"It Didn't Go So"

"It didn't go so," she said under her breath. —Erna Brodber, Myal, p.84.

Unremarkable deaths of social distancing - 01 Apr 2020 22:25

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This piece was picked up by the critical theory journal Telos.

If a global region has a low incidence of COVID-19, (eg. Africa in the bar chart below), or a US state has a low incidence (eg. "flyover country" in the heatmap below) that does not mean it is well. Social and economic disruptions in the wake of this spring's virus will be unevenly distributed in intensity and time. Socially-distanced rural suffering will long outlast the news cycle and panic.

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COVID-19 is a real crisis. It is unique for being concentrated for once in places where global travelers, professionals, and creatives live. When risk for those populations is controlled to a level they can accept, expect panic and restrictions to ease. Our world happily tolerates death tolls far in excess of the worst projected for COVID-19 when only rural people or people with a high school education or less are at high risk.

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Kentucky, where I live, expects our COVID-19 crisis to peak on Saturday, 16 May, with 1,600 hospitalized and 240 in ICU beds on that day. By then, New York is expected to no longer need any COVID-19 beds. Their peak will have been a month and a half previous. Kentucky (more accurately, Lexington and Louisville) will probably be fine when we peak. Tennessee (e.g. Nashville and Memphis) probably won't. Expect the news to have moved on by then.

Kentucky expects less than 900 COVID-19 deaths this year. We also still expect our normal of upward of ten thousand heart disease and cancer deaths, 3,500 chronic lower respiratory disease deaths, 3,300 accidents (1,600 of the accidents will be drug overdoses. 730 will be firearm deaths, mostly suicides), and over 2,000 strokes. According to the CDC, the next seven causes of death in Kentucky — which all remain more likely than death by COVID-19 — are Alzheimer's disease, diabetes, kidney disease, septicemia, and flu/pneumonia. If the 10th cause of death is redefined as flu/cov/pneumonia, it will nearly double and take the spot below stroke in the Ky mortality list. Early death from all these causes will remain most likely among rural people and people with less than a high school education, and is unremarkable.

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It is too early to say how impacts of this spring, such as missed medical appointments, furloughed health care workers, small businesses failing or being bought out by monopolies and private equity firms, higher health insurance premiums, local government budget shortfalls, distressed and broken families, and a possible economic depression will affect normal causes of death in Kentucky. Since at least Durkheim's 1897 study on the topic, it has been known that social isolation increases the suicide rate. Without significant political pressure, increases in hazard that are largely contained away from professionals and creatives will be tolerated.

Globally, the unremarkability of early death in less cosmopolitan classes and places is more extreme. The nearly landlocked Democratic Republic of the Congo, for example, is arguably in Africa's "flyover country," despite its megacity, Kinshasa. It has no or nearly no cases of COVID-19. However, the country is in a grade 3 public health emergency, the same WHO rating as Italy.

Risk factors for COVID-19 death, by income
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Why? First on the list is a virus I can't even spell: Chikungunya virus disease. Also the fifth year of a cholera outbreak, the third year of an Ebola virus outbreak, the second year of a Measles virus outbreak, the third year of a Monkeypox outbreak, the second year of a "Plague" nobody with research dollars cares enough about to do the science to specify what exactly it is, the third year of a vaccine-associated acute paralytic polio, and — the kicker — the aftermath of war.

The economic interests that destabilized the public health capacities of Europe and the US in the last 25 years (most acutely since the Global Financial Crisis) cut their teeth with structural adjustment and imposed austerity programs in Latin America in the '70s, Africa in the '80s, and the former Soviet Union in the '90s. The people who did most of the dying during those apocalypses are remembered as, well, just the sort of people who die.

In a fiery essay in the Players Tribune (W 25 Mar), Miami Heat's power forward Udonis Haslem described the consequences of the selfishness of Miami spring-breakers.

You see that video going around of these silly ass college kids down in South Florida on spring break? Talking about, 'If I get corona, I get corona, bro,' and all that nonsense? …When the average person in Middle America thinks about…social distancing…, maybe they picture a bunch of schools shutting down and then these kids going home to a bunch of nice houses and chilling for a couple months. Eating snacks, playing video games. Mom's working from home, doing conference calls….

For a lot of kids, the truth is that school is the only structure they got. It's the only food they can count on. It's the only safety that’s guaranteed. You take that all away? You better be prepared to protect them…. If you got a roof over your head and some food in your fridge and you don't have to go to work to feed your family, just do the easiest thing in the world, man. Fuck your spring break. Just keep your ass at home.

Mortality in Kentucky
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The mortality rate from suicide, drug overdose, and alcoholic liver disease mortality in Kentucky by educational attainment, for white non-Hispanics age 45-54 who have a bachelor's degree compared to those who don't. From Deaths of Despair and the Future of Capitalism by Anne Case and Angus Deaton.

What he wrote about spring-breakers could easily be said about cosmopolitan entrepreneurs (social or otherwise), nonprofit managers, partiers, artists, and urban professionals in the hardest hit cities—New York, New Orleans, and Detroit. It's maybe no coincidence that those three cities were the most attractive to highly mobile creative-class people I've known in the last decade. Through conferences, weddings, vacations, and other irresponsible travel, mobile professionals and creatives and their wealthy patrons are vectors for a plague that will ultimately hurt them far less than it will hurt people they don't think matter.

I live in a poor county within an afternoon drive of some of the poorest in America. The last two hospitals I worked in routinely take patients from 300 miles away and employ staff who commute a hundred miles each way (eg. Lost Creek to Lexington). Helen Epstein, in the New York Review of Books (R 26 Mar), described how my rural neighbors may react to an economic shutdown over the coming months with suicide, conspiracy theory, and physical pain, but no political mobilization. While these things may endure, the COVID-19 panic will last only as long as our betters are at risk.

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As I socially distance, I check in with my brother, my neighborhood, the truck stop, my workplace, and the places and people I love. What do forgotten people who live in our neighborhoods or our counties need, materially and culturally? What will we need once our betters feel safe and have liquidity, but the place we used to work has closed forever? It's time to somehow carry those we love with us, not through a snowstorm, but through a long winter.

We live together on the Titanic. If first class cabins are taking on water, steerage was long ago flooded to its roof. Governors have worked to protect us, but the federal executive and legislature of my country are now enacting policy like the CARES Act that pumps water out of first-class into the few remaining airspaces of second and third-class cabins. Debt forgiveness, uncapped federal programs with clear qualifying events, and the universal, legally-enforceable right to healthcare and paid work would be a whole new boat.

I'm not suggesting more grants for the Bill and Melinda Gates Foundation to do plague research in Africa. Nor do I argue that Kentuckians should defy social distancing orders and go to church. I'm merely noting that the source of our present panic is an apocalyptic moment spread by and touching the lives of those who at best administrate the apocalypses of others in what they consider normal times. - Comments: 0

SARS-CoV-2 links - 22 Mar 2020 17:31

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This page is updated three times a week. I watch the world from below and to the left. I like universal socialism and decisions that strengthen the resources of particular communities and traditions. Links added on W 15 Apr have red date.

