House Calls Make Cents

Every Tuesday afternoon I have the privilege of hanging out with my buddy Jim Walton. During this time we enter the homes of very special people in need and I get to observe, and sometime participate in, the awesome responsibility of providing care to those among the most in need.
This work is starting to get some attention. Last weekend the Dallas Morning News Business section carried a story on this important work. It featured Jim with a very special patient, Ms. Ransom.

She is a pillar in the Roseland Homes community and has been an activist for most of her 86 years. She is also dying of cancer and I have the unique privilege of getting to know her better as she transitions ‘home’.

Very early in our house call experience I inquired if this activity made economic sense. I knew that in private practice a family physician must see around 22 patients a day to be fiancially viable. Jim and I only see around 5 in half a day. I haven’t done the complete analysis however after about 18 months of this I can see that this is indeed viable. Jim sees very difficult patients, most are quadriplegics who, while for the most part are stable, need his monthly visits and weekly visits from our Community Health Workers (CHW). The uninsured (indigent) do have access to health care, they get it in the Emergency Departments (EDs) of large hospitals all over the country. In Dallas this costs the hospital about $1,000 per ED visit. If they are admitted through the ED, and because they don’t have a regular physician this is how the uninsured get admitted, it costs the hospital a shade over $1,000 per day. It is very unusual for one of Jim’s patients to need to go to the ED or get admitted. In fact since I’ve been working with Jim I believe only one has been admitted and one another has had to go to the ED. He is a quad who had to be transported because of complications from changing his catheter. The ambulance bill alone was $690 – $600 for the pick up and $10 for each of the 9 miles. His ED bill was around $690 and incurred other hospital fees of about $3,000.

Quads in general are fairly stable, their big risks are wounds on their butts (from pressure) and urinary tract infections (UTIs). Keeping these folks out of the hospital makes economic sense and it is really cool to be a part of these folks lives on this level.

Talking about God without talking about God

Last week I met with a pastor who did a strange thing, he didn’t mention “God” until the very end of our discussion. Rev. Don Parish is the pastor of the True Lee Missionary Baptist Church, a church his dad founded about 60 years ago. True Lee is located in the Frazier area of East Dallas, the poorest neighborhood in the poorest part of Dallas County. True Lee has about 750 members, the largest church in Frazier, only about 10% of whom live there. He is a wonderfully committed man who cares about the community he’s from and the potential of the folk who remain, mostly because they have to. He chooses to remain and do what I would call true church leadership.

What really struck me was that he was the first ‘religious’ person I’d met who didn’t mention God, but talked as eloquently about faith and religion without hammering church, scripture, and the bible down our throats.

I was there as part of the Southern Sector Dallas Initiative, a bold idea Baylor has to build in Frazier a wellness center focused on diabetes. Our idea was to meet at True Lee and continue the work, Rev. Parish wasn’t on the agenda. But as he welcomed me and the rest of the team it became clear that if we sat down and listened we would learn much… and learn we did. Among our learning objectives was to learn more about this community, its history and its people. Rev. Parish took us through this as the son of a prominent preacher who grew up on the very spot we sat. He also talked about health and rattled off statistics and anecdotes that frame the issues we are efforting to address.

• In Frazier only about 30% of its residents own their homes
  Rate of home ownership is a clear marker for the ‘health’ of a community. 30% is low, very low. Exacerbating this is the fact that most of the 30% bought in the 60s and 70s. These people will be dying soon and no young people buy homes there.
  
• There are no public gathering places
  Folks stay in the house not because of the heat but because of the crime, mostly stemming from drugs and prostitution that runs rampant.
  
• The people have little hope
  Apathy is a vicious virus that adversely impacts the community. The people have no hope so the people don’t care enough. They don’t care enough about themselves, they don’t care enough about their neighbors, and they don’t care about their community. We struggle with apathy, it is flourishing. This community is not used to having resources (adequate police protection, grocery stores, employment opportunities).
  
• The people there are sick
  Frazier, a majority Black community with a growing Latino population, has the highest infant mortality rate in Dallas county. By the way infant mortality, along with life expectancy, are key markers for the health of any population. In Dallas county Black infants die at five times the rate of White infants. Rev. Parish also sees hypertension, diabetes, cancer, and STDs amongst his parishioners.
  
• Trust is low
  Rev. Parish took us through some history here. When the State Fair came in and bought up a significant part of the community they basically condemned many homes to make room for parking for the State Fair. There is a real trust deficit, outsiders are viewed with scrutiny.
  

Rev. Parish did not stop at describing the problems. He also offered solutions, not just what someone else should do but what he has done and is doing.

