The following thoughts also apply to OZ, original EU countries. There are two serious sides to health care delivery in the Developed World. The first is supply of adequate numbers of trained providers at all levels to meet the increasing acuity, demand and complexity of First World medical standards and regulations. The second is the impact on those countries which provide a large number of the above mentioned health care staff.
This struck me once again as I hang out with Carmen as she wends her way through the system. Adventist Hospital visibly does not discriminate in employment that I can see. Race, color, creed, religion, gender, country of origin, religion make absolutely no difference. What they are looking for is expertise, care for patients and a willingness to work hard. That is not to say that there are not going to be hiccups in the system (not enough staff on is always an issue with nurses in every hospital in which I have worked) but that this is not a hospital that looks like the kind in which I trained (Minnesota in the 70s).
But there are serious issues facing the US health care system: we simply don’t train enough native born individuals irrespective of ethnic origin to fill the number of personnel needed. Not by any means. The same is true in the UK which draws on both the Commonwealth and the EU (up to now) to fill its ranks. The situation in Scandinavia (working off 5 year old memory now) is that the Eastern European EU countries have filled many of their needed slots. We have an aging population in the US, the same as many of the original EU countries. Population is at replacement level or below except in the immigrant/refugee population. All countries in the west are becoming more diverse whether they want to or not. And it is not just the acute care system that needs medical personnel, an aging population, one that lives long enough to develop many of the challenges of extreme age (read 95+) requires personnel for nursing homes, rehab facilities, visiting health nurses and respite.
Over the last two days, I have had the wonderful opportunity to talk with numerous staff. Many were immigrants as teens or children when their parent/s came as refugees/immigrants to the US. A few others were trained outside the US and moved here for further training. Or to use the skills they had learned from books but had no opportunity to use at home due to lack of facilities/equipment. And here is where the moral/ethical considerations come into play. Countries that can barely afford basic health care, in fact generally not able to provide much of anything due to lack of funds/infrastructure/political will can not afford to train individuals who then leave to practice elsewhere. Or can they? There are those countries which actively produce excess providers knowing they will go overseas and send their salaries home to family remaining in country. The classic example with which we are all familiar is the Philippines which has citizens working everywhere else in the world in hospitals to ships in order to make more than at home.
Where are they from? Africa, the Caribbean, Indian subcontinent, Central America. All well qualified, all feeling like they are actively contributing. With rare exception, they couldn’t do this level of work at home (see comment about lack of everything above). Would they go home? Maybe. If there wasn’t civil unrest, if there was a chance to practice high acuity medicine, if there was family to go back to, if there were excellent schools for their children, if they weren’t looking at massive overcrowding and primitive living conditions.
Can we [US] continue to deliver the standard of care that we except to receive as patients without immigrants? Obviously not in some areas of the country, perhaps not in most. Maybe so in others where there are bountiful training opportunities and young people who want to stay locally (see San Francisco). Can we do something in return for those countries which are loaning us health care professionals? Probably, and not just the Gates Foundation or those Universities which have research projects or limited partnerships. All of what could be done is well above my paygrade as the old saying goes. But these are things to think about. And to seriously understand what is going to be the US future if we seriously curtail immigration.
Which I think was longer for my friend having surgery than me.
I haven’t been an inpatient for a while and certainly not one facing major surgery since 1995. I don’t count a shoulder scope as major surgery. Rehab yes, but nothing major as far as recover on the surgical side. So anyway – Adventist Hospital with staff and patients coming in all sizes and shapes. Visitor parking that is free. Yes, free parking which is unheard of in most major metropolitan areas. Except for the SFVA which offers free parking but has extremely little actually available.
Back to the present – surgical waiting room for hours where I had a chance to talk to a myriad of interesting people: a gentleman in his early fifties who was there supporting his sister-in-law while his brother faced yet another in what seems to be an endless number of surgeries, a guy who fits the classic “long haired looking hippy” of my era who is probably mid40s worrying both about his family member in surgery and their 9 month old family pooch who has just had a leg amputated secondary to a tumor and an elderly man waiting on his partner hoping for good news but not really expecting it. Everyone gets a case number when they come in. Visitors have it written down along with a sticker saying they are a visitor. The electronic board on one wall lists location of patients by their case number by pre-op, in procedure or pacu. (Post anesthetic care unit for those not of US medical background).
I found the cafe/cafeteria. Their coffee is quite decent and a lot cheaper than Peets or Starbucks. They don’t offer completely healthy choices, but each and every item lists caloric load as well as distribution and amounts of protein, fat, carbs and sodium. I could easily live without knowing how many calories in each item come from fat, but that is just me….