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43 days since 100th known US case. News:

  • 2 days since IHME predicted US peak, 6 days til Ky peak.
  • Observed peaks are likely a false result produced by a lack of increase in testing, and not suggestive of true case rates. The future is expected to be "fat tailed" (highly uncertain). Based on observations in Europe, new case discovery may reach a steady state rather than decreasing in the near-term.
  • Starting in mid-March, partial lockdowns were imposed state by state in the US. Starting in mid-April, there is increasing pressure to lift stay-at-home orders.
  • Senators Bernie Sanders (I-VT), Richard Blumenthal (D-CT), Mark Warner (D-VA) and Doug Jones (D-AL) introduced the Paycheck Security Act, a bill similar to one introduced by Josh Hawley (R-MO), and worth lobbying your senator about. If passed, it will:

cover payroll and benefits for all employees up to $90,000 in salary, and “a portion of fixed operating costs” for businesses affected by the crisis, large and small (unless they have very large cash reserves), for the next six months. Recipients of the grants would not be able to cut pay and benefits for workers and would have to offer previously laid-off workers their job back. There would be restrictions on stock buybacks and dividends (remember big companies would be eligible too), caps on CEO compensation, and protection of collective bargaining agreements. Obviously, by keeping people on payroll, it protects employee health care for those who have it.

Economic numbers:

  • The lockdown-induced global jobs crisis is the deepest and most sudden on record. In four weeks, 22 million unemployment claims were processed in the US. Many more were filed but systems couldn't handle the volume. Furloughs continue.
  • In the first two weeks, 3.5 million workers likely lost their employer-provided health insurance. Tens of thousands of news and healthcare industry workers lost jobs. Finance and insurance did not experience significant job loss.
  • US Congress passed the CARES Act, a $2 trillion relief bill, half the size of the federal budget and the largest relief legislation ever passed by Congress. Multiple Federal Reserve actions preceded and followed it.
  • 80% of the bailout that reached individuals went to people earning more than $1 million/yr, due to a tax break bigger than the airline bailout.
  • $6 trillion got to investors via Federal Reserve vehicles quickly, buoying the stock market.
  • Money to the rest of the population passed through slower and less dependable institutions: the Small Business Association (via loans originated by local banks), unemployment insurance, and IRS checks sent to local banks.
  • The Fed will soon own 3/4 of debt in the US.

Virus numbers:

  • The US is the world's only country to exceed 200,000 (W 1 Apr) and 700,000 (F 17 Apr) confirmed cases.
  • 153,000 global COVID-19 deaths (6% of 2.6 million avg annual respiratory infection deaths). 37,000 deaths in US.
  • Half of US cases and 60% of US deaths are in NYC and its metro area.

Send me links or data you want to see posted.

Live data

Cases, fatalities, recovered, tested:

Treatment and mutual aid:

Policy guidance:

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News watchers

Mutual aid resources

Telework, intimacy without proximity, and big tech

  • My thoughts:
    • Older/poorer people1 are silenced when they don't know how to DM in Slack or unmute themselves in Zoom, when they have bad or no internet, a pay-as-you-go hotspot, or internet only through their phone.
    • Consider slowing pace and bandwidth, promoting more autonomous work. What can be done by phone or dial-in conference-call, email (lists), mail or delivery with groceries, or by newsletter? How do you promote meetings so people don't miss them? School buses are dropping off and picking up class assignments and lunches in many places. How can work, education, or organizing be more distributed and democratic, on and beyond the internet?
    • Older ways of communicating require more work/cost/thought from the sender (eg. using carbon paper or tracing paper and screen printing to produce newsletters). Digital communication requires more (sometimes an overwhelming degree more) from the reciever.
    • Learn about mail art. Send some. Make and mail masks. Send letters. Send mix CDs or homemade crafts. Send money. Think something complex all the way through with a buddy by mail, maybe a buddy in prison, an expert in their field, or a buddy in another country. Mail isn't only for recieving packages.
  • Work, school, family, church, and accessing benefits have become largely computer-mediated. For example, over 90,000 schools in 20 countries moved classes to Zoom videoconferencing.
  • Fight Amazon is the beginning of a conversation about how local retail can fight Amazon (with tech/marketing/logistics) and survive.
    • People can buy books from bookshop.org without hurting local bookstores.
    • Restaurants are considering how to deliver without losing up to 25% to predatory startups like DoorDash or Grubhub (restaurant profit margins are already razor-thin, like 3%-5%).
    • The conversation is an important complement to antitrust law (eg. as applied by the EU, FTC, and DOJ) and to the Senate's proposed Paycheck Security Act.

Benefit programs

  • IRS for getting $1200 economic impact payments direct-deposited (warning: US Bank and other banks may take it under certain circumstances).
  • SNAP for your state, to apply for food stamps.
  • Dept of Labor state resources, including unemployment application, labor rights, and help finding a job. Unemployment insurance has been extended to self-employed and gig workers.
  • NCOA resources for seniors, including Meals on Wheels, transportation assistance, Medicare help, and assistance with utility bills and prescription drug costs.
  • NIDA resources for finding online alcohol/drug recovery support meetings, guidance for treatment providers, and changes to court, jail, and prison policy in your state.
  • SBA page to find a lender eligible to issue a loan under the Paycheck Protection Program (PPP). Terms: The PPP provides 2-year loans of up to $10 million for businesses with under 500 employees. The loan will be forgiven if at least 75% goes to payroll and employees are kept on for at least 8 months. (Currently out of money, F 14 Apr).
  • CFPB information on student loans, mortgage relief, etc.
  • USA.gov coronavirus page for a comprehensive list of government agencies' COVID-19 pages.
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Care and testing

[Care in early stages:] Often the virusemic period is…like a slight cold: malaise…, a slight [subfebrile] temperature…. Take good care of the nasal mucosa and oropharyngeal area…. [Rinse the nasal mucosa with saltwater. Use] non-prescription [decongestants]…. Make a good [saltwater rinse of] the oropharyngeal area behind the uvula…, too…. [Don't just squirt it up your nose, gargle it deep down your throat] and rinse it out…. [Repeat] until you…[have free, unobstructed] airways….

I would advise those people who can afford to buy a nebulizer [aerosol, with ultrasound]. When a cough starts, it is desirable to still apply the medications that we prescribe for patients with bronchial asthma…[like] Berodual, or Ventolin, or Salbutamol…. These drugs improve mucociliary clearance, relieve spasm…. [Use expectorant/mucolytics like] ACC and Fluimucil…. What you can't do is use glucocorticosteroids [like] prednisone, methylprednisolone, dexamethasone, betamethasone [these impair immune response].

[Therapy in later stages:] [If] the cough increases and…there is shortness of breath…: stop, this is a qualitatively different patient…. A cold is one thing…a viral-bacterial pneumonia…is a fundamentally different thing…. We…usually prescribe fourth-generation cephalosporins…in combination with vancomycin [for pneumonia]. This combination is broad, because very quickly there is…a change of gram-positive and gram-negative flora. What immunomodulatory drug to prescribe is a question for scientific research…. In this situation…immunoglobulin…substitution therapy [can help]….

If this situation is not controlled and the disease progresses, then…a person cannot breathe on their own…. Cardiogenic pulmonary edema can be treated with certain medications, [but] this pulmonary edema can only be treated with a mechanical ventilation machine or advanced methods such as extracorporeal hemoxygenation.

