Wednesday, June 27, 2007
Take to the Streets - Lessons from Teachers
Michael Moore's new film "Sicko" will hopefully bring to a wide audience the inequities in our healthcare system, but it will take all of us to change this unfair system. The Teachers with whom I spoke and who I've been writing abouton this blog encourage us to take action. One of the purposes of listening to their stories and the stories of others is to jog our memories so that we remember our stories and revisit them with a new perspective that leads to hope and action.
The Teachers’ stories reminded me of the time when I “took to the streets” to get adequate care for Ron my first husband who had ALS and lived on a ventilator for seven years.. At the time I was not aware of my ability to stay focused and refuse to be set aside by a medical establishment and the insurance companies that were not interested in our dilemmas. As I come back to this story I realize that during that time I learned in my bones the connection between the personal and the political—not a theoretical understanding but a connection made because it was directly connected to Ron’s life and death and to the life and death of many others. Let me tell you the story.
As we attempted to keep up with the progression of Ron’s illness, manage his nursing care and the quality of his life while balancing Ron’s needs with the needs of the rest of the family, we had a serious financial problem. Ron was told by his employer, Hewlett-Packard (H-P), that after being at home on the ventilator for one year, he had used up his lifetime maximum medical coverage on their private medical insurance plan. As an employee, he had an option to enroll in another plan, but they were doubtful that anyone would provide him with home care.
We had to shift all our attention to the economic demands of Ron’s care. In a panic, I asked the group of friends with whom I had been meeting to help me figure out what medical insurance options were available for Ron. The group responded by sending a letter out to fifty people who knew us and were concerned for our well-being. The letter included a report about Ron’s health care options.
With this letter, the Pulleyblank Trust was born. Its purpose was to keep Ron at home by getting him medical insurance that covered his twenty-four-hour nursing care. If that effort was unsuccessful, the Trust was committed to raising money to keep him at home. The Trust started out with twenty friends and family members. By the time Ron died, more than five hundred people had participated in the Pulleyblank Trust.
We decided that Ron’s best insurance option was coverage by Kaiser, a Health Maintenance Organization (HMO). As an H-P employee, Ron had the right to transfer to the Kaiser plan. Kaiser’s written policy was unclear about how many hours of home care they would provide, but it was the best coverage available to him. Under Home Health Services it read: For members without any Medicare benefits, skilled nursing services on a part-time or a part-time intermittent basis as prescribed by a Plan physician are provided without charge in the service area.
Soon after we signed up with Kaiser, I called the home care supervisor and asked her how we should we proceed. She called me back after a few days.
“Mrs. Pulleyblank,” she said, “your husband will have to come into the hospital so that we can assess his situation.”
“But that’s impossible,” I responded. “Do you realize that he has been living at home on a ventilator for a year? Putting him back in the hospital doesn’t make sense. Why can’t someone come out here and do the assessment?”
“Mrs. Pulleyblank, the rules state that home care is only available for patients who are currently hospitalized. If your husband is to be considered for home care, he must be in the hospital. If he stays at home, he will not be eligible.”
I was desperate. Using my most professional tone I explained, “Ron hasn’t had an infection this entire year. If you insist that he come into the hospital, you place him at a risk for pneumonia. You are suggesting that a man with a serious illness like ALS, who is doing well at home, should be put in the hospital to assess if home care is appropriate, and you may kill him in the process.”
I was sounding less professional by the minute. The home care coordinator didn’t notice one way or another.
“Mrs. Pulleyblank, those are our rules. Will Mr. Pulleyblank be coming into the hospital?
This was another one of those moments. A decision had to made, no
reasonable choices were available, and so I just proceeded.
“He will be there on January first.”
When Ron went into Kaiser Hospital, I went with him, determined not to leave his side. He caught pneumonia within twenty-four hours. As we had predicted, the change of environment and the many strains of bacteria in the hospital were too much for his fragile system. He went from living on life support at home to almost dying in the hospital because of an administrative rule. In addition to pneumonia, his life was at risk because the nurses on the ICU had difficulty monitoring him on the ventilator. He had no way to signal when he needed them. More than once, I entered his room to find the alarms on his ventilator ringing and no one responding. I tried to keep calm and explain to the staff what Ron needed. They only half-listened to me.