• Health Screening – the church is very involved with educating folks on the importance of screening, and getting them access to it. We do health screening all the time, we’ve saved the lives of 4 of our members through prostate screening alone. I am working on expanding this to the entire community.
• Policy/Community Involvement – Rev. Parish is Board President of the MLK clinic, the only ‘free’ clinic in the area. He is on the Board of the Fair Park Community Development Corporation which operates a ‘weed and seed’ program. He is also working with UT Southwestern’s Community Medicine department. He is also running for City Council, the election is May 2007.
• Touching Lives – Rev. Parish does pre and post marriage counseling, relationships are based on trust and if you do something to ‘withdraw’ that trust you must ‘deposit’ something to rebuild. He also collaborates with other churches and organizations to try and effect change. I’m willing to work with anyone that’s willing to do something positive in this community. He also has worked on a relationship with Richland College to teach their college courses, not just their remedial ones, there in the community.
• Building Bridges with Latinos – He recognizes that we must work on Black – Brown relationships. He mentioned the growing Latino population he’s reaching out to. He has already discussed English as a Second Language (ESL) courses with Richland. He also thinks we should eduate ourselves. I think we should also teach SSL (Spanish as a Second Language), my last sermon focused on this.
• Capital Investment – On the wall of the fellowship hall where we met were two drawings. One was of a church/sanctuary and the other was a community center. Rev. Parish shared with us his vision for the spot where we sat. Of course the Pastor of a church talking about a new church building is nothing new, in fact I think most of these guys spend way too much time raising money to build buildings versus building lives. Rev. Parish’s pictures, and plans behind them, were over 10 years old. He needs capital investment to make this vision happen, he also recently decided to divert all the money raised for the church/sanctuary to the community center, Frazier needs a community wellness center a lot more than it needs another church.
  

How refreshing it was to listen to a Reverend who had such passion, knowledge and love for the people. The notion of taking the building fund and using it for a community center epitomizes his spirit and priorities. Church so called ‘leaders’, and all of us, can learn much from his walk. I look forward to our next meeting in a couple of weeks. JFK was right, here on earth God’s work must truly be our own.

An Interesting Discussion

On Thursday nite my buddy James Reed asked me to speak at Smokey John’s. James Reed is a wonderful spirit, he’s an ex-offender and in recovery. I’m also proud to say he’s my friend. James has inspired many folks, not just me, with his heart and authenticity. He has created a ‘community’ of ex-offenders and others who gather at Smokey John’s, a local BBQ joint, every Thursday nite to fellowship, eat, and hear the word. There were about 70 people there Thursday nite and here is an outline of what I said. I was attempting to inspire and as always when I run in these circles I suspect I got much more than I gave.

Pray with Your Feet

I want to talk about fear…. “What do you Fear?”

Our deepest fear is not that we are inadequate.
Our deepest fear is that we are powerful beyond measure.
It is our light not our darkness that most frightens us.
We ask ourselves. Who am I to be brilliant, gorgeous, talented and fabulous?
Actually, who are you not to be?

You are a child of God.

Your playing small doesn't serve the world.
There's nothing enlightened about shrinking so that other people won't feel insecure around you.

We were born to make anifest the flory of God that is within us.
It's not just in some of us: it's in everyone.

And as we let our own light shine.
We unconsciously give other people permission to do the same.

As we are liberated from our own fear.
Our presence automatically liberates others.

-- Nelson Mandela

========== I AM A CREATION OF GOD ==========
I grew up on a wonderful home. We had love, discipline, books, spirituality (no necessarily Religion). In the den there was a cartoon.

I know I’m Somebody, ‘Cause God Don’t Make no Junk

Very early I felt responsible for the gifts.

• NOT perfection – scripture doesn’t say that
• NOT meek and weak… My strength is in my weakness.
  II Corinthians 12:9 – 10
  And He has said to me, “My grace is sufficient for you, for power is perfected in weakness.” Most gladly, therefore, I will rather boast about my weaknesses, so that the power of Christy may dwell in me

NOT alone w/out help. “I can do it all!!” - I’m getting help here right now!

===== WHY DO I GO TO PRISON ======
I have found people there I admire, respect and trust, they persevere
- Perseverance – Romans 5:3 – 6
- And not only this, but we also exult in our tribulations, knowing that tribulation brings about perseverance, and perseverance, proven character; and proven character, hope; and hope does not disappoint, because the love of God has been poured out within our hearts through the Holy Spirit who was given to us.