What are the tests we need to detect coronavirus infection?
…PCR [polymerase chain reaction] testing, look[s] for viral RNA to determine whether a person is infected…. PCR testing…is now ramping up very, very rapidly in state and local labs as well as in academic medical centers and in the commercial sector…production will grow tremendously. Roche has a machine that will run 1,000 samples at a time. If you go to a commercial lab, they take a swab, they package it, they quite often send it to another facility somewhere else. The turnaround time is typically 72 hours. In that period, it's very, very hard to manage patients and their contacts. It's a nightmare for the healthcare worker.

[Antibody tests are a crucial tool to combat this epidemic.] We need point-of-care tests…you use a finger stick, drop the blood on a small device, and have a readout in 15 minutes. These tests measure antibody response to the virus and are extremely useful. Yet we don't have a single [rapid] test licensed in the US. In China, in South Korea, and in Europe, those tests are used. The manufacturer for this rapid test is producing a million a day.

Study populations in China are reporting significant co-infection rates with COVID-19 and influenza. Yes, you can have both….

Church; Library

Policy, economy, civic virtue

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Rich people getting things, asset prices rising, large military spending and corporations getting bailed out…doesn't…cause the fragility of our system…in any direct and straightforward way. Our system is fragile for specific and direct reasons: we don't have the infrastructure to respond to crises.

We don't have an indefinite mandatorily funded Medicare for All system which quickly and proactively responds to crises. We don't have a legally enforceable right to a job. We don't have government bank accounts for all residents of the United States (but hopefully congress will pass Tlaib's bill and change that). We don't have a system for providing grants to every business in the United States. No amount of money going to where we don't think it should have gone reduces our capacity to create this infrastructure….

This is the largest, fastest economic crisis that has ever happened…. We need 3.5 trillion dollars distributed to households at a minimum — let alone the support system we need for businesses.

Human social institutions are phenomenally durable. We are, as a species, fond of genocide, warlords, raiding, subjugation and misery, but also collective education, storytelling, celebratory feasting, and religion, and it's remarkable how the latter group have historically survived the worst depredations of the former. It seems really crazy to think that oil shortages or inflation would render libraries and fire department fish fries irrelevant, or that hiding out protecting your patch of jerusalem artichokes would somehow be a better use of your one lifetime than fixing roads or otherwise maintaining civic engagement…. Don't give up on other people just yet.

Proud of my state

In the chart below, light bars are tests until 18 March. Dark bars are confirmed cases. (As of 17 Apr, there are 129 confirmed case deaths in Kentucky and 142 in Tennessee. The confirmed case rate is much higher in Tenn, but the risk of death from a confirmed case is higher in Ky).

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Kentucky news

This week's news: rural cases are rising most rapidly in institutionalized populations, people who work in institutions, and counties where many people commute to big cities to do work that can't be done from home. Layoffs of healthcare workers continue, reaching Ky's biggest healthcare systems. Volunteer labor is replacing previously paid care and supply chain jobs.

News aggregated by the Kentucky Office of Rural Health, updated Mondays.

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Peer Recovery Supports Training - 19 Oct 2017 20:28

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NEC's Technical Assistance Center is the best repository for peer recovery supports evidence base and technical assistance I know of. It is run by Oryx Coleman, who co-founded the Freedom Center in Massachusetts with Will Hall.

Good recorded webinars

IPS

eCPR

Open Dialogue

Other recovery tools

For more of my thoughts on how to teach recovery peer supports, see my blog post on Teaching Mental Health. - Comments: 0

Roles for providers in action medical support - 18 Dec 2016 06:31

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Medical providers who have not cross-trained as street medics are welcomed as an integral part of street medic mobilizations. It feels good to get out of the hospital or the clinic and work in the field, free for a moment from the encumbrances of paperwork, "cover your ass" medicine, and frustrating administrators. However, many other things are also different on the street. You don't have staff, advanced diagnostics, easy referrals, charts to give you baseline on patients, or a controlled working environment.

By working outside of medical institutions, each action medical worker becomes personally responsible for establishing and maintaining appropriate clinical boundaries in the street. How you carry your social authority may cause some people to cling to you and others to be afraid of you and refuse care. Working as part of an action medical mobilization requires an open mind, real humility, and a willingness to learn from anybody, admit what you don't know, be creative, and constantly improvise. And it can change your life.

A few roles have a particularly good "fit" with providers who have not cross-trained as street medics.

Buddy

You can plunge right into the fire and work in the field at actions, housing, or jail support as the buddy of a street medic. Don’t cheat yourself by buddying up with another medical provider; find a street medic who is not a medical provider. Your exchange with her in the street will be worth it. When choosing your buddy, get to know her and ask her questions before making a commitment. Ask when and where she was trained as a street medic, and if it was a 20 hour training. If she can't tell you, or didn't attend a 20+ hour training, she isn't a street medic. Find another buddy.

It is appropriate to ask a street medic for names and contact info of people she has worked with at past actions who can "vouch" for her as a medic. Feel free to ask, and to check in with those people and find out what they have to say about her. Ask her what actions she has worked at and what she thought of them. Ask what kind of risks she prefers to take at actions. Ask about her political philosophy. Ask if she holds any certifications or licenses in the medical field.1 Ask if she is an herbalist. You're looking for someone you can trust in the field, and someone you would like to work with. Some medics may not want to work with you if you do not have action medical-specific training. Among the many legitimate reasons for their preference might be their concern about your practical politics of informed consent or your skill in more highly fluid tactical situations. Don't be offended; be grateful your lack of affinity was discovered *before* you entered the field!

If you find someone you'd like to buddy with, encourage her to take point and to provide the majority of the care. Start practicing empowerment with your buddy! If she seems really inexperienced it's probably because she is. From your position as the "scene assessment" buddy, you can learn what your buddy knows and maintain the detachment to kindly help her grow in her confidence with assessment and care skills. Her bad health promotion judgment calls are learning opportunities for her and sometimes chances for you to kindly and respectfully help her learn. You will probably make bad tactical judgment calls, from which she can help you learn. You and your buddy can decide to switch roles in the course of care if she wants you to get hands-on with the patient or you need her to make judgment calls about your team's response to a rapidly developing environment. Debrief after every patient, and take the time to listen as well as to teach.

Clinician

Action first aid spaces and wellness centers are very different animals from most community clinics. They exist as an additional tier of care provided by action medical at an action, and do not replace existing community health services when those are needed. Patients who do not immediately need emergent care services offered by technical medicine use action wellness/first aid space to rest, get a higher level of patient care than can be provided in the street, get injuries documented, receive wellness services or nursing care, or consult with an herbalist or other clinician.

A common sight in action wellness/first aid spaces is "the drunk guy who face-planted." His friends flagged down a street medic and reported he stood up on a park bench and fell on his face. He's drunk so you can't really evaluate the cause of his altered mental status. No vomiting, no observed transient loss of consciousness, pupils equal, round and sluggish in response to light. The medics try to get the guy's friends to take him home and follow the guidelines on the head injury aftercare sheet, but they came all the way from Montreal and really want to be out in the streets. So the friends take him to the action wellness/first aid space. During his evaluation, he's meek and apologetic. Medics make him comfortable and let him sleep, herbalists brew up some tea, and a medic wakes him up every hour to check his pupils and look for late developing signs like raccoon eyes or Battle's sign. He feels better by the time his friends come back, and the medics send his friends home with clear instructions for using the head injury aftercare sheet.

