Sexual Assault Awareness Month: Prevent Sexual Violence

Sexual Assault Awareness Month (SAAM) is observed in April to highlight sexual violence as a major public health problem and increase public understanding about it. The effort can help us support rape and sexual assault survivors and victims as well as their families.

One of the most vividly brutal rapes I have ever seen portrayed on TV was The Sopranos, Employee of the Month (Episode 30, Season 3), when Dr. Jennifer Melfi is raped in the stairwell of her office garage after work. Forget House, Scrubs and definitely Grey's Anatomy, The Sopranos is my favorite medical show. Medical problems are the undercurrent of almost every episode. Dr. Melfi is given sensitive care in the Emergency Department, and is able to identify her attacker, but justice is denied her when evidence is mishandled. Recuperating from her injuries and psychological scars, tensions erupt between her and her husband. She dreams that her mob boss patient, Tony Soprano, is a vicious Rottweiler dog and part of her longs to ask him to mete revenge where the legal system failed her. Like the majority of women, I myself have been a target of attempted sexual assault three times. The first time I successfully fought off my attacker on sheer adrenaline. I had scratches on my neck, reported it to the police and they laughed at me. The second time, my would be attacker chased me in a truck and I went into a grocery store. The third time, my car broke down at night and a crazed man banged on my windows screaming he wanted to "help" me. I waited, terrorized, until a tow truck came to my rescue.

Sexual violence is an international problem, but in the US:

• one in every six women is a victim of sexual assault as are one in 33 men
  
• 44% of rape victims are minors, under the age of 18
• 15% are under age 12
• 29% are age 12-17
  
• 80% of rape victims are under age 30
• 34% are American Indian/Alaskan
• 18% are Black
• 17% are White
• 25% are Mixed Race
• 93% of juvenile victims KNOW their attackers
  

The high risk years are ages 12-34. Risk peaks in late teens. Girls 16-19 are four times more likely than the general population to be victims of rape, attempted rape, or sexual violence. The good news is that, in the US, rape and sexual assault has fallen by 69%. The bad news is that it is suspected that 60% of sexual assaults are not reported.

For other coverage of The Sopranos medical issues, read my post The Barbarian Invasions & National Cancer Control Month.

Thank you AlexPears for use of the photo.

Labels: Dr. Melfi, prevention, rape, sexual assault, sexual violence, Sopranos

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Oh Canada! Thank you Dr. Liana for Grand Rounds 3.31!

Canadians twice in a week! They sure are smart. Dr. Liana is a hockey lovin' rural medicine resident blogging her way through Alberta and put together a really fascinating trek through the solar system of medical writing at Med Valley High this week. She included seven posts about the college kids who were killed in Virginia last week, including one of mine,

Messed Up Guys with Guns: National Youth Violence Prevention Week

I wrote two more on the subject:

Asians and the Stigma of Mental Illness: National Minority Health and Health Disparities Month

The Human Brain as a Deadly Weapon: Privacy Laws vs. Protecting the Public

Other folks at Dr. Liana's Grand Rounds were thinking along similar lines:
When Individual and Societal Rights Collide: Institutionalization, Patient and Societal Safety and Mental Illness from Universal Health N=1.

As Dr. Liana recommends, "Discuss amongst yourselves..."

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The Barbarian Invasions & National Cancer Control Month

There are some films worth seeing more than once, and this weekend I had a chance to view the French Canadian beauty, Les Invasions Barbes (2003), or The Barbarian Invasions. From director Denys Arcand, this truly brilliant comedy/drama won an Academy Award for Best Foreign Lanuage Film in 2004. If you are uncomfortable with vulgarity, moral or sexual ambiguity, intellectuals or drug use, read no further. Filmed in French with English subtitles, we get a glimpse into a Canadian healthcare system that's not working too well for a womanizing history professor with cancer, estranged from his family. Shot in yellow light in a crowded hospital, we see patients on gurneys in a hallway amongst the linen carts, hear monitors, telephones, overhead pagers and off camera voices. It looks like dear old dad is in purgatory.