==== ARE WE SLAVES TODAY=======

“The Slave’s mind is often full of religion and empty of history” – Ras Jahazeil


= THERE ARE GREAT MEN WHO SPEND SIGNIFICANT TIME IN PRISON =

Viktor Frankl
Nelson Mandela
Mahatma Gandhi
Malcolm X

==== WHAT IS YOUR RESPONSIBILITY ======

Pray with your feet – Frederick Douglass
Be well rounded, get your education, get the help you need – we all need it.
If you lined up 10 people and told me a certain number of them are in the system, have a TDC number (or 2) and I had to pick them out. I wouldn’t even have to look at them. I’d ask them, “Who among you have a HS Diploma or GED?”
It is the single biggest indicator of whether someone will end up in the system.
Seek Truth, exude truth – I John 3:18
Little children, let us not love with word or with tongue, but in deed and truth
Seek and develop your integrity; Psalm 41:10 – 12

Integrity -
1 : firm adherence to a code of especially moral or artistic values : INCORRUPTIBILITY
2 : an unimpaired condition : SOUNDNESS
3 : the quality or state of being complete or undivided : COMPLETENESSsynonym see HONESTY

But You, O Lord, be gracious to me and raise me up,
That I may repay them.
By this I know that You are pleased with me,
Because my enemy does not shout in triumph over me.
As for me, You uphold me in my integrity,
And You set me in Your presence forever.

As Bruva Stanley said last week, Step Into your Destiny!!
Not wait for, not pray for, not hope for…. But Step!!! …. A destiny promised us by our Creator???
Examine your own hope!
Find your confidence, step into your destiny, BELIEVE GOD is in you, has plans for you: II Corinthians 4:7-9
But we have this treasure in earthen vessels, so that the surpassing greatness of the power will be of God and not from ourselves; we are afflicted in every way, but not crushed; perplexed, but not despairing; persecuted, but not forsaken; struck down, but not destroyed.

Faith – “acting like it is so, even when it ain’t so, until you MAKE it so”

JFK - With a good conscience our only sure reward, with history the final judge of our deeds, let us go forth to lead the land we love, asking His blessing and His help, but knowing that here on earth God's work must truly be our own. – JFK Inaugural Speech, 1961

Color, Medicine and Trust

My buddy Sean Hudson, who works for Pfizer in their H.I.V. Marketing organization, recently sent me a story about how the pharmaceutical company Schering-Plough is being criticized because they have purposely excluded Blacks from the early stages of clinical trials for their new hepatitis C virus (HCV) protease inhibitor, SCH 503034.

In general people of color do not trust ‘the man’… whether that man represents the government, medicine, education, or business. Of course we don’t have to look very far back in history to understand where those fears may come from. However with medicine this mistrust can be more damaging. If I don’t trust my government I may not vote and avoid police. If it don’t trust the education system I won’t embrace the curriculum and will perhaps drop out of school. If I don’t trust the business community I’ll be cynical about how companies are only in business to exploit me and I’ll begrudgingly work for them only if my lack of options mandate it. However if I don’t trust medicine or health care in general I could die earlier than I have to. I could also influence my Black friends and family to avoid interventions that could prolong their life. Granted there is good reason not to trust medicine. The Tuskegee Experiment was a 40 year 'study' sponsored by the US Public Health Service where they ‘experimented’ on 400 Black men in the deep south to see how late stages of untreated syphilis impacted them. Their scientists essentially withheld treatment and information from their subjects to sit back and observe how syphilis progresses in Black men. They told them they had 'bad blood' and didn't offer any clue as to what they were up to. This remains the shining example as to why people of color do not (should not?) trust medicine.

A recent University of Houston study published in the March Journal of Acquired Immune Deficiency Syndromes reported 30% of Texas African Americans and 22% of Texas Latinos believe HIV is a government conspiracy to kill minorities.

Schering-Plough maintains that its recruiting practices for its clinical trials are legit, their spokesman Robert Cansalvo argues because Blacks are known to respond poorly to one of the drugs SCH 503034 is being tested with that including them in the early trials is ‘unnecessary' and that they will definitely be in the next round of trials. Says Cansalvo, “It’s a question of timing when to include them.”

Some HCV scientists and activists agree that their approach to selecting subjects is sound and Schering-Plough should proceed so that this potentially valuable product moves closer to becoming available to those in need. However critics from community based organizations to Hep C advocacy organizations see their selection practices as an egregious disservice to Blacks who are in the most need. HCV is three times more common among Blacks than among Whites. Cure rates are lower for Blacks on existing meds and Blacks are more susceptible to complications of HCV like liver cancer, liver failure, and cirrhosis, all of which can lead to death.

