transformation.

You can make all sorts of arguments about whether or not the world is getting worse. When you look back at events like the Holocaust and periods of history like slavery and segregation you could make the case that we are not more violent and worse off than in the past.  And then, Charlottesville.  It’s tragic and shameful.  It’s almost hard to believe it really happens.  Almost.  Except, it happens every day. This might be the worst we’ve seen, but every day people would rather take for themselves than give to someone else. People chose to fear the other and decide that a message of hate is going to save them.

First, may we all condemn white supremacy and the events from Saturday.  Secondly, let’s admit that violence and hatred and suppression happens every day.  It happens in big huge giant ways and in the smallest of small ways. It happens every time there is an incident of domestic violence. It happens every time we refuse to condemn amisogynistic statement or a racist joke. It happens every time we tolerate a gender pay gap and a minimum wage that leaves families below the poverty line.  It happens every time we give in to the fear that someone will come and take away the life we have ‘built’ or our security. In both big and small ways we are guilty of putting our own well being above all else and deciding that someone else’s life matters less than our own.

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What then, must we do?

Open our mouths.  Dare to say something when your friend, your neighbor, your fellow church member or even someone in your family privately or publicly says something that is oppressive, racist, supports gender bias or invites hatred. We must say something. It won’t be easy, it probably won’t be popular, but it will be right.  But it must go beyond just our voices.  If we really want to be agents of change in our society we can’t just use our voices but must embody justice, equality and peace with our whole selves.

For those in my tribe called Christian and especially Nazarene, IMG_0635it means putting your money where your mouth is and then making sure your hands and feet follow your money.  That’s right.  It’s not enough just to send your money to the after school program or the food pantry or the non-profit.  Giving your money is necessary and sacrificial but not necessarily transformational. To be transformed means you take an afternoon off from the comfort of your office where you are paid more than you probably ever need and find yourself  sitting next to a child that looks remarkably different than your own and help them learn to read or finish their homework.  To be transformed means to bring your kids with you to serve a meal to someone for whom life has not given many opportunities and forge a friendship.  Not only will it transform you but your kids will grow to understand they aren’t the only people who matter. Transformation is to remove the “us” and “them,” to eliminate the fear of someone who believes differently or looks differently or behaves differently than you.

Today, if you find yourself saying “I haven’t done anything terrible” think about those first 4 words.  Have you done anything at all? Be generous.  With your time, your money, your life. Put the needs of someone else above your own. Condemn anything that represents hate of the other, fear of those who look differently than you or closing doors and windows to the poor, the widow and the orphan. Instead, may our lives reflect a God who would rather arm his people with food, with health and with life than with weapons. A God who looked beyond gender, race, age or anything else when He came to offer healing and hope.

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the measure of success.

How do we measure success?

The Pastor and I were discussing the events of the last few months and upcoming events. Elections, the national title game, the end of the church year, the end of the calendar year, the NFL playoffs, the Super Bowl, the upcoming year.  Each of these events has many ways in which those involved can measure success.  For some, success is equal to winning.  For others, success is equal to just being present in something greater than yourself. Success can be measured on a personal level, a team level, a national level.  And not all those measurements will come up with the same answer in the same situation.  Let’s take employment, for example.  If the unemployment rate goes down then, on the national level, it will be counted as a success.  But, if you lost your job in that same timeframe and are yet to find new employment I am guessing you would not agree that there was major success in reducing unemployment.

 

In medicine we measure success in many ways. One of the most common ways is morbidity and mortality.  Morbidity refers to disease or worsening health and mortality refers to death.  We view morbidity as complications or poor outcomes related to disease or surgical or medical interventions. Mortality is easy to measure.  Did the patient live or die?

How does our own nation do?  When we look at comparable countries (those with total and per capital GDP rates above average in the last 10 years) we find that we have worse mortality rates for almost all diseases than in those other countries.  The US spends more on healthcare than any of these nations.  Why the difference? Some of it falls on the healthcare system itself.  We have issues that lead to difficulty in accessing healthcare; we have a complex system that contributes to cost, and for many Americans a significant portion of that cost will be spent in their last year of life.  But there are also social determinants that impact our health.  We have more obesity, a more sedentary lifestyle, and more disease caused by environmental factors.  When we evaluate morbidity, or disease burden, we see that despite having a lower rate of smoking and alcohol consumption, we have higher rates of lung cancer, alcoholic abuse and alcohol related liver disease than comparable countries.

