Home Health and Hunger

Nanci, a good friend of mine since nursing school, recently left her position as CCU (Critical Care Unit) RN at our large regional hospital. Like me, my friend is a lifelong learner (probably why we’re friends), and after obtaining her CCRN certification, she decided to move on to her next care-giving learning experience, one with better hours and less stress—home health. She’s been at it since the end of October, and after only a few days in the field, she texted me, overwhelmed by the poverty she was seeing up close. “I had no idea, and I thought of Little Free Pantry. Maybe there’d be some way LFP can help.” One of the homes she visited had no running water. Its single working stove burner provided heat.

To qualify for home health care, a person must be homebound; if a person can get to outpatient physical therapy, that person does not qualify. This means most folks who receive home health care are elderly. According to National Association for Home Care and Hospice 2010 statistics, of the 12 million receiving home health care, 69% were over 65. With the “graying of America” well underway, I imagine that number is higher now, and medicare enrollment is expected to more than double over the next 15 years.

When I was in nursing, I had a particularly soft spot for geriatric patients. I guess I have a particularly soft spot for this population more generally because since the LFP Project inception, it’s really bothered me that LFP isn’t a solution for homebound seniors; like most bricks and mortar pantries, folks go to it. 



I told Nanci I’d think about it.

Food security involves several components—access, distribution, stability…. In America we have more than enough food for everyone. For those doing hunger work, distribution is often the most challenging part. Mobile food pantries are trending, but these usually work through host locations, and folks must still go to them. Hard for the homebound. This is why Meals on Wheels is such a critical social support (and why you should call your Senators/MOCs and ask them to increase its budget funding). But Nanci’s patients often aren’t even getting that. Unlike the home I mentioned in the first paragraph, most do have a way to prepare their own food.

Then, I remembered six area law enforcement agencies had recently partnered with our local food bank. Officers receive boxes of food for distribution on their beat, feeding folks, building relationships.

Nanci works M-F, seeing around eight patients a day. Her agency employs eight RNs. These have a similar case load. More LPNs and therapists. Estimating, the RNs at this single agency make 320 house calls a week. 


What if home health care providers partnered with anti-hunger agencies, empowering their nurses to utilize the two-question food insecurity screening tool and equipping them with healthy, emergency food supplies to promote nourishment and healing?


These nurses would not only be feeding the old, sick, and hungry. They’d be uniquely positioned to conduct assessments tracking outcomes of healthy food as intervention for a demographic that will only grow. As the most trusted profession, they would also be uniquely positioned to provide point of care nutrition education.

Law of Unintended Consequences

Letting you know up front some of this content is tough.

Today is World AIDS Day. I probably wouldn’t have written about it had it not been for Bono’s recent appearance on Jimmy Kimmel. (U2 fan from way back, Achtung Baby and *gasp* Zooropa, favorites.) (RED) Campaign spokesperson since its inception, Bono talked about this year’s campaign, which raised $500 million dollars. At the end, Kimmel cut to a video of the “currently unemployed” President Obama, who says, “Hi everybody. This World AIDS Day, everyone has a role to play.” Huh? I thought we had this. And here we are.

The 2014 Scientific American article, “Food Security and the Fight Against HIV/AIDS,” corroborated in fact much of what I guessed about AIDS trends, noting several achievements: new infection decline, 61% accessibility to antiretroviral therapy (ART), AIDS-related mortality dropping from its 2.3 million peak in 2005 to 1.6 million in 2012. However, declines, accessibility…these things aren’t happening across the board, and one of the drivers of inequity in sub-Saharan Africa is…you guessed it, food insecurity. Predictably, those infected with HIV/AIDS have higher medical expenses. They miss work. All of which exacerbates food insecurity and affects outcomes. Also predictable but something I hadn’t let myself think about much, hungry people engage in transactional sex, increasing transmission.

US trends are even better, but inequity still complicates. People of color are disproportionately affected, and a highly publicized 2010 CDC study suggests infection among heterosexuals living in inner-cities most depends on poverty; rates doubled among those living below the poverty line. The surveyed were not IV drug users, though they could have been more proximate to them. The CDC 2016 “Today’s HIV/AIDS Epidemic” fact sheet blurb about poverty as an exacerbating socioeconomic factor implies an additional reason: "Those who cannot afford the basics in life may end up in circumstances that increase their risk for HIV infection." (Emphasis mine.) Transactional sex.

