Alarming 650,000 lb of Antibiotic Streptomycin Approved for Use in Agriculture

I recently read an alarming article in the New York Times which stated that the antibiotic streptomycin is being used to fight an insect-transmitted bacteria in orange and grapefruit trees. The bacteria causes citrus greening disease, which eventually kills citrus trees. In humans, streptomycin is used to treat serious infections, such as TB and plague.

Against the strong warnings of the United States CDC and FDA, and contrary to norms that make such practices illegal in places like the European Union and Brazil, "The E.P.A. has proposed allowing as much as 650,000 pounds of streptomycin to be sprayed on citrus crops each year. By comparison, Americans annually use 14,000 pounds of aminoglycosides, the class of antibiotics that includes streptomycin."

We are already facing a health landscape in which drug-resistant infections are becoming increasingly common in humans. When bacteria encounter antibiotics, the weakest bacteria are killed off first, while the strongest bacteria that can quickly adapt to fight the medicine sometimes survive. This happens especially frequently when people only take 4 days of an antibiotic even though their doctor prescribed 7 days, for example. Those remaining stronger bacteria are the ones that reproduce, making bacteria babies that carry on their antibiotic-fighting traits and go on to infect the next person. If this happens frequently, due to adaptable bacteria having regular encounters with antibiotics, bacteria emerge that cannot be fought off even with our strongest existing antibiotics.

Spraying streptomycin in large quantities for agricultural purposes will speed up this process of creating stronger bacteria that human medicine can no longer fight.

I sympathize with farmers who are losing their entire crop and source of income. At the same time, I can confidently say that there is no single fruit or vegetable that I would save if it meant returning to a time when the plague and TB killed large numbers of people or when the most basic life-saving surgeries like C-sections were not safe due to the infections that followed. Before the discovery of antibiotics, average life expectancy was 47 years old. I am alarmed at the rate we are using antibiotics in humans and cannot fathom a world in which it makes sense to use nearly 50 times that amount to save a beloved fruit.

I am contacting my representatives in Congress to fight this decision, because I want to preserve the effectiveness of antibiotics for years to come. I hope you will do the same.

Source: https://www.workcare.com/antibiotic-awareness-week-when-do-you-need-medication/

Unhelpful Thinking Style: Always Being Right

One of the greatest revelations in my personal understanding of mental health has been learning about "cognitive distortions." Also known as unhelpful thinking styles or misbeliefs, these are the lies we tell ourselves which skew our thinking and are frequently associated with depression, anxiety, unfettered anger, and a host of other issues. In good news, we can make positive strides in our mental health by noticing these lies and countering them with the facts. This is the basis for much of cognitive behavioral therapy, which is one of the few styles of therapy that scientific studies have shown to be effective across a wide spectrum of mental health issues.

A couple years ago, as I was reading a list of common cognitive distortions, I was surprised to find one mentioned that I hadn't noticed before: "Always Being Right."

This must be a mistake, I thought. Sure, argumentative know-it-alls can be jerks sometimes. But these psychologists can't possibly think such arguing has roots in the same categories of thought as depression and anxiety. I mean, I can see the falsehood in depressive thoughts, like, "I am a loser. Things will never get better," or common lies of anxiety, like, "It is terrible and unbearable if someone else is disappointed in me. If the worst case scenario happens I won't be able to handle it." But these ways of thinking are just totally different from being right about things!

However, as I was reflecting recently on the idea of "rightness" being a cognitive distortion, one of the most egregious scenarios from my own life came roaring back. Several years ago, I was having a nice pleasant back-and-forth email discussion about health policy with two friends. The exchange ended in me explaining the concept of adverse selection with a detailed mathematical example, thus proving why insurance companies cannot sell plans to individuals with preexisting health conditions. (Sounds smart, right?) I was vindicated!

On yeah, did I mention one of my two friends was battling a life-threatening illness at that time?

I wish I could say this story is made-up.

Surely a person with any common sense and human decency would know better, you say! Surely you should have seen that your response was valuing the argument over the friendship! Surely you should have thought before you hit "send!" Trust me, if I could take that whole thing back, I would in a second.

Fighting her disease was emotionally and physically draining. Had I stopped for a moment to consider the topic we were discussing from my friend's perspective, I would have realized that she would be justifiably angry and terrified by the idea that she could also one day be excluded from buying health insurance because of it. Math or no math.

And yet somehow in the moment, I told myself that if I had a factually correct and logically sound argument, that meant it was "right" to share my view. It took my friend directly pointing out how inconsiderate I was being in light of her situation, to remove the blinders and show just how wrong my "rightness" really was.

While that example is more extreme than most, I still do stupid things like this sometimes. Tell me an opinion, and I can rattle off ten reasons why someone would hold the opposite view. But I am slowly learning and growing, practicing reflective listening, being ok with leaving things open, being more aware about what others think and feel. And thankfully, I have some amazingly patient friends in my life.

I have also had friends who argued in futile circles with me when I wanted to drop a subject or belittled me over minor points of disagreement in conversations. So I feel confident saying from the other side of the experience that it doesn't feel good, breaks down trust, and is not likely to change someone's mind.

Based on my personal experiences with the art of debate and my observations of others, here are some of the common lies I have identified that are associated with always being right:

Misbeliefs Because of Our Personal Insecurities

• If I am wrong about something, it proves that I am a phony, not intelligent, or not competent. To borrow a phrase from Backus and Chapian, "That would be terrible and unbearable."
• If others think I am wrong about something, it follows that they will think I am a phony, unintelligent, or incompetent.
• It is terrible and unbearable for others to have a low view of my intellect. I am responsible for forming and maintaining others' opinions of me.
• If I do not conclusively prove I am right about something, others will incorrectly think I am wrong, and that would be terrible and unbearable. It is terrible and unbearable for someone else to continue thinking I am wrong after a conversation where I share my views.
• The only way to combat the anxiety or rumination I experience when I do not correct someone else's wrong thinking is to express my opinions whenever I feel the urge.
• If my loved ones think I am wrong about something, they will lose respect for me or will no longer value me.
• My knowledge, opinions, and logical faculties define my personal identity.

