Monday, December 31, 2007

Reusable Living Christmas Trees and Happy New Year!

Happy New Year!

Thank you for reading this blog, now in it's new location at . I thought it would be a good incentive to write if I got rid of the .blogspot. [A side note, if you buy a domain name be sure to buy the privacy option, otherwise your name and address become public domain. Learned from my husband right after I bought concretegardener.]

I'm really happy to have people reading. I'm hoping that writing will help me to express myself better, and learn from readers, too. I'm open to many different directions. One thing I've been thinking about is the "in-between" phase that people in new countries face. I recently graduated but I am not eligible to officially work for a few months. It's a scary thing-- how do I spend my time if the financial incentive (short term and long term) is removed?

Also, I would like to point you to the Christmas tree above and to the right. It was $7.00 at Trader Joe's and I am thinking of keeping it my whole life, or Eugene's whole life, depending on who lives longer. Over a 75 year lifespan, we will save hundreds, thousands, millions maybe [exact figure may vary] on Christmas trees, and we will gradually become deeply attached to our growing tree, who we imaginatively named Christmas Tree. If we move, we may need interim tree-sitting support. If you're interested, there are left over living trees floating around Boston and other US cities-- get one now and you can avoid cutting down a tree next year.

Happy New Year!

Sunday, December 30, 2007

Are these really trees?

As some of you know, I waited with anxious anticipation for the Arbor Foundation to send me my 10 free trees, in exchange for joining the Arbor Day Foundation. I waited, waited, and waited, expecting that any day the postman would be really angry with me for making him carry unwieldy trees to our doorstep.

But he wasn't angry.

He wasn't angry at all. Because what he brought was a little plastic wrapped bag that felt like it couldn't have more than a twig in it. And it wasn't even one of my trees. It was all 10, wrapped together.

I planted them in one pot, because I thought the best solution may be to let them grow a bit then turn them into bonsais. But who knows if they are alive. oh well...

The Trees


In other news, we saw some upside down trees at the Massachusetts museum of contemporary art. Unsurprisingly, they don't like being upside down so seem to die after about a year of it. It's an interesting intersection of science and art, though!

Check back soon or subscribe by rss feed for news on breadmaking, stuffed mushrooms, lifelong Christmas trees, and more!

Monday, December 24, 2007

Mandela, Mbeki, Zuma: Thinking Back and Looking Forward

I remember in 1994, I was turning 11 during the first democratic elections, and was nervous about what would happen to South Africa. Many of my classmates immigrated, and I thought that when apartheid ended, I wouldn't be allowed to go to university. I didn't understand the concept of apartheid too well, or why our neighborhood consisted primarily of white people. But I remember being concerned, and that the only thing that made me comfortable with staying was the fact that if we left South Africa, my dog couldn't come with. That seemed like a pretty awful thing.

When I was 16 I left South Africa for Wales, UK. It was an exciting time for me. I realised there was something wrong with the system and the society in which I had lived, but I still didn't have a clear concept of what had happened, or the implications that apartheid had on the whole of South Africa. It was the privilege of ignorance.

"Without God, anything is permitted" (Dostoyevsky)

In Wales I began to see that I was very lucky to have experienced grace as a white South African. I have heard many South Africans who agree that apartheid was bad but say they didn't have anything to do with it. But, as with white Americans, the facts are like the elephant that's easily hidden in day-to-day life. The South African economy-- the schools I attended, the job my dad had, the infrastructure we enjoyed--would have been unimaginable if not built on the backs of non-white South Africans.

I know I, and many of you, have spoken and thought about this at length, so my purpose here is not to educate you about apartheid or to engender feelings of guilt. I don't want to say that South Africa doesn't have problems, or that you haven't personally suffered as a result of crime. Rather, I want to emphasize the privilege of having been forgiven in a very radical way.

Justice would have prevailed if non-whites had been given lump-sum payments and replaced whites in jobs, etc. That is not what happened. I know that today, affirmative action is happening, but I still received a scholarship in 1999 to go to Wales despite my race, and South Africans of all races still have many opportunities. I struggled to find a job during 2005 when I was in South Africa, but I didn't struggle to get into university. My family, who are not abroad as I am, has been safe and has been able to enjoy South Africa in a new way. Justice didn't prevail.

The African National Congress made a concrete decision to transition in peace. Although Nelson Mandela is the man praised for this transition, it is more clear now than ever that the ANC is a democratic organization, where the will of it's members, not the will of the leader, take precedence. The movement decided that the best way to achieve its ends was peacefully. I believe that they did what they believed was best for the country, but they also made an ethical decision. They made a decision about the value of human life-- value that had been consistently denigrated during apartheid. They made a decision, I believe, that because God exists, not everything was permissible in 1994.