Last Fall, Urban Institute and Feeding America released details of another highly publicized study, “Impossible Choices: Teens and Food Insecurity in America”. Focus group conversations with teens in ten communities across the country revealed, "Teens in all 10 communities talked about some young people 'selling their body' or using 'sex for money' to make ends meet. However, these themes were strongest in high-poverty communities."A young woman from Portland, OR, told researchers, “It’s really like selling yourself. Like you’ll do whatever you need to do to get money or eat.”

I warned you.

Back in Africa…Having recognized systemic inequity as the barrier in the fight against HIV/AIDS, over the last decade PEPFAR (the United States Government’s President’s Emergency Plan for AIDS Relief), UNAIDS (the joint United Nations program on HIV/AIDS), and WFP (World Food Programme) have facilitated increased adoption of food and nutrition security policies within larger HIV and AIDS policies. Among the $2.2 billion in proposed budget cuts to our global world health program, President Trump proposes to cut PEPFAR (an agency begun by George W. Bush) funding by 17% with total cuts of $800 million to the HIV/AIDS global health program. One day ago, the (One) Campaign cited a Kaiser Family Foundation report projecting these cuts could result in nearly 300,000 deaths and more than 1.75 million new infections each year. Organizations everywhere, including the Gates Foundation, are ringing alarm bells; they see proposed cuts as a sign of US retreat from the global fight against AIDS.  

Today, back in the US, the GOP is lining up votes for a tax bill analysts say will add $1 trillion to the deficit, and anti-hunger organizations are ringing their own alarm bells. It remains to be seen whether the bill will pass and if so, how lawmakers will balance the federal budget. What seems certain is withdrawal of funds for the global fight against HIV/AIDS will cause new infection rates to rise again after a decade of retreat, and withdrawal of funds to support hungry folks will mean more hungry folks. Some of those will do whatever they need to do to get money or eat.

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Why Thanksgiving

Folks are increasingly put off by Thanksgiving. It is a fictional event divorced of brutal historical context. Black Friday brawls may in fact more accurately reflect historical truth and who we are most of the time. And the current US Census held in 2010 found that 80.7% of the population lived in urban areas. Harvest?

I get it. Except I don’t get it. I’ve always loved Thanksgiving—the food, family…the reading. (This year Barnes & Noble conducted a survey finding Thanksgiving Eve is the biggest reading day of the year!) More than these things, though, I love how Thanksgiving Day centers reconciliation, peace, gratitude for what we have today. Even if we jockey for hot dealz tomorrow. Even if it’s all a beautiful lie. (Think Yann Martel’s Life of Pi.)  How it inserts itself between Halloween and Christmas, two holidays that are frequently too much. Finally, growing up in a rural, Northeast Arkansas farming community, I do understand the significance of harvest, yielding community along with bushels.

I love the idea of a holiday especially for giving thanks. I have so much to give thanks for.

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This Thanksgiving I am deeply grateful, though, for those who daily rekindle my spark.

1.       My family, with whom I can just be.

2.       The LFP/BB community, who chooses optimism.

3.       Kids, who teach me.

4.       Project stewards, who choose trust and compassion.

Because of you, my flame is bright. Good for seeing in the dark. (Or beyond Black Friday.)

Happy Thanksgiving. 

A Good Habit

Mama’s always kept a neat house. My urge to “pitch it” first and ask questions later comes from her. I speculate, though, that like she and I, lots of neatpins have one messy space where we nod to entropy. For me, my car. For Mama, her pantry. Cans upon cans stack and topple. When she remembers she has her own culinary Room of Requirement, finding anything is a mini-archaeological expedition. The number of websites offering tips for cleaning out one’s pantry suggests she’s not alone.