Misbeliefs About Others

• It is terrible and unbearable for someone else to live their life believing something that is not factually, logically, or ethically correct.
• All incorrect thinking has major consequences.
• It is my responsibility to correct people who are wrong; if I don't correct this person's opinion, they may never know they are wrong, and that would be terrible and unbearable.

Misbeliefs About Our Superiority and Importance

• I often know more about certain issues than people who have personally experienced them. Personal experience only creates bias.
• When someone remembers or interprets a situation differently than I do, my recollection or analysis of events, conversations, intentions, etc. is definitely the correct version.
• If I provide the correct information and logical framework, people should change their minds to my view.
• If someone does not agree with me, it must be because they do not fully understand my arguments and reasons. (I should probably explain them again.)
• If someone does not agree with my well-thought-out opinion, it is an indication of their unwillingness to acknowledge facts, their low IQ, or their closed mindedness.
• My opinions are almost always based on the facts, while those with differing opinions are using emotional or faulty logic / premises; I am objective, while others are biased.
• My understanding and analysis lead to completely right living and purely motivated actions; others' misbeliefs lead to entirely wrong living and actions.
• The conclusions I have drawn based on the facts are as good as facts.

Relational / Social Misbeliefs

• Being right is more important than being kind.
• Expressing my opinion is more important than understanding another person's thoughts and feelings.
• It is always important to express my opinion, even if it...
• hurts someone else's feelings.
• interrupts the agenda of an event.
• disrupts the overall purpose of a conversation.
• involves strong language or tone.
• insults a core part of someone else's identity.
• embarrasses someone else.
• makes spectators to the conversation feel uncomfortable.
• etc.
• Correcting factual inaccuracies can only benefit conversations and can never detract from them.
• If I don't express my disagreement with someone, it is the same as saying I agree or allowing others to assume that I agree. Therefore, I have a responsibility to argue all issues.
• Conversations should always continue until both sides agree on the answer.
• I should always be the one to decide when a conversation is complete.
• It is terrible and unbearable to be silent when I have a thought.
• Wrong thinking needs to be dealt with immediately - there is no such thing as an inappropriate time to speak up when it comes to inaccuracies or false logic.

And many others. If you find yourself thinking any of the above with some regularity, you may be falling into a cognitive distortion trap.

Some signs you are experiencing this kind of thinking include getting irritable or anxious when someone disagrees with you, spending time researching information to prove others wrong, having multiple friends or loved ones who have expressed hurt feelings from your discussions, continuing conversations even when the other person would prefer to drop the matter, spending significant time arguing on internet forums, needing to have the last word in disagreements, and feeling most at peace when you are confident you and others have reached the right conclusion about a subject. (Source)

The cognitive distortion of "always being right" can be especially hard to recognize in ourselves, since those who experience it are confident their side is in the right in nearly all situations, thus limiting self-reflection. It may be useful to have a close trusted friend help you identify if you are exhibiting the behaviors common with this unhelpful thinking style. 

In truth, most people can live perfectly happy and functional lives believing many wrong things. It may be unpleasant when someone thinks you are wrong or disagrees with you, but it is not terrible and unbearable, and in fact, you can live a perfectly fulfilling and contented life being misunderstood by many people. Your identity and intellect are not inherently changed based on what others think about them. While you may prefer people to change their minds when confronted with your analysis of the facts, it is not actually terrible and unbearable if they don't. Even when someone fully understands your arguments, they may still disagree with you (and even be rational doing it). Many of the people we surround ourselves with have excellent logical capabilities and memories as accurate as our own. And we are all susceptible to bias - including you - that's just called being human. Sometimes pointing out errors or arguing over being right takes time and energy away from more crucial things at hand. Maintaining healthy relationships sometimes means holding back our opinions, regulating our tone of voice, or ending some types of disagreements before they feel fully resolved - and all of those choices may be unpleasant at times, but they are not terrible and unbearable and are usually signs of good character.

Above are the sorts of truths we can embrace to combat the cognitive distortion of always being right; things are not as terrible and unbearable as we tell ourselves they are. It may even be helpful to repeat these kinds of truths whenever we find our minds racing in the direction of misbeliefs.

Of course, some people fall to the opposite end of the spectrum, telling themselves they can never disagree or express their own opinions. They believe the effects of such discord, usually others' disappointment in them, would be terrible and unbearable. That, too, is its own type of cognitive distortion. As Backus and Chapian astutely point out in their book, "Telling Yourself the Truth," while we all prefer to have others like us, it is not necessary or even possible that we be liked by everyone, and while others' disappointment may be unpleasant, it is not actually terrible and unbearable. Sometimes wrong ideas do have genuine negative consequences that need to be addressed. It would be inaccurate to say that it is never ok to hurt someone else's feelings with our opinions. For example, when someone crosses an important boundary we have set, we may need to speak up.

So we must strike a balance.

We should feel free to have and share ideas and to express our genuine needs and wants without giving power to our basic insecurities, assuming our intellectual superiority, or disregarding relational consequences.

I suspect I will always love debate in some form, and anyone who knows me could probably never imagine a reserved version of my personality. But I can still choose to believe truths about my own identity and social responsibilities when it comes to personal speech.