Action wellness/first aid spaces don't see themselves as definitive care. In a pinch, they stretch their resources and pull off amazing feats with patients who absolutely refuse transfer to definitive care. But for everybody else, the clinic triages them into those who leave quick with or without a simple intervention, those who stick around for a while for assessment over time or rest, and those who leave quick in an ambulance or a car for the hospital. The action wellness/first aid space needs a good list of local low-cost and free health and social services to give patients who require definitive follow-up or services the action wellness/first aid space cannot provide.

There isn't a staff at the action wellness/first aid space to keep things running smoothly, just the volunteers scheduled during your shift, with whatever skills they have. They serve the patient, not the doctor. A street medic with experience in action wellness centers or action first aid spaces (and their buddy) should always be onsite to do clinic coordination or everything could fall apart. Jobs that need to be done include scheduling, constantly organizing and labeling supplies (and throwing out or hiding supplies that should not have been donated), cleaning up, and staffing the front desk. Some spaces include intake workers; in others, you do your own intake. People come in waves that depend on the action and mood in the street. Sometimes it's dead for three hours, then the space is suddenly swamped, right after the provider left from boredom.

Nurses and herbalists prove some of the best at intuitively understanding what is needed in action wellness/first aid spaces. The basics are two pillows and a blanket somewhere that is quiet, clean, accessible and feels friendly and safe enough for patients to relax; a box of correctly-sized exam gloves; and a caring, competent, sympathetic clinician. Everything else is extra.

Generating records for lawsuits and criminal defense

Patients sometimes want police-inflicted injuries documented for legal purposes. Common injuries include almost visibly imperceptible wrist abrasions or bruising combined with compression neuropathy of the superficial radial nerve caused by long custody in overtight handcuffs, or 30 cm wide contusions in lateral lumbar regions caused by blunt force trauma (usually from projectiles fired at fleeing protesters). Sites where requests for injury documentation are most common include at jail support (when support teams including medics, legal, and comfort maintain vigil outside holding facilities to receive released arrestees), in the action wellness/first aid space, and at housing sites. Street medics take photographic and written evidence of injuries and give these records to the patient. Reports written by anybody other than a medical provider are considered hearsay by judges, but usually a legal team can use them to build a case.

Medical providers have the authority to create official medical records which can be used as legal documents in court. The authority to create legal documentation of injuries can be a great asset to patients. In the United States, medical doctors and doctors of osteopathy are granted this right in all states. The ability of nurse practitioners to produce official medical records with the authority of legal documents in court is governed differently by each state's advanced practice nursing or advanced nursing practice laws. When producing medical records for patients, be sure to provide your business card or other contact information along with the record, so the patient can easily contact you and call you as a witness in court. Be aware that if they do initiate a lawsuit, it may be several years before you are called.

Medical records for hungerstrikers

Official medical records are also highly useful in support of hungerstrikes. Hungerstrikers use their own declining health as a bargaining chip, often when more moderate tactics have failed, and all they have left to bargain with is their own lives. Accurate, regular medical records collected every week (or more frequently during precipitous declines in health) can be given to the patient who may then share them with their support team in order to publicize their cause and their determination. Records may be used in court and you may be called as an expert witness if the court intervenes on the behalf of the hungerstrikers.

The role of a support medic during hungerstrikes is never to support the strikers' health — health support begins when strikers voluntarily break their fast and need info about a safe food reintroduction schedule, aftercare, and recovery support. Hungerstrikers' intent is to get as dangerously unhealthy as possible as quickly as possible and be as well-publicized in their campaign as possible so they can win as soon as possible. Lab reports on significant bloodwork interpreted by a sympathetic doctor on an evening news program can spark widespread concern and sway public opinion very quickly.

When hungerstrikers are incarcerated people (as they often are), you may use your social privilege to gain access to them and release the records to the support person(s) of their designation. In these situations, your special access allows you to be a valued advocate if they are being abused (ie. by forcefeeding orally or intravenously, which is rarely legal, by clandestine harassment or torture, or by inappropriate and life-threatening food reintroduction after a voluntary end to the fast).

Injury prevention

One of the greatest assets medical providers can bring to action medical mobilizations is wise and strategic use of medical authority and social position.

At a large Occupy Wall Street action in New York City, a street medic buddy team was evacuating a patient with a head injury and altered mental status using a chair carry. Their goal was to get the patient clear of the crowd and outside police lines where they could transfer care to EMS. They grabbed two medical doctors in white coats who were protesting with a group of doctors and asked the doctors to help them negotiate through an otherwise impassable situation. Doctors who look like what people expect a doctor to look like can flag a cab in situations when it will not stop for anyone else.

In an unusual situation at a large anti-globalization protest in Philadelphia, a paramedic was waiting for ambulance backup, kneeling in the street and immobilizing the head of a downed patient with cervical spine crepitus and mechanism of injury for a c-spine fracture. He used his paramedic medical rank (higher than first-responder and EMT-B trained police officers) to order an advancing line of heavily-armed riot police to turn down a side street and re-form behind him. The line of police complied.

Similarly, an outraged medical doctor who looks like a medical doctor can work magic in a civil disturbance at times when a medic who looks like an outraged protester would become an additional casualty. At the Miami Republican National Convention in 1972, the police raided the truck street medics were using as a mobile staging unit. The police dumped all the supplies on the ground and were tossing lit matches on the pile. In the pile were two full O2 cylinders, and surrounding it was a dense crowd. A nurse practitioner in the crowd (who looked like a protester) found her way to a nearby hotel lobby, grabbed a bystander who had the look of medical authority about him, dragged him outside, and showed him the situation. The presumed doctor quickly went from fighting her off to full-blown outrage at the dangerous situation the officers were actively creating in the midst of a dense crowd. He took his outrage directly to the most in-charge-looking officer, who curbed his little pyromaniacs before anything exploded.

Spend enough time in the streets, and you will get your own story of a daring rescue using nothing but your posture of authority and negotiating skills, your courtroom testimony that changed the whole tone of a trial, or your neatly placed phone call or email that defused a situation before it ever happened. It is magical to be able to put your authority on to challenge illegitimate authority, and take it off to work in a horizontal organizing structure or provide care to a person who is extremely skittish after being brutalized by another authority figure. Using your authority strategically is a way of providing care.

Legal notes

This document is about roles, but most medical providers come to this work anxious about legal liabilities. Insurers want to scare doctors into thinking volunteer care is legally risky even when it isn't, because insurers benefit financially when anxious doctors give them money. Thus if you search the literature, you'll find a weird clash of strongly-worded suggestions that volunteer providers carry malpractice insurance and strongly-worded reminders that malpractice suits are vanishingly rare when it comes to volunteer doctors.