In the film, as in many families, father and son are worlds apart politically, intellectually, financially. The father refers to his son as a "...vicious, ambitious capitalist..." and himself as "...a sensual socialist...". The reality of death has a way of breaking down those barriers. Sebastien, a broker from London, comes back to Montreal and takes Remy, his dad, via ambulance to the US for a PET scan on the advice of a doctor friend in Baltimore. The news in bad, but Remy rejects the idea of going to the US for treatment so Sebastien, corrupting some easily persuaded hospital employees along the way, takes over an unused hospital floor and turns it into a suite for his dad. As adult children, one thing we can do for our parents is to provide a good death. How far would you go for your parent, dying of cancer?

I lost my own father to prostate cancer about a year before I saw this film for the first time. Like Remy and Sebastien, we were worlds apart in many ways, but death and losses over the years had brought us together. I was more the sensual socialist and he, sharing a birthday with W., actually saluted a billboard of Rush Limbaugh as we drove past it in Arizona. He was not an anti-intellectual, however. He spoke several languages and made it a point to learn the languages of the indigenous peoples of Arizona were he spent his last years, like the Tohono O'odham's. We shared a love of travel and Camus' The Stranger , only he could read it in the original French. My only other language is Spanish. He was diagnosed with prostate cancer,the third leading cause of death in men, at the young age of 60. Although slow growing in older (over age 75), prostate cancer is more aggressive in younger men, a fact that eluded my mother, with tragic consequences. My father met with his doctors and made the decision himself to have radiation therapy rather than definitive surgery, because he didn't want to deal with the potential complications of impotence and incontinence. Eight years later, he bewailed the fact that he had the same complications he had tried to avoid and wondered, too late, if he had made the right choice.

My father had a great sense of humor. He used to joke, "Janet, always remember, you're just one sixth of a dysfunctional family." The dysfunction came to a head with my dad's diagnosis. The mother in most families is the locus of emotional support. When a mother is in denial about her spouse's illness and instructs her kids not to talk to dad about his cancer because it upsets him, the hounds of hell of resentment and misunderstanding are unleashed. Like Episode 3, Season 1 of the Sopranos Denial, Anger, Acceptance, where Jackie Aprile is in the hospital with cancer, the denial is so thick you need a meat cleaver from Striale's Pork Store to cut it. There is a bad seed in every family and I rebelled against my mother's code of silence, had the effrontery to take my dad on a vacation to Portugal three months before his demise. The fates conspired and I had enough frequent flyer miles to get him a first class ticket through Paris, where he had an unscheduled layover in a five star hotel at the airlines expense. We had a good time.

In the Barbarian Invasions, when everyone realizes the end is near, Sebastian borrows a friend's cabin on Lake Champlain and transports his dad there along with a group of friends. Sebastian got his father's pain under control through the help of a heroin addict and a nurse. When the end was near for my dad, my sisters broke free of the spell my mother had cast over them and spent some beautiful time saying their goodbyes with my dad in the hospital, and at home. My mother fought us on that, too. She didn't want the hospital bed in the sun-filled family room, all of us crowded around my father and his catheter bag and the undeniable pain of cancer that had metastasized to the liver. In the US for pain control, we have hospice care. The hospice nurse came out and delivered the oxycontin liquid which I gave to him sublingually (under the tongue). She told me to keep giving it to him until his pain subsided. It didn't take long. His breathing subsided too, and he was gone.

Thank you, jknorri, for use of your lovely photo of Lake Champlain, Thankg06. Nice pickup.

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Covering the Uninsured

Here is an issue that most Americans are familiar with in one way or another. For the last five years, the Robert Wood Johnson Foundation has even promoted a week to sponsor it. This year, “Cover the Uninsured Week” runs from April 23 to April 29.

This issue has been highly analyzed. In fact, the sheer numbers of facts and figures have a tendency to numb the brain, thereby leaving the reader mystified about the basic nature of the problem. So let’s keep it real simple.

When it comes to one’s health, unanticipated problems often arise. Governments, employers, individuals and families all have some interest in healing the sick, and in keeping people healthy.

Overwhelmingly, the uninsured are the working poor. The group especially includes those who work for very small companies. These facts suggest that one way to begin to attack the problem would be to provide some assistance to small businesses, thereby allowing them to begin extending the benefits of basic health coverage to employees and their families.