I will end by noting that apparently, God is well aware of the human tendency to use our speech carelessly, rather than to love well. I am always challenged by just how many verses in scripture teach the wisdom of staying silent and carefully guarding our speech. That has never been my forte. In God's eyes, feeling the need to constantly prove I am right actually shows foolishness rather than the superior wisdom I may think it demonstrates.

"The one who has knowledge uses words with restraint, and whoever has understanding is even-tempered. Even fools are thought wise if they keep silent, and discerning if they hold their tongues." ~Proverbs 17:27-28

Thank you to all the friends, mentors, and loved ones who continue to support me on this journey called life! May we all let go of the lies that hold us back and keep growing in the wisdom of self-control and love.

Please note that I am not a mental health practitioner or a licensed counselor - just a public health professional interested in the subject. Want to know more about Cognitive Distortions and how they might be affecting your mental health? Check out some of the articles linked throughout the text above, as well as the secular book, "Feeling Good: The New Mood Therapy," by David Burns, and the Christian book, "Telling Yourself the Truth," by William Backus and Marie Chapian. In particular, I borrowed the phrase "terrible and unbearable" from Backus and Chapian, because it resonated when I read their work.

Companion Planting

Photo courtesy of Stephanie Stein.
The green onions are about twice as
tall as the photo shows and very thick.

A while ago, I wrote a post about our patio garden. In that post, I shared one of my biggest learnings: a successful small container garden is like an ecosystem. Many edible plants do best when they have flowers and other plants supporting them, acting as repellants for undesirable bugs and as attractions for good critters.

While pest control is certainly one important aspect of the ecosystem, I have since learned that plants can be compatible for a host of reasons. A friend tipped me off that she planted her green onion and chili pepper plants together in the same pot, because she had read they support one another. The peppers had a good yield, and the onions got huge!

I started reading more about it and learned that this is called “companion planting.” Companion plants may help each other by producing higher yields, better flavor, disease resistance, and/or pest control.

Conversely, some plants may actually stunt growth when planted together. For example, while garlic and onions may work great with pepper plants, they are known to stunt the growth of beans and peas. Tomatoes and potatoes are also not a good match, as they can be negatively affected by the same blight and may spread this to each other. Corn, mature dill, and kohirabi are also poor companions for tomatoes.

Seasoned gardeners have compiled extensive lists of plants that make great companions and sorry enemies. To read more about the relationships between specific plants that interest you (and to find companion planting charts), see here and here.

As we start our next garden, I hope to put this companion planting knowledge to work, as well as learn new skills and information, in order to grow a successful, healthy, and delicious crop!

Encountering Jesus

My mother-in-law gave me a book called, "A Balm for Gilead: Meditations on Spirituality and the Healing Arts," by Daniel P. Sulmasy. As I have read this work, a handful of ideas and prayers have struck me as quite profound and have stayed with me.

One I wanted to share in particular is a new take on the passage Matthew 25:31-40. Here are the words of Jesus:

“When the Son of Man comes in his glory, and all the angels with him, then he will sit on his glorious throne. Before him will be gathered all the nations, and he will separate people one from another as a shepherd separates the sheep from the goats. And he will place the sheep on his right, but the goats on the left. Then the King will say to those on his right, ‘Come, you who are blessed by my Father, inherit the kingdom prepared for you from the foundation of the world. For I was hungry and you gave me food, I was thirsty and you gave me drink, I was a stranger and you welcomed me, I was naked and you clothed me, I was sick and you visited me, I was in prison and you came to me.’ Then the righteous will answer him, saying, ‘Lord, when did we see you hungry and feed you, or thirsty and give you drink? And when did we see you a stranger and welcome you, or naked and clothe you? And when did we see you sick or in prison and visit you?’ And the King will answer them, ‘Truly, I say to you, as you did it to one of the least of these my brothers, you did it to me.’

I have always read this passage to mean that when we serve those who are on the outside, remember those who are forgotten, uplift those who are downtrodden, empower those who are oppressed, then we are caring for those who are close to Jesus' own heart. In this sense, when we love the "least of these," we are showing that our hearts are aligned with Jesus' heart, as well as serving those who are experiencing many of the trials Jesus himself experienced (poverty, rejection, etc.) And Jesus will remember these acts as evidence that the Holy Spirit was doing God's work of love and healing through us. 

In his book, however, Sulmasy takes this a step further by suggesting to those of us in the health care field that an encounter with a person suffering from illness or pain is an encounter with Jesus himself. There is some aspect of a sick patient that reflects the person of Jesus directly. It is not just metaphorical that we are helping someone like Jesus, but rather, we are encountering the Christ incarnate in some way. Sulmasy reminds us that Jesus said, "I was sick and you visited me." In Sulmasy's own words,

"To be a  healer is to find God in those in need of healing. For the Christian, healing is a direct encounter with the divine. And that encounter, if genuine, necessarily causes personal transformation. In the parable of the Good Samaritan (Luke 10:29-37), the priest and the Levite ignore God when they ignore the wounded man, and so their lives remain unchanged - they keep walking down the same path. The man the Good Samaritan finds bleeding on the side of the road is really the Lord. And in picking him up and binding his wounds, the Samaritan's life is changed.... 

"...So, although religious health care professionals may often want to understand themselves as 'channels' for God's healing power, Christianity teaches that they would perhaps be better served if they understood themselves first and foremost as persons privileged to serve God by serving the sick (p. 24)."