Followed by transfer to the ward and settling in before I headed out in the rain.
And before you think I am totally and completely out of it, please remember that I spent most of the years between 1981-2015 living outside the US. Outside of occasional brief stints, I have had no contact with US based primary/secondary school eduction with my children. In fact, other than my own experience as a student aged 17 and under, DoDDs schools provide my only window into US based schools. I have no experience with Parent/Teacher Associations or whatever the current nomenclature for what I remember as the PTA. Certainly I know nothing about them or their fundraising outside of what I have read in fiction.
For those reading this and living outside the US (Australia, New Zealand, Canada, UK for English speaking plus the salting of French and German speakers) I effectively am as naive about such organizations as you.
How was I to know that PTAs have added “evenings out at a family restaurant” to their fundraising repertoire? Carmen knew about such things and explained it to me, but I hadn’t a clue. It did explain why our chosen location for dinner – The Silver Diner was packed with children and their families. Kindergarten through Second as it seemed to be. According to our poor waitress, the group had made a reservation for “about 25” which turned out to be a gross underestimation.
How does this work? The group makes an arrangement for a time when the restaurant normally is not that busy and in return gets an amount per head or % of sales from the group. It obviously made the kids happy, there were cheerful youngsters everywhere excited about seeing their friends. Kids coloring, parents and grandparents looking poleaxed and the waitstaff dodging the waist high crew as they attempted to take orders and deliver meals.
The young lady in line behind us as we entered explained that she could see kids from her class and was ever so excited. When one of the kids informed her that her teacher was having diner, I thought she would wiggle out of her skin. With rare exception, the kids were actually well behaved. As a group, it was almost as diverse as the Bay Area without the breakdown along ethnic lines that is all too often seen in San Francisco.
The menu was great, featuring burgers and other US people friendly food in varieties from buffalo through salmon to vegetarian (I didn’t want to ask if they had a separate grill) with a pick list for adding additional condiments. Veggies were offered in lieu of fries. The water was cold and served with lemon. In other words, nice comfort food, it the place wasn’t so filled with cheer, kids and noise that you couldn’t carry on a normal conversation.
The location faintly reminded me of the 5 & Diner that Noah and I ate at once in Scottsdale. With a major exception – the Silver Diner chain does as much as they can to be part of the “farm to table” movement and locally source their comestibles whenever possible.
Lou is progressing – and other than that – it is raining. Again.
There are things about an 0500 that shouldn’t have been a surprise to me, but I was still blindsided. Bag Drop off for United didn’t open till 0330 giving only a 45 min window for checked luggage. I guess they think it is not longer a problem since just about everyone seems to carry all of their possessions onto the aircraft so they can be throughly angry when there is no overhead storage space. Me? If I can check a bag for free, I will do so every time.
Security opens at 0400. Boarding began at 0410 and there wasn’t a coffee to be had in the terminal area before 0500 including the United Club which also just happens to be open from 0500-2200. Go them. It is perhaps the only time I have boarded an aircraft without a line, without dozens of pre-boards or pushing and shoving because it is so important to be the first or second person in line rather than the fifth.
No pictures leaving SFO – as we climbed the fog promptly took over. The mountains between SFO and DEN are amazing with snow caps and a few obvious glaciers present. Admittedly from our altitude you can’t see much, but habitation was wonderfully lacking underneath our wings for most of the journey.
Unfortunately it was easy to tell when we approached Denver. And it wasn’t that the mountains started to flatten out or that there were threads of roads visible brown against the green. It was the air. From clear to nasty yellowish-brownish haze in a layer obscuring the high-rise towers of downtown in the distance. For what it is worth, the haze continued after takeoff as we flew east.
Now can anyone explain why architects, often known for designing extremely dull buildings more resembling a high-rise basement than any place a person of sense or discernment would want to live or work all seem to go nuts when faced with designing an airport terminal? Normal building? Nah, it is an AIRPORT. As such there seems to be a requirement for swooping rooflines, acres of glass and noise levels only marginally short of a train station with all platforms full. Denver is no exception. This is perhaps one of the weirdest designs I have had had the misfortune to view. Plops of snow? Stylized mountain peaks? Meringue? And the scariest part of all – this design pre-dates the legalization of pot in Colorado.
