A healthier future

I worked for over seven years to increase awareness of an important health condition that warrants everyone’s attention as 1 in 10 of us have it, and 1 in 3 of us are at high risk of developing the mostly preventable version — diabetes.

Every year as November approached, we would see and begin the preparations for Diabetes Awareness Month, and yet I would think to myself: “Every day is diabetes awareness day!” Thus my mixed feelings toward awareness days even as I knew that 1 in 5 people with diabetes don’t know they have it, and more than 8 in 10 individuals with prediabetes are unaware. This for a health condition that has the potential for significant improvement or control, and potential prevention — if we have the understanding of how to care for ourselves and manage our diabetes or prediabetes.

There are other kinds of awareness events, such as National Wear Red Day (on Feb. 4, this year), which raises attention to heart disease being the No. 1 killer of women, and all of February being American Heart Month; June being Alzheimer’s and Brain Awareness Month, and Sept. 5 to Sept. 11 being National Suicide Prevention Week. The calendar is now full with these kinds of awareness events and it’s difficult to register their existence, let alone keep track of them. Which has helped me now realize there actually can be a benefit to focusing much-needed attention, and has me wondering: As all of us are touched by one or more of these health issues, how do we support and amplify each other’s concerns so that we can all, together, contribute to building a healthier future?

Health equity means that everyone has a fair and just opportunity to be as healthy as possible. And we have long considered the United States to be the land of opportunity. Yet our current standing among developed countries as having the worst maternal mortality — where most maternal deaths are preventable — reminds us that we face a significant threat to the opportunity for all to thrive and contribute to this country’s future prosperity. There are many contributing factors for our current situation — some relate to individuals, many relate to our living conditions, and even more relate to systemic factors such as the availability of health insurance coverage, access to health care, bias that may be built into how things are done and more. Thankfully, more attention is being focused on helpful policy solutions that impact how care is provided in the clinical setting as well as the supports that can help all birthing people have healthy and positive perinatal experiences and contribute to community well-being.

This year April 11 through April 17 marked Black Maternal Health Week — I hope we will all be curious to learn why we should all care enough to be aware.

Finding connection

I recently found myself on a Zoom call with some medical school classmates I hadn’t spoken with in many years. While not a fan of school reunions, I found their enthusiasm infectious as we later considered how to encourage all 85 classmates from the Dartmouth Medical School class of 1997 to attend our upcoming reunion.

Later, I realized that over the last year, I had a few wonderful opportunities to reconnect with lost friends. There is the friend from San Diego who I have only seen once since my wedding 20 years ago; I spent two hours on the phone catching up. There is the friend from Pittsburgh who was my long-distance best friend in high school, back when pen-pals meant you wrote letters by hand and sent them through the (snail) mail. We lost touch until she emailed me. It turns out she has lived in New Hampshire longer than I have! There was joy in reconnecting with people who played significant roles in my becoming who I am today.

The universal need for social connection is well-documented, as are the benefits to physical health and mental and emotional well-being. Having social support networks is considered a social determinant of health — meaning part of the 80 percent of what contributes to our health outside of health care (which contributes at most only 20 percent). Not having social connection can have long-term negative health impacts. Social connection is not about the number of friends or contacts we have, or the number of groups we belong to. It’s about our subjective sense of connection, our feelings on the inside of being connected to others.

According to the Stanford Center for Compassion and Altruism Research and Education we can “give, share support and do acts of service and kindness for others” as compassion and volunteering create that helpful sense of connection and purpose. We should also prioritize taking care of ourselves, and asking for help when we need it. Oftentimes others in our lives would be happy to provide assistance.

On a population level, policy makers can promote awareness of the positive effects of social ties, being attentive to avoiding policies that have a negative effect on social connection, and prioritizing beneficial policies, interventions and programs that reduce social isolation and strengthen social networks and opportunities for connection.

In these challenging times of pandemic fatigue, climate disaster and what feels like the brink of world war, the words of Martin Luther King Jr. resonate for me: “Whatever affects one directly, affects all indirectly. I can never be what I ought to be until you are what you ought to be. This is the interrelated structure of reality.” In the words of a very successful marketing jingle from a while back, go ahead, “reach out and touch someone.” I’m pretty certain you’ll be glad you did.

Grateful for the magic

Our family has always enjoyed stories. Car rides, since the time my daughter was very young, have included listening to fables, fairy tales and fantastic fiction from the time we first heard New Hampshire-based Simon Brooks in person and then purchased his CDs. And our lives have revolved around musical theater since my daughter was enthralled by a Manchester Community Theatre Players production at age 4 and she left the auditorium filled with wonder, singing the words. Our home has been filled with song ever since!