For me, what seemed at first to be a subtle shift in perspective, upon further prayer and meditation, turned out to be earth shaking. When I look into the eyes of a person in the midst of physical or spiritual pain, can I see Jesus Christ himself? And if so, how will I encounter him, and what will he show me? How will I respond? While I still believe that God may use health care professionals as a conduit for his work and love in the world, I am also moved to think that upon my next encounter with human illness, if I look for it, I may see the glimmer of Christ incarnate.

How that will change the way I look at a person!

To learn more about how Jesus has shaped my drive to serve through public health, check out my post, "Jesus as a Community Organizer?"

The Unhealthy Comparison Game

About a month ago, a friend posted the below meme on her social media page.

I chuckled a little to myself, recognizing that like many young moms, she has undoubtedly received more than her fair share of unsolicited opinions about her life choices. And she is looking on the bright side of things!

But then I stopped smiling. I have friends who have had children young, but also many who have had children later in life (or who are still waiting) for a whole host of reasons. I wondered what they would think. What the post was really saying was, "Stop judging my life choice. To prove my point, I will judge your life choice (or something that might not have even been your choice) even more. So there! Take that!"

It dawned on me that this was human nature on display. Why is it so much easier to look on the bright side when we can look down on someone else?

This is not just a phenomenon of parenting.

When I was in fifth grade, I remember walking out of the locker room for gym class on the first day that was warm enough to wear shorts. I heard laughter and felt certain it was directed at my chicken legs.  (I still had no calves in site when I ran cross country and lifted daily in high school, so I was doomed biologically.) I remember feeling hurt, but I brushed it off and cheered myself up by thinking, "Oh yeah, well at least I am smarter than all of you."

And so at the ripe old age of ten, I began a long career of making myself feel better by looking down on others, usually without even realizing it.

I think it can be healthy when we learn to appreciate our strengths or the positives of our circumstance when confronted with weaknesses and challenges. This is not to say we should be blind to our situation, but rather, we can rest assured that no one is good at everything or experiences every advantage, but everyone is good at something and has something to contribute; I have gifts that I bring to the table.

But it is all too easy to corrupt an awareness of our strengths or good fortune into a self righteous comparison with others. This is especially true when we are feeling insecure in some way.

At least I look more attractive, run faster, write better, work harder, earn more money, sing louder, eat healthier, keep my house cleaner, act more responsibly, have a more prestigious title, drive a faster car, volunteer more of my time, go on better vacations, pray more, keep better friends, get more attention from the opposite sex, parent better, have seen more of the world, paint more beautifully, invest wiser, went to a better college, cook tastier, you-name-your-favorite-point-of-pride than that other person or group.

But I am convinced that this way of thinking does not have nearly the positive effects we think it will.  It is ultimately born out of jealousy and the need to feel important. The problem is, no matter how many merits we accumulate, there is always going to be someone else who is smarter, faster, and better than we are. We can never be satisfied in this striving. In the end, we have made someone else feel lower, and we still do not come out on top.

God's word says, "But if you are bitterly jealous and there is selfish ambition in your heart, don't cover up the truth with boasting and lying. For jealousy and selfishness are not God's kind of wisdom. Such things are earthly, unspiritual, and demonic. For wherever there is jealousy and selfish ambition, there you will find disorder and evil of every kind." (James 3:14-16) 

It also says, "For by the grace given me I say to every one of you: Do not think of yourself more highly than you ought, but rather think of yourself with sober judgment, in accordance with the faith God has distributed to each of you." (Romans 12:3) 

And finally, "But he said to me, 'My grace is sufficient for you, for my power is made perfect in weakness.' Therefore I will boast all the more gladly about my weaknesses, so that Christ's power may rest on me." (2 Corinthians 12:9) 

It is hard to love others when we are looking down on them, and it is difficult to really care about someone else's needs when we are focusing so intently on our own advancement and image. Not to mention, it really doesn't help us a whole lot, either.

Strong relationships and communities are built on honesty about our faults and hardships, celebrating each other's strengths and good fortune, and spurring each other on to grow. If we trust what God says in these passages, then we can let go of jealousy to embrace both our strengths and our weaknesses, because they both present opportunities for God to put his own greatness on display. And we can embrace the mantra that we are better as a group because of the amazing gifts every person brings to the table.

It is my hope that as I mature as a person, I will grow more secure in who I am in God's eyes, so that I can also grow more thankful for who others are, as well. It is my hope that I will stop making myself feel better by bringing others down.

I encourage you to consider what areas of your life might be points of unhealthy pride or comparison? How is self righteousness sucking life out of yourself and your community? How can you choose health by exercising thankfulness for what you have while also celebrating what others bring to the table?



p.s. I also recently read this great article about the comparison game among women and in parenting. It takes on a surprising and refreshing twist mid-article. And I think the attitudes and lessons it mentions apply to folks in every life situation. Check it out!  "No Leprechauns, No Valentine's Boxes, No Elves, and Why That is Okay"

My Day Care Pet Peeve

When I was looking for a day care for my young son, I read reviews on Yelp and looked at the photos for each place. I was shocked by how many professional licensed facilities had pictures of blankets and toys in baby cribs!

As a new parent, one of my biggest fears is Sudden Infant Death Syndrome (SIDS), a term used to describe the sudden unexplained death of a child under age one. The experience of SIDS is tragic and heartbreaking for any family that goes through it.

Although much is still unknown about SIDS, many important risk factors are known, and by following the American Academy of Pediatrics (AAP) guidelines, parents and caregivers can significantly decrease the risk that this tragedy happens in their own home.

Among the recommendations, for children under the age of one, the AAP says that babies should sleep on their backs with no soft objects or loose bedding in the crib. This means no blankets or stuffed animals.