The “Cover the Uninsured” web site contains useful information beyond the statistics, covering such topics as About the Week and What You Can Do. The site also has a Policy Center, which assists in linking the reader to information regarding health care coverage in their home state.

Of course, if you do have an interest in the stats, they are also available on the site. They come in two flavors: there is a brief sheet of Myths and Facts, as well as the more comprehensive Chart Pack.

Slings and Arrows Cartoon Courtesy of CartoonStock.com

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Asians and the Stigma of Mental Illness: National Minority Health and Health Disparities Month

The Office of Minority Health Resource Center (OMHRC) looks at minority health disparities in the month of April. Asians with mental health problems are very much on our minds this week.

Who are Asian Americans? According to the Office of Minority Health (OMC), there are 14.4 million Asian Americans, roughly five percent of the total population. The US states with the highest concentration of Asians: California, New York, Hawaii, Texas, New Jersey, Illinois, Washington, Florida, Virginia, and Massachusetts. The OMC offers a one page primer on mental health and minorities, mentions stigma, talks about problems of access, but mostly in terms of poverty and linguistic barriers.

There may be close to 15 million Asian Americans, but there are many distinct cultures within that population: Laotian, Cambodian, Vietnamese, South Korean, Chinese, Taiwanese, Japanese, Filipino, East Indian, Pakistani, Nepalese, Sri Lankan, Afghani, Hmong, Bhutanese, and Mien. Each culture has different languages, different health beliefs, different immigration routes into the US, different education, income levels and insurance coverage. Mental health experts at Johns Hopkins University identified some barriers confronting Korean Americans with mental illness "...stigma,...refusal of treatment,...anxiety about confidentiality."

Benjamin Chu, MD, MPH has stated that in a culture driven to succeed, Asian Americans may be intolerant of mental illness in its members. In a provocative 2004 Medscape Today article, Overcoming Stigma in Asian American Mental Health, Dr. Chu observes that our mental health care system is "passive...waiting for people to declare themselves in pain...," dependent on the individual or family to make the first move. Dr. Chu was speaking at a 2004 conference of the New York Academy of Medicine, where mental health experts convened to discuss this very subject, Stigma in Asian American Mental Health.

The panel reported that for Asians in general, mental illness "..violates a code of conduct." Families try to keep members with mental illness at home, hidden, a secret. Hochang Benjamin Lee MD states that Korean Americans are a "... particularly underserved community, as evidenced by their low psychiatric admission rate and low utilization of outpatient services." Since 75% of Korean Americans are Christian, he recommended using the churches as one forum for education about reducing the stigma.

Art heals a lot of wounds that medicine can't quite get to. A shout out to two great Korean American women artists:

• Grace Lee, winner of the Emerging Director Award at the Asian American Film Festival in New York for her wonderful indie film, The Grace Lee Project.
• Jen Pack, Fiber Artist and my friend.

For more about the deadly intersection of youth violence and mental health read:
Messed Up Guys with Guns: National Youth Violence Prevention Week

Thank you midbach for use of the photograph.

Labels: asian americans, mental health

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Messed Up Guys with Guns: National Youth Violence Prevention Week

It hurts to write this post. My nephew, David Kofalt, graduated from Virginia Tech last summer. He looks and talks like all the kids you see interviewed on the news. He is smart, sweet, intelligent, articulate, hard working. So was his good friend Ryan Clark. Ryan Clark was one of the wonderful kids whose noble life was ended by rampaging man with guns, Cho Seung-hui. From all accounts, Ryan, or "Stack" as he was affectionately called, was handsome, lovable, caring, fun-loving. He had a 4.0 average, was a few weeks shy of graduating with a triple major and had plans to pursue a PhD. His human brain was functioning superbly. His parents must have been so proud. How they feel today is unbearable to contemplate. What could we possibly give them or do for them to compensate for the loss of this wonderful being they raised and nurtured so well, that he lost his life coming to the aid of another person?

What about the brain of his killer, 23 year old Cho Seung-hui, also a senior at Virginia Tech University, an English major? From the accounts that are coming together, he was a loner, a writer, who was disturbed, quiet, who did not like to talk. Surviving students have told unfathomable stories of him laughing maniacally as he coldly murdered as many kids as he could. His parents must be in utter despair with shame and bewilderment.