In the United States food is relatively cheap, and we prefer it pretty, which means we waste A LOT. The Environmental Protection Agency says food ends up in landfills and incinerators more than anything else we throw away--as much as 50% of all produce, according to a 2016 Guardian report. Before doing the research for this post, I hadn’t given much thought to the food waste my own household creates. Now, I can’t stop thinking about that ½ quart of week-ish old strawberries next to a much older quart of heavy whipping cream in our fridge. The *several* boxes of couscous in my own pantry.

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It matters we don’t think about it; waste has both personal and global cost. The EPA estimates 20% of total U.S. methane emissions come from landfills, and at least some of what we throw away could help feed a few of the 42 million food insecure American households, households living without the luxury of strawberries.

In The Power of Habit: Why We Do What We Do in Life and Business, Charles Duhigg expands on his finding that every habit consists of a simple, three part, neurological loop: a cue, a routine, a reward. Daylight Savings Time is a cue to change smoke detector batteries. The routine completed, one feels his/her household is safer, validated as a responsible care-giver. I propose we cultivate a new annual habit. Using Thanksgiving preparation as a cue, let’s clean out our pantries. Maybe some of us won’t need to add chicken stock to our holiday shopping lists, saving time and money at the grocery store. More of us will find items we can donate to local food banks/LFPs/Blessing Boxes. Giving these forgotten items will make us happier, and we’ll be keeping them out of the trash, reducing our carbon footprint. I can think of no better way to “Give Thanks” for our abundance.

Please see linked resources for every day ways you can reduce, reuse, and recycle food waste.


For general suggestions: https://www.epa.gov/recycle/reducing-wasted-food-home

To find a food bank near you: http://www.feedingamerica.org/find-your-local-foodbank/

To find a place that will take donations including prepared food:  http://sustainableamerica.org/foodrescue/

Veterans Day

First, a bit of history:

World War I hostilities between Allied nations and Germany ceased on the eleventh hour of the eleventh day of the eleventh month of 1918. On that anniversary the following year, President Wilson proclaimed November 11 the first commemoration of Armistice Day. Armistice Day wasn’t a legal holiday until 19 years later.

In the coming years American servicemen and women would serve in World War II and the Korean War. At the urging of veterans service organizations, the Act of 1938 was amended, the word “Armistice” struck and replaced with “Veterans.” On October 8, 1954, President Eisenhower delivered the first “Veterans Day Proclamation,” and we’ve observed it ever since. I won’t go into the Veterans Day 1971-1977 three-day-holiday stint except to say it was confusing, diminished significance for some, and the November 11th observance was restored.


Veterans have their days. If at all, many of us, myself included, observe those days by posting a flag pic/call to remembrance on social media. Some attend an annual parade, year over year crowds diminishing in tandem with numbers of those honored. A few place flags or wreaths at the graves of the loved and lost.

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1 in 4 Iraq and Afghanistan war veterans are food insecure. I wonder how many of that 25% feels honored this Veterans Day. 

The good news is organizations like Mazon: A Jewish Response to Hunger are paying attention. In just the last few days, Members of Congress, too, expressed concern over high rates of food insecurity among veterans. In a letter dated November 8, 2017, to Veterans Affairs Sec. David Shulkin, US Representative Al Lawson (FL) asked the department for a 2018 report of data collected re: food insecurity among veterans. Rep. Lawson wants to expand SNAP for veterans. The following MOCs signed that letter.

Al Lawson

Michelle Lujan Grisham

Seth Moulton

Tim Walz

Peter A. DeFazio

Dwight Evans

Denny Heck

Chellie Pingree

David Scott

Kirsten Gillibrand

James P. McGovern

Tim Ryan

J. Luis Correa

Julia Brownley

John Garamendi

Jimmy Panetta

Jacky Rosen

Tom O’Halleran

Each of these MOCs has at least one thing in common. (Hint: it's a letter.) I do not know who was asked to sign.

On March 4, 1865, in his second inaugural address, President Lincoln exhorted our nation (soon to see his assassination and the Civil War’s end) to the following:

“…let us strive on to finish the work we are in, to bind up the nation’s wounds, to care for him who shall have borne the battle and for his widow, and his orphan, to do all which may achieve and cherish a just and lasting peace among ourselves and with all nations.”

