Philip A. Lederer

Risk and Resilience Among Families in Urban American Indian/Alaska Native Communities

Dr. Daniel Dickerson from UCLA is already one of my favorite researchers because of his work on drumming and recovery among Native Americans. He has also written about the Native Drum, Dance, and Regalia (NADDAR), a health-promoting intervention recently developed for urban American Indian/Alaska (AI/AN) families that provides workshops on drumming, dancing, and regalia making. I recently stumbled upon Daniel’s new qualitative paper on risk and resilience among AI/AN young adults.

The paper is full of interesting quotes. For example, this one about intergenerational trauma:

“My mom came from the reservation. She came down here, and I think so many bad things happened to her
and her family that she didn’t want that element with us. And so … we obviously didn’t learn any traditional
practices either.”

And this quote, about therapy:

“We did get him into therapy and then they did talk to him about stressors, like how to relieve that stress. …
Within his group of friends, the parents, we’re all connected, and we know each other very well”.

Parents described using family tradition to reinforce Native identity, by reiterating statements to their children
about family lineage, for instance:

“I told my youngest daughter, ‘I know you don’t know your grandpa, but your grandma and your grandpa are
full-blooded Navajo.’ And then I said, ‘See that picture up there? That’s my dad. That’s your grandpa. He’s
full-blooded Navajo. … You’re not Mexican, you’re Native American.’”

I think this paper is very important because it gets a good look at the root causes of trauma and some potential solutions which are applicable beyond the American Indian/Alaska Native community.

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Dr. Jim Muller in the Boston Globe

I was delighted to read the front page article in yesterday’s Boston Globe about Jim Muller, a good friend of mine, regarding the importance of US-Russian cooperation to prevent nuclear war. Jim is a cardiologist and researcher who also speaks fluent Russian and has spent decades working against nuclear weapons. (In 2018 I was a co-author of an op-ed in the Boston Globe with Jim and Dr. John Pastore, another cardiologist and advocate for the abolition of these weapons).

Despite his incredible life experiences and Nobel Prize, Jim is humble. He genuinely wants a world free of the nuclear threat and argues that cooperation between the US and Russia on health issues is the best way to make that happen. For example, there already exists a collaboration between Harvard Medical School and Russian tuberculosis experts. Why couldn’t this be grown into a full Medical Education Partnership Initiative, as has been done in Mozambique and elsewhere? It seems like preventing nuclear war should be our top global health priority, and Jim has pointed us in the right direction. Please contact me if you have interest in collaborating with us on this work.

In other news, Melissa Calica and I, from the Longwood Chorus, joined Lisa Wong, Martha Vedrine, Adetomiwa Victor Owoseni, and Joia Mukherjee to sing at the candlelight vigil for Paul Farmer. The gathering was held in the frigid cold on the Harvard Medical School quad last night. It was a powerful service, and besides the choral number (we sang “Soon and very soon”), a Longwood Symphony string quartet, and folk music, we enjoyed the remarks delivered by Harvard School of Public Health Dean Michelle Williams.

Finally, regarding Paul Farmer, it’s worth reading the piece by Mosoka Fallah and Eric Reinhart in the Lancet, Apartheid Logic in Global Health. Dr. Reinhart also wrote another important piece in 2021, Medicine for the People.

The bottom line is despite the devastating war in Ukraine, there remains hope for health and healing. But for this hope to be realized, each of us must do our part and speak out, and sing for peace and justice.

Dr Louise Ivers speaking at the candlelight vigil for Dr Paul Farmer

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Machine Learning for Antibiotic Resistance

Today I turn your attention to a paper in Science by Mathew Stracy and colleagues, Minimizing treatment-induced emergence of antibiotic resistance in bacterial infections.

The researchers used whole genome sequencing and machine learning and looked at a large number of urinary tract and wound infections. They discussed the importance of resistance being driven by “rapid reinfection” from a bacterial strain resistant to the prescribed antibiotic. The machine learning algorithm can help reduce the emergence and spread of resistant pathogens.

I’m not clear that machine learning for antibiotic resistance is ready for “prime time,” but it is getting closer. These data-driven approaches need to be validated and integrated into electronic medical records, such as EPIC.