The ANC used to be a movement more than a party. Today, the party has had to reinvent itself, as the changes it faces right now are much more complex, and far less clear-cut, than in the past. How should the ANC relate to the SA government? How should the government negotiate between growing the economy and offering opportunities and justice to the poor? How should the government treat multinationals making huge profits on South African soil?

There are difficult times ahead, especially under new leadership. Although I didn't support Zuma, and being here in Boston I'm far removed from everyday life in South Africa, what happens in South Africa is very important to me. May more South Africans experience grace in 2008.

Moving back from the ANC to me, 1994 was perhaps my most concrete and extreme experience of grace. As a result, I can't casually condemn or ignore unjust systems or individuals. There is a lot of power to be had in engaging, negotiating and thinking through beliefs together. This Christmas, I'm grateful for grace.

Saturday, December 22, 2007

In Pictures: How to Make Dumplings

Jo Hunter Adams

One great thing about US cities is that it's relatively easy to get ingredients for a very wide variety of foods. For example, near our house is a Super 88, where we can get any Chinese food we want, and a more limited variety of other Asian foods. I recently learned how to make dumplings and I wanted to share it with you, because it's very easy and is one food that almost everyone likes. (side note: in Durban North, there is a Chinese grocery across the road from the Engen off Umhlanga Rocks Drive, between Danville Girl's High and Umhlanga Rocks Drive. Sorry, I always forget the name of the road.) These are as good, but without the preservatives of shop or restaurant-made dumplings.

Ingredients you need:
Small pack of mince (ground beef or pork, pork is usually better)
Scallion/green onion
soy sauce
dumpling wrappers
sesame oil (if possible)
ginger (if possible)
ground up garlic
finely chopped carrot (optional)


To make the filling, mix mince/ground meat, scallions, a little sesame oil, about a teaspoon of garlic and some finely chopped vegetables (really, really tiny, as small as you can).

Mix well with a wooden spoon.

Making the Outside

Have a little bowl of water and the dumpling skins. Dip a [clean] finger in the water and gently wet the edges of the dumpling skin.

Put about a tablespoon of filling into the center of the dumpling. You'll see what works when you try to close it. Trial and error is fine!

Fold the skin in half, and press the edges together. They should seal well. If they don't, dab a little bit of water with a finger.

Place the dumplings on a lightly floured surface.

Cooking the Dumplings

You can boil them, steam them or fry them in a pan with a tiny bit of oil on the bottom. I like frying them because it's very quick and they come out crispy. You can also add them to soups.

If you have the dumplings on their own, you can make a quick dipping sauce using soy sauce, sesame oil, vinegar and a little sugar. Try it out and see what your taste buds like best!

Friday, December 21, 2007

Henri Nouwen

Just as words lose their power when they are not born out of silence, so openness loses its meaning when there is no ability to be closed. p32, Reaching Out.

Wednesday, December 19, 2007

The Greatness of Pure Cranberry Juice

In probably my favourite class at Wellesley, I got to test out the antibiotic properties of cranberry juice (staph, e-coli, strep bacteria) in-vitro. The results were amazing: even dilute, fairly fake cranberry juice had significant anti-bacterial properties when tested on staph and e-coli. Since then, I've thought really highly of the juice. It's one of those great, natively New England, creations!

It is really bitter. I think this means you don't drink as much of it, which is probably ok. A little goes a long way with cranberry juice, especially when a bottle of pure cranberry juice is pretty expensive (around $4.89 at Trader Joe's). In addition to be strongly antibiotic, it is also rich in vitamin C. It's antibiotic properties make it very effective against oral bacteria. It has dietary fiber.

And it just tastes healthy enough to make you feel healthy, which is powerful in and of itself. An article in the New York Times this week reports a study of 44 hotel maids who, when they changed their idea of their exercise level, they experienced significant health benefits. That is, without actually changing what they did, awareness that hotel work was physical activity made them lose weight and helped lower their blood pressure. It was a small sample, but it's a compelling thought! (

Check back soon or subscribe by rss feed!

Coming soon
Comparing the US and SA presidential race (Apples and Oranges?)
Keeping carrots
Are those really trees?
How to make Dumplings

Sunday, December 16, 2007

2015, The Pessimistic View

In the previous article, I referred to some of the things that would need to happen for us to see a different, more positive image of U.S. health care in 2015. In this article, I will look at the possible scenarios whereby the situation could look far worse in 2015.

So, we're looking at a system in 2015 where health care costs are spiralling out of control (20% of GDP and rising), more people than ever are uninsured, the nursing shortage is deteriorating further, etc.

"Business as usual" could have produced this result, as we are currently in a trend towards increasing health care costs, and also decreasing levels of insurance.