The human brain is amazing in its capacity for creativity and destruction. How the brain of the individual develops depends on genes, environment and experiences of the child. Stress hormones can cross the placental barrier, effecting the child in utero. Depressed mothers who are emotionally unavailable to their children and unable to respond to their non-verbal cues wreak havoc with their developing brains.

Mass murderers have one thing in common: they are always male. I'm a huge Sopranos fan, so I am not unfamiliar with cruel, manipulative women or mothers with Narcissistic Personality Disorder. I know womens' brains go haywire and they do bad things like kill their kids. No matter, male gender is the number one risk factor for violent behavior. Females are sneaky, covert in their violent acts. Males go on rampages and then shoot their own faces off.

Violent males can't control their impulses. Their frontal lobes, prefrontal cortex and limbic system are wired wrong. They have less grey matter in their brains. The amygdala may be damaged somehow and a Cho Seung-Hui may not experience the rush of pleasure and rewards from socialization that Ryan Clark did. Cho Seung-Hui's brain lost the capacity for empathy or guilt while RAyan Clark's brain overflowed with empathy, compassion, and good humor. A deadly mix of decreased serotonin and increased testosterone may have decreased Cho Seung-Hui's fear and built up a lethal stew in his brain. Combined with easy access to semi-automatic guns, he made a decision to carry out an orgy of anti-social, testosterone fueled mayhem. Ryan Clark was studying, studying hard to understand and help people with malfunctioning brains. Cho Seung-Hui executed him before he had that chance.

It isn't the cops and the kids and the parents who can make a difference. Maybe it's time we in health care start advocating PET scans and neuropsychological evaluations for kids before we put guns in their hands: whether for self-defense, defense of our country, or sport. Would that help us identify kids who need help and prevent youth violence?

For more on this subject, read Asians and the Stigma of Mental Illness:National Minority Health and Health Disparities Month.


Thank you TW Collins for use of your photo, Blood on Your Hands.

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Thank You Dr.Dork!

Once a week Grand Rounds - a carnival of health-related blogs - is hosted by a medical blogger who sifts through multiple entries (and this week it quadruple the normal amount...I can't imagine how many that is but I can only assume it was a lot!) from the medical blogosphere to find the best the posts to share. The posts are featured in the host's issue of Grand Rounds on their blog. This week it was hosted by Dr.Dork and is very well organized into different categories for your reading pleasure. Enjoy!

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April is National Humor Month

Who knew it would be so hard to find medical articles from trusted sources that talk about the benefits of laughter and humor to health. Small wonder we hardly ever hear such statements as "it's summer time, let's get season pass co-payments to the hospital!" or "if you don't behave I won't take you to see the doctor...". There is a growing body of knowledge out there however that seems to have found a connection between laughter and enhanced health.

Laughter is beneficial to relationships (common sense, right?), and this article in Psychology Today underscores that. It's a quick read and for all those who are connected in any way to any other human beings it is well worth the 8 minutes it takes to read it. The Humour Foundation, based in Australia, is the brains behind the Clown Doctors (self-explanatory) and their whole organization is geared towards promoting the health benefits of humor by infusing laughter and humor into the practice of medicine.

Other than it's benefits in building and strengthening human relationships here are some other health benefits of humor and laughter.

Now that you're up to speed here's my challenge. The entire month of April is National Humor Month so do your part in helping promote the health and well-being of others and post a joke or funny story in the comments section of this posting, and if you don't have a sense of humor then borrow someone else's...we'll laugh anyway, and it's cheaper than paying to attend a laughter workshop!

Photos courtesy of a4gpa and chippenziede

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Thank You, Dr. Keagirl

This week's installment of Medical Grand Rounds (v. 3.28) is hosted by Dr. Keagirl, an attending Urologist from "Big City, U.S.A."

We at Healthline would like to thank her for shining the spotlight on our medical bloggers in this issue. Several Healthline blogs were featured, including blogs from Healthline Connects and from Healthline Observances.

A wide range of topics are covered in this week's edition of Grand Rounds. In order to view the full list of offerings, please click here. It is well worth checking out!

Photo Courtesy of Dr. Keagirl and her medical blogspot, Urostream.

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