As we watched the Harry Potter 20th Anniversary special I realized there was something different about this particular story centered on three children at the wizarding school of Hogwarts. Sure, my husband and I had seen every movie as soon as it was released. And he had read all the books. However, once our daughter was old enough to be introduced, things took on a different character.

My husband began by reading her the first five books. Being the Ravenclaw that I am, we followed age-appropriateness guidelines for watching the movies. As she grew, my dyslexic daughter was able to ear-read by listening to the stories herself. Soon she had completed the whole series and was listening to it again, for a second and then a third time. Listening to the stories, little by little, at bedtime, provided a comforting touchstone for my Hermione-inspired daughter, up through middle school. We lost count of how many times she heard the whole series and suspect she could place in the Guinness Book of World Records if we only knew.

The highlight of many Christmases included Potter-themed clothes, gear and games, including our Hufflepuff, Gryffindor and Ravenclaw “letter-sweater” jackets for my daughter, my husband and me, respectively, that we then wore to an interactive HP-themed Christmas show in Portsmouth! We once left a family reunion in Sarasota and drove across Florida to spend less than 36 hours at the new (second) Universal theme park and experience the train ride between parks. Most memorable was her 8-year birthday party, an all-out HP-themed extravaganza complete with a “run-through” train station wall, a sorting hat, a Quidditch game, a car in a “Whomping Willow,” adults in character — my husband was Rubeus Hagrid and I Professor McGonagall — and a trek through the Forbidden Forest to save the unicorn by all the children in their Hogwarts regalia!

We have mourned the death of Alan Rickman and other cast members. And watching the retrospective, I got misty realizing the cultural phenomenon that Harry Potter has proven to be — inspiring millions of children, youths and adults, to not lose hope, to fight for good, and to understand and trust the transformative power of love. Now that’s true magic.

Tell your story

Everyone has a story to tell. As a doctor, people share their stories with me related to their health and their lives — often about sickness, suffering and loss, and also about celebration and wonderful things. I’m a receiver of stories — and it’s an incredible honor to be entrusted with such a privilege.

Lots of people are now telling their stories on social media platforms, sharing to larger and larger audiences, where stories are often rewarded with “likes” and going “viral.” Thanks to Covid-19, we have been living through historic times that will be remembered like the Black Death of 1350 or the Spanish Flu of 1918 — “history” in the making!

A new storytelling initiative in New Hampshire offers an opportunity for all of us to tell our own stories from this unprecedented time we’re living through. Our Story: Reflections from the Pandemic and Beyond (ourstorynh.com) is a forum to create, share and collect stories across New Hampshire via multiple media and from multiple sectors of life, experience, feelings, hopes and thoughts of life during and before the pandemic and in anticipation of a post-pandemic reality.

Storytelling is transformational. Research has revealed that storytelling benefits both the person sharing and the listener. In fact, listening to other people’s stories has been shown to activate parts of the brain as though we were experiencing the events ourselves, creating a powerful connection to both the narrative and the storyteller. Stories can inspire and motivate and be uniquely memorable as they engage both head and heart. Perhaps this is why storytelling has existed in every culture across time.

What most inspired me to volunteer to help bring the Our Story NH project to fruition is its grounding in an ethical framework that intentionally centers equity. The primary goal is to create a space for self-expression, healing and an opportunity to be heard where participants tell their own stories on their own terms and where the storytellers completely own their stories. There is a therapeutic dimension to telling our stories via whatever medium we choose. Our Story NH will offer a number of ways to capture people’s experiences and personal histories including listening stations around the state as well as digital storytelling workshops. And a community council to inform and guide the project is in development — perhaps you might be interested?

For now, I invite you to share your story via the website (ourstorynh.com) — in text, audio, video, photo or artwork form. We all have stories to tell. Won’t you join us in telling yours?

Primary care

Some of us may remember Marcus Welby, M.D., the TV show that highlighted the general practitioner who made house calls. I have vivid early childhood memories of my own family’s doctor, Dr. Gerry, coming to the house to tend to a sick family member. Years later I learned to make house calls, first as a medical student and then in my family medicine residency training. I can recall important moments visiting patients in their homes when I practiced in Lawrence, Massachusetts. My husband, also a family physician, recently mentioned a house call he made; this got me wondering why the thought of house calls provokes such strong and fond memories. I believe it is that they highlight the trust I had — first with my family doc, and then the trust I engendered with my patients.

Amid the flurry of misleading claims and disinformation about the Covid vaccine, we’re hearing recommendations to speak to one’s primary care provider for information we can trust about the Covid vaccine. A survey by the Larry A. Green Center revealed that people who were previously vaccine hesitant who then got vaccinated reported that receiving advice from their own doctor is what changed their mind. It makes sense that receiving advice tailored to one’s own health profile in one-on-one conversations provides a supportive and caring space to address questions and concerns in a way that results in increased confidence.