The incentive for full insurance coverage was mainly political, and the president largely realised their goal of insurance for all. However, this insurance was poorly finance and so uninderinsurance became an even more serious problem. Many people were bankrupted despite having paid premiums, and compulsory health insurance was called into question. Their reasoning was "why pay premiums if the premiums are useless when we get sick." Americans refused to pay high premiums for substandard health insurance, and so coverage became even more of a problem.

At the same time, malpractice suits increased and doctors felt compelled to practice very conservatively, liberally calling for expensive tests because they did not know their patients' health care histories and could not easily judge whether or not a test was really warranted.

Nurses' jobs were unpleasant. They felt as though they were constantly coding for various procedures to act as gatekeepers between patients, health care institutions, and insurers. This problem of billing was compounded as nurses were in ever-scarce supply, and the profession became increasingly unpopular.

As the financing of health care and the health care itself was increasingly disjointed, health care costs increased. Doctors felt that it was inappropriate to make decisions based on money.

Check back soon or subscribe by RSS feed to read these new articles:

How to make dumplings
How to make berry crumble
How to save on heat
Are these really trees?

Saturday, December 15, 2007

2015, The Hopeful View

"There is likely not one solution that solves the problems in [U.S.] health care 100%, but 50 solutions that each solve the problem 2% are just as good." paraphrased from Alan Sager

The professor of my Health planning and management class suggested that one way to conceptualize the challenges of planning an effective health care system is to think forward to 2015, and imagine a perfect system. From there, think back on what needed to have taken place to realise this goal. The perspective that there could be 50 solutions that each help a little bit is helpful in emerging from a state of inertia/paralysis, because your solution doesn't have to solve everything. At the same time, it's valuable to think about your corner of the solution in terms of the other 49-- your solution cannot cripple the solutions of others.

The key ideas in a positive and hopeful picture are full financial protection, identification and stabilization of needed numbers of institutional caregivers (hospitals, nursing homes, home health agencies, health centers) and professional caregivers (doctors, nurses technicians, and others), overcoming non-financial barriers to care, substantial improvements in efficacy, appropriateness, and quality of health services, and cost controls that stabilize health spending at 16 percent of GDP. What were the events inside or outside of health care that precipitated these changes?

The Picture I Imagine

In early 2009, when a democratic president was inaugurated, there was already momentum for change. Over 60 million Americans were uninsured, 150 million were underinsured, and few people felt that their health care addressed their most important needs. Health care spending was spiraling towards 19% of GDP.

This picture meant there was a public openness to new ways of thinking about health care, and to ideas that went beyond the usual debate about coverage and cost control. I'm going to look at 5 people in health care, and the solutions that they managed to implement fully before 2015. You can use your imagination to think through all the other stories that would have had to have been taking place simultaneously for everyone to truly be covered.

Snapshot 1: Administrative Efficiency
Christine was one of the many people in midst of this change. She lobbied for changes in business law to simplify billing and to create a clear relationship between spending and provision of care. From her perspective, this was the major source of waste in the health care system.

Together with thousands across the fifty states, she led change in medical schools, so that business studies were included as an integral part of medical school. She understood that we would only enjoy the fruits of these changes in the long term. Many doctors encouraged this change because they felt that they would like to make informed choices about health care spending. Certain medical schools felt that this curriculum encroached on already scarce time to teach future doctors clinical skills.

She also encouraged a symbiotic, rather than antagonistic, relationship between health care providers and insurance companies. That is, an agreed amount of risk was standardized and balanced between providers and insurers. This meant that responsibility for payment could not be shifted between providers and insurers. Essentially, this represented large scale capitation. It meant that doctors in this system were responsible for providing care using a finite budget. As practices under this system were fairly large, insurance companies felt that the system would not interfere with their profits, as at least a few of the patients would need expensive care, and it would be the doctors, not the insurance company's problem to think about these "problem patients". On a large scale, this greatly simplified administration and allowed doctors to earn more from relatively fewer patients. Patients received better care. Nurses were able to practice nursing and not be bogged down with coding etc.

Snapshot #2: Coverage
A collaboration between health care advocacy organizations effectively lobbied for universal coverage and genuine financial protection. Financial protection was initially unpalatable for a large portion of the population, who felt that they would have to pay for other people's health care. However, momentum came from the large portion of the population who were angry and frustrated at the increasing costs of health care as a percentage of GDP. They felt that until people were able to go to the doctor when they needed to, the ultimate cost would continue to increase. Rationing care and financial protection became intertwined: both were needed if the absolute cost of health care was to stabilize.