This advice makes sense to me, given the way I have seen my own baby interact with blankets when we are together (putting them in his mouth or grabbing and pulling them over his head). Babies who are still learning motor skills are able to get themselves into situations that they cannot get out of, and objects in a bed can shift at night. These scenarios can lead to suffocation if a child gets stuck with their nose and mouth against a soft object.

Yet based on the photos I saw and the in-person visits I made to facilities, there are many child care professionals still ignoring this critical advice!

Even at the day care we ultimately selected, which has kind and caring staff and a nurturing environment, we were asked to provide a blanket for our son, who was just shy of four months old when he started attending. Instead, I wrote on all his forms that he wears a sleep sack (see examples here, here, and here) to stay warm during naps and should never be given a blanket or any other object in his crib. His caregivers respect our wishes, and we know our son is safer for it.

Although we took care to make sure our son was sleeping based on the AAP guidelines, I cannot help but continue to be bothered by the countless other children who are not benefitting from a safe sleep environment - both at home and when left with people who are supposed to be child care experts.

I sincerely hope that caregivers - especially employees of licensed day cares - receive more comprehensive training on the topic of safe sleep. Parents are trusting these facilities and professionals with their little ones.

Precious lives may be at stake.

Thankful for the Common Cold

Perhaps a little too predictably, after his first week at day care, my baby has a cold. Which means I have a cold. We just got over another cold a couple weeks ago. Apparently, this is my new life.

Yesterday, I found myself sitting in a closet - I mean lactation room - at work, sniffling through my stuffy nose while pumping breast milk, feeling self-pity that God would have the nerve to let my baby get this cold. Hearing my baby wake himself up with coughing in the middle of the night, watching him struggle to breathe well through his dripping nose, and seeing his grumpy tired face on the days we are home together is really hard. No mom wants to watch her baby suffer, and with the common cold, there has been a serious limit to what I can do to make him more comfortable. To make matters worse, my brain seems to have rewired itself to make fretting over my son its own full-time job, something I scoffed at in others until the day he was born.

But then as that pump kept whirring, I had another thought.

I am privileged to be able to expend so much energy worrying about the common cold.

I was reminded of all the things I am not worrying about - of all the things I have to be thankful for. I am thankful that my child has plenty to eat. I am not worrying about malnutrition's effects on my baby's immune system, because I have money to buy food, a well stocked grocery store of safe foods within walking distance of my apartment, and even a private room to pump breast milk for my baby while I am at work.

I am thankful that just this morning I was able to drive five minutes from my home to a doctor's office to get vaccines for my son, so that I am not worrying about him being paralyzed by polio, suffering liver damage from Hepatitis B, or experiencing apnea or pneumonia as complications of whooping cough.

I am thankful to have clean water available from multiple taps in my home every day, so that I am not worrying about life-threatening diarrhea. I am thankful that I had a safe birth experience for my son and that my baby came home from the hospital with me a few short days later with a working heart, strong lungs, a cancer-free body, and an ever-growing curiosity about the world around him. I am thankful that my child has four living grandparents who love him to pieces. I am thankful that I have the financial situation and employer flexibility to work only three days per week, giving me two whole weekdays to play one-on-one with my son. I am thankful that the region where I live does not have malaria-carrying mosquitoes. I am thankful for access to life-saving antibiotics and medicines should my child ever need them. I am thankful to live without fear of daily bombings around my home. I am thankful that my son has a pack-and-play for sleeping, a car seat for safer travel, and an abundance of diapers, along with a huge network of generous friends and family.

The more I sat in that little room and thought about it, the longer the list grew. There are millions of parents throughout the world - and even in my own backyard - in the grip of deep suffering and fear for their children. I realized that in the big scheme of things, I really am one lucky mommy.

So while my ideal week would involve a little more sleep and a lot fewer boogers, today I feel thankful for all of the things I am not worrying about. And I am thankful for the freedom and privilege to worry about this little nuisance called the common cold.

Witness Misidentification: Exonerated by DNA Evidence After 11 Years for a Rape He Didn't Commit

I recently had the pleasure of talking to a lifelong friend who now works for The Innocence Project. The organization seeks to exonerate wrongfully convicted individuals through DNA testing. They also work to change criminal justice policies that contribute to such wrongful convictions. Since their founding, they have already exonerated 334 individuals; their clients have served an average of 14 years before being released. Many of the crimes they investigate are sexual assaults.

Source: http://www.innocenceproject.org/causes-wrongful-conviction

I have countless public health colleagues who are passionate about ending sexual violence. They are advocating for a culture of consent, fighting to change sexist notions and skewed views of masculinity, campaigning against the shame and stigma that many experience when they come forward about an assault, and working to help victims heal from the trauma of sexual violence. They are rightly angry that anyone has to experience this form of violence and that those who do may be deprived of the respect, care, and justice they deserve. This is an extremely important public health topic.

But what happens when a real crime has been committed, yet the wrong perpetrator is identified?

Approximately 82% of rapes are committed by an individual known to the victim. In these cases, witness misidentification is typically not an issue. But in the other 18% of cases, the assault may be the only instance when the victim sees their attacker, and they must rely on their memory of the traumatic event if and when there is an opportunity to identify the perpetrator.

My friend shared with me the story of Ronald Cotton and Jennifer Thompson. Thompson mistakenly identified Cotton in a 1984 lineup, feeling certain that his was the face of her rapist, a face she had painstakingly studied during the commission of the crime in the hopes of catching the man if she lived through the experience. In 1995, however, new DNA technology showed that Cotton was innocent and identified the real perpetrator, Bobby Poole. At that time, Poole was already in prison at the same facility as Cotton for other crimes he had committed. Thompson was shocked; she had been so sure.