Now those are all national statistics.  Measuring outcomes in a large scale view.  It is not the only way to measure success.  A patient might measure the success of their surgery based on when they are able to get back to their yoga class or weekly run and their surgeon might be measuring success based on the time it took to complete the surgery, or by minimizing blood loss or the patient’s hospital stay. Your primary care doctor may img_5778measure success by looking at vaccination rates, patient satisfaction, personal job satisfaction or seeing that long time patient achieve their weight loss goals or quit smoking.  Your OB might measure success by lowering their c-section rate, improving quality of life in the women they care for or when that patient who has long-suffered with infertility or pregnancy loss finally gives birth.

How will you measure success in 2017? Maybe you will set a personal goal for your health, your business, your family.  Maybe you will look at national data like the unemployment rate or what the Dow Jones does.  Maybe you will measure success by what your own state does for its own citizens.  Hopefully many of us will measure success in ways that are much less “measurable” but in ways that have much more meaning.  May we measure success by how we treat our neighbors, how much our children know that they are loved, by how the widow and orphan are cared for and by how we have given away from ourselves in 2017.

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women on lockdown.

In 2013 the Center for American Progress rated Oklahoma as one of the worst places to live for women. Why?  Well, in addition to our above average gender pay gap, ranking near the bottom for women in poverty, and the huge number of uninsured women, Oklahoma has more women in prison than any other state in America.

As a background, the United States imprisons more of its population than any other nation in the world.  In the last 20 years, the percent growth of female inmates was twice as much as male inmates.  So, as a country we have a trend.  When you look at my own state, Oklahoma, we have experienced exponential growth in female incarceration not screen-shot-2016-12-26-at-9-09-16-pmseen in any other state.  As of 2015, Oklahoma puts 127 of every 100,000 women behind bars.  Compare that to 63 of 100,000 as the national average.  From 2015 to 2016, the number of incarcerated women in Oklahoma increased by 9.5% while the number of incarcerated men decreased by 1%. This begs two questions from me: Why do we have so many women in prison? And then, are we any safer or better off with all these women behind bars?

First, at least 2/3 of the women in Oklahoma who are in prison have committed non-violent crimes. Many are incarcerated due to drug offenses, which up until recently carried serious jail or prison time due to Oklahoma laws.  There is no compelling evidence that we are any safer with a high female incarceration rate.  According to the our state Bureau of Investigation, violent crime in Oklahoma was up about 3.5% from 2013 to 2015, and non-violent crime was down by about 4.5% in that same time frame.  The overall violent crime rate in Oklahoma has decreased 7.3% in the last 10 years, while the rate of female incarceration doubled in the same time frame.

For the last couple of years I have given a lecture to our second year medical students on the state of women’s health in Oklahoma.  The good, the bad, the ugly.  I always touch on our incarceration rate.   Why?  Because our other state health indicators are major reasons why we incarcerate so many women.  1 in 25 women enters prison pregnant.  Over 2/3 of incarcerated women have a minor child. The consequences for these children are devastating.  Also, more than half of incarcerated women in our state have experienced domestic violence in adulthood and/or abuse in the home as a child. About 70% have been diagnosed with a mental health disorder.  Why does this matter? Because in 2013, our state ranked 46th (where 1st is best) in mental health expenditures per capita that were state funded.  picture1Most women in our state who enter prison live in poverty and have a lack of education. Again, we rate 40th out of 50 for number of women in poverty.  When women in Oklahoma are marginalized in health and economics, they are disproportionately more likely to end up in prison.  But is the news all bad? Fortunately, no.  In 2015, our state passed 2 bills that allowed reduced sentences for drug offenses and judges to deviate from mandatory minimum sentences.  Then, in 2016, the people of Oklahoma passed a state question that made certain drug and theft related offenses misdemeanors instead of felonies.  The money saved from the reclassification of these crimes will be used for rehabilitation programs, thanks to another state question supported by the voters in my state.  Tulsa County, along with the George Kaiser Family Foundation, have established a Women in Recovery program.  Since 2009, they have helped 475 women and over 1,000 children.  But we still have a long way to go.