No need to beware the Ides of March; spring is almost here. Stay positive!

Having a Growth Mindset is most important.

Singing in the Longwood Chorus a few days ago. Yay to Jeremy Faust, our conductor, and Carolyn Hsu, our president.

Planting our Indoor Garden

I’m not going to pontificate about Russia and Ukraine this morning, except to say that we need a peaceful resolution to the conflict as soon as possible. No war. No nuclear weapons. President Biden, please step up and be the leader the world desperately needs.

Instead, I wanted to share a few photos I took last night from our kitchen, planting our indoor garden. These seeds will germinate and grow and in a few week we will transplant them into our raised beds. Spring is near. We have hope.

Once the snow is gone we can transplant the seedlings

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CDC’s Sexually Transmitted Infections Treatment Guidelines

A recent issue of JAMA has published a clinical guidelines synopsis of the 2021 CDC Sexually Transmitted Infections (STI) Treatment Guidelines. The JAMA synopsis was written by Drs. Aniruddha Hazra; Maggie Collison, and Andrew Davis. (The original STI treatment guidelines were written by a group of nine experts).

Dr. Hazra, from the University of Chicago

Dr. Collison, from Northshore Medical Group

Dr. Davis, from the University of Chicago

The two-page JAMA clinical guidelines synopsis is well written, and its brevity is appreciated, as the original CDC guidelines are 192 pages long (!).The JAMA synopsis focuses on major recommendations and changes, evidence base, benefits and harms, and areas in need of future study or ongoing research.

For example, Drs. Hazra, Collison, and Davis talk about the dose of ceftriaxone used for gonorrhea and the first-line treatment for non-gonococcal urethritis and cervicitis (including chlamydia) being doxycycline. Antimicrobial resistance is another topic of concern.

The bottom line is sexually transmitted infections are a major public health issue globally. In America, the number of annual cases continues to increase. Our current approach is failing, because of our broken health care system, COVID-19 disruptions, and stigma. We need a holistic sexual health approach and an investment in public health infrastructure if we are to address this problem.

We will fail to control STIs unless we advocate for real health care reform, such as a single payer / Medicare-for-all. (Disclosure – I am a member of Physicians for a National Health Program, which advocates for universal health care). Federally qualified community health centers (FQHCs) should be much better supported, because they are the safety net of American health care. (Disclosure – I practice at an FQHC in Dorchester, Massachusetts.

https://www.youtube.com/watch?v=HzFsUVwZK5A

I’m now back in cold, snowy Boston, but a few days ago I was in San Diego, where I took this video. For three years of internal medicine residency I had my continuity clinic at Logan Heights Family Health Center, a federally qualified community health center.

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Two decades ago… our trip to West Virgina

Two decades ago, a group of students from Brown University drove to rural West Virginia for our spring break. I was the leader and was accompanied by friends Murtuza Gunja, Ja-Yun Cho, Ben Sigelman, Suraj Gorkhali, Jenny Partivit, Margaret Sweitzer-Hamilton and several others. It was a week of trying to repair houses while learning about rural poverty. There was one fatal flaw – we didn’t know much about fixing houses. I certainly didn’t know anything, and hadn’t done much preparation.

Back row: Next to a house we were trying to fix up. Suraj Gorkhali, Ben Sigelman, me, Hazel ___, Murtuza Gunja, Matt __. Front row: Elmer __, Ja-Yun Cho, ____

But we did our best, climbing ladders, cleaning out gutters, and trying to help with other projects. We certainly saw a different side of America than we were experiencing in the Ivy League.

The Brown Daily Herald, the University’s student newspaper, published a supportive article about our efforts. What I said in the piece was true – we were grateful to the West Virginians who had opened up their homes to us, and tolerated our (my) bumbling.

In our down time, I enjoyed playing fiddle with my friend Ben, an excellent fretless banjo player. For the rest of my life, I’ll wonder why I was wearing bunny ears in this picture.

Our full group. Others included Jenny Partivit, Margaret Sweitzer-Hamilton, Dena ___, and three others – I can’t recall their names. If someone could help me fill in the blanks, that would be great.

