So blogging has fallen a little by the wayside, and will probably be somewhat sporadic until Easter. By then I should be more caught up and back to my regular schedule.

I have been ignoring the healthcare reform debate because I just can’t bear to listen to it anymore. It just drones on and on, and the final product–if it passes–is not really going to change very much.

But has anyone heard a peep from our Surgeon General yet? I mean, in the middle of all this commotion with healthcare reform, has she ever made a statement? Does she support the president, the bill, anyone or anything? The only thing I’ve read about her since she was sworn in is that she thinks that we need more minorities in medicine. And when she threw out her statistics, it was obvious that she was talking about needing more black doctors, and not minorities in general.

The real issue is to get more students interested in careers in science and medicine–students of all stripes, colors, size, shapes, and origins. Our nation needs physicians, scientists, healthcare workers in general–we don’t need more lawyers, stockbrokers, MBAs and politiicians. But that seems to be what we are mass producing, rather than people who produce anything of substance.

And with all of the problems in healthcare, and with this big debate over reform going on, is this what our Surgeon General sees as the most pressing problem? That this topic is what she has devoted her first talk to?

Kind of pathetic. I don’t want to write this woman off completely, but hey lady, let us know you’re alive and kicking.

So now we have the Terminator. The long awaited fourth Terminator movie, which has been resolutely panned by Terminator fans, film critics, and just about everyone else in-between. I’m not going to give a movie review–there are plenty of them out there, as well as endless forums to comment. What I am focusing on is the medical aspect of the movie.

Granted, this is a movie, and we do have to cut some it some slack. But the last 10 minutes can go down in history as some of the dumbest moments in the history of film–it was a totally pointless ending, it wasn’t needed, it was stupid beyond belief, and from a medical viewpoint–well, its enough to make you want to terminate the Terminator franchise.

So if you plan on seeing the movie and don’t want the wonderful ending spoiled for you, then read no further.

John Connor, the leader of the human resistance, is skewered through the chest by a big, mean machine. Now this piece of iron went clear through his chest, damaging his heart and undoubtedly puncturing his lungs. I mean, the lungs are there unless he has a unique physiology that eliminates his need to breath oxygen.

The machine/man, Marcus Wright, saves his life by chopping off the Terminator’s head and helping Connor out of the building before it blows up. Next scene, we see Connor all bandaged up, lying on an operating table in a makeshift hospital. Now, to emphasize, the human population left alive on earth is in pretty dire straights. No more fancy medical centers, no fancy equipment, no big Pharma companies left mass producing drugs…this is rustic and makeshift. This is hard times and make-do-with-what-you-have.

So Connor is lying on the table, with an IV running. For someone who is supposedly near death, whose heart is about to stop beating momentarily, he doesn’t look all that bad. Strange how no one mentions that his lungs have also been punctured, and for someone who’s heart is failing, he seems to have no trouble breathing.

But now everyone is all is a tizzy because they fear that their great leader and prophet is about to die. Wait, wait, we can save him. He just needs a new heart. What a relief, piece of cake.

Strangely enough, their only concern is finding a new heart for him. There doesn’t seem to be any question that a heart transplant can be undertaken with their primitive equipment. For no reason whatsoever, the hybrid man/machine Marcus decides to give his heart to Connor, and there just happens to be a heart transplant surgeon with no medical ethics standing by. I mean, heart transplant surgeons are a dime a dozen, especially in a war zone where most of the population has been killed.

Well, live and learn. And I guess they had a whole team assembled who could assist–everything from scrub nurses/techs, perfusionists to work the heart-lung machine (yes, I guess they just happen to have one of those–don’t you?), ventilators, oxygen, the right tools, and of course, all those drugs that Connor will need to take for the rest of his life to keep his body from rejecting his new heart.

And of course Marcus is just the right blood type, and no one has any ethical issues about killing him so that Connor can have his heart. Afterall, he has only proven to be more valuable than John Connor, and more of a hero…

Anyway, fast forward and the operation is a big success and Connor is being taken away somewhere by helicopter. So there we have it. People in the future are willing to kill someone to take a heart, and that someone is their best hope and their best weapon, and a lot more valuable than their fearless leader. And heart transplants have become so routine that its no problem to perform one in post apocalyptic times.

This movie is a contender for the most ignorance concerning a medical procedure, as well as one of the dumbest endings of all time. And the thing is, this ending had nothing really to do with the story. The medical tear jerker wasn’t needed, and I don’t know what the producer/director was thinking, but it certainly repulsed the audience. Not only because the idea of a heart transplant in these circumstances was so inane, but the idea that the great John Connor would be so selfish and self-serving to take the heart of a living person, and the one who saved his life.

But people still take them as the gospel truth. In a study that was recently presented at a neurology conference, the researchers found that TV does a miserable job of presenting seizures and first aid with any sort of accuracy.

