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Students Influence Schools to Incorporate Gender Fluidity into their Practices and Lessons

Posted: November 20, 2017

At the age of 15, after rehearsing in the shower, Sofia Martin made an announcement to the students at Puget Sound Community School. “I’ve been thinking a lot about who I am,” Sofia recalled saying at the morning meeting, a daily assembly of the school’s 52 students and staff members. “I’ve come to the decision that I’m nonbinary, which means that I’m not a boy or a girl.” Sofia asked the teachers and the students, who are in grades six through 12, to use the pronouns they or them, which they promised to do.

Over the course of the next year, Sofia, who is now 18, pushed for a gender-neutral bathroom and encouraged fellow students to name their pronouns when they introduced themselves. Today Puget Sound, a small, unconventional private school in Seattle, has converted a former men’s room into an all-gender restroom and four more students have made similar announcements in front of the whole school. “I don’t want to suggest that we got this perfectly right, although I will say that doing something was right,” Andy Smallman, the founder and director of the school, wrote in an email about the restroom.

At some schools, teaching for and about transgender people is a battle, epitomized by nationwide debates over “bathroom bills.” But at others, educators aren’t battling against trans students or their needs. Instead, schools like Puget Sound are altering their policies to include transgender kids and, more broadly, to make gender a deliberate part of the curriculum. Students are leading the way, driving schools to adopt more inclusive teaching methods.

“Ten years ago, I wasn’t really talking at all about transgender in my classes,” said Emily Umberger, who teaches health at two private schools in Charlottesville, Va. Now, “the kids are very comfortable asking questions about gender identity, transgender stuff. It’s amazing how much that has changed in a few years.”

Of course, not all schools or parents accept these changes. Glsen, a national nonprofit focused on L.G.B.T. issues in K-12 education, notes that in some parts of the country there are laws that forbid teachers to talk about gay and transgender people in a positive way in the classroom.

But at some schools — many of them rooted in progressive pedagogy, with an emphasis on hands-on learning and social responsibility — teachers and administrators are listening when students demand they catch up on gender. Educators then have to figure out the quotidian details: Can boys wear skirts and still follow the dress code? How should teachers explain that most people with uteruses will get their periods, but not all people with their periods have to be girls? And what to do about those bathrooms, anyway?

Many educators and students noted that the goal is not just teaching kids to be accepting of trans or gender nonconforming people. Instead, it’s about loosening up the whole idea of gender, for every kid. “This is not about those kids,” said Deborah Roffman, a teacher at the Park School in Baltimore who has been teaching human sexuality for 40 years. “Everybody in this building has a gender identity, which exists along a continuum.”

Unlike the stark sex-ed films of the past (with messages that amounted to “Don’t have sex, because you will get pregnant, and die”), today teachers read aloud from books about transgender kids (or books about gender-bending crayons or same-sex penguin dads) to start conversations. Rossana Zapf, a learning and curriculum support coordinator at the Miquon School in Philadelphia, read the elementary students Jazz Jennings’s picture book “I am Jazz,” and Michael Hall’s “Red: A Crayon’s Story,” about a blue crayon who is mistakenly labeled red.

Ms. Umberger in Charlottesville said she uses a little game to explain the gender binary, the idea that boys and girls are opposites and that people must be one or the other. “I’ll say, what’s your favorite color? Is it lime green or crimson? And they’ll say, actually it’s royal blue,” she said. By showing that sometimes two rigid options aren’t enough, she teaches them what it means to be nonbinary.

“The students are so hungry for this,” said Nora Gelperin, the director of sexuality education and training at Advocates for Youth, a Washington-based nonprofit that provides a free sex-ed curriculum for K-12 students which includes lessons about the range of gender identities. “When I’m in a school, the students are leading the way, and adults are desperately trying to catch up.”

At the moment, though, even little kids are grasping the big ideas. At the Advent School in Boston, Erina Spiegelman, who is an instructional coordinator, recalled that a teacher last year asked a group of students the big question: “What is gender?” The first answer came from a second-grader: “It’s a thing people invented to put you in a category.”


Documentary ‘Lovesick’: Matchmaking For HIV Patients Explores ‘Human Cost Of Loneliness’

Posted: November 17, 2017

When filmmakers Ann S. Kim and Priya Giri Desai stepped into Dr. Suniti Solomon’s office in April 2008, they knew they weren’t meeting any ordinary doctor.  Having discovered India’s first case of HIV in 1986 and founded one of the country’s foremost AIDS clinics, the physician was now providing her patients with matchmaking services in addition to medical care.