Cotton                                            Poole

After Ronald Cotton's release, Cotton and Thompson became friends and have worked together to educate the public about wrongful conviction and to advocate for criminal justice reform. They even wrote a book together called, "Picking Cotton: Our Memoir of Injustice and Redemption."

My friend's passion for the issue and recanting of this true story piqued my interest, and I later watched the 60 Minutes episode about their experience. It is truly powerful.

This is not a story about false accusation due to a made-up story. Jennifer Thompson was raped. And it is not that Thompson was intentionally misidentifying her attacker. Rather, in a way, her memory was tricked when she initially saw a photo lineup that included Cotton and not Poole and noticed some key similar features, such as the angle of Cotton's eyebrows. (Cotton says that other inmates even sometimes confused he and Poole and called one by the other's name.) When Thompson picked Cotton out again in an in-person lineup a short time later, his face was cemented in her memory. Even at Cotton's re-trial in 1987 (before the DNA evidence surfaced), when Poole was in the court room due to a fellow convict's testimony that Poole had admitted to the rape, Thompson did not recognize Poole's face; she was still convinced Cotton was the perpetrator, and he was convicted a second time.

One of the most interesting and telling quotes in the 60 Minutes segment comes from the detective in the case. "Law enforcement wasn't schooled on memory. We weren't schooled in protecting memory, treating it like a crime scene, where you're very careful and methodical about what you do and how you use it. We weren't taught that in those days." (6:40 into the Part 2 video below)

I highly recommend watching the below 60 minutes episode. Not only does it tell the story of Cotton and Thompson, but it also goes into some very interesting scientific experiments on memory that will change the way you view eyewitness testimony.

60 Minutes "Eyewitness Testimony" Part 1

60 Minutes "Eyewitness Testimony" Part 2

While public health seeks to prevent sexual violence in the first place and fights for changes in the public discourse to create a culture of believing and empowering victims, my hope is that we not forget to promote true justice for both the Jennifer Thompsons and the Ronald Cottons of the world.

Get a Breast Pump with no Copay!

Doctors, early childhood specialists, and public health professionals have shown that there are many benefits to breastfeeding for moms and babies who are able to do so. And a breast pump can help a mom continue providing milk for a baby even when she cannot feed him or her directly. For example, many working moms use breast pumps during the work day to express milk for day care the following day.

Since the passage of the Affordable Care Act - also known as Obamacare - many insurance plans now cover breast pumps at $0 copay. The law requires it! Since I have not seen this new benefit widely publicized, I thought I should share with others. (It is important to note that some plans may be grandfathered, meaning they do not have to comply with all of the new rules yet, and some public plans may not be required to offer this benefit at all. But there is a good chance that your insurance does cover it, so why not check?) If you are pregnant and wanting to use a breast pump, even occasionally, I definitely recommend at least looking into it - all it takes to verify is a quick phone call or email!

And the great part is many stores that sell breast pumps will do the work for you to find out what your insurance covers.

For example, Target has a breast pump program. You can either call the phone number listed on their program website or email them at TargetBreastPumpProgram@mckesson.com with the following information:

- full name
- date of birth
- expected due date or delivery date
- address
- phone number
- insurance name
- insurance member ID (including any letters)
- insurance group ID
- insurance phone number
- first and last name of your OBGYN or midwife
- doctor's phone number

They will then contact your insurance company on your behalf and email you back with information about which breast pumps are covered in full by your plan. They will also let you know how much it would cost to purchase an upgrade, for example, to get a bag that can hold all of the parts. Then you email back about which breast pump you want, they handle the insurance transaction behind the scenes, and you simply go pick it up at the location they tell you (a Target store near you).

I was amazed at how simple it was to acquire my breast pump. Now it is hard to imagine life without it! I was able to leave enough breast milk in the freezer for my husband to feed our eight-week-old son when I left them alone together for a long weekend. And I was able to enjoy participating in a friend's wedding across the country knowing that our baby would be well fed back at home!

8 Tips to Get the Most out of Marriage Counseling

Relationships affect our physical, mental, emotional, and spiritual health tremendously, and for those who are married, our relationships with our spouses can be some of the most impactful and life-giving ones we have. Yet even good relationships have areas or seasons of conflict.

Recently, I have had several conversations with friends and family about marriage counseling. Matthew and I have been married for five years now. About two years into our marriage, we decided to go to counseling for several months to help us work out some areas of conflict that we felt were not improving through our own efforts.

Our marriage was not in a state of crisis. We were mostly happy, enjoyed each other's company, and felt secure in our commitment. But there were certain topics that we were unable to discuss without tears being shed due to events and discussions that had happened in our dating relationship and early marriage. We felt that we would be stronger in twenty years if we dealt with these topics in year two, instead of waiting for our challenges to devolve into something more.  So we asked our church for a list of counselors, picked one, and jumped into unknown relational territory for us!

Our Wedding Day, August 2010
(photo take by Anna Wu)

As my friends and family know, after our experience, I became a huge proponent of marriage counseling. It is not as if I now see counseling as a panacea for all relational problems. Just like the rest of marriage, counseling was hard work, and that's coming from someone who did not feel on the brink of disaster going in and was on board with change from the get-go. So no, counseling is not a silver bullet.

So what did counseling do for us? It gave us new frameworks and tools to break out of our thought patterns, communication habits, and actions around certain topics. Although we have always been very strong in communication (you kind of have to be when you date long distance, as we did for two years), counseling helped us reframe one particular challenge from a you-versus-me issue to an us-versus-the-problem one. The new ways of thinking about the issue that we learned eventually changed the way we interacted around it completely.

I am by no means a relationship expert, nor would I claim to know what works for everyone. (That's why I needed a counselor!) However, having had a positive experience with marriage counseling, I wanted to share a few things we learned  through our time on the couch about how to get the most out of counseling, in case it helps another individual or couple in need of some extra support.