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This Veterans Day, don’t “wave a flag.” Call your MOCs (800-826-3688) and urge them to reject H.R. 1, the Tax Cuts and Jobs Act, a bill that provides massive tax cuts for the wealthy paid for by cuts to low-income programs and the safety net—programs benefitting veterans. Determine whether your MOCs are in fact patriotic, heeding Lincoln’s call to care and a "just and lasting peace." If not, next time do your patriotic duty and vote them out. 

 

On Zinn and Career Development

 “Small acts when multiplied by millions can transform the world.” That quote is attributed to Howard Zinn, an American historian, playwright, professor, and social activist probably best known for his A People’s History of the United States, (a book I highly recommend). When I built this website, LFPs were already multiplying. Thinking the quote appropriate, I put it at the bottom of the What We Do page. (That page needs work, BTW.) A year and a half later, I have a much better idea what it means.

Having graduated from a small liberal arts college with a degree in “English,” I enrolled in a master program to “study Faulkner” under the guise of becoming a teacher. After two years’ graduate assistance teaching Freshman Composition I and II, I went to law school (for a semester). “Teaching is a calling,” I said. “I can count the number of truly inspirational teachers I’ve had on one hand.” I wasn’t hearing the call. University of LaVerne’s website offers this: “50% – 70% of students change their majors at least once. Most will change majors at least 3 times before they graduate. Students should choose a major based on current job trends.” Many of us (me) are still trying to figure out what we want to be when we grow up.

Years later through the LFP Project I learned I love working with kids. Last week I worked with two Springdale Public Schools 4th and 5th grade EAST Initiative Program groups. The kids plan to map all NWA-area services from LFPs to LFLs to bricks and mortar pantries. They’d already mapped food deserts and hope their continued work will provide location guidance to potential pantry stewards/emergency food organizations. They’re considering the merits of website development over app development. A student asked about data. I explained because anonymity and discretion are conceptually critical, collecting data is difficult. One of the schools decided to connect with a local engineering firm about a solution.

Also last week, City of Charleston Vegan Club, Charleston Veggies & Vegans, and City of Charleston Faculty for Compassionate & Sustainable Living celebrated World Vegan Day with a potluck and party. Admission to that event was a vegan donation to the Lowcountry Blessing Box Project.

This Saturday, Algiers Point Free Lil Pantry will host a Free Lil Thanksgiving planning meeting at The Crown and Anchor English Pub.

A small act multiplied by millions does transform the world because it inspires others, whether to the same or tangential action. A small act’s greatest potential to transform the world, though, is that it creates unpredictable and diverse opportunities for connection among those in its orbit—from EAST Initiative Program students, to engineers, to vegans, to pub-goers--those connections influencing unpredictable and diverse action across disciplines. So much complexity may be found within an empty box, a small act.

Often what mediates that complexity is our simple human need to serve others--a community’s impoverished, someone at the bar. What are the current job trends? Is it any wonder we don't know what to do with ourselves? Better guidance for those of all ages might be, How will you serve?

Logistics

All day yesterday, I was a logistics manager.

Before LFP, I was a Thrivent Financial Associate. I made my own schedule, which came in handy when LFP took off since almost immediately I was working full-time on LFP-related stuff.  I maintain my securities license and affiliation with Thrivent but stepped back from a role with expectations. This means I still do some Thrivent work.

Task one: Coordinating a local poultry producer’s donation of Thanksgiving turkeys to two area churches, a task once handled by Thrivent volunteers. (It’s complicated.) On November 17th I’ll pick up and deliver 52 raw birds.

Task two: Coordinating an Indianapolis newspaper’s donation of 50 plastic newspaper boxes to LFP. I am in Fayetteville, AR, but because of the work I do (LFP) when I’m not doing my actual work (Thrivent), I have connections to Indianapolis-area groups. They’re taking it from here. 50 new projects!

Task three: Creation of a spreadsheet of Northwest Arkansas area LFPs, made for a large local corporation who will use it do community service. (26; another five unconfirmed.)

And so on until 8:15.

Poverty and distribution are the leading causes of hunger, and I spent all day yesterday on the distribution side. I'm ready to get to work on poverty. I anticipate that work, too, will have lots to do with the logistics of mobilizing people to act.