One night during the first week, when I had stepped out of the room for a few minutes, a nurse turned Ron’s ventilator off by mistake and left the room without turning it back on. He would have died if I hadn’t returned when I did. That night I lost control. I started screaming and crying.
Someone rushed in to see what was the matter and led me into the office of the head nurse. I couldn’t stop shouting. I was hysterical. I told her about all the things that had happened. I was shaking with exhaustion and fear. She sat with me until I calmed down, listened to my complaints, and said that she would look into the matter. From then on, Ron got excellent care. It took me almost losing my mind, but we were finally taken seriously. It was clear that in what we were facing, rational discourse would not do. I hated getting upset, but it gave me courage to speak out in a much louder voice as we continued to face insurance obstacles
Ron’s infection was cured, and the wheels of Kaiser’s home care committee turned.
After three weeks, Ron was allowed to return home with a prescription for twenty-four-hour nursing care. Kaiser said that they would provide twenty-four-hour care if Ron chose to stay in the hospital, but because we were choosing home care, they would provide only two shifts of nursing or sixteen hours per day. We were responsible for the third shift. Luckily, I had Blue Cross insurance through my employment at Children’s Hospital at Stanford. My policy would cover the third shift for 200 days a year. We turned to the Trust and our families to find the added money that we would need for the other 165 days. We again had a plan in place, but it wouldn’t last long.
Each time that we developed a working home health-care plan, I believed that this new system would last. I craved stability in this time of chaos, and I felt that if I did things “right” I could stabilize my life and the life of our family. Yet our plan kept unraveling.
Ron and I had believed that the doctors, insurance companies, and employers would help us in a medical crisis. The truth was that the representatives of these institutions looked to me to solve our problems. Each group had their set of priorities. None of them saw Ron’s need for home care as their responsibility. In order for Ron to live at home, we had to alter our perception of the problem, to see home care for a catastrophic illness as not our personal problem but a societal problem. Ron’s health needs raised the larger question of who was responsible for care if the medical choice to live on a ventilator was offered to someone with a terminal illness. If as a society we decided that this was the “right” choice to offer patients, didn’t that imply that adequate care had to go along with it?
But no one addressed this question. Instead, physicians, nurses, medical insurers, and employers made independent decisions that left people like Ron alive but without adequate care. This left me with few choices and a confused sense of responsibility.
Keep Posted. More about this to come. If any of you are currently fighting for health care let us know your stories.
Monday, June 18, 2007
Praise for Blowing on Embers
To be released September 2007 by Llumina Press
PreOrder now at:
http://www.llumina.com/store/preorderembers.htm
Advance praise for Blowing on Embers.
This book deepens our understanding of the creative power of narrative for finding a way through problems and even catastrophes. Psychotherapists will strengthen their practice by reading it, but because it is so rich in narrative and so deftly unencumbered with jargon, it is a book to pass on to friends or clients going through difficult periods -- or simply to read and hold in memory as a resource for the unknown future."
Mary Catherine Bateson, author of Composing a Life and Willing to Learn: Passages of Personal Discovery.
Bravo! Ellen Pulleyblank Coffey has written a hard-to-put-down book about how to live with the hard times. She takes us along on her own journey to see beyond the dread of ambiguity and guilt surrounding illness and suffering, teaching us through mesmerizing narratives of profoundly interesting women about how to live well despite troubles. As if we were sitting around a campfire, listening to others tell their stories, we learn that indeed, happiness exists side-by-side with pain.
Pauline Boss, author of Loss, Trauma and Resilience, and Ambiguous Loss.
Through her stories, Ellen Pulleyblank Coffey reveals how wisdom is dispersed throughout a network of people— whether one receives,, learns from, or gives to the other. She shows convincingly how a person’s lifetime accrues all the world’s knowledge if there is a listener nearby who asks good questions while blowing on embers.
