Shape the World You Want by Voting

October 24th, 2016


            In November we will have the opportunity to vote, and thus help shape our world—both nationally and locally. Please vote, even if you don’t follow my suggestions!

Most politicians have personality traits that set them aside from the normal populace. Usually those traits are an asset. Unfortunately this is not true with one of the current presidential candidates who has a personality disorder: narcissism. This psychiatric illness is concerning for someone who must make decisions that will affect our country and the whole world. A person with narcissism thinks of himself, not of his constituency. This narcissistic personality disorder has allowed Trump to lie with impunity; he probably believes his own untruths! I fear what might happen if he were president and had to make a decision about launching a nuclear attack. Trump is a disgrace to our country.

Several amendments to the Colorado constitution are on the ballot. One would create a new healthcare system for citizens of our state. Currently we don’t have a healthcare system in our country; we have a tangle of fiefdoms run by overpaid administrators. Insurance companies and other financial parasites suck half of healthcare dollars away from actual care. We need a single payer system such as the other 9 of the richest countries have. Unfortunately, I don’t think that ColoradoCare will do what is needed. I will vote against proposed amendment 69.

My main concern about 69 is women’s issues. The ColoradoCare’s board of trustees might end up with a majority adverse to contraception. It couldn’t happen, you say? Surely the board would realize that reproductive health is a human right and saves up to $7 for every dollar spent? Unfortunately our elected officials don’t always make rational decisions. Remember what happened in the Colorado legislature to the bill that would have paid for effective IUDs? Sponsored by Republican Representative Coram, that bill was killed in our state senate.

There are economic reasons to support Amendment 70, which will raise the minimum wage in Colorado from $8.31 to $12.00 per hour over the next 4 years. Boosting the economy is one. For me, however, it is just ethical to pay employees close to a living wage—about $13.00 for a single person in La Plata County. I will vote for 70.

Using tobacco is incompatible with good health; therefore it is beneficial to decrease its use. Taxing tobacco is a good idea, and increasing the current tax with Amendment 72 is a great plan. The tax is a disincentive, and the money will further healthcare and medical research.

I am of the age when terminal illnesses become common—although I’ve been lucky so far. We have come a long way with hospice and palliative care, but there are people with terminal illnesses whose lives are miserable and would like to take “life-ending, doctor-prescribed sleeping medication”. I have cared for some people whose last days were wretched and who wanted an end to their misery. I support Proposition 106, the “Medical Aid in Dying” initiative.

In La Plata County we have the opportunity with Ballot Issue 1B to fund a new terminal and other improvements to our airport. As one who flies fairly often, I am aware of the problems with our current facilities. However, I see reasons to vote against the expansion. I suspect air service is in its heyday. As the price of fuel rises and constraints on emissions come into play, it seems likely that people will fly less rather than more. Furthermore, the airport expansion would propel county expansion, but is that what we want? Isn’t our population big enough as it is? Let’s not vote for this big tax increase.

There are three Ballot Issues I do support even though they will mean an increase in taxes. 1A will be used to maintain our roads and bridges. Roads are used by everyone and are essential for our economy. I believe that having our roads in good condition is more important than a new airport terminal, and at much less cost. Furthermore, well-maintained roads improve the safety of all who travel in our county, so I consider this an issue of public health. Two Ballot Issues are for money to improve our schools, 3A for Durango and 3B for Bayfield. Educating our children well is vital for our future; please vote for this support.

            I don’t like politics, but chose this subject because this election is so important that we all need to participate in the democratic process.

                                           © Richard Grossman MD, 2016

Move Upstream

September 28th, 2016


“Many children in this area have families that are unable to care for them. Fortunately, there are orphanages here in town that are able to care for small babies until their families are able to care for them again. The situation here is desperate, and many of the babies brought to the orphanages are severely malnourished.”                                                                        Phil and Laura Olaniyi

            Laura and Phil formerly lived in Durango but moved to Mozambique where they are starting an orphanage, “Heart for the Needy”. Let’s look at some of the statistics for this East African country.

Mozambique is one of the fastest growing countries in the world; women there have an average of almost 6 children. The country’s infant mortality is tragic, with 83 of every thousand children dying before they reach one year of age. This is one reason for the high fertility, since couples usually don’t choose to have small families until they know their children will live to adulthood. The maternal mortality rate is also very high. The average per capita income is only $3 a day.

These statistics don’t begin to tell the anguish of a mother who cannot care for her child, or the grief of a family who cannot care for a baby whose mother died in childbirth. Fortunately there are compassionate people such as Laura and Phil to care for these abandoned children. Even though they are far away I feel close to them in a way since I have worked with both of them—and I helped when Laura was born.

I agree with a statement Laura made on her blog: “Let’s be honest for a second, though. An orphanage is only putting a Band-Aid on the real problem – poverty & oppression.”

I admire Laura for being so perceptive, but I want to add another cause of “the real problem”—undesired fertility. In Mozambique only a quarter of girls are enrolled in secondary school, and only 11% of married women use modern contraception. The fertility of non-educated women is twice that of women with secondary school education, 6.8 and 3.4, respectively. This is an example of the wonderful power of educating women!

In the developing world young women often have very little power or control over their lives. Older men approach them with offers of money or coveted goods in exchange for sex. Rape is also common. The story of such an unfortunate young woman is told in the short YouTube video “Not Yet Rain”, filmed in Ethiopia.