This is a tough issue. It is a bit unsettling that Blacks are excluded from the early stages of a clinical trial for a drug that could address a virus that disproportionally impacts them. Also these protests and bad press do nothing but fan the flames of mistrust that many people of color have regarding the medical establishment.

I understand the urgent need to develop, test, and bring to market drugs that will treat some of our most pressing viruses, and diseases they cause, to market. I also understand this work is done against a backdrop of fear and mistrust.

Given both these factors I think Schering-Plough is wrong here. I don’t have a problem with the exclusion in the early stages, they seem to have solid clinical rationale here. I do think they could be more sensitive to the context in which they operate and should proactively reach out to the advocacy groups and other organizations who question their selection and work with them to explain, and discuss, why their selection rationale makes sense and their selection plans for future stages of their trial.

Their work is too important, and the scars are too deep, to ignore history and these important issues around trust that are still with us all.

30% of Texas African Americans and 22% of Texas Latinos believe HIV is a government conspiracy to kill minorities.

What happens when actuaries are wrong?

My buddy Dr. Marcus Martin from the J. McDonald Institute here in Dallas has an interesting idea about how to build wealth in the Black community. Get young Black men life insurance policies. The basic premise is that Black men die earlier than most other demographics in the US and for young Black men in urban areas the death rate is much higher than those of other races from other demographics. If we encouraged young Black men to get insurance policies, then their families could benefit financially from these very unfortunate, premature, and statistically predictable deaths. Also, if insurers started to pay out policies this would get their attention and perhaps we all would see our connection to these young men to the point where we might put a bit more effort in a solution. A noble idea and creative plan.

On Monday I had the opportunity to visit Memphis to check out the Church Health Center with Marcus, Jim Walton, and Albert Black. On the trip we discussed Marcus’ idea. I mentioned that I used to work with a few actuaries during my job at The Travelers in Hartford during undergraduate school. I mentioned that they were pretty bright folk that would recognize the trend and figure out how to charge higher premiums for these ‘at risk’ Black men. I didn’t think they would calculate incorrectly. I dunno the law here but even if this is illegal they would figure out a way to get around it.

They aren’t gonna lose money on this, but what happens when actuaries are wrong??

I recently read a story about a real AIDS patient who bought a life insurance policy back when she was originally diagnosed in the early 90’s and has essentially ‘outlived’ the actuaries. Now the company that helped broker her policy wants to back out because she is outliving the financial model. Her staying alive is costing them money.

The anonymous patient from Philadelphia “M. Smith” at the time of learning of her HIV status was reasonably healthy and never suspected that her ex-boyfriend had HIV and infected her. However when he died from AIDS complications she knew he was responsible. She, like many others at the time and even now, viewed this diagnosis as a death sentence and she wanted to get her affairs in order. M. Smith, who was single with no children, was leafing through POS and saw an ad offering to buy her existing $150,000 life insurance policy. The company, Life Partners, would pay her $90,000 up front and cover her combined life and health insurance premiums if she lived longer than two years. When she died Life Partners would collect the full value of the policy, at a potential 60% profit. The sooner she died the higher the profit. She signed the contract in 1994 and neither she nor the actuaries at Life Partners thought she’d still be alive some 12 years later.

Quick aside, isn’t there a bit of irony in a company called Life Partners that is in business to profit from it’s client’s deaths? Anyway…

Like most businesses Life Partners doesn’t like losing money so last August, the day her premium was due, Life Partners sent her a letter saying they ain’t gonna pay her life insurance premium no more. They demanded in the letter that she pay the premium herself. M. Smith had recently turned 50 and now has cancer, her premiums have jumped to $29,000 a year, money she doesn’t have. M. Smith hired a lawyer and when Life Partners was pressed the company president agreed that they would pay her premiums because they were ‘contractually obligated’ to do so. Where was the obligation when they sent her the letter?
Anyway, Smith and her lawyer are still wary because at other times in the past Life Partners has threatened to abandon the contract which would essentially void the life insurance policy. Smith claims these threats cause her additional stress and jeopardize her health.

Of course there is still no cure for AIDS but with new medications that are readily available Magic’s case becomes far more common. These new interventions are very effective of prolonging the lives of HIV positive folks. The AIDS Law Project in Pennsylvania has said that the actuaries in companies like Life Partners never considered that a relatively quick AIDS death might not be a sure bet. Companies like Life Partners continue to pay hundreds of thousands of contracts they negotiated during the 90’s, money that of course cuts into their profits. As we’ve seen companies will go to great lengths to avoid this.

I like Marcus’ idea, I just think that life insurance companies will likely respond very quickly if ‘at-risk’ young Black men start buying life insurance.