James Griffith, M.D. author with Griffith ME: The Body Speaks: Therapeutic Dialogues for Mind/Body Problems and Engaging the Sacred in Psychotherapy: How to Talk with People about their Spiritual Lives.
This is a wonderful and inspirational book. Affirming the resilience of the human spirit, Pulleyblank Coffey is masterful in describing and bringing forward the essence of the detailed stories of remarkable women coming through some of life’s greatest challenges. The narratives highlight a core principle that growth through the hardest of times is an ongoing process in connection with others. It is a terrific resource for all of us – women, men, lay persons, and professionals.
John S. Rolland, M.D. author of Families, Illness, & Disability: An Integrative Treatment Model.
The voices in Blowing on Embers are those of women who have faced enormous adversities and have found ways of living with them. Their voices are brought together here so that we can learn from them how to live with loss, and grief, and hope for the future.
Joan Berzoff, co-editor of Living with Dying: Handbook for End-of-Life Care Practitioners.
Tuesday, June 12, 2007
Reflection on Teachers -Moving to Action
From childhood, Kaethe and Suraya knew that they were part of a larger world filled with danger and injustice. As children, they learned that they had responsibility for others while they listened to their parents talk about less fortunate people in their midst. As adults, for different reasons, Kaethe and Suraya live under duress. Illness hangs over Kaethe’s life and makes it necessary for her to manage daily pain. Suraya’s continued advocacy for women in Afghanistan keeps her in danger. These obstacles deter neither woman. Instead, buoyed by their commitments to service, they entreat us to join them by writing, speaking, and teaching
I think now about Kaethe’s notion of how a small action matters. Don’t most of us feel that in difficult situations, whatever we do just isn’t enough? Whatever I did for Ron did not seem to soothe his pain or mine. If I had thought that each small act of kindness mattered, I might have felt some relief. If I had connected our suffering to the suffering of others, I might have felt less isolated. I hope that when I find myself spiraling into pain or grief in the future, I will remember Kaethe—on the radiation table but focusing on Johanna in South Africa—and I will connect with others beyond myself.
Suraya’s story reminded me of the young Kosovars that I interviewed after the war. Like Suraya, they held strong beliefs that had sustained them during their worst times. They told me that, in moments of crisis, they thought about those who had died for them, those who were still alive, and those who were still to come. They held to the conviction that no matter how many people died, as long as one Kosovar survived, they would endure as a people. In moments of terror, this belief fueled their courage to defy oppression.
The Teachers stay centered by not forgetting what they believe. They stretch beyond their personal circumstances to join with others. In moments of distress, they find threads of meaning and connection. They tell us to hold onto the values that we care about most, to place these values at the center of our concern for others, to resist our sense of vulnerability, and to speak out against injustice. They develop ways of thinking that lead them to action. They choose to work on behalf of others.
Teachers come into our lives in many ways. Sometimes we read about a famous person who inspires us. Or perhaps a circumstance in our life pulls us out of ourselves toward others with a similar plight. Kaethe’s and Suraya’s stories remind us to keep our eyes out for Teachers who are ahead of us, but who are willing to help us reach out beyond our own suffering. Kaethe and Suraya tell us not to allow our fears to deter us.
Take a moment. Think of someone you know or someone you’ve read about whose life or work influences you. Let us know what lessons move you toward action even when you are afraid or hampered in your own life. It is in these reflections that we move into new survival stories.
Keep Posted – My book “Blowing On Embers” will be released at the end of August.
Tuesday, June 05, 2007
Feminism could rise again if we remember
Suraya’s description of her work with women struck close to home. In the 1970s, I was part of a group of women who started the Women’s Center in Stockton, California. Those of us known as the “founding mothers” were struggling with how to make a difference in our community, how to develop our own professional lives, and how to care for our children. Our struggles paled, however, in the face of the struggles of other women in our community who had been raped and had no protection.