Why should you care?  What can you do?  I think, no matter what state you live in, the rate and growth of female incarceration in our country should alarm you.  As a gynecologist I’m probably biased but I think we can measure the success of our nation by the success of its women.  If we can keep women out of prison their children are more likely to succeed in school and avoid drug abuse and addiction.  We should be advocating for increased mental health services in our states and in our nation; for reduction in the gender pay gap and other measures to reduce the number of women and families in poverty.  We should find ways to reduce domestic violence in our nation.  We should support efforts like the Women in Recovery program, and drug and mental health courts that focus on rehabilitation services.  No one knows this better than my sister-in-law, who also happens to be editor-in-chief of this blog.  She works in the drug court system.  She sees women as offenders every day in her home state of Missouri.  She knows it takes, sometimes, half a dozen times or more for offenders to find recovery.  She will be the first to tell you there are no easy fixes and no simple answers.  But I believe if we begin to change the idea that prison is the solution, then we can begin to create a culture where we focus on restoration and rehabilitation for our women.  I think we will all benefit. We have a shared brokenness.  We should share in the efforts of recovery.

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love is more than a sentiment.

Well friends, Advent is in full swing and we are fast approaching Christmas Sunday!  And guess what?  Christmas Sunday is….on CHRISTMAS!  Traditionally we celebrate Christmas Sunday on the Sunday that falls closest to the 25th.  But next week we will celebrate the morning of Christmas.  And I’m excited.  But today is the 4th Sunday of Advent.

We light a candle in celebration of love.

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In the Advent Scripture from Isaiah today we are reminded that God comes to us as Immanuel.  “God with us.”  We have come to that time in Advent when we begin to really anticipate the birth of Christ. Most of you will be familiar with the story.  Mary, the mother of Jesus, is engaged to Joseph. Except then she is pregnant.  And it’s not Joseph’s baby. You can imagine the drama that this would create. It’s a story we want to romanticize.  We like to paint a picture where both Mary and Joseph are overjoyed at the thought of having a baby but I have to believe that they both understood the hard work, the shame, the isolation they would face.  They had enough faith to bravely accept the ways in which God had chosen to use them and follow wherever this path would lead.

The reality is that God comes to us in one of the most uncomfortable stories of all time. Single mother. Unglamorous birth story.  Weird visitors. If it happened in my hospital today people would look the other way or maybe roll their eyes.  But it leads me to believe that maybe God is at His best “Immanuel” in times when we are most uncomfortable. The difficult part is being able to recognize the Immanuel in our own lives. We tend to move away from the uncomfortable spaces, to stay quiet when we see something that isn’t right, to ask how others are doing with the expectation that they should say all is well.

God loved us enough to have Christ come into the most uncomfortable spaces in our lives. If we are to be His people then we must love in the same way.  There is a lot to be uncomfortable with.  Watch the news, read the headlines, get on social media. Aleppo. Violence against women. More gun violence.  Road rage. Sexual assault on our college campuses. Cold and dark days of winter.  But, because Immanuel, we can speak out against violence.  Because Immanuel we can speak out against oppression and injustice. Because Immanuel we can sit with someone in their despair. The Immanuel allows us to sit in anger, bitterness, sadness and frustration with our lives and He doesn’t move away, He moves closer.

If we truly believe that God is with us today as He was way back then, then you must know that God will move with you into the darkest of spaces and that He calls you to move with someone else in the same way. It won’t be easy.  It will feel uncomfortable. It will mean we have to move out of our daily self-centeredness and begin to notice the world around us. And it will be exhausting. Is it worth it?  Honestly, some days I have no idea.  The Pastor and I have spent lots of time in uncomfortable spaces with people. The return on investment is small; sometimes it’s nothing.  But when I am at my most uncomfortable I want nothing more than to share my burden with another and believe in God as Immanuel. Like Mary and Joseph, we are called into the uncomfortable and God goes with us.

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to be merciful.

Wow.  What a week it has been.  I had been prepping to write something on Zika virus, which, as you can imagine, is hard to put a theologic spin to…but I feel overwhelmingly obligated to discuss the newsworthy yet tragic events of the last few days and weeks.  Unless you don’t do the internet…which means you wouldn’t be reading this blog, you know that former Stanford student and swimmer Brock Turner was convicted of sexually assaulting a woman and then only sentenced to 6 months in jail, of which it seems he will likely serve 3.  If you haven’t read the victims 12 page letter, please do.  Your eyes will well with tears, your insides will hurt, your ears will sting and you will have some tiny insight in what it means to be victimized and humiliated.  If you haven’t a clue about the prevalence of sexual assault, you can read this blog post and get just a bit of insight.  The outcry against this young man’s sentence has been appropriately broad and loud.

