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(L to R) Director Patricia Brennan, Michael Green, Ellen Forney, and MK Czerwiec before the National Library of Medicine Graphic Medicine discussion panel. Photos by Chia Chi Charlie Chang, courtesy of National Library of Medicine

 

On March 1st, the National Library of Medicine celebrated the launch of their new exhibit and collection: “Graphic Medicine: Ill-Conceived and Well Drawn” which was guest curated by cartoonist & mental health activist Ellen Forney.

It was my great pleasure to speak with Dr. Patricia Brennan, the first nurse and first woman to serve as Director of the National Library of Medicine. We discuss graphic medicine, its importance, and its applications. Hope you enjoy listening to this conversation as much as I enjoyed having it. To learn more about the Graphic Medicine collection/exhibit at the National Library of Medicine, including an online curriculum for both middle grade and college students, go to https://www.nlm.nih.gov/exhibition/graphicmedicine/index.html

Follow on Twitter: @NLMdirector @ComicNurse  @ellen_forney
Listen to the interview here:

(L to R) Director Patricia Brennan, Michael

This is a guest post by Ms. Brett Thompson-May, General Counsel at Mississippi Board of Nursing Ms. Thompson-May is currently enrolled in George Washington University’s Health Policy and Media Engagement Certificate program.

~There can be no keener revelation of a society’s soul than the way in which it treats its children.~ 

Nelson Mandela

Children have become the biggest losers to the opioid crisis impacting our nation as foster care entries have spiked 32% due to drug related causes.  With ninety-one Americans dying daily of opioid abuse, the effect upon foster care services has become overwhelming.  The opioid epidemic does not discriminate, and the children of many parents who have abused drugs are taken from their families, forced to cope in new environments and who, by no fault of their own, become the real victims. 

The epidemic has extended to pregnant women who give birth to infants diagnosed with the condition of neonatal abstinence syndrome (“NAS”).  The syndrome arises when mothers who used opioids or other drugs go through agonizing withdrawal symptoms. NAS symptoms include high pitched cries, tremors and difficulty sleeping.  Babies with NAS are usually born prematurely, underweight and at high risk for exposure to Hepatitis and HIV due to their mother’s drug abuse. 

Fraternal twins Mary and Evan were born in a Mississippi hospital January 2016.  Their biological parents were addicted to opioids, and the children, who were born premature, were also addicted.  Mary and Evan were born with significant levels of opioids in their systems, and medical personnel immediately injected each one with a shot of Methadone to begin the purging process of drugs in their systems.  Three days after their birth, child protection services placed the care and custody of Mary and Evan with their elderly maternal grandparents.  The biological parents’ rights were temporarily suspended, and they were both placed in treatment and rehabilitative programs to reunite with their children.  The plan ultimately failed as the parents could not overcome their addictions.

Babies like Mary and Evan are not exceptions as there are more infants born with drugs in their systems and who, like Mary and Evan will end up in the foster care system.  Because of the opioid crisis, an increasing number of children removed from mothers with opioid addictions are being placed in foster care thus lowering the average age of children who enter into the system by as much as three years. 

Mary and Evan had an option for custody and care in their aging grandparents.  Steve and Edith were in their 70’s, had been retired for several years and were looking forward to a slower and easier time of life when the twins were placed in their home, turning their lives upside down.  The couple had already raised three children and were now faced with being new parents —again.

Raising twin babies who also suffered from opioid withdrawal proved to be a challenge.  Edith and Steve lost many a night’s sleep while taking turns rocking the children to comfort them, as they suffered from constant tremors.  Weekly trips to the doctor to receive more methadone injections became routine while financial resources to provide for food, shelter and clothing were depleted. Steve went back to work in order to pay increased expenses and sold their retirement home to buy a more suitable home for the children.  While child protection services provided some financial help, those funds were not adequate to offset the increased financial responsibilities.

At the federal level, the Department of Health and Human Services (DHHS) documented the correlation between increasing foster care entries and drug abuse, as well as overdoses.  DHHS found a 10% rate of increase in overdose deaths that directly corresponded to the 4.4% rate of increase in foster care entries.  In 2016, 92,000 children entered foster care due to substance abuse by at least one parent.  Thus, the need for supportive services to address co-occurring problems of both parent’s recovery and child safety are imperative to help combat the problems the opioid crisis has created.  

Funding for child and family services has been eliminated or severely limited at both the national and state levels.  The 2018 federal budget proposes substantial cuts to groups such as Administration for Children and Families, the Substance Abuse and Mental Health Services Administration, and the Temporary Assistance for Needy Families program.  Efforts to repeal and replace the Affordable Care Act have also included initiatives to cut Medicaid funding even though Medicaid is the largest payer for addiction and family services.  While current administration stands behind the Family First Prevention Services Act, this Act makes families choose who should receive Title IV monies—the addicted parents or children who need foster care services.  