The Stockton Women’s Center began the first rape crisis center in the area. The common belief in the United States at that time was not much different from what people believed in Afghanistan. Rape was the fault of the victim—“she probably asked for it.” Women who were raped were interrogated and humiliated by the police. The legal system was ineffective in prosecuting rapists, many of whom were not charged, and most of those who were charged were acquitted or got off with light sentences.
The Stockton Rape Crisis Center managed to develop a relationship with the police, to train them in interviewing women respectfully and in collecting evidence that made it more likely that rapists would be prosecuted and convicted. The situation in Kabul that Suraya described was more brutal, but in that moment I felt my own vulnerability and felt connected to all women who live in jeopardy.
If women can band together and help each other under such difficult circumstances, turning to one another in more fortunate circumstances should be easier. I worry that in the United States we have lost sight of one another as women, that the women’s movement has been co-opted by a media that once reviled it and now portrays it as having no purpose because women’s rights are already guaranteed. Many women still live in poverty, and I fear that unless we continue to speak with one voice, we will again find ourselves without the rights that we take for granted. I worry that our individual concerns and ambitions have drowned out what we know about our need for shared action.
Even today, after Suraya has removed her burka with the fall of the Taliban, she struggles to keep the fight for women alive. Foreign journalists interview her and tell their stories in the west, but these interviews hardly reverberate in Afghanistan. Her group does not have the money to continue publishing their magazine. Suraya ran as a candidate for the Loja Jirga, the new parliament in Afghanistan. According to her sister-in-law, she received a majority of votes, and yet somehow these votes were lost, and she was not seated in the parliament. Suraya continues her work.
Matter-of-factly, Suraya said that her life is still in danger every day. I asked her, if she was afraid.
“No,” she said, laughing. “For a long time after being shot, I was very ill, and then when I recovered I just went back to work. I had no time to be afraid. If I were afraid, I couldn’t stay in Kabul and continue our work.
“Once I began this work, I knew that I would have to live with danger. I accept that and somehow I believe that even with these dangers I can make it. When a person chooses her way and goes this way, then she doesn’t have to be afraid. Someone can hurt you or cause you pain, but he cannot force you to think differently. I follow what my mind tells me to do.”
Suraya’s story reminds me that, even with loss, I live with good fortune. I am free to travel, to work, and to speak my mind without fear for my life. She helps me widen my frame so that I see more clearly how the day-to-day struggles of my life, even during the most difficult times, do not compare with those of others who live in starvation and political oppression. Her story calls me to reach beyond my comfortable life to work to help others. It reminds me that it is easy to look away from others’ pain when there seems to be nothing that I can do to relieve so much misery. Like Kaethe (see her story earlier on the blog) Suraya focuses on the work of each day. She never gives up, and she keeps moving in the direction of justice. Her story compels me and hopefully you to do the same.
Friday, June 01, 2007
Teaching Resistance in Kabul
Suraya #4
Suraya continued her fight for women even as the political circumstances made it more difficult for her. When the Russians first took over in Afghanistan they released all the political prisoners and for a short time Suraya was free to continue her work, but in 1988, the Russians left Afghanistan. By 1992, the Mujarhadeen, warlords from the north of Afghanistan, were ruling the country. On the first day of the Mujarhadeen rule, they revoked the freedoms that were available to women under the Russians.
Although women were not yet required to wear burkas in the streets, Suraya decided to return to wearing her burka because she believed that it helped her to continue her work and allowed her to travel. Women mostly stayed at home. In the streets, where rape, kidnapping, and killing of women were commonplace, the burka sometimes protected them.
In the mid-1995s, the Taliban replaced the Mujarhadeen. The western powers and Afghanistan’s neighbors initially supported these strict Muslims. The Taliban forbade all women to be out on the street without their burkas.
In a moment of danger, Suraya decided that she would have to change her name and become someone else. She told no one about this, and her family thought that she had been killed. She chose a foreign name. When the Taliban heard about a woman by the name Parlika organizing other women and asked about this woman, they were told she was not an Afghani woman.