Federal protections for physician volunteers:

  • Volunteer Protection Act (VPA) of 1997.
  • Federal Tort Claims Act's (FTCA) Medical Malpractice Program, as extended by the Health Insurance Portability and Accountability Act (HIPAA) of 1996, and further extended by the Patient Protection and Affordable Care Act.

State protections for physician volunteers:

  • Good samaritan laws are on the books in all states; they generally apply to emergencies if the emergency wasn't caused by the good samaritan, care wasn't grossly neglegent or reckless, and care was given with permission if possible.
  • Some states immunize medical volunteers via the same apparatus used to immunize state employees from liability (operates similarly to federal FTCA Medical Malpractice Program, and usually includes a state-administered defense fund).
  • Some states (eg Michigan) immunize all volunteers from suit, including volunteer health practitioners (with exceptions, like surgery).
  • Some states (eg Virginia, Connecticut) immunize volunteer health practitioners by allowing them to purchase malpractice insurance with premiums paid by the state's department of health.

These laws come out of a recognition that states have abandoned their responsibility to serve the health needs of their population, and the unrealistic hope that volunteerism can somehow fill the gap.

There are still three things of which you must beware:

  • Records you generate must stay with patients — HIPAA still applies and fines start at $10,000.
  • You lose your license by forgetting to renew it, not by fulfilling your oath outside of your institution.
  • Protests are places of intense ethical conflict — you must struggle to be relentlessly ethical, not because you fear lawyers, but because your soul demands it. - Comments: 0

On affinity group medic trainings - 29 Nov 2016 08:03

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Dave P and I taught an Affinity Group Medic (AGM) training in Atlanta as part of the convergence against the Klan last April. Hopefully these reflections will contribute to the larger conversation about trainings that's been happening among street medics over the last year or so.

What is an Affinity Group Medic?

The purpose of an AGM training, as I see it, is to promote the assembly of affinity groups. I would wager that self-organization into affinity groups does more to improve health and political power than any other intervention we make.

The way the training promotes self-organization is by promoting a circumscribed goal. The AGM doesn't attend to the health of strangers; only the health of friends. In order to be useful in an AGM role, she has to assemble an affinity group.

I believe that, unlike street medics, AGM is not a basic scope of practice. It is a role, like comms or police liaison. I teach that the only requirements to be an AGM are the desire to fill that role and the consent of the group. The AGM training may make one a better AGM, but is not a prerequisite for the role.

In an action, an affinity group has a goal. That goal might be to cut a fence, block a road, provide safer space, do clinical support, carry water, do media, be marshals, spiral dance, scout, drop a banner, make lots of noise, cook and serve food, do childcare, do jail support, or whatever. The AGM's job is to help them achieve that goal without injury or illness. It is a before, during, and after role.

What are the core skills?

During a human barometer, people arrange themselves from "strongly agree" to "strongly disagree" in response to the statement "People come to me for help." This identifies natural AGMs, and leads to good conversations, especially between the agreers and the disagreers, about things like referrals and healthy boundaries.

I see the core of the ideal AGM skillset to be SAMPLE and confidentiality. When I taught an AGM training in Ferguson, we spent a lot of time on confidentiality. Unfortunately we breezed by it in Atlanta. This is in contrast to what I see as the core of the street medic skillset: initial assessment and consent. The difference: AGMs care for friends; street medics care for strangers.

SAMPLE helps the AGM start health conversations, build trust, and assess risks faced by group members before the action. If the medic knows group members' allergies, medications, and past pertinent medical history in advance, she can better assist when group members are trying to balance personal needs with group actions. Confidentiality is the ethical response to the trust that affinity group members extend to their medic.

During the post-training evaluation, students said they liked

  • PEARL1 buddy check-in
  • SAMPLE
  • HALTS and "What did you do to take care of yourself today?"/"What do you need to do?"
  • Local resources: alternative to 911 mental health crisis line, peer support warmline, others.

I don't have the eval notes in front of me, but I remember people saying they had concrete situations in which they could immediately apply those assessments and resources.

A student raised how AGMs are prepared for acute first-aid, but recovery is a prolonged process. Some students wanted to improve their skillset for supporting post-action/post-crisis recovery. That stuff won't be included in the 6 or 8 hour AGM training as I teach it, but would be good to flesh out into a good-length training for the populations we serve.

The agenda for the 7-hour training in Atlanta

  • 2 hour health and safety (open to people who don't want to stay for the rest)
  • Affinity groups lecture, SAMPLE practice, and confidentiality discussion
  • Scene assessment and communicating about a scene practice sessions and debriefs
  • First aid lectures, demonstrations, and practice sessions (no initial assessment)
  • Lecture and discussion on local referral options.2

If we'd been able to do it on Thurs, the plan was to support AGMs in teaching the Health and Safety training Friday.

The 2 hour health and safety is is similar to this outline (which I use as a handout): Ferguson health promotion training outline. That whole training is fun and works well. Students do human barometers, paired buddy check-ins, eyeflushes, and a really fun "best-dressed protester" exercise.

The affinity groups lecture, SAMPLE practice, and confidentiality discussion used Sophia's SAMPLE training sheets

The scene assessment and communicating about a scene practice sessions and debriefs used Dick R's style of communicating about a scene: Scene safety training exercise) and a scene awareness exercise led by Dave P that I think I've seen Charles and Leah do in the past. Both exercises were hits.

For the first aid lectures, demonstrations, and practice sessions we worked through Colorado Street Medics' 2010 first aid zine,3 which all students got a copy of. We dumped fake blood on each other, students practiced gloving up, using roller gauze, walking assist, putting each other in shock position, etc. CSM's zine is pretty good because it has pictures. I'd like to start sending students to Where There Is No Doctor's new first aid chapter and Buttaravoli & Stair's Common Simple Emergencies on their phones during future trainings.4 I feel like otherwise they'll forget to look at it when they need it.5

There were no activities during the lecture and discussion on local referral options.

Four final comments

1. We should have integrated SAMPLE more deeply into scene assessment (give people cards with AMPs of their fictional affinity group before going outside for the exercise), first aid, and referral options. As it was we taught SAMPLE then never referred back to it.

2. Street medic trainings (because of the centrality of consent) provide lots of opportunity for practicing communication. AGMs don't need that much practice, but could use some. It should be adapted to mimic communication with someone the AGM knows.

3. We taught privacy circle but didn't emphasize how intensely a crowd mobs a casualty; wanting to help or protect the casualty, or just curious. I remembered this crowd behavior when, during the anti-Klan action, a person with a breathing difficulty was mobbed by a crowd (including two street medics who didn't recognize that a nurse was already on scene). The paramedics arrived promptly with oxygen, but that poor person needed space.

4. Scenarios adapted for caring for known friends instead of randos would be great.

Hope these reflections help someone :) - Comments: 0

SAMPLE training sheets - 30 Apr 2016 19:21

Tags: first-aid how-to protest training

I got these SAMPLE practice sheets from a training Sophia wrote for Chicago Action Medical around 2003ish. She may have gotten them from Black Cross Health Collective or may have written them herself. I love to use them for teaching students how to take a patient history. A fragment from one of my training outlines from 2013 is in this post below the practice sheets.

Besides seeing the utility of SAMPLE and learning the acronym, an objective I always have when teaching SAMPLE is to encourage students to suspend forming an opinion; to live in the question, not the answer.