A robust primary care system is important for having better health as a country overall, and the essential elements of primary care are that it be comprehensive, continuous, accessible and coordinated. In other words, they’re always there for me when I need them, no matter what the complaint or concern, they can address most of my needs directly, and when additional help is needed they can connect me with who I need to see while keeping track of the various providers and recommendations to address my needs — all while supporting my ability to understand and take care of myself. These essential elements together contribute to building authentic relationship, and relationship is foundational to trust.

When people are talking about complex things like the Covid-19 virus and the pandemic we’re in, it’s important to have a trusting relationship with a health care provider with true expertise in medical science — whether an individual person or a practice — to help us sort through the noise presented to us by social media and politics. While house calls are less common today, trust is still at the center of the doctor-patient relationship. Your primary care provider stands ready to give it to you straight about the Covid-19 vaccine and is prepared to answer any questions you might have with your best interests at heart.

Taste of Home

I love tacos, and when I first arrived in New Hampshire in 1993 as a medical student living in the Upper Valley, I realized I was a long way from Southern California and the tacos I’d grown up with when the only Mexican food source was a fast food chain franchise, where I was astounded to see the overhead menu displayed phonetic spelling for each of the food items: “boo-ree-toe”!

One day, my two Mexican-American classmates and I set out in search of Mexican food rumored to be available in a not too distant town in Vermont. It felt like a quest. Sadly, our too expensive (for our student budgets) meal was disappointing, and we resigned ourselves to living in a beautiful place with no gastronomic connection to home. We were excited when Shorty’s opened; the chips and salsa made it a favored site for celebrations!

Fast forward 28 years and I am thrilled to learn of Lalo’s Taqueria in Lebanon through “The Flavors of our Neighbors: At Lalo’s In Lebanon, The Taco Is King,” an NHPR story reported online July 2. A mouth-watering picture reveals authentic-looking tacos I can practically taste, light years from what I experienced in 1993, and sparks an urge for a road trip to catch lunch or dinner!

New Hampshire Public Radio is now running a wonderful limited weekly series, “The Flavors of Our Neighbors”/”Los Sabores de Nuestros Vecinos.” The Editor’s Note begins, “More than just a place to eat, local restaurants provide a taste of home for people through food and connections made with the folks who run them. This was never so evident as when the pandemic closed many of these gathering places, some for good … comprised of multimedia stories that highlight Latino restaurant owners, we learn how these entrepreneurs have not only weathered the pandemic but found ways to thrive and continue to provide a sense of community for their customers.”

In addition to stimulating our appetites, these stories evoke a connection to home, family, culture and community, for those of us with recent or remote roots in one of the many countries of Latin America. This is especially evident in the first story in the series, “The Flavors Of Our Neighbors: At Don Quijote, It’s Important To Feel At Home,” which highlighted restaurateur Sandra Almonte’s efforts “to make each person who walks through here feel as though they were stepping into their grandparents’ house.”

I am honored to be a member of the community-media partnership that collaboratively conceived of this project. We hope you will be inspired to check out “The Flavors Of Our Neighbors” and join us in creating community together over good food, as friends and neighbors in New Hampshire.

Foraging Memories

The elderberries are in full bloom. For my family they hold special significance as they remind us of my father-in law, who passed away almost four years ago.

My father-in-law loved his wild edibles. Every year at about this time he would drive along the country roads of Pickaway County in Ohio where he lived, keeping an eye out for elderberry flowers at the edges of woods and farmers’ fields. He’d carefully take mental note of their location so he could return later in the summer to forage for their magical berries. I’ve heard how he’d make elderberry wine with the berries — or how they’d get baked into one of his wife’s delicious pies. He also had many “adventures” getting stuck in ditches and battling poison ivy and always had colorful stories to share about his quest for those berries.

My husband has continued the elderberry passion, planting them on our property and harvesting them for all things elderberry. He also enjoys spotting them while driving around Manchester and New Hampshire, and talks excitedly about how they evoke memories, brighten up the drives and landscapes, and provide nectar and pollen for our local honey bees — another one of his passions, best left for another day’s column.

Most years, he and our daughter cook up a batch of elderberry syrup that is especially nice on yogurt and vanilla ice-cream. He has not yet forayed into making elderberry wine, but I suspect that is coming. The cooked berries regularly go into people’s smoothies and many live in the freezer for winter treats, once again reminding us of summer’s warmth and of fond times with my father-in-law. (Do note the tart berries can be toxic and should be cooked before eating!)

One of my less-favored consequences of working with elderberries are the inevitable purple-stained fingers that linger for days — and yet they, too, evoke “tasty” memories and trigger anticipation of the next elderberry treat that will be heartily enjoyed. (“Tasty” is a food adjective commonly and enthusiastically used by my husband’s family.)