“Lovesick” follows Solomon — who died in 2015 — and two of her patients, Karthik and Manu, as they navigate a society in which the filmmakers said marriage is a non-negotiable, but where relentless stigmas against HIV and AIDS makes it near-impossible for anyone to make their diagnosis public, let alone find a life partner. Comparing viral loads and white blood cell counts alongside standard matchmaking criteria like religion and income, Solomon and her team play Cupid, working to bridge the gaps between social norms and unspeakable taboos.

After a combined 36 years in public health reporting and television production, the filmmakers said they saw a rare opportunity with Solomon to illuminate an often-hidden side of life with HIV and AIDS. “The human experience angle offered an interesting contrast from the data-driven ways this issue is usually addressed,” Kim said.

Although the filming process culminated in some surprise payoffs for the audience, it also underscored several persisting social stigmas in India. “These people are part of a community that looks down on everything they’re living, whether it’s being single, childless, or HIV-positive,” Desai said. “They need explanations for it all without giving themselves away. That the doctor was empathetic enough to help them find answers for the next person who questioned them, was an incredible gift.”

Solomon was especially well-prepared for the job, the filmmakers noted, given that she had skirted convention throughout her own life. When other doctors recoiled from treating patients during the early days of HIV, she took an early retirement from a high-powered research position at Madras Medical College to establish the YRG Care Centre for AIDS Research and Education, the filmmakers said. She was married late by traditional standards to her longtime love, a Christian from southern India, rather than a partner chosen for her by her Hindu family. Unlike most women of her generation, she had just one child.

Her choices, the filmmakers said, reflected an attitude that proved invaluable for her patients: a thorough awareness of cultural norms, but little sense of obligation to adhere to them. Desai and Kim observed that she thought nothing of introducing a woman from Chennai in eastern India to a man based in Mumbai in western India if they seemed otherwise well-suited on paper. Knowing that geographic mobility and inter-community marriages were uncommon for most of her clients’ socio-economic standing, she’d urge them to tell questioning relatives that they simply fell in love.

Marriage has allowed Solomon’s patients more than life without ostracism, Kim, who worked as chief design officer for former U.S. Surgeon General Vivek Murthy, noted. “‘Lovesick’ is a testament to the increasing evidence around the human costs of loneliness, and these couples embody the science pointing to social connections as fundamental to human health,” Kim said.

Viral loads, white blood cell counts, and adherence to treatment regimes have been known to improve once couples marry, she added. “Dr. Solomon’s matchmaking doesn’t just make for nice stories. It has truly helped people manage their disease,” Kim said.

Above all, the filmmakers aim to demonstrate modern love in the face of continued global stigma against HIV and AIDS. “Populations everywhere, from Eastern Europe to the Asian-American community here in the United States, are struggling with it. People haven’t considered what it means to be HIV-positive and find love, even though it’s such a universal need,” said Desai. “We hope ‘Lovesick’ opens that conversation by showing that a life of dignity is possible after a positive diagnosis.”


After Hurricane Maria, Mental Health Specialists see Toll among U.S. Puerto Ricans

Posted: November 16, 2017

Orlando, Florida-based therapist Janera Echevarría was not surprised to see an upsurge in the number of Hurricane Maria refugees arriving from the island seeking treatment for anxiety, depression, and stress. After any disaster, the counselor explained, it’s par for the course. In the area, groups and agencies are helping provide services to those who fled the monster storm and its devastating aftermath.

“Even if you were unharmed and your house was okay, living an experience like this is emotionally traumatizing,” said Echevarría of the hurricane that hit Puerto Rico on September 20th. “In one way or another, after a disaster — manmade or natural — it is expected that people will suffer some kind of post traumatic stress.”

However, what has alarmed Echevarría, a twenty year veteran in the field of mental health, is how deeply the hurricane’s aftermath has hit islanders who live outside of Puerto Rico. “I have a client, a 60-year-old grandmother, who stopped eating because she feels guilty that members of her family might be going hungry,” Echevarría said. “I have another client, a woman in her 40’s, who is sleeping on the floor because she says that her sisters lost everything so she is in some form of solidarity with them. She has a perfectly comfortable bed but prefers to suffer and sleep on the cold concrete floor –it’s a form of flagellation.” These reactions may seem illogical to some, but for people who are not mentally resilient, it’s the only way they know how to cope with stress. Technically it’s a form of survivor’s guilt, she explained.