“Television dramas are a potentially powerful method of educating the public about first aid and seizures,” study author Andrew Moeller, of Dalhousie University in Halifax, in Nova Scotia, Canada, was quoted as saying. “Our results, showing that television shows inaccurately showed seizure management half the time, are a call to action. People with epilepsy should lobby the television industry to adhere to guidelines for first aid management of seizures.”

The researchers screened all episodes of the highest-rated U.S. medical dramas including “House,” “Grey’s Anatomy,” “Private Practice” and the last five seasons of “ER” for scenes involving seizures. Of 59 seizures that occurred, 51 took place in the hospital. When measured against guidelines on seizure management, researchers found inappropriate practices — including holding a person down, trying to stop involuntary movements or putting something in a person’s mouth — occurred 46 percent of the time.

So if you are interested in learning first aid, please don’t rely on medical fiction. Take a course with the Red Cross instead.

I’ve been reading a few articles about this, and all of the experts agree on one thing–if you want to volunteer, do not do so on your own. Do not get on board a plane and expect that you will be cared for once you hit the ground. This is not the movies or TV. This is real life, and volunteers who arrive without a plan or contacts tend to become part of the problem rather than the solution.

Join a reputable group, such as Medecins san Frontieres (Doctors without Borders), Americares, Partners in Health, etc. National Nurses United is organizing nurses in the U.S. But please, find a group to support you and who will direct you once you arrive.

Next, reevaluate your skills. While all kinds of healthcare workers are needed, right at this moment, the greatest need is for surgeons, surgical nurses, anesthetists, trauma care specialists, post-op nurses–basically, trauma care is the greatest need right now. If you work in psych and have never worked in a surgical setting, now might not be the best time to go. Your skills may be needed later on, after the immediate crisis, but you need to think carefully if you can truly be of help right now.

Third, take a long hard look at the situation. There is nothing romantic about going to a devastated nation, especially one that was already on the edge. Conditions in Haiti were pretty deplorable before the earthquake hit–ravaged by hurricanes and storms over the past few years, civil unrest, abject poverty, poor infrastructure, high rate of infectious disease—well, you get the picture.

Conditions are pretty bad, and as a volunteer, you are not going to be housed at the Ritz Carleton and get catered meals by a fancy French chef. It’s rough going, and you are going to be putting yourself at risk of infection, and injury. In addition, there have been many aftershocks, so the earth has not yet settled down.

Violence and looting have taken hold, so you would also be at risk in that sense.

It will be dirty, with poor to no sanitation. There will be terrible sights to behold–thousands of people with nowhere to go. Injured people unable to get help and living in the streets. Corpses piling up. Unbearable smells.

Many volunteers who do go to war zones and to places where an extreme disaster has occurred experience post traumatic stress syndrome. Yes, it can be as traumatic for the helper as it is for the victim.

Anyway, this is not to discourage anyone from going, but just to go into with your eyes open. The developing world, even in the best of times, can be shocking for Americans who have not done much traveling.

I am curious how nurses, as a group, feel about the current form that healthcare reform has taken. I haven’t seen much news about nurses, but then, nurses are rarely interviewed and opinions from nursing groups aren’t usually sought–except for issues that are strictly nursing related.

So if any nurses are reading this, I would love to hear some comments. Personally, I don’t think it will have much of an effect in the workplace, at least not initially. More patients may seek medical care if they gain insurance, but then, it is difficult to say how insurance policies will change. Higher copays? Bigger deductibles? Less coverage? All of these things will affect the number of people seeking care, and the type of care.

Oh yes, and the selection of an obese surgeon general at a time when obesity is fast becoming the number one health issue in this country (what were you thinking, Barack????).

I don’t have any predictions for this year, other than I hope that the healthcare reform bill is miraculously transformed into something that resembles reform and not a sweetheart deal for the insurance industry. It is difficult to say what this year will bring for nurses, but regardless, nurses need to stand up for themselves and make an effort not to take abuse and to demand respect.

Really, I hate to call names, but I have to wonder about the mental stability of those who are occupying Senate seats and trying to reform the nation’s healthcare.

One of the wunderkind had a brilliant idea of taxing people undergoing cosmetic surgery and procedures in order to “pay” for healthcare reform. Not that these people are already paying for these services out of pocket, and they have nothing whatsoever to do with the issue at hand. But I suppose it was the idea that only rich folks get their faces tightened and tweaked, so why not milk them a little more.

Well that didn’t go over well with the plastic surgeons, derms, and others who make money from this. And healthcare reform needs the support of the medical community, so they dropped the “Botax.” Next victim–tanning salons.

Now, we have elected officials, who supposedly have some degree of intelligence, who believe that they are going to solve the money problem by taxing tanning salons. And here’s where the eyes roll round and round and round.