Speaking of take-off – or rather the events leading up to getting on our way – it turned out that we all exited the plane in Denver – Gate B24 knowing that if – and only if – you were continuing on to DCA it would be the same plane. A different flight number, a different crew and most likely different seats which explains why we all got off, hung out and then re-boarded the exact same plane, Sheesh. But at least I didn’t have far to go (gate wise) unless choosing to go on a search and purchase mission. Weather caused a bit of delay, but they will be handing me breakfast and the outlet at my seat works (unlike the first leg).
On arrival to DCA I managed to collect my luggage, insure that I had enough charge on my cell phone to insure ability to communicate and headed off to the Metro.
I like the Metro Cars – and I now know where BART received its’ inspiration:
Yellow line to Gallery Place, Red Line to White Flint. Oops – train only goes as far as Grovesnor so yet another change. Carmen bailed me out there. Cell phones are so nice to have.
This was a day spent on wheels in either our car or Shana’s Fiat. I promised Dani I would give her a ride to work, I had to go into San Francisco which was car to BART and back; I needed to pick her up from work. Then there was getting Alex to and from work, picking George up at BART on his return from NYC and getting Shana’s car back to her house along with Noah and his stuff. George did a couple of runs before picking me up to take me back to Berkeley. Something about needing to get home and packing for tomorrow’s departure.
I managed to read a bit and finished my current audiobook – Simon Winchester’s Precision. For anyone interesting in science, engineering and/or the industrial revolution it is a great read. He does his own narration being one of the few authors who can pull that off. I think it might be one of those books which may well be more interesting in audio than written page since it has aspects of technical but it is really about the story. Winchester is an excellent raconteur.
All of this lead to my mind going in circles when I should have been sleeping
I am still trying to identify why particular colors of embroidery floss seem to vanish just as I really would like to add that particular number to the canvas. I suppose I could accuse Shana’s two cats of stealing skeins, but that wouldn’t be the truth. Although they love string and would pounce in a heart beat I don’t see them as going on the offensive. I have some DMC floss-holders, I have a few baggies-on-a-ring and then there are the bits and bobs hiding in the bottom of whatever box, envelope or container I could swear I just emptied. In between being frustrated by the cross-stitch I did a bit of ironing for Shana as quilts go together much more easily when the blocks get ironed.
Yes, there was cat help for that as well
In between I listened to the NYY vs As game. Or watched the box on my iPad when it finally got underway over 2.5 hours late. Something about rain. Not an issue for the East Bay…
None of us thought about Mother’s Day or brunch till about Thursday at which time it was impossible to get a reservation anywhere.
At least anywhere that wasn’t fast food.
We agreed that there was nothing magic about Sunday vs Saturday and headed to the Royal Cafe on San Pablo to enjoy a lovely breakfast on a sunny and clear morning.
After we dropped Alex and Noah back at the house, Dani, Shana and I headed off on a round of errands. The end result of the day was that Shana and I ended back in Richmond to the vocal scolding of two cats who felt they had not received their proper due of petting this day.
Back to cross-stitch, some sewing and perhaps an audiobook.
I think it is turning out all right…
I have been working on a new project for the last several days and finally inserted a page for it under the project Menu.
Lou was a good dog.
If you know dogs, there are some that are loved by their owners, but no one else would ever say that they were good.
Not so with Lou. He was a good dog. Sociable, traveled well, polite, friendly but not overwhelmingly so and lived for his job. His job being working all day with David. It is a hard job for a dog, keeping a contractor under proper supervision. The whole day may be traveling around in the truck and visiting job sites (we will not mention the occasional treat) and keeping one’s person properly supervised.
This was Lou’s role in life and he filled it admirably. But in April, not so young a dog anymore, he became ill. Multiple vet visits and treatments, it was obvious he wasn’t ever going to get better and was absolutely miserable.
Since there is snowballs chance in hell of David ever reading this, I feel safe in posting that I am making decent progress on a present for him. I don’t know that he wants a picture of Lou on his wall, but I think he just might need one.
there were more attending today’s game than were here last night. While the attendance might not seem much to you, it is impressive for a Wednesday afternoon, especially during the school year.
Apparently it was student day. I am used to seeing buses during the summer as teams, programs and summer camps fill Wednesday afternoon’w with trip to the Oakland Coliseum. But in May?
Since I was running late to the game and actually didn’t arrive until after the first pitch, I didn’t notice the dozens of school buses in the parking lot. Since I normally come in the ADA entrance on the BART side of the stadium, there weren’t lines of young people to wade through. But what became obvious early on was that there were a LOT Of young voices yelling. And yelling interesting chants at strange times.
There must have been 16 high schools, a dozen middles schools and an equal number of elementary schools with their names prominently featured on the big boards in the 4th/5th inning breaks. Then there was the great camera work featuring, it seemed, every last group at one time or another.