Nearly sixty days after the category five storm landed, millions are still without electricity and desperate for basic necessities such as warm food, water, and shelter. In Echevarría's downtown Orlando practice, she has begun seeing the toll such images are taking on the mental health of Central Floridians.

Echevarría, who was born and raised in the western Puerto Rican town of San Germán, has seen the strain in her inner circle. Discussions around the dinner table revolve around the latest news from the island. Family members and friends discuss having trouble sleeping, experiencing fears about the future of the island, sadness, and some, say they are unable to fully focus as they watch the latest news and hear from family members having a rough time.

The most vulnerable populations after disasters are children, who don’t have the capacity to understand the scope of the devastation. Echevarría also sees it in women, mostly mothers and grandmothers, who suffer doubly because they are not on the island to do what Puerto Rican mothers do best — nurture their loved ones.

Brain experts say that even witnessing images destruction from afar, such as scenes of strangers' lives ruined, wound the brain. But if it’s extended family, the wound is deeper.

Nancy Rosado is a veteran of disasters. She was in charge of a mental health unit helping NYPD officers cope with the aftermath of 911. She was already in Florida when the Pulse nightclub massacre happened. During the massacre, Rosado said she that she helped provide culturally competent training for local officials. Everyone grieves and mourns differently and Puerto Ricans are no exception. "It was important to let officials understand that culturally, we see loss and grieve in a unique way. Our language is different, even the forms of mourning expressions are unique,” she explained.

This time around, Rosado said she took a step back from the disaster, because she said that “even those trained to help others are also affected.”

Experts say that directly helping others is one of the ways to cope with stress. Another way is to take a break from the news cycle, as images do cause harm and humans are not built to take in so much suffering at once.

One of the most important ways to handle stress is to talk about it. “For Puerto Ricans, therapy is not the norm,” the mental health professional explained. “We are used to staying in the family. But this is something catastrophic and we have to be able to open up. My suggestion is that if you feel like you can’t handle seeing so much loss, to get help from a culturally competent professional.”

“It’s important for anyone suffering from afar to now that they are not alone," said Rosado. "Others are feeling the same way.”


How the Opioid Crisis is Affecting Native Americans

Posted: November 15, 2017

Last week on an NPR program, there was a conversation about how the opioid crisis is affecting African-Americans and Latinos. NPR felt that it was necessary because so much of the news coverage has focused on the white rural experience, which while important, is not the only one.  Now NPR's Michel Martin looks at how the crisis is affecting Native Americans. 

For some insight, he called Dr. Ron Shaw, the president of the Association of American Indian Physicians:

MARTIN: So, Dr. Shaw, it is a fact that white rural communities have been hit especially hard by this opioid crisis. But we were looking at a report from the Centers for Disease Control that said that, actually, the death rate of Native Americans from opioid overdoses was the highest of any racial demographic. Some 8.4 per 100,000 Native Americans died of opioid overdoses in 2014. Can you tell me more about that?

SHAW: Well, I believe that in any population where there are a depressed or a low socioeconomic status, any time you have those issues, people are more vulnerable to opiate overdose. Now for Native Americans, many Native American populations suffer from what is known as historical and intergenerational trauma, which has to do with historical events that have afflicted Native American tribes, everything from Wounded Knee to other issues that have affected us culturally that have caused kind of a historical shame that has transmitted across generations, even to succeeding generations, that it has been shown to be associated with increased rates of depression, drug use and drug addiction. So that's the additional issue faced by Native Americans and perhaps more sensitive in those populations that live in reservation areas.

MARTIN: From the work that you've seen and the work that you've done yourself, what do you think are the best ways to treat this problem with a particular focus on Indian country and Native American communities?

SHAW: I think the two most important pieces are, first of all, this is a biological disease at its core, whatever the reason is. And we're still finding out why experimental and recreational use in youth progresses more rapidly to opiate addiction in native populations. We're still trying to find out the best practices for preventing or slowing that down. But the biological basis is a disorder in the reward pathway in the brain known as the mezal limbic system. An important part of that therapy has to be medication-assisted treatment.

