healthier lifestyles. Wednesday was mostly devoted to health disparity issues, and this morning started off on a similar note.

Then, this afternoon, I had a fascinating discussion that really helped pull some of this together. It seems like so much of patient education is about imparting information to patients. You have diabetes. You need to exercise more. You need to eat less sweets. It also seems like so much of this 'patient education' fails because patients aren't compliant with what their doctors are telling them.

Some of this may relate to health equity issues. Are the doctors imparting information providing information that is culturally aware? Perhaps they've been trained and think about difference between latino patients and caucasian patients. Yet perhaps this is too blunt a tool. My friends of Venezuelan descent are quick to point out how different they are from our Puerto Rican, Mexican or Argentinian friends. For that matter, there are similar differences between Italian-Americans and Irish-Americans, and then you get to families like mine. On my side of the family, there is English, Scottish, Irish, French, Dutch which has been mixed together for generations. We have certain traditions around food and family gatherings. On Kim's side of the family, there is Italian, Irish, English and Russian, some of it much more recently arrived in the United States and mixed together. There are a different set of traditions. As a family, we try to mix all of this together that into something that is uniquely part of our family.

A couple of us have specific dietary concerns related to our health so meals and traditions are created that specifically relate to our cultures and our health conditions. My wife takes great pride in her ability to create great meals that meet all the family requirements. Every family is different. How do other families create meals that meet the specifics of family tradition and health needs? This probably is something that needs to be created by the family, and not imparted by medical providers.

When you look at people confronting major health challenges, they gather at online sites, where they share experiences and ideas, where they discover, together, aspects of their diseases, perhaps information that the medical community has yet to discover. This seems to be constructivist learning about health which is far different from most patient education. The patient support sites, are, in certain ways, massive open online courses (MOOC).

As an alternative to traditional patient education with low compliance rates, can we design massive open online courses where patients with more common and in some cases less threatening diseases can participate in shared learning experiences that result in better health? It seems like an interesting challenge.

Related to the MIT MOOC, I have set up a Google+ community LCL Health. If you're interested in exploring this further, please join us.

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