“An ounce of prevention is worth a pound of cure.” Karen Shragg has used a similar expression in the title of her book: “Move Upstream: A Call to Solve Overpopulation”. In it Karen points out that so many of the problems we face, including climate change, ocean fisheries depletion, and extinction of species, are caused by increasing human overpopulation. Similarly, the need for orphanages is (in part) a symptom of unwanted fertility.

I have two friends who live in Bayfield who spent part of their childhoods in orphanages. Both are productive citizens who might not have survived if there had not been institutions to care for them as small children. In addition, relatives adopted a boy from the Democratic Republic of Congo when he was 3 years old. Mason’s birth parents died when he was small, so his grandmother took over his care. Unfortunately, she was unable to meet his needs then he was well cared for in an orphanage. Mason has joined a loving family in Durango who are giving him opportunities that would be impossible in Congo.

Orphanages provide a wonderful opportunity to care for some of the world’s most vulnerable children. There are few orphanages left in the U.S.A., but in developing countries there are many, and there is much need. As Laura points out, however, orphanages are just a Band-Aid for the real problems—terrible poverty, low status of women and many unplanned pregnancies.

We should “move upstream” to get at the root of the problem rather than just using Band-Aids. Steps that will help include supporting international family planning organizations such as the Population Media Center, and help the Population Connection terminate the Helms amendment, which restricts government funded agencies from even talking about abortion.

Until we have solved the problem of unplanned pregnancies, the only humane action is to care for orphans the way Laura and Phil are. I am sending them a check to help them as they build Heart for the Needy. What a boon it will be for orphans in Mozambique!

© Richard Grossman MD, 2016

Honor Childfree People

August 26th, 2016

Graph of childfree women %

“Let each of us honor someone who does not have children.”

                                    Ecologist Jim Schenk

            I stopped in a store on Main Avenue to buy a Christmas present. When I returned the proprietor’s greeting and asked how he was, he replied honestly. “Not too good”. He had just broken up with his girlfriend.

He went on to explain that they had been together for a long time, but were splitting up over her wish to have a child. He explained that he did not want the responsibility of parenting.

A Brit who subscribes to my monthly Population Matters! emails wrote: “For your next email to us in a month or so, would you perhaps consider discussing why women [feel they need to] have babies; and why it is not questioned? It brings reproductive rights in conflict with the planet very starkly. Is anything so important so not discussed?”

Finally, I was talking with the director of a nonprofit. She told me that the day, August first, was International Childfree Day. There is Mothers’ Day and Fathers’ Day, but I had never heard of Childfree Day. “People like me don’t get much recognition!” she exclaimed.

These events lead me to write about the option of not having children. We tacitly assume that women will contribute one or more babies to the human family: our society is pronatalist. This is especially true in some religions that encourage large families. The book “Confessions of a Later Day Virgin” brings this out well, with humor. The author, Nicole Hardy, had no idea that a Mormon woman could be childfree until she read Terry Tempest Williams’ “Refuge”. Williams and her husband are both Mormons, and childfree.

Despite our pronatalist society, some people elect not to bear children—they are voluntarily childless. There are many reasons for this, including religious (e.g. nuns and priests), dedication to work and the huge responsibility of being a parent—like my Main Avenue salesman. In the past being childfree required sexual abstinence, but that is no longer the case—fortunately!

There is another, important reason to be childfree. From time to time I hear from patients that they want to limit their fertility because of their concern about overpopulation.

The woman who started International Childfree Day, Laura Carroll, is married but childfree. She has studied pronatalism in our culture, as well as the effect of bearing children on individuals and on our society. She suggests several “Alternative Assumptions” in her book, “The Baby Matrix”. One alternative assumption is that there is no need for almost everyone to parent. We have already “been fruitful and multiplied” and now increasing our numbers is counterproductive. Another Alternative Assumption: parenthood should be a conscious decision.

What will happen when I’m old if I don’t have children? In many societies the only social security is family—especially children. That is no longer so true in our society, where families are often geographically spread out. Carroll’s Alternative Assumption is: “Finding my elderhood support structure is my responsibility.”

You want to parent? Carroll also writes about the advantages of bearing just one child. She dispels the myth that “only” children have problems; indeed, they tend to excel. Then she dispels myths about adoption, which she says is easier and less expensive than rumored. She suggests adoption for second and subsequent children for parents who want more than one. She points out that our human population is already unsustainable. “Having fewer, not more, biological offspring is the true humanitarian act because it ultimately lessens the

suffering of people and the world’s natural environment.”

Don’t childfree people miss out on a lot? Yes—but what they miss out on is both good and bad. Dirty diapers aren’t that much fun! Is it possible to weigh the pros and cons of parenting versus a childfree lifestyle? Of course that comparison will vary immensely from person to person. However an analysis of the responses of almost 2 million people in the USA, after controlling for factors such as marital status and income, “…the presence of a child has a small negative association with life evaluation….” Put simply, childfree adults are happier!

The number of childfree women is increasing. Whereas 40 years ago only one in ten women in the USA spent her life without bearing a child, now the figure is closer to one in six. This is good for the planet, and good for the people who do not want to parent. We should honor and support them in this choice.

© Richard Grossman MD, 2016

Creative Commons Attribution 3.0 United States
This work is licensed under a Creative Commons Attribution 3.0 United States.