Even given a 4:2 loss, the kids seemed to be happy with their outing. A cluster of them, high school age, were on my BART headed toward MacArthur. A rather harried late 20s was with them. I asked her how many she had. Only this dozen. Are they all here? I certainly hope so! But most of them ride BART regularly and they all are interested in heading home….
In general, BART needs a face lift. Badly. The current set of cars are old, clunky, difficult to keep clean and lacking in what has come to be routine in major cities as to signage and accessibility.
As it happens, there are new trains on the way. Not at all like the test cars which have been in the system for a couple of years; these new cars are sleek. The seats can’t be taken apart by any enterprising subway sleeper. They have significantly less seating but markedly better standing space. The handicap locations are clearly marked as are the bicycle areas. What is even more important is that there is electric signage. At the end of the car, the sign clearly states the current station. The electric boards in the cars have both station information and map with the current location clearly noted.
Gee! Just like a real subway that you would find in any International city!
The seats are suspended so that cleaning should be easy. There are no cushions to be pulled off or stolen. There is signage. Plus, none of the seats would be comfortable for sleepers.
I wonder how soon the homeless advocates are going to complain that these cars discriminate…..
Discussing the new cars was by far better that talking about today’s baseball game. Let me just leave it with – didn’t suck as badly as yesterday….
I am staying at Shana’s for the next few days. Left her alone for a few hours to go the As home game. The Astros were in fine form. The As were not. After the top of the 5th the Astros were ahead 11:0 and I decided to head home. My decision was reinforced by the presence of some junior “drummers” who were having a good time but making it challenging for the rest of us. And add Josh Reddick for the Astros in Right Field happily signally our outs.
By the time my BART reached MacArthur the As had finally gotten one run. As I write this, the game is not yet over with a score of 16:1. The team is just going to have to tough out the remainder of the 9th. I almost wish them three fast outs just to end the pain.
Seems to me there really should be a mercy call by the 7th inning stretch….
But barely. The As squeaked out their win, thank goodness in the regular number of innings. Unlike yesterday, getting the bat to connect to the ball wasn’t the problem. It was after that connection to have that ball go anywhere useful. Like getting a hit instead of a foul or pop-up.
In any case, at least it was only nine innings.
I am not on West Coast time. In fact, after all those time changes both coming and going – or was that going and coming? – followed by a flight from NYC, my body says that it is time to get up early. Which means about 0330 or so on West Coast time.
I had been glad that tonight’s baseball game was starting at 1835 rather than 1905 figuring that the extra 30 minutes would mean getting home at a reasonable time of day.
At the end of 9 innings – the score was tied 0-0.
As it was after 10 innings, 11 innings. At which point I looked at George and said – 12 innings is my limit.
Final Score 2:0 thats to Khris Davis pulling out a home run with one on base….
I am still tracking down whatever mail came in while I was gone. The suitcase is unpacked and the last of the laundry is in the basket. My pillow is calling me.
It is Friday. There is a home game. I am sitting with the usual crowd in the Right Field Bleachers.
The As pulled off two home runs in the first inning to lead 4:1. But then the Orioles came back to tie the game in the 6th which meant that Mengen doesn’t get credit for the win, but rather Trivino who was on the mound in relief when the go-ahead run in the 6th. An insurance run in the bottom of the 8th pretty much clinched things.
For those of you not enamored of baseball – sorry about that….
It is a nice start to the series as the losses to the Astros and Mariners are still stinging….
It wasn’t all that early and we were stuck in traffic.
George had volunteered to pick me up at SFO. If there is no traffic – oh, let us say about 0300 in the morning (yes, redundant) one can sail to SFO in about 35 minutes from the house, most of which is taken up with getting to/from the freeway. Morning, afternoon or what turns out to be mid-evening? It is a complete other story. As we are sitting at almost a standstill on Hwy 101N headed into all of the San Francisco merges I looked at him.
“I really appreciate you doing this, but…”
“If I had taken BART, I could already be at North Berkeley….”
Although, it wasn’t like I hadn’t spent time waiting earlier today. Carmen and I had disembarked, then stood in the taxi line. Wisely as it turned out since there was a lot of construction between Pier 88 and Penn Station. Dragging suitcases plus our tired bodies would not have been fun. Miriam met us and hung out in the Amtrak Lounge till it was Carmen’s time to board her train. Then there was lunch followed by my catching a NJ Transport train to Newark. $9 for the train and I was already at Penn vs hiking 8 blocks to the Port Authority Bus station and paying $15 for the train? No brainer there..