8 Tips

1. You don't have to wait until you are in crisis to go. (My husband says you shouldn't wait until crisis.) Most people can and should learn to resolve minor conflicts in healthy ways between themselves, so I am not suggesting you drag your spouse before a conflict arbiter for every disagreement. But I also don't think we have to experience catastrophe level conflict to seek support. Some conflicts (like ours) come up every few months for years without any progress seeming to be made. These conflicts don't need to be earth shattering to slowly erode your trust and joy. Some very common conflict areas in marriage - money, in-laws, children, sex, etc. - can take a toll over time, and my hunch is that the majority of couples could benefit from some improved communication in at least one nagging area. I was so thankful that our friend group had a positive culture around counseling, because we experienced no stigma in the decision to go. In fact, most of our married friends had been at one point or another. It did not mean that our relationship was worse than other folks'. It meant that we were so committed to each other that we were willing to go to great lengths to work on ourselves.

2. Before you start counseling, talk about what you want to get out of it. This was hugely important for us. Counseling can be expensive and time consuming. Matthew and I decided that we wanted to learn new tools to handle a specific area of conflict, and we told our counselor up front that we would attend counseling until we felt we could continue on a positive trajectory on our own in that area. We didn't feel like we had to be perfect or talk through every detail of that conflict, and we didn't feel like we needed to address every single other type of conflict in our marriage. Rather, we wanted to be confident in our healthy ability to resolve the new challenges that inevitably arise in any relationship. After a few months, we felt like we were on a steady path to healing and growth in our particular area of focus, so we ended our professional counseling while continuing to implement on our own the tools and techniques we had learned. Setting a goal from the outset helped us to stay focused throughout counseling and to know when and how to make the transition out of it.

3. Not every counselor will click with you. It is ok to try out more than one. It helps if their general philosophy is in line with your personal beliefs and goals. Although we stuck with the first counselor we tried, many of our friends told us beforehand that they had tried two or three different counselors until they met someone who they respected, who they felt understood both spouses, and who gave truly helpful advice. It is ok to shop around if you need to. My biggest fear going into counseling was that our counselor would "take his side." I was relieved when she heard us both out. At times, she did speak hard truths to one or the other of us, but because we trusted her perspective, we were more receptive to her counsel.

4. Go in with an open mind; consider that you may be (probably are at least in part) the one who has to change. Don't get me wrong. Even one spouse changing for the better can have a huge impact in a marriage. But the opportunity for growth and healing is multiplied by that much more if both spouses are willing to make adjustments. There are two sides to every story, and the reality is that you cannot force another person to change. You can only change your own attitudes and behaviors and pray that the other person follows suit. Some conflicts are more one-sided than others, but we all have room to grow. Going in with a positive attitude and willingness to change personally makes all the difference.

Engagement Photo, 2010
(photo taken by Anna Wu)

5. But you also don't have to agree with everything the counselor says. When the counselor judges a situation in a way that does not ring true for you, after honestly considering what they have to say, it is ok to disagree. That person may hold some different spiritual views, cultural norms, relational expectations, etc. than you and your spouse. Just because you may need to change some things for your marriage to thrive does not mean you have to do everything the counselor's way. When you disagree with the counselor, this is a good opportunity to find out what your spouse thinks. If they agree with the counselor, you may need to go back to number four and see if it applies. But sometimes a counseling session can spur good conversation when you get home precisely because you did not agree with everything said, opening the door to affirming what you and your spouse do believe.

6. Not every session (or even any one session) will be life changing. Take the long view. Sometimes, we left counseling feeling like we did not learn anything new or like we discussed a topic that didn't quite seem relevant to our overall goal for counseling. On those days, we wondered whether we had just wasted an hour of our lives and a chunk of change. (And maybe we had sometimes - more on that in point seven.) Other sessions, we saw the value of the conversation but didn't leave suddenly feeling like different people. Rarely did specific and measurable change come after a single counseling session. Rather, it was something like a year later, when the previous area of conflict came up, and I didn't feel defensive or angry or sad or even like there really was a conflict anymore, that I realized counseling had worked for us. When we had a calm conversation about the topic and each trusted what the other was saying, my husband and I just looked at each other and said, "Wow, we are in a really different (great) place right now! How did we get here without even realizing it?" It happened through gradual (but intentional) change that we could not always see in the day to day slog. Now, several years later, we recognize how different we are for having applied those new ways of thinking over an extended period. It is easier to maintain perspective throughout counseling if you go into it having a realistic long-term view of relational growth.

7. But you can feel more like you are making direct progress each week if you prepare for each session and are intentional about the topics of discussion. Ok, so you may not experience major life change in one week, but at the same time, there are more and less effective ways to spend your time in counseling. If you have something you want to discuss, make a game plan to bring it up as soon as you start the session. We found that sometimes, one of us was having a bad day at work when we showed up to counseling, or we had a minor disagreement in the car ride over, and that ended up being what we talked about for our whole session! Although dealing with our work hangups and resolving what we were having for dinner were certainly important to us, we didn't want to pay someone else to help us in those areas at that time. We found that by having a brief discussion the day before (or even five minutes before) we went to the counselor, we were able to isolate some topics that would be useful for discussion, such as new successes in our relationship, important conversations that had come up in the last few weeks around our area of conflict, questions we had about the tools we had previously learned, etc. It really helped to ask ourselves what we thought we needed to take the next step forward in our relationship based on the specific goal we had set up for counseling as a whole. And our counselor seemed to appreciate our directness about what we wanted to get out of the process, as well!