Learning about poverty in West Virginia led me to the Mississippi Delta later that year, again with Murtuza Gunja. After college graduation, I went to Guatemala, and later to the Dominican Republic, Botswana, Mozambique, and other countries. Poverty and health has been the focus of my life’s work.

But probably the biggest impact of the West Virginia trip was Murtuza and Ja-Yun. The trip kindled a spark, leading to a relationship, and are now they are married with two kids in California! So the spring break trip was definitely worthwhile.

https://www.youtube.com/watch?v=pCY5d4yMLdM

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What would Dr. Paul Farmer say about Russia/ Ukraine?

East-West tensions are escalating, as Russian nuclear forces are on high alert following Western sanctions that forced the Central Bank to raise its key rate to save the ruble. Meanwhile, gunfire continues in and around the Ukrainian capital. If Dr. Paul Farmer were alive today, what would he say about these events?

It’s impossible to know, but Paul Farmer was a tireless human rights advocate. I strongly suspect he would be calling for a ceasefire and deescalation of nuclear tensions between the US and Russia.

President Joe Biden must immediately put into place a plan to abolish nuclear weapons globally. As Dr Ira Helfand and I wrote in an op-ed on CNN.com in 2016 (with edits):

Nuclear weapons are the greatest threat to our national survival. The US cannot disarm unilaterally, but it can join and provide leadership to the international movement to prohibit these weapons. The world desperately needs a leader with vision and courage. Let’s hope that the president of the United States will be just that.

It’s time for each of us to step up and speak out. No to war. No to nuclear weapons.

Yesterday morning we left Los Angeles, saying goodbye to Sang Yoon

We fly over the Midwest. This planet is so fragile. Nuclear war is not a option. These weapons must be abolished.

Back at home, in Massachusetts. What a vacation. I now realize the Great Spirit was with us throughout our journey, everywhere we went.

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Back in San Diego once more

Yesterday was my last morning in San Diego, and I had six more miles to walk with my backpack, violin, and giant baseball piñata. So off I went, from Point Loma toward the Seaport district. Soon I was hot and hungry, wishing I had water and a bag of fresh cherries. Too bad – the harvest doesn’t begin until April.

The thing that stood out as I walked, still on the lookout for the Great Spirit, was the homelessness. Tents and sleeping bags were everywhere, tucked behind shrubs and recycling bins.

Leaving with the baseball piñata, thankfully empty.

A tent along the waterfront.

A tent hidden in front of the USS Midway. What kind of country are we that we spend hundreds of billions on the military, and nuclear weapons, but a pittance on housing, drug treatment, etc? Our democracy, and capitalism itself, has lost its way.

Suddenly, I saw a flash – a ponytailed man raced past me on a recumbent tricycle! Or perhaps he was the Great Spirit? I started to give chase, but he was gone.

I imagined a future with recumbent tricycles zooming across Southern California, not a car in sight. A pipe dream? Probably, but a cool dream nonetheless.

I took a breath.

The rest of my journey was uneventful. I saw sailboats, took the bus to LA, then the train to North Hollywood. I walked around for a bit, then was picked up by my brother-in-law, Sang Yoon. He was impressed by the giant piñata. So was Joe, at our party in Northridge.

Carrying the enormous piñata across San Diego

The tuna industry in Sam Diego seems to be doing well

Another dedication to the Spaniards. How about a dedication to the Native Americans who died?

Dedication to the soldiers from WWII. What about preventing WWIII, triggered by Russia/Ukraine? It’s almost as if we want a big war, to distract ourselves from COVID and our floundering democracy.

Let us now praise famous men… look at the music staff / note tattoo on this sleeping gentleman’s neck.

Amelia Earhart, vanished on an around the world flight,1937. Perhaps she was carried away by the Great Spirit.

Throwing candy back into the piñata – why? Because it’s fun!

The piñata never actually fell. I had to climb a ladder, to take it down.

Acorn, hanging out with Jae, Sang Ah, and Joe. That is a cool dog.

Sang Yoon, taking us back to Ktown. He is an amazing driver.

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My walk to Tijuana

Our weeklong vacation is winding down, so it was time to do one of my favorite things in the world- to go to Tijuana.