If the bill is passed in its current form, a 10-percent tax would be placed on individuals buying tanning services. Who are paying for these services out of pocket already. But they think that taxing tanning salons are going to raise $2.7 billion over 10 years. Are they totally daft? First, why should someone using a tanning salon, paying out of pocket, be taxed for it?

Second, unlike cosmetic surgery, which can be quite expensive, tanning salons are quite cheap. A session in a tanning bed cost about $10 or $20 dollars. Unless someone is a really heavy duty user, it isn’t gong to add up to much. And with the tax, people may just use it less often. But really, getting a dollar or two here and there is just not going to raise a lot of money.

So here’s a brain twister for them. If they want to raise money and improve health at the same time, slap a tax on McDonald’s, Burger King, Taco Bell, Coke, Pepsi, candy bars, sugary breakfast cereals, pesticides, and all foods that you need an organic chemistry textbook to decipher the ingredients with. Tax commercial agriculture, tax the commercial beef/chicken industry (put a hefty tax on the hormones and antibiotics that they feed to the animals), etc.

Tax all the unhealthy stuff. This way, people can pay in advance for their future diabetes and heart disease care! Or their future cancer.

But these are powerful industries, so they get treated with gentle loving care. Preventing disease in the first place is the single most important thing that real reform needs to look at, but unfortunately, politicians will be politicians.

Anyway, I am so fed up with this. What we need is real reform of the insurance industry, and then real measures to lower healthcare costs. But that would mean stepping on a lot of toes, so no one wants to go there.

This message is from Daily Word, December 24:

In a transforming moment, thoughtfulness becomes my practice in life and generosity becomes my expression of love. As I give birth to new ways of thinking, feeling and being in the world, the love and life within are renewed and revealed, in large acts of generosity and love or in simple acts of kindness. These are the sacred experiences that bring life and love to my family, community and humanity.

The spirit of Christmas….

In an interesting, albeit short, article in Arabian business.com, the nurse-less plight of the part of the world is revealed.

Nursing colleges in the UAE are failing to recruit Emirati nurses, despite government-funded sweeteners including full scholarships, the dean of a prominent nursing school has claimed.

Dr Vijaya Kumaradhas, dean of Ras Al Khaimah College of Nursing, one of the country’s largest nursing schools, has said Emirati students remain significantly under-represented – a fact that is contributing to the country’s nursing shortage.

“There is a definite shortage, but Emiratis will not become nurses. There is a stigma where nursing is concerned. In our college, we don’t have any local student.” she said.

The article doesn’t cite reasons for the lack of interest among Emiratis, but several of those who commented offered their perspective. All of them live or lived in the region, so I imagine that they are speaking from experience. Most agree that it is cultural, and that nursing is not considered a desirable career for a young Emirati woman. And in fact, the attitude is prevalent in many Middle Eastern nations.

There are very few nurses who are natives of the region, and there are many reasons why the profession is shunned. One nurse expat working in the region wrote: It entails touching bodies, much intermingling with males, and for some, would mean that they would leave the profession when married anyway. As long as beliefs remain the same, nothing will change and they will be dependent on expats. They have to buck up and see this for themselves. I’ve worked in the Middle East as a nurse for many years and have yet to see reform on this issue.

Another commenter noted that shift work is unappealing, and goes against local custom; most Emiratis wouldn’t want their daughters/wives to work night shifts. It is against traditional values for the lady to be out of the house at such late hours.

As a profession, nursing is not highly regarded, and parents do not encourage their daughters (and certainly not sons!) to study nursing. Pay is low, hours are poor (sound like a familiar scenario?), and nurses are seen as maids, more or less.

So it doesn’t seem that the Emirates are going to be attracting a lot of their own citizens anytime soon, unless they increase the pay, and really make an effort to change the perception of the job. Attracting men into nursing would also help, since that would reduce the intermingling with males.

As a result, I have no idea what has happened thus far with healthcare reform, except for the barest of tidbits that people insist on telling me about. I know that the Senate voted to begin the debate, and current polls say that the public isn’t too excited about the state of affairs. And why should they be? There are 1900 pages of verbosity and who knows what it is hidden in them? What does this bill actually say?

Well, no one seems to know. Most people would like some sort of health reform, but do not like the form that this debate has taken. There are too many secrets, too much verbage, and no clarity. How much will it cost? Will any of us get our money’s worth? Why should we be forced to purchase health insurance, and what kind of insurance is going to be available?

And so on. As I said once before, I could have written this up in 5 pages, clear and concise. Regulate health insurance like a public utility. Give the industry a 5 year period to become all non-profit. Change the design so that the primary concern is for patients and not stockholders.

Anyway, I intend on staying on my news diet until the end of the year.