Now, the psychosocial treatment of the disease, which has to do with social living skills and having to address historical generational intergenerational trauma, that will be specific for native populations. We've always known that culture is prevention when it comes to drug use or drug abuse at an early age, but culture also is treatment. And so implementing treatment specific and culturally relevant treatment items in the treatment curriculum are very important.

MARTIN: Is there anything giving you hope right now? I mean, what is giving you hope right now? What's getting you up in the morning to keep working at this?

SHAW: As bad as it is that people are dying, it's finally got people's attention that this is an illness. And it'll translate into proper illness funding for other substance use disorders. Because in Oklahoma, it's still methamphetamine and alcohol. Who knows? Maybe before this battle has had some results, opioid use disorder and overdose deaths may increase in Oklahoma. But it's affecting Indian country, so I've used my expertise for any community, even if it's not particularly as high in the Osage nation right now.

Listen to the conversation or read the full transcript at

Pregnancy and Childbirth Mortality Rates on the Rise for African American Women

Posted: November 14, 2017

Every year, around 700 women in the United States die as a result of pregnancy or delivery complications. As many as 60,000 expectant mothers suffer problems that come close to costing them their lives.

America is one of the most developed nations in the world. Average life expectancy has been generally increasing over at least the last five decades, and deaths from illnesses that were once widely fatal, including polio, smallpox, tuberculosis and AIDS, are sharply falling. Yet when it comes to the natural process of childbearing, women in the U.S. die in much higher numbers than those in most developed nations, where maternal deaths are generally declining.

A woman in the U.S., where the maternal death rate more than doubled between 1987 and 2013, is more likely to die from pregnancy-related causes than in any country but Mexico among the 31 industrialized countries of the Organization for Economic Cooperation and Development that reported data.

There are various theories why — persistent poverty, large numbers of women without adequate health insurance, risk factors related to stress and discrimination. All come together here in Texas, with a twist that has become one of America’s most confounding public health problems: African American women are dying of pregnancy- and childbirth-related causes here at stunningly high rates.

The maternal death rate in Texas after 2010 reached “levels not seen in other U.S. states,” according to a report compiled for the American College of Obstetricians and Gynecologists, based on figures from the U.S. Centers for Disease Control and Prevention.  Black women in Texas are dying at the highest rates of all. A 2016 joint report by the Texas Department of State Health Services’ Maternal Mortality and Morbidity Task Force found that black mothers accounted for 11.4% of Texas births in 2011 and 2012, but 28.8% of pregnancy-related deaths.

“This is a crisis,” said Marsha Jones, executive director of the Afiya Center, a Dallas-based nonprofit that has taken on the issue. In May, the center published its first report: “We Can’t Watch Black Women Die.”

“There isn’t a single thing that explains it,” said Lisa Hollier, an obstetrician-gynecologist who heads the state-appointed Maternal Mortality and Morbidity Task Force. “There are so many different factors.”  The task force compared the health of a group of women who died during pregnancy, childbirth or in the immediate aftermath to those who survived in 2011 and 2012.

Cardiac events, drug overdoses and disorders associated with hypertension were the leading causes of those maternal deaths, the task force found.  Nationally, problems such as obesity, diabetes, caesarean births and delayed prenatal care are among the risk factors commonly seen, Hollier said. Such factors are particularly prevalent among black women.  “So we have a population of women that is less healthy when they are entering pregnancy,” Hollier said.

Texas has the largest number of uninsured people in the U.S., and there have been substantial cuts to women’s health programs that offer family planning and other routine services to low-income women, including screening for diabetes, hypertension and cervical cancer, which if left untreated could play a role in maternal deaths. Many of the dozens of clinics shuttered in recent years due to slashed state funding also offered prenatal care.

Manda Hall, associate commissioner for community health improvement at the agency, said several initiatives are underway to address the maternal mortality crisis. They include a program that encourages women planning to become pregnant to make wholesome lifestyle choices and another targeting historically black academic institutions that offers training focused on preconception health, the importance of fathers, health disparities and reproductive life planning.

Researchers say such programs might have an effect, but given that low-income white women fare better than black women, the causes may run deeper.

“Just being a black woman in America comes with its own level of stress,” said Jones, the Afiya Center executive director.  Some studies have shown that chronic stress triggered by racism and discrimination can lead to health problems such as diabetes and high blood pressure, and these in turn can lead to preterm births, low birth weights and life-threatening complications.


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