Finally, I remind students to trust the people they help. Often this interview helps chronic illness sufferers or people with disabilities remember what they need to do. They are already the experts on their conditions! We assist them in locating the problem with SAMPLE. After they decide on an course of action, we may assist them in carrying out their plan.

In affinity group medic (AGM) trainings, I encourage students to talk with their affinity group members confidentially about members' allergies, medications, and past pertinant medical history before an action. This establishes knowledge that can help the AGM be a better wellness buddy, and also establishes trust. If you can keep group members' confidence before they're hurt, they'll trust you more later when they're hurt and scared.

Kaylee

S: Shortness of breath.
A: None.
M: Inhaler for asthma.
P: Diagnosed with asthma at age 15; no other medical problems.
L: Had nothing to eat today.
E: Running from cops; scared.

Jayne

S: Headache around eyes.
A: Sulfa drugs.
M: Takes birth control pills.
P: Got hit on head one week ago, had a wrist fracture one year ago.
L: Nothing to eat today; has been drinking coca cola and water and peeing "a lot."
E: Went out on blockade at 7 AM; slept 3 hours last night.

Malcolm

S: Nausea and diarrhea.
A: Milk, nuts.
M: Epinephrine for allergic reactions.
P: Nut allergic reaction about 6 months ago; had to go to hospital.
L: "Shitting every 15 minutes," has not vomited; ate big chicken dinner last night but nothing today.
E: Chicken dinner; just been hanging around convergence center all day.

Inara

S: "Sprained" wrist with pain (hurts to move it).
A: None.
M: None.
P: Broke same wrist in 1996.
L: Ate oatmeal and drank tea about 2 hours ago, went to toilet a few minutes ago.
E: Fell on wrist, running around in crowd.

Simon

S: Fell down, dizzy, feel hot.
A: Aspirin.
M: Seizure medications.
P: Seizures since age 23.
L: Ate breakfast today at 8 AM, lunch at noon, went to toilet an hour ago.
E: Stood in sun at rally for about 6 hours now.

River

S: Itching on abdominal area.
A: Hay fever.
M: Homeopathic pills for hay fever.
P: Skin condition "with a name I donÕt recall" that cleared up with medication in 2003.
L: Ate pie for breakfast, drank coffee and later tea.
E: Used special soap meant to take oil from skin as protection from tear gas.

Zoë

S: Drunk, dizzy, nauseous.
A: None.
M: "Just the whisky!"
P: "I drink all the time!"
L: 12 drinks in 3 hours, ate a pizza 2 hours ago, urinating constantly.
E: "Just felt like partying after the big riot."

Wash

S: Chest pain, with 'acidic' feeling.
A: None.
M: Rheumatoid arthritis medications.
P: "I have heartburn," denies history of heart problems.
L: "Deep fried Mars Bars" and a pizza for lunch today, no dinner yet, drinking water.
E: Ate about 60 minutes ago; no other events since then.

SAMPLE patient history

Refer students to SAMPLE on chart paper—students must see SAMPLE, not just hear it.

Facilitator says: Sometimes the SAMPLE history is over quickly. Sometimes it is a time consuming and detailed interview that begins in the first few moments of patient care and continues until you walk through the doors at the emergency room. Good SAMPLE histories can be disorderly and divergent. They go off on tangents. They explore deeper than the basic questions. They encourage the patient to talk and elaborate when the patient is able.

S: for Symptoms.
A: for Allergies.
M: for Medications.
P: for Past medical history.
L: for Last food and drink (and last shit and piss).1
E: for Events.

Facilitator says: Run through SAMPLE in your head every time you take a history to make sure you cover all your bases, even if you ask questions out of order. Memorize this acronym.

Trainers model SAMPLE and debrief

Facilitator says: Let's see what we can learn by taking a SAMPLE history.

3 students: volunteer. Each gets a Reader opened to Sophia's SAMPLE practice sheets. Each student gets to pick which patient they want to be without telling trainers.

Trainer buddy pair: interviews each student sequentially in front of class.2

After each interview, facilitator asks class: What did you learn about (patient's name) from the SAMPLE history? What do you still want to know?

Students model SAMPLE and debrief

6 more students: volunteer. They come up in front of the class in pairs and each of 3 students playing medics interviews each of 3 students playing Sophia's patients.

After each interview, facilitator asks class: What did you learn about (patient's name) from the SAMPLE history? What do you still want to know?

OPQRST pain history

You don't get much information by asking, "What are your symptoms?" There are lots of good questions for zooming in on the chief complaint. The most useful a string of letters from later in the alphabet.

O: for Onset.
P: for Provokes/Palliates.
Q: for Quality.
R: for Region/Radiates/Refers.
S: for Severity (1-10).
T: for change over Time. - Comments: 0

Scene safety training exercise - 30 Apr 2016 15:58

Tags: first-aid how-to protest training

This training exercise is based on the way that a long-time member of Chicago Action Medical mentors new medics when they buddy with him. As they walk around a protest, he asks questions like the ones below. One of his buddies suggested we drop most of our scene assessment lecture and replace it by assessing the actual scene (with some added imaginary elements) around the sketchy locations we hold trainings.

Actual scenes students have walked through at trainings I've led include loading docks, blind alleys, razor wire-topped fences, broken glass, no running water or handwashing stations, broken water filtration (contaminated water source), high-speed busy roads, dangerous banner drop locations, bus shelters, children and people with extremely limited moblity, and an approaching wildland fire. At several trainings, students used their breaks to control risks they had identified.

The below training text is from a 2013 training in the Piedra Wilderness Area of Colorado. It is not the whole Scene Assessment section, just the "good parts." Since 2013, I've used this exercise with modified questions in St Louis, Chicago, and Atlanta. It's always a hit!

Introduction to scene assessment

Facilitator says: Watch surroundings and communicate.

  • Look for danger.
  • Make the scene safer.
  • Be prepared for the scene to change.

Facilitator says: Scene assessment encompasses a lot of continuous observations:

  • Personal (Ethan’s here, he gets seizures).
  • Specific (the baby bloc pushing strollers is right next to the Commie bloc chanting about shooting Obama).
  • Big picture (open businesses, street grid, weather).

Facilitator says: Always assess scene and stay situationally aware—especially when things seem calm and no one is injured.

Practice communicating about a scene

Facilitator says: We’re going to practice doing scene assessment as medic affinity groups here at camp. An experienced medic will walk around camp with each group, and guide you to see the scene.

Proctors: identify selves.

Students: break into as many groups as there are proctors.

Facilitator says: before you head out, answer these questions:1

  • Who are the organizers and logistics people at this camp?
  • Is there cell reception in camp?
  • Who has a charged phone?
  • What is the local emergency number for medical/trauma emergencies? What resources exist for someone in camp who needs help with sexual/domestic violence, STI/blood-borne illness testing/treatment, mental health crisis, poisoning, or addictions recovery support?
  • If you call 911, what hospital will someone end up at?
  • What is our camp evacuation route?
  • How long would it take to evacuate one limping (assisted) or unresponsive (carried) person to a rendezvous point? All the way to definitive care?