There won’t be much medicine in this post.  Instead, my mind has been brewing over the question…what does it mean to be merciful?  When I read about tragedy or see it lived out before my own eyes the word that comes to the forefront of my mind is mercy.  A word that conjures many emotions but I find difficult to define.  So, like any gal in this decade, I texted my church girls and asked what they though it mean to be merciful.  Here’s what they said.

“Good ole’ Webster: compassion or forgiveness shown toward someone whom it is within one’s power to punish or harm.” (of course from an educator).  The other answers were some variation on this.  Interestingly this followed a lengthy “discussion” (via text) on power previously in the day.  So I asked myself, what does it mean to be merciful in the Stanford assault case?  Where does compassion lie when someone has no remorse, no awareness of what they have done and what they have destroyed?  What does it mean to be merciful to the victim?  To her sister?

And then today 50 people were murdered and another 50 plus were injured in Orlando by a man with an agenda of hate.  We can all speculate on who and what that hate was about but I think it would be hard to argue that this wasn’t motivated by hate.  Is there a place for mercy in this situation?

You see, we all hold positions of power at some point in our lives.  We might have authority at our job, with our children, or something as simple as being waited on in a place of service such as a restaurant.  I think how we hold that power is key.  We can clutch it tightly and find the best way to punish our enemies and fuel fear and hatred or we can hold it gently in our outstretched palm and exercise a judgement that is fueled by compassion and forgiveness.  Sounds easy, right? (kidding.)  I believe we can be merciful without sacrificing justice for the victims around us.  DISCLAIMER: I don’t excel at mercy.  I’m pretty good at judgement.  Professionally, I try hard each day to ensure I give power back to people.  That patients feel like they have a voice and that what they say matters and I see them as an individual who matters.  I’m certainly not perfect at it.  Personally, I find it much easier to judge the people in my social circles than to extend mercy.  I want to be confessional so you’ll understand I find this as difficult as you.

So what does that look like?  For the Stanford assault case, I think mercy for the victim is a prayer that says she will forgive herself each time she has a passing thought that maybe she deserves some blame.  For the young man I think a place of mercy is much more difficult to find.  Maybe it’s a prayer that instead of absolving him of responsibility and judgement, his eyes will be open to the breadth of damage he has caused with the crime he has committed.  Where is mercy in Orlando?  I believe it’s compassion for groups of people who have been victimized over and over again and often have no power in our culture.  In both circumstances I think mercy is finding a way to ensure that we know and understand how best to gently handle a position of power and to teach those around us that same meaning.

The truth is I really don’t know in these tragic situations and others like it how to find myself on the side of mercy.  The quote at the top of this blog from Pope Francis is overwhelming to me.  But it is the truth.  May we learn to extend mercy to our enemies.  Maybe then they will do the same and the world will have a smidgen less hate in it.  May we teach our sons (and our daughters) about mercy so that they will know how gently power is to be held.  Maybe then when a young man sees a vulnerable young lady he will think protection instead of victimization.  I don’t think mercy is about protecting ourselves, I think mercy is about protecting others from the harm we and others around us might do to them.  Not with raised fists and weapons but with love and forgiveness for others.  To strive to understand the other, our enemy, our opposite and to teach those around us to do the same.  To give the nameless and faceless victim a voice.  Screen Shot 2016-06-12 at 10.37.46 PM

I know it’s a long shot, but I am convinced that if we experienced mercy and showed it to others then maybe we would understand what it means to lay down power.  We might see less guns and more reading programs.  We might see safer college campuses.  We might lower our voices during the political season to listen and learn.  You see, extending mercy means you understand the person standing across from, whom you have power over, not as object but as subject.  Someone who deserves to be extended compassion and forgiveness.  I wonder if Brock Turner understood mercy he would have seen his victim as a person instead of an object to be owned and used.  Finally, may we be merciful with ourselves when we find no capacity to think of forgiveness when confronted with hate-filled crimes and injustices that we see in the world around us.  May we ask for mercy from those who we have exercised power against wrongly.  We should exercise forgiveness continually and may it spur us to practice a prayer my dear friend sent to me today. “Jesus Christ son of God have mercy on me.”

 

(top photo credit to catholic.org who has an entire website dedicated to memes…who knew?  The other two images are from the Instagram account of the official Nazarene church)