Suraya laughed as she remembered walking in the street, completely covered in her burka, when a man stopped and asked if she knew a woman with the name Parlika. He said that he had a letter and some amount of money for this woman from out of the country. Suraya told him that she didn’t know this woman, but she thought that she must be a foreigner because her name was not an Afghani name.
Suraya had to allow her family to believe that she had been killed in order to protect herself and them. Her choice of anonymity ran up against her strong family ties. Suraya said that at the time, she could think of no other way to continue her work. She stopped telling her story for a brief moment and then, as she had done for many years, she put her attention back on her underground work with women.
Before the Taliban, the women had gone to the cemetery daily to remember their relatives. The Taliban allowed the women to go to the cemetery only on Wednesdays. Suraya and her group of women decided to use this time to find ways to organize women to help each other.
At the cemetery, they created a ritual of hope. Suraya began by bringing eleven walnuts, giving one nut to each of eleven women she met there. She said that the nut would bring them good fortune, and if they accepted the nut, they were asked to agree to come to the cemetery for seven weeks. They were asked to bring eleven nuts each time to give to eleven other women. Every week more and more women came to the cemetery. The Taliban tried to get the women to go away, but they kept coming.
The women formed groups around each eleven nuts, bringing food to share with one another. They began to talk about their dreams for the future and to tell stories about what was happening in their families. Their conversations changed over time, and they spoke with each other about what to do if they were raped or forced into marriage.
Stories poured out—somebody had been raped, someone had been tortured. Under their burkas, no one’s face was seen and no one’s name was spoken, providing the women with the anonymity they needed in order to speak freely. Someone would start, ‘I know of a woman who…’ and a terrible story would follow, and then someone else would tell another story.
The women’s secret protest expanded to Thursdays, when some of the women got together at one woman’s house to make a special dessert. These women would carry the dessert and the stories house-to-house.
Some of the worst stories were the forced marriages of very young girls, fourteen years old. Before the Mujarhadeen, a woman could meet the man she was arranged to marry. Arranged marriages usually went well because similar people were brought together, such as educated women and men who were introduced at the request of their parents. Under the Taliban, arranged marriages became horrible. Women were forbidden education, and young girls were often taken far away from their families by old men who treated them like slaves.
Suraya said, “With all the stories, we raised the consciousness of the women and their expectations and their hopes, but the stories of rapes were almost unbearable. After rape, many of the women committed suicide. Sometimes there would be gang rapes. Men would just break into a house and rape all the women in the house. We were told about a girl aged fourteen, who was raped by seven men until she died. When women are raped, if they are not killed in the rape, they are sometimes shot by family members. When they aren’t killed, they are kicked out of the community. They become nothing in the eyes of others. These women need someone to treat their wounds and to help them to identify the people who are guilty. They are not the guilty ones.”
During this Taliban period, girls’ schools were closed. With four other women, Suraya created a core of teachers for an underground school. Despite the risks, these women had to do something to educate girls or there would be an entire generation of uneducated Afghani women. Each of the first group of women went to talk to three or four other women and encouraged them to form a group of teachers. Each small group supported one another in becoming teachers for five to seven students.
The underground groups organized all over Kabul. Sometimes these groups did more than educate girls, helping women leave the country or escape from forced marriages. The brothers and father of a woman would choose a husband for her and then there would be a month before the marriage. The group would prepare the woman to escape the night before the wedding using their own money to help her get away. If she were caught, her own family would kill her, so how she escaped was very important.
Suraya searched for money to pay for the teachers and other needs of the women’s project. Women got money from their husbands if they were sympathetic, and women who had money gave money. The women also developed a business weaving rugs that supported the effort. Some of the money they collected went to families whose houses had been burned when the Taliban suspected them of illegal political activities. For security reasons, most of the women did not know the others’ names.
The women’s burkas served as effective disguises as they moved from city to city. They started more underground schools and enlisted others in the movement. Although the Taliban tried to find and stop them, word spread and more and more people helped.