Groups: Go assess the scene around the training location for 10 minutes. As they walk around, their proctor asks Dick Reilly-style questions like these:

  • Where are your exits?
  • Where are your treatment areas?
  • Where are the police?
  • Where are their bosses?
  • Where are the legal observers?
  • Where are children and elders?
  • Could the weather change?
  • Who is most at risk here and why?
  • What are the biggest dangers here and why?
    • What are choke points?
    • Obstacles for panicked crowd?
    • How can we calm crowd?
  • What is the state of food, water, and sanitation?
  • Where are alcohol and intoxication clustered?
  • Where can someone go to get away from all alcohol and intoxication all night?
  • Where can someone shelter-in-place out of weather?
  • How can someone leave camp to get care or go home?
  • If "…," then what would you do?2
  • If "…," who would you involve, where would you refer the person, or who could improve the situation?

Debrief

Facilitator asks: How did communicating about the scene as a group change your individual perception of it?

If your team sees injured protesters

Facilitator says: Look for danger/needs/resources. Stop to decide plan and activate back-up. Scene assessment continues while your buddy team:

  1. Exits the scene,
  2. Uses available resources to control scene (but does not assesspatient or provide care),
  3. Or controls scene, engages patient, prepares to do advocacy.

Calling 911 to activate EMS

  • Know location; In city: exact address if possible, at least cross streets. In backwoods: know name of your area, directions to road-accessible rendezvous point, nearest highway mile marker, GPS coordinates.
  • If you’re a medical professional, identify your title, cert or shield number for authority drag purposes (or choose to remain anonymous).
  • Say patient’s chief complaint (if known). Follow dispatcher’s lead. Stay on phone. Response time depends on 911 dispatcher’s assessment of urgency and availability of responders.

Scene control options

Get to a safer scene by foot, car, transit, cab, or ambulance

  • Get out of cold, rain, wind, or heat.
  • Help someone back up from a fight
  • Get to wellness center or hospital.

Stay put; make scene safer around you

  • Calm, comfort, reassure: Sometimes the scene is safe but the injured person is so hyped he doesn’t recognize it is safe.
  • De-escalate and redirect hostile/nosy bystanders: Use humor, give something to do, be polite, firm, and cheerful.
  • Create privacy circle. - Comments: 0

What Katrina taught me - 27 Aug 2015 18:09

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I wrote this two years ago for a Katrina anniversary event I agreed to speak at but couldn't attend.

Good evening everyone. Thank you to Nancy for inviting me to speak at this event. Unfortunately, a little disaster prevented me from attending. On my way back from training health workers in the Four Corners region of Colorado, the clutch gave out on my car. While I try to put together $900 to remedy this situation, I'm stranded far from home, far from this event and my job and everything I had hoped to do this weekend.

My little personal disaster is not a bad place to start thinking about what it means to weather a storm like Katrina's aftermath. The subjective experience of a catastrophe is in many ways like that of a million little disasters repeated across space and through time, with those who are vulnerable no different from those vulnerable outside of disaster.

I remember the emptiness of major streets in the Algiers neighborhood of New Orleans after the winds and rain of Katrina had been replaced with impossible stillness and impossible heat. I remember who stayed in my neighborhood: disabled residents and elderly residents and a few of their caregivers who could not bear to leave them — and a handful of neighborhood leaders who felt a responsibility to stay to ensure the survival of the neighborhood.

I remember the forces that wanted us gone: the cracker squads who declared "open season on niggers," the police who closed the parish border to blacks, trapping disaster survivors in, the 82nd Airborne and 1st Cav soldiers who evacuated the Fischer Housing Project a week after the storm as if it were an insurgent village on the border of Pakistan. The flying vees of unorganized New Orleans Police who kicked in doors and settled scores. The politicians who staged a land-grab, promising 80,000 property lots to developers, then had to ensure that 80,000 property owners remained displaced.

Most of all, I remember why a ragtag group of people who believed in the right of black communities to practice neighborhood self-defense established and developed the first civilian healthcare services in the city, a free clinic on the corner of Teche and Socrates streets in the Algiers neighborhood on the West Bank of New Orleans. I think those of us who nurtured the clinic through its first months had many different reasons why we did so, but we met on one.

The City of New Orleans was built by its residents. It is its residents. The world owes New Orleanians for the vibrant life they made from the scraps they've had to work with, the music and way of life that makes the world smile. The city could only be rebuilt by its residents. In the aftermath of the storm, its survivors and heroes faced dispossession, state terror, and casual murder. Those who wanted to stay might benefit from a health corps to attend to their medication refills, listen, and advocate for them as they strove to hold ground against dispossession and rebuild. We knew how to do health work.

Every day was like a year after Katrina. I don't talk too much about it anymore, because once I start it is hard to stop. Maybe you're lucky that I'm stranded with a broke down car in a national forest, because it means I can't overwhelm you with stories of the horror and the hope I lived through. Some day, if you see me, stop me on the street and ask about Katrina. For as long as you want, I'll tell stories that have come to define my life.

For now, I have three goals. I want you to imagine catastrophe in a way that makes it familiar, not foreign. I want you to know the degree to which disaster survivors rise to almost any occasion and totally outclass organized relief efforts. Finally I want you to know how even the organized relief I loved most suffered from a failure of the imagination. I will say this now, and again after I make those three points: in a catastrophe, our hope does not come from the hills, it comes from us.

To make the familiar foreign, I want you to imagine that your house burned down. No one died in the fire, thank God. You lost your essential documents, your mementos, your bank card, checkbook, medications, eyeglasses, food stamp card, phone — everything. The Red Cross puts your family up in a shelter for a while. Some of your family and friends help; some avoid you. You try to deal with your insurance and your financial institutions. Most of what you lost can never be replaced. Even years later, a certain pain and alertness remains.

Now imagine that your bank also burned down, and the local Red Cross. All the hotels, and all the pharmacies, all the grocery stores and food stamp offices burned too. Your psychiatrist's office burned, the emergency room burned, The Lighthouse for the Blind burned, and so did the homes of everyone you've ever known and everywhere you've ever been. Everywhere you could walk to is burnt to smoking ruin, but you can't even see to walk. What would you do?

I don't know you, but I'll wager money I know what you'd do. Within 24 hours someone would find you, and together, the two of you would find someone else to help. You'd help them dig through the wreckage of their home. You would canvass the neighborhood, meet neighbors you never knew you had, look for survivors. You would give away food you found and share information. You would begin to self-organize, prioritize, and surprise yourself with your collective ingenuity.

When the soldiers were sent in to New Orleans after Katrina, they were told to restore order, to establish a jail, to clear houses, to stop looting, and to fear disaster survivors. The guardsmen who stayed long enough to properly see for themselves, saw a New Orleans safer and more egalitarian than was imaginable, self-organized for survival, with bitter enemies working side-by side. In my neighborhood, when our detachment of guardsmen realized this, they knew they had been misled. By mid-September 2005, they began to ignore their orders and ask survivors how they could help.