Back from 2008-2011 I was nicknamed “TJ Phil” by my friends Monica Bhagat and Mike Rhodes because of my passion for Mexico. Yesterday I decided to rekindle that spark by walking from San Diego to Tijuana, in search of the Great Spirit.

Back in 2011, Mike, Monica, and I walked about 17 miles from Coronado to San Ysidro. We didn’t make it all the way into TJ, and we has to take a bus the last three miles, however. So yesterday I decided to give it another go, solo, carrying my violin, passport, and water bottle. My friend Ben Hulley lent me his sunglasses so I was good to go.

I took off at 9 AM in Ocean Beach, looking excitedly for the Great Spirit. Unfortunately, I soon realized was headed in the wrong direction – toward Canada, not Mexico.

So I corrected course, turned 360 degrees, and walked South along the waterfront, toward the border. Five hours later, my friend Ben Hulley picked me up in Logan Heights, almost in National City. I had failed to reach my goal by over 10 miles, but I did have a belly full of tacos.

So we drove into Tijuana and went to Playas before the soccer game.

I am smiling as the walk starts, carrying my heavy violin case.

A few miles in, I made a guitarist friend and played a song, “Santa Fe” in front of the USS Midway. Perhaps my new musician amigo was the Great Spirit?

Sailboats in the harbor. I imagined living in one, like my attending physician from UCSD, Dr Robin Ryder, did long ago

Petco Park, home to the San Diego Padres. Play Ball!

Excited to be arriving in Logan Heights, where I had my primary care continuity clinic for three years.

This could be a totem pole, a tribute to the Great Spirit.

Outside the health center where I had my clinic from 2008-2011. UCSD no longer has a relationship with Logan Heights Family Heath Center.

After 10 miles of walking I needed some refreshments.

Back on the road. I know this isn’t the Great Spirit. It looks like a Diablo.

Lost pup:(

Perhaps s/he was looking for the Great Spirit.

Ben Hulley picked me up before I accidentally wandered onto the US Naval Base. Then we drove down to Playas De Tijuana.

But first, we stopped by Playas looking at a garden near the border fence.

Dr. Ben Hulley and I, standing where the border fence stretches out into the Pacific Ocean

Back in California after the soccer game (Tijuana won, 2-0). I do think I found the Great Spirit in the stadium, among the singing, flag waving, dancing Xolos fans.

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In San Diego

Now I find myself in the Point Loma neighborhood of San Diego, home to the famous Sunset Cliffs. Yesterday’s journey started off with a walk in Los Angeles from Koreatown to Union Station. On the way I passed the LA Philharmonic Concert Hall, and I thought up a joke:

“What’s the fastest way to the LA Phil, Phil?”

“Practice.”

The LA Phil is led by Gustavo Dudamel, a product of Venezuela’s El Sistema

At Union Station I spent two hours in parking lot next to Aladdin Bail Bonds, because our Flix bus was late. But not to fear, there was a food truck and I dined on spicy quesadillas. I also broke out my fiddle and played a jig. No worries about the large correctional institution across the street, or the sherif driving by several times.

My music attracted the attention of Ron, who was very friendly, along with his Chihuaua, Joe. We has a great conversation about BB King, Dave Brubeck, and other musicians. Could little Joe be the Great Spirit, I wondered, as the dog spun around, chasing and biting his own tail?

Joe, all snuggled up for a bus ride to San Diego.

In La Jolla, I spent a couple hours walking and chatting with my high school friend Ginger Stauffer. Then I met with Dr. Simerjot Jassal, the UCSD Internal Medicine program director. And now I am settled in at Ben Hulley’s house in Point Loma. Ben is a hospitalist at the San Diego VA, and a fledgling guitarist.

With Ginger, on the UCSD School of Medicine Campus

With Simerjot Jassal. We talked about primary care, federally qualified health centers, and teaching residents about advocacy and op-Ed writing, among other issues.

The parking lot next to Aladdin Bail Bonds where I played some fiddle, and met Ron and Joe the Chihuaua

Ben Hulley teaching Hank the basics of guitar. They have a nice acoustic Martin dreadnought

On my journey to Union Station I was surprised and saddened by how many homeless people I saw. So many tents and makeshift shelters. Perhaps one of them is the Great Spirit

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