8. Sometimes one or both spouses also need to seek individual counseling. This is something we have mainly learned from some of our friends who have gone to marriage counseling. There may be some situations where deep individual challenges are affecting your relationship (or just yourself), and it can be hugely beneficial for one spouse to seek additional guidance. For example, if one of you is dealing with depression, a history of abuse or abandonment, addiction, unfaithfulness, or any number of other challenges, counseling with your spouse may not be the best space (or the only space) to unpack all of the ways this is affecting you.

5 years married, 38 weeks pregnant, 2015
(photo taken by Jen and Jason Ko)

While the above tips will not necessarily work for everyone, these are the things that we found most helpful or that stuck out from what our friends have shared about their own experiences in couples counseling.

With the birth of our first child, we have had yet another opportunity to reflect on what marriage counseling meant for us. And we both agree that the emotional growth of the first five years of our marriage - including those months in counseling - prepared us to be completely different spouses and parents than we would have been otherwise. I can look back and see how God was working in that time, and for that, I am supremely grateful. I would not hesitate to go to marriage counseling again for some guidance on a particular issue or even a marriage "check-in" or "tune-up" should we feel the need.

Body Image During Pregnancy

A while back, I posted an awesome video of Jennifer Garner commenting about her latest "baby bump." I felt thankful to see a woman being proud of her body for the amazing feat of bearing children. In a culture that judges women based on appearances so much, it was a breath of fresh air!

I have heard so many pregnant women comment about feeling overweight and unattractive, and I've always thought, "Stop being dramatic. You're pregnant! You're supposed to look like that!"

Little did I expect that when I experienced pregnancy myself, my feelings about my body would be so mixed. Realizing that I am about to surpass my husband in body weight is hard, even though I know that weight is what's healthy for my baby. Seeing so many other parts of my body change beyond just the weight is hard, too. Things leak and sag and ache in ways they did not before. I need my husband to tie my shoes when we go on a walk (and I still have 12 weeks of getting rounder left to go!) Amidst these changes, I sometimes struggle to keep a positive attitude.

Some days, when I look in the mirror, I think my bump is pretty cute, I feel excited about what is to come, and I have joy about the ways my body was made for this purpose. Other days, I walk around calling myself "pudge muffin" or using any number of names that I know in my heart are not helpful or uplifting; I would never say those things about another woman, and yet I feel ok thinking them about myself.

Me at 26 weeks (left) and my friend
Lillian who is due a few weeks later.

Further complicating the pregnant body experience is the way it affects my interactions with others. During the first trimester, I wrote about how lonely it felt to be pregnant and feel sick, with almost no one else knowing. Now, I find the opposite is challenging. Something that began with the most intimate expression of love is now on public display to every stranger on the street; whether I want to share or not, my pregnancy is being carried with me on my physical body everywhere I go.

One particularly trying aspect of this is attempting to graciously listen and respond to others' comments and opinions about this body. (These comments are on top of all the opinions about breastfeeding, co-sleeping, modes of dress, discipline, and all of the other advice well-meaning folks share when they see my baby bump - but those are for another post altogether.)

Even though my weight is on track for my stage of pregnancy, and I have been told as much by my doctor, in just one single week, I had three different people - yes, three - look at my baby bump and ask me whether I was sure I was not having twins. (Aka, "You look enormous!") Each time, I laughed it off and reassured the person that I am not having twins, to the best of my and my doctor's knowledge. Other times, I have had people tell me I am not eating enough at an event and that I shouldn't be depriving myself. I usually just chuckle and let them know that I have eaten a meal beforehand.

But inside, I keep wondering why so many people (mostly women) think these comments are ok, especially when they are in direct response to the size of my abdomen.

Here is what I really wish others around me knew. Being pregnant is physically and psychologically hard! And if you've been through it before, you should know that better than anyone! I hope that personal experience can lead to extra sensitivity instead of extra license to critique.

Comments about a pregnant woman's size in almost any form can cut especially deep; not only do they single out a woman's appearance, but they also carry the added weight of critiquing a mom's ability to adequately care for her unborn child. If I can't even manage to feed myself correctly for the sake of my baby's health now, imagine the parenting disaster when the child comes out!

Anything along the lines of, "Wow, you're huge!" no matter how cleverly disguised or cutely worded, does not feel good. I am capable of tracking my own weight and making decisions about when I am hungry and what is best to eat. Even if I were visibly struggling with putting on more weight than is ideal, that would be a matter between my doctor and me. And then there are some women who struggle with not being able to put on enough weight during pregnancy and can feel belittled or saddened by kind-sounding comments about how they "don't even look pregnant."

A pregnant body is no less personal than any other body. Every woman carries pregnancy differently, and each person who experiences pregnancy has to come to grips with a new physical reality that is different than any she has experienced before.

I am sure I have made insensitive comments to pregnant women in the past and not even realized the implications. I may even still be doing it from time to time! Going through it myself, however, I can really see the importance of being positive - and when in doubt, silent.

Despite the experiences described above, it's not all bad.

For me, the second trimester involved increased energy and much more positivity about the life stage my husband and I are entering. And I can confidently say that my close friends and family have been amazingly supportive. My mom and sister helped me shop for maternity clothes and kept telling me how great I looked. My husband reminds me every day that he loves me, appreciates what I am doing for our child already, and thinks I am beautiful and sexy. And many friends, both young and old, have said things like, "You look great!" or, "You have that pregnancy glow!" that make me feel uplifted and encouraged. They have listened well and even laughed with me in response to my so not carrying twins! To these amazing folks, I say, keep doing what you're doing. I am so thankful for you!

19 week ultrasound - It's a boy!

Baby feet.