It is harder to show the ecological toll of Katrina, because I don't know it well enough. I was inside a clinic for 18 hours a day, 7 days a week, so never saw the effects of the Murphy Oil Spill in St Bernard Parish, or the land loss in native communities of lower Lafourche and Terrebonne Parishes. I didn't get to see the massive hazardous waste dump in New Orleans East where a city's worth of building material was deposited. I wasn't with my cousin when she encountered a quarter million dumped refrigerators. The human toll — and human potential — that I saw from the clinic took all my attention. Our biggest environmental illnesses were a nonspecific rash and the Katrina Cough, a difficult-to-treat upper respiratory infection that everybody had for a while.

After Katrina, I saw only people, and the bonds between people. At first I saw people who lived on a fixed income and depended on medications to manage their asthma, blood pressure, diabetes, chronic pain, or schizophrenia. The storm came on the 29th, so their check was gone and so was their medication. Then I saw people who needed to talk through horrific experiences, terrible fears, and the impossible challenges ahead. Then I saw hundreds of Sewerage and Water Board workers who needed tetanus and hepatitis vaccines before they returned to work. I saw people who felt safer sitting in front of the clinic than in their homes because of the constant danger of state violence. I saw our clinic volunteers decompensating and finding no one who could understand the burdens they carried after all they had witnessed.

This brings me to our failure of imagination. Our little clinic, established by nonprofessional movement first-aiders and disaster survivors in a mosque, was for a year the busiest free clinic in the nation, ranked in the highest tier of clinical care. Thanks to volunteers and donations, we provided care at the lowest cost per patient. All very exciting.

However, in our exuberance, we replaced disaster survivors with out-of-state volunteers, dropped our initial model of being a medical support corps in order to emulate Federally Qualified Health Centers, and failed to provide adequate mental health support to our volunteers. The clinic did not close. It is still at 1401 Teche St, and still sees patients. It is a long-term commitment to the health of a black American neighborhood it joined in a time when the oldest and sickest stood their ground against a militarized land grab.

However, I also learned the toll that disaster takes on those that come from out of town, who leave their lives to spend months or years participating in relief and recovery as unpaid volunteers. New Orleans was a citywide support group for a while. Survivors were invited, but out-of-town responders were not.

After listening to hundreds of survival stories, becoming deeply involved in people's lives and struggles, and living under extreme state violence, responders found that their families and friends away from the disaster could not understand their struggles, and neither could disaster survivors. The toll that the clinic took on its volunteers was too heavy. We needed to understand our own vulnerability and collectively provide for our own recovery, and we did not.

The disaster of Katrina only began with the storm. It continues with the deadly depredations of real estate vultures. Their land grabs mete out more destruction than the flood could. Those who want to help may find it too difficult to do anything now, unlike in 2005 when it felt like we could do everything.

Whatever form your concern for affected family, friends, or strangers may take, remember who always does most of the relief work — devastated people who need something to do in times of crisis. Not the Guard, not the Red Cross, not even the little clinic I loved and helped to build.

In times of catastrophe, follow your gut. Your help will never come from the hills, only from you. Despite governments' proclivity for repressive violence and business's proclivity for anti-human opportunism, in times of crisis people self-organize and demonstrate a strength that could turn the world right-side up.

I am sorry I was not able to be here in person, but thank you for allowing me to share my experiences. - Comments: 0

Finding people arrested in Charlotte - 22 Aug 2015 17:36

//Tags: //

I recently had to find some people in the Charlotte-Mecklenburg, NC system. This post is a quick tutorial on how to find your people.

Finding Arrestees

If your friend was arrested in Charlotte, and you want to find out the charges and bond amount, see the Mecklenburg County Sheriff's Office Inmate Search page: http://www.mecksheriff.com/inmatesearch.asp

"Arrest inquiry" search info is updated shortly after the arrest, and includes charges and bond amount. "Inmate Inquiry" information is usually available within six hours of arrest, and includes the arrestee's Prisoner ID #, where the arrestee is being held, and (if you click the "view charges" button), the next hearing date.

Making Bail

If you go to a bail bondsman, you will be required to pay 10% of the bail amount, and someone with a job will have to "secure the bond," or sign that if the person does not show up for court, they will be on the hook for the rest of the bail amount.

If it says they're being held at MCJC (the central jail), you can wait for their release at 801 East Fourth Street, Charlotte, NC 28202.

Finding Court Dates

To find upcoming court dates in an ongoing case, check the North Carolina Court System calendar. You can enter a Citation Query by Defendant Name: http://www1.aoc.state.nc.us/www/calendars/CitationQueryByName.html

When entering someone's name in the NC Court citation query box, do not insert space between the last name and the first initial. For instance, to search me, type in "Keller,A" with no spaces. You will find the court date, county, courtroom, and session (morning is 9 am, afternoon is 1 pm). You'll also find the charges, and the name/agency/badge number of the arresting officer. - Comments: 0

Bad parents - 21 May 2015 15:31

//Tags: //

In the United States, many psych and substance abuse services have been pushed to become more trauma-informed as a result of the profoundly influential Adverse Childhood Experiences (ACE) study. Advocates push this discursive shift: do not ask "What is wrong?" Ask "What happened?"

In the midst of this discursive turmoil, tidy categories like "serious mental illness" leak and rupture and are called into question. I wonder about the usefulness of such categories and classifications. Do they allow more effective government of disabled personalities, or do they co-produce these personalities? Most likely, they accomplish many contradictory things at once.

First, a caveat: Mental illness is not a predictor of violence. It's a predictor of victimization. People diagnosed with mental illness are five times more likely to be murdered and significantly more likely to be assaulted, raped, mugged, and arrested than controls. They die 25 years earlier than people without psych diagnoses.1 Now, on to the show.

Foucault and his students looked into the discursive turmoil around a famous case of parricide 150 years ago, at the beginning of the construction of categories that trauma-informed critiques now challenge. That conversation is documented in the book I, Pierre Riviere, having slaughtered my mother, my sister, and my brother: A Case of Parricide in the 19th Century.2 The debate around modern Pierre Rivieres revolves around whether they are mentally ill, terrorists, or common criminals. The terms in 1835 were very different. By resurrecting the case of Riviere, Foucault showed how our categories are not eternal; how they have an outside.

More recently, Mark Ames covered Michael McLendon's 2009 workplace killing spree in Alabama, which included what Ames called a "mercy killing" of McLendon's mother and her dogs. Ames needs an editor, but his courageous take on parricide and workplace violence also seeks an outside to the classification of McLendon's character. By investigating the scene as well as the killer, Ames highlights the legitimate desperation caused by horrific everyday violence of chicken factory workplace conditions, routine wage theft, lack of legal recourse against local oligarchies, and the costs of municipal bankruptcy due to unpunished white-collar crime. This context clarifies the cognitive dissonance when someone — who believes that free, white, male, 21, and American entitles them to something — finds that they are in fact fungible. Is it serious mental illness? Terrorism? Common crime? Desperate, pointless guerrilla resistance by isolated individuals?

The conversation about adverse childhood experiences has begun, but the presence of routine social violence in lives like Riviere's and McLendon's curiously drops out of court, media, and scholarly narratives of massacre. When the righteous suffer, they can cling to stories like Job of the Bible, the Catholic saints, or Husayn ibn Ali, the grandson of Muhammad. But when those who were born unrighteous and will always be considered guilty suffer, attempt to resist, try to breathe, what is their narrative? That they had bad parents? - Comments: 0

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