In Steve and Edith’s situation, they didn’t receive a dime initially because the parents benefited from Family First monies to help with treatment and rehabilitation.  Only when the parents failed with their plan could Steve and Edith become eligible to receive meager financial assistance. 

Fighting the opioid problem has taken its financial and emotional toll on Steve and Edith as well upon states and community resources and families.  Thankfully, 24 Senators in Washington led by Chuck Grassley (R- Iowa) and Dianne Feinstein (D- Calif.) are requesting funding specifically for the needs of children in foster care systems.  These funds would be directed toward community programs, counseling and treatment, mental and behavioral health services and care coordination/ reunification services.  Grassley and Feinstein have made public the statement that “investing in prevention, as well as treatment, will help reduce the number of children and families impacted by this epidemic.”

In Mississippi, the opioid crisis has caused the number of children in foster care to increase, prompting the hiring of an estimated 150 more social workers to handle the influx of children.  Former Mississippi Supreme Court Justice Jess Dickinson now serving as Commissioner of Mississippi’s Department of Youth Protection Services is pleading with state leadership for more prevention services and community partnerships to help Mississippi recover from the opioid crisis and devastation upon children families. 

Mississippi ranks last in overall childhood welfare and has increased its foster care entries by 30%.  More awareness, more funding and more involvement in saving our children is paramount to fighting the opioid crisis that has plagued our nation, our state and our neighborhoods.  Little Mary and Evan may have had a chance to thrive thanks to their grandparents and a pro bono Mississippi attorney who helped Steve and Edith eventually adopt Mary and Evan.  So many more children in our state and nation are in need.  Those who are interested can contact their U.S. Senators

This is a guest post by Ms.

This is a guest post by Dr. Jacqueline J. Hill, Associate Dean of Nursing and Allied Health at Southern University and A & M College. Her involvement and advocacy in healthcare and educational issues spans over 20 years. 

 

As you may remember, in 2010 the Affordable Care Act (ACA) or as it’s known Obamacare, was signed into law by President Barack Obama. Of the various provisions included in the Act, one of the more popular provisions was the coverage of pre-existing conditions. That’s the provision that prevents insurance companies from denying coverage for a condition the person had before they tried to get insurance. 

Even with the repeal and replace movement of the ACA by the Trump administration, removal of the pre-existing provision was not one of the changes proposed.  In November 2016, the Kaiser Family Foundation conducted its health tracking poll to determine if healthcare was a major factor in the presidential election. The survey found that many of the law’s major provisions (e.g., health coverage for 26-year olds and pre-existing conditions) were quite popular, even across party lines –which begs the question, “why would President Trump want to overturn the pre-existing provision of the ACA?”

Initially, I thought this effort was driven by the insurance industry, but after further investigation, my findings revealed that was not the case. It seems that America’s Health Insurance Plans (AHIP), the trade association for health insurance companies, supports the pre-existing condition protections under the ACA. According to AHIP “Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019,” They plan to file an amicus brief to support the ACA law. 

So if insurance companies are supporting it, what’s pushing the movement?  Apparently, a lawsuit was filed by 20 states in February 2017 challenging the constitutionality of the individual mandate. Despite the Supreme Court’s ruling earlier this year on the individual mandate, the Republican tax bill eliminates the penalty for not buying insurance, which goes into effect in 2019.  To put it simply, the individual mandate is the part of the law that required everyone to have health insurance. The attorney general of Texas, Ken Paxton, asserts that without the individual mandate, which is the cornerstone of the ACA, the ACA is unconstitutional.

If the courts are in agreement with him then that means that persons with pre-existing conditions would be subject to the pre-ACA era of insurance companies denying them insurance coverage. Unfortunately, the Justice Department has refused to defend the ACA law and are leaving it to the courts.

According to Health and Human Services, approximately 130 million people in US under 65 years of age have pre-existing conditions.  We all know someone who was denied insurance or could not afford the exorbitant cost of insurance for having a pre-existing condition, e.g., diabetes, hypertension, etc. prior to the implementation of the ACA.

Recognizing the role that the ACA has played in assisting people who were previously unable to be insured justifies the importance of maintaining the pre-existing component of the ACA. 

So, what should we as citizens do? We should write our legislators and implore them to not allow this to occur. Recommend that they not tamper with the pre-existing provision, since removing it will negatively impact so many Americans.

Additionally, we should inform key stakeholders such as the insurance companies, nursing associations, and other grassroots organizations and voice our support of the pre-existing provision.  As noted earlier, it’s one of the provisions that most people agree is a good one. What we don’t want to occur is go backwards to a time when so many were not afforded insurance.

Dr. Jacqueline J. Hill is Associate Dean of Nursing and Allied Health at Southern University and A & M College. Her involvement and advocacy in healthcare and educational issues spans over 20 years. 

This is a guest post by Dr.