Check in was easy, then the pain of getting through TSA followed by waiting for my flight. Add in three hours of time zone change to the almost six hours of in the air time and I was more than ready to greet my very own pillow.
On the itinerary our arrival time is listed as 0800 in NYC. We are docking at the Manhattan Pier. I am not sure which one of the 88,90,90 pier it is because it is not listed anywhere. Most of us are assuming it will be Pier 92 since that has historically been the docking location for NCL ships. Why it is not listed? Actually easy. Ships are actually listed by cruise departures. This ship will be remaining in NYC for about four days. Then she sails to Miami, but without official passengers. So there is no departure cruise. Therefore – no docking listing.
Having said all of that, we have been slowing chugging along at about 10 knots all day. In spite of the Captains best effort to get nowhere in a big hurry, our arrival time has slid earlier and earlier. Now it looks like we will be docked before 0200 in the morning. Obviously, no one is disembarking that early – customs and immigration would not be amused.
Accordingly, this afternoon, Stu and I made a tour of the upper decks, looking for a viewing location and hit several snags. The Haven is forward on the ship. Upwards of Deck 15 which has the Observation Lounge (all interior, i.e. windows with lights on) there is no place forward on which to stand and see out. There is also a fair bit of breeze. We picked out a couple of areas which I just went to double check. No – can’t get up to the Laser Tag area on the top deck which has a lovely view over Starboard and was as far forward as possible. I found I could get to a small alcove on Deck 18 so that is where I probably will head.
If I remember correctly, the last time I actually sailed into NYC was about 2014 on the Legend on a clear September morning. I was doing a back-to-back up to Quebec City and found, much to my disgust, that there was absolutely NOTHING at the Cape Liberty Terminal. Nothing, no coffee shop, no wifi, no nothing. I did get some lovely shot of both the bridge coming in and the Manhattan Skyline. I am going to try for the skyline again but reserve the right to hang it at any moment and go to bed.
It was a quiet day here on the ship. The weather has cleared but it is still too cold for my taste to be out on the water slides. Other options are the electric go-kart track (not interested) or laser (even less interest thank you very much). Besides, there is a charge associated with these two activities and I just don’t see it.
I did manage to finish up the empty areas on the main cross stitch in progress and fooled around with software to design the next project up. Other than that – there was food. This is a ship – there is always food….
Coming back in from the cold and the rain, I didn’t sit down to write this note until after I had drained my shoes, wrung out my socks and had a nice hot shower. Oh, and stopped @ Local (the 24 hour restaurant) for soup and a warm sandwich. Should I mention they have amazing carrot cake? Carmen, Stu and Mary have been after me for days to try it.
Anyway, this is not my first port call in Halifax. I have been here enough times to feel comfortable in navigating the downtown area, hitting libraries and museums along with a familiarity with several of the local craft shops. What I haven’t experienced before was winds, 6*C and driving rain on any of my visits. It made going from the ship to the Atlantic Superstore (umbrellas cheap) to the main craft store (one missing color of DMC floss, note umbrellas were cheaper but I already had one) to the Maritime Craft Store on Grafton Street (the other needed color of floss), back to the Loop (yarn store, behaved myself). And on, along streets, through puddles, across intersections and generally passing places I would spend more time. If the sun was out; if it wasn’t raining. If my leggings weren’t soaked to the knees.
I spent time in both the Maritime Museum and the Map Store before heading along the boardwalk back to the ship. The Farmer’s Market and Pier Stores were doing a brisk business. The rest of the merchants along the board walk hadn’t bothered to set up. But the Farmer’s Market opened a week early and was doing a brisk business in prepared foods (everyone), fresh vegetables, bakery and meats (locals) and handicrafts – lots of business off the two ships in port.
I don’t think I ran into anyone in town from the second ship – HAL’s Veedam which is doing the 7/14 day Boston/Montreal trip. But it wasn’t all that hard to spot their passenger’s at the terminal shops. Older than ours with a heavy leavening of French Canadian. Also, carrying an umbrella with a ship’s name on it could also be construed as a hint.
I have dried out completely and am finally feeling warm. I think it is going to be more than a day before my shoes dry out – a hair dryer was suggested. Since I don’t need them again till Thurs morning I might just see how they do propped up on their own.
Meanwhile, the cloud layer is lowering. Sunset is allegedly ~2020 but suspect it will be fairly dark long before then. I am thinking … hot chocolate? Latte ? Maybe a Mocha…..