I realize these little things we take for granted, such as flowers on the side of the road that we may not even notice most days, spark important and meaningful memories. What are the items or events that do the same for you? I hope we can all take time to appreciate and savor the little things that help bring meaning and sweetness to our life today.

My family and I are grateful for the generous gift of memories (and yummy treats) that the elderberries provide us today and every year. I wish the same for you and yours.

New life, new joy

Spring is a time of rebirth and renewal. I have found the increase in sunlight hours and warmer weather to be invigorating, inspiring hope and infusing optimism. I’ve noticed more people are out when I am out on my neighborhood walks, often with dogs or baby strollers, and strangers exchange friendly greetings in passing. My walking partner and I have optimistically started a couch-to-5K app regimen. My elderly mother has resumed her daily laps around the driveway, slowly regaining strength and endurance as she shakes off the winter and arthritic deconditioning from months spent indoors. And my husband is carefully tending and planting fig cuttings to grow more fruit trees.

Additionally, with 40.1 percent of New Hampshire’s total population with at least one dose, and 19.2 percent fully vaccinated, according to an April 4 report from NPR, and now all residents age 16 and older eligible, I sense the heightened anticipation for our return to some semblance of the pre-Covid “normal.” And while we patiently wait for all our family and friends to get vaccinated, I am excited to resume safe, outdoor socializing with others, including backyard barbecues and evenings around a firepit, all facilitated by the warmer weather, as social interactions are a really vital contributor to our mental health and well-being.

We know that the pandemic has resulted in many of us feeling isolated and lonely, with increased stress and anxiety, thus necessitating learning healthy ways to cope with stress and build resilience; and sometimes requiring professional assistance. Connecting with others, talking with people we trust about our feelings, and sharing our concerns through meaningful conversation are powerful coping tools. Unwinding, whether alone or with friends, undertaking activities we find enjoyable and doing good and helping others are also helpful for our well-being, as are efforts to take care of our bodies, such as regular physical activity, eating healthfully, getting plenty of sleep, and avoiding excessive alcohol, tobacco and other substance use.

Finally, connecting with community can be really impactful. For me this has manifested as returning to church after a year to resume playing music with others, thanks to being fully vaccinated. And so I returned to accompany the lone keyboardist who has carried on this past year; the other musicians and singers are looking forward to returning once they are vaccinated, as well. In my faith, Easter Sunday is of monumental significance, and the new life and new joy of the occasion was evident in the upbeat and celebratory music and rhythms that stirred clapping and swaying and inspired hope for new beginnings.

As the warmth and wonder of spring unfold, what new opportunities will you be exploring?

We are connected

I’ve been hearing and thinking about annual cycles lately including Black History Month, the Lunar New Year, Mardi Gras, and the last day we worked in person — or the day our lives changed dramatically — due to the Covid-19 pandemic.

At our house, this one-year mark coincides with my 89-year-old mother getting her second Covid vaccine and that’s a really big deal for us. For the last year, we have been working so hard to keep her safe in the midst of this pandemic. Her health has been our primary motivator to keep wearing masks and physically distance when our longing for social connection was pulling us to congregate with friends – she is the reason we’ve been so cautious. We’re really grateful that she was able to get the vaccine.

Many people who are vulnerable and at risk are waiting eagerly for their turn; others are more hesitant for a variety of reasons. We know that this virus has disproportionately affected some populations at higher rates because of the unique combination of factors that make certain groups more vulnerable — being older, having multiple chronic medical conditions, or being a member of certain racial/ethnic groups. These differences, known as health disparities, arise not because of any biological differences between groups as we are all part of the same human family. Rather, it is for reasons such as being more likely to be employed in essential work settings and thus at greater risk of being exposed to the virus, and more likely to be uninsured and have less access to health care with more chronic medical conditions. These factors are called the social determinants of health, where longstanding underlying inequities have been revealed by the pandemic. That is why some of us say that everything contributes to health, and health contributes to everything — because good health is requisite for our ability to be successful in school, to be productive workers, to enjoy time with our families, and to live long, fulfilling lives.

As a glimmer of light at the end of the tunnel begins to shine with increasing numbers of people vaccinated, and hospitalizations and deaths finally beginning to decline, we can dare to look forward to resuming the in-person celebrations we had to cancel or put off. And I imagine that even the mundane activities of our daily lives will seem celebratory — going to work and chatting around the water-cooler, convening in person, exchanging handshakes and hugs.

The infectious nature of this pandemic has illuminated how we are all connected, that any one of us is only as healthy as others in our community, that we are all in this together — and that at heart, we all want the same thing.

Dr. Trinidad Tellez is a family physician and health equity strategist, community advocate, and consultant.

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