Compromises included strict guidelines for beginning and end of life care, where doctors were protected from lawsuits within the new framework. Guards were put in place to protect middle-class taxpayers. The Medicaid (MA) and Medicare programs were expanded. A federal free care pool was created and grown. A three year program began in which highly paid medical professionals did not receive salary increases. This money was used to build a free care pool and create financial protection for all uninsured individuals seeking care. An amnesty period was followed by coverage. This coverage did not include care that was considered futile, and in this way was a painful cost control.


Deep change required some level of desperation. It required a sense that radical change was required. It required political will and compassion. It required difficult choices not to do certain expensive tests unless indicated. It required patients to give up their right to sue.

Friday, December 14, 2007

Thinking through US Health Care


"We cannot live under the idea that we can give everybody all the health care they need. Rationing of health care is inevitable because society cannot or will not pay for all the services that modern medicine can provide. People in this state must search their hearts and pocketbooks and decide what level of health care can be guaranteed to the poor, the unemployed, the elderly, and others who depend on publicly funded health services" Oregon Health Decisions, 1988

Since this blog is largely about finding ways to stay healthy in a responsible way, I thought it would be good to post a snapshot of US health care. I believe that many of the readers of this blog may not be from the US-- this one's for you! Looking forward, this post sets the stage for my next two posts:

(1) What it might take to see a different picture in 2012, a picture where everyone has good, appropriate care without ever having to worry about how they will afford the care, or if they will lose insurance.

(2) What might have happened if the opposite had taken place and we're looking at a disaster in 2012: costs spiralling out of control, more people uninsured, the nursing shortage further deteriorating, etc.

The Snapshot

47-60 million without insurance and some 150 million under-insured
1.7 trillion (that is, 1.7 000 000 000 000) in yearly costs, or 16% of national spending.
"The United States spends more than twice as much on health care as the average of other developed nations, all of which have universal coverage"^ yet
Comparing Japan, Sweden, Canada, France, Australia, Spain, Finland, the Netherlands, the United Kingdom, Denmark, Belgium, the United States, and Germany, the United States ranks*:
- 13th(last) for low-birth weight percentages
- 13th for neonatal mortality and infant mortality overall
- 11th for postnatal mortality
- 13th for life expectancy at 1 year for females, 12th for males
- 10th for age-adjusted mortality.

20-30% of patients receive inappropriate care.
An estimated 44 000-98 000 people die each year as a result of medical errors.


Many readers will compare the US system to the South African system. I would like to do the same in a future post. I think it may be useful for thinking about health improvement in both countries. The South African system recognizes health care as a Human Right, which the US system does not. Yet people in the US generally receive much better care.

So, let's look at the "Human Rights" aspect of health care. The limitation of the "human rights" language of health care is that one can never guarantee health. We all get sick and we all die. As one professor at BU School of Public Health says, this fact means that health care has a 100% failure rate. As a result, it's really difficult to measure what is a reasonable amount of care. Some people will need far more resources than others. Yet the right to care is also one of the most fundamental-- it's a life and death issue.

In the U.S., patients and health care providers are uncomfortable with the idea of rationing. Surely everyone should get the best possible care that is available? Unfortunately, the answer is "no". Particularly when what is available is often extremely cutting-edge and therefore expensive, as in Boston, there has to be a limit. The challenge is drawing a line between one type of care and another. The challenge is saying no to some types of really expensive care. As a result, US health care spending is spiralling out of control.

As in the South Africa, socio-economic inequality is a root problem in the health care system. People are not guaranteed care. Worry becomes an intricate part of any visit to the ER, specialist, or primary care physican.

I argue that the deeply fragmented nature of health care is a major source of waste and of poor care. Health care is not a commodity like any other, so it cannot be treated as a common commodity in a free market. In a free market there are always people who lose everything, but losing money is one thing, and losing one's health is another.

^The Physicians' Working Group for Single-Payer National Health Insurance, Proposal of the Physicians' Working Group for Single-Payer National Health Insurance. JAMA August 13 2003, 290 (6)
*Starfield, Barbara. Is US Health Really the Best in the World? JAMA, July 26, 2000 26(4)

Wednesday, December 12, 2007

Getting back to the Concrete Gardener

(Ice in Oklahoma, From the BBC

I didn't realise how long it had been until someone reminded me. I'm going to get back to posting regularly in the next few weeks, and build some good content here. My goal is to post on Mondays, Wednesdays and Fridays from January onwards. I'll be finishing my MPH in about a week, which is really exciting. Also, I wanted to point you to, which is my personal blog, and, which is what we do for fun...

It's midwinter so the questions are different. I've decided to shift gears slightly and look at Boston in winter, and also look at social responsibility as a Christian, in general.

Coming up this week: Health Care in the US-- best and worst case scenarios.

Coming up in January:
Looking at the United States primaries in parallel with the South African ANC race to nominate a new president.
Comparing United States and South Africa Health Care (Ideology and reality)