THE COMPLEX ISSUE OF ADDICTION – A COLUMN BY SOUTH DAKOTA GOVERNOR DENNIS DAUGAARD

 As a state, we grapple with many issues.  Some are very complex, with no easy fix or single solution.  These may require sustained effort over long periods, through different administrations and legislatures and generations of South Dakotans. Drug abuse is one such issue.

We continue to wrestle with methamphetamine use in our state. On the prevention front, the Department of Social Services has funded more than 245 presentations, to thousands in communities and schools, urging against methamphetamine use.  The Attorney General’s office has also undertaken a preventive education campaign. This month Prevention Resource Centers will complete a meth prevention toolkit for communities.

For the most part, we are seeing less meth manufactured in home-grown laboratories. It is more often manufactured on a larger scale and trafficked into the Midwest. The drug interdiction task force, made up of Division of Criminal Investigation agents and Highway Patrol officers, has been hard at work over the last year to stop meth from coming into our state and we need to continue to do more to choke off these distribution channels.

For those who are severely addicted, the Department of Social Services is working to expand and increase access to treatment, ensuring treatment is evidence-based and that providers are equipped and trained to provide intensive treatment models.

We’ve recently seen some hopeful results from our treatment programs. In the last year, more than 2,000 offenders have received treatment for substance abuse under the Public Safety Improvement Act.  In 2017 over 69 percent of individuals entering treatment for substance abuse completed successfully, 25 percent higher than the national average. Ninety-eight percent of those that completed treatment in 2017 reported an ability to control alcohol, 94 percent reported the ability to control drug use, and over 85 percent reported employment at discharge.

We’re seeing a promising trend in smoking as well. The smoking rate among young adults in South Dakota went from 34 percent in 2011 to 13 percent in 2017. High school smoking rates went from 23 percent to 10 percent in that same period, putting us below the national average for the first time.

We can celebrate that we are turning the tide on smoking and seeing success among those who seek drug treatment. These facts make me hopeful that South Dakota can meet the addiction challenges ahead.

We cannot mandate away addiction; no legislative fix will completely solve the meth problem. Some answers simply extend beyond government’s capabilities.  But we must do all we can, and we need all hands on deck. Private organizations, law enforcement, communities and individuals all have a role to play. Progress may be incremental but it will come so long as South Dakotans are persistent.

PROVIDING OBAMACARE RELIEF FOR SOUTH DAKOTANS BY U.S. SENATOR MIKE ROUNDS

Obamacare premiums rose 20 percent for South Dakotans this year, and I continue to hear stories of fewer health care options and out-of-control health care costs as a result of the ill-advised Affordable Care Act. While repealing Obamacare and replacing it with a consumer-driven, truly affordable system remains a top priority for me, we continue to take meaningful steps to provide Americans relief from this law.

The Tax Cuts and Jobs Act helped relieve Americans from Obamacare, by including provisions to delay the Medical Device Tax and the Cadillac Tax for two years and by delaying the excise tax on health insurance plans for one year. Importantly, this legislation also repealed Obamacare’s individual mandate, so that nobody will be forced to pay a tax penalty if they don’t want to purchase health care coverage that they don’t want or need. The individual mandate was an unpopular tax in an unpopular law that disproportionately hurt low-income families. We’re glad to see it go away. We were also able to successfully repeal Obamacare’s Independent Payment Advisory Board, which is a special panel of unelected bureaucrats tasked with finding savings in Medicare by rationing health services for seniors.

The Trump administration has also taken steps to give states more flexibility in administering federal mandatory spending programs. Most recently, the Centers for Medicare and Medicaid Services (CMS) announced it will give states more flexibility regarding work requirements for certain Medicaid beneficiaries. This will allow governors and state government leaders to shape state Medicaid policies that work best for their state rather than following rules issued by Washington bureaucrats. Already, nine states have applied for work requirement waivers to implement these new flexibilities and two waivers have been approved, including South Dakota’s.

President Lyndon B. Johnson created Medicaid in 1965 as part of his War on Poverty. The intent of the program was to provide health services for low-income children, seniors in need, individuals with disabilities and pregnant mothers. It was designed to be a pathway out of poverty.

As Americans, we take care of the most vulnerable in our society—the very young, the very old and those who cannot take care of themselves. The Affordable Care Act opened up Medicaid to include healthy, able-bodied, working-age men and women, which has added to the high cost of the program. In 2015, an estimated 70 million people were enrolled in Medicaid. That is 21 percent of our entire population!

Medicaid and other mandatory spending programs like Medicare and Social Security are on an unsustainable path. In the long-term, Congress needs to reform the federal budget process so that it can exercise greater control over the sustainability of mandatory spending. In the short-term, giving states the flexibility to manage Medicaid in new, innovative ways will help make Medicaid more manageable.

These are important steps toward our goal of eliminating the unpopular aspects of Obamacare, but the fact remains that premiums are still too high, insurance companies are leaving the marketplace and millions of Americans have been forced off plans they liked. I will continue to work with my colleagues to relieve hardworking families from Obamacare’s perils as we seek to make health care truly affordable and accessible for all Americans.

POWER IN COMMUNITY

Photo:Pixabay.com

By Peg Ryan
Mile High Pilates And Yoga

January has come and gone.  According to just about every article on the subject, most New Year’s resolutions have now reached the graveyard of good intentions.  Fortunately, any time is appropriate to get back on that bandwagon and try again.  As we all know, every day is a new day and a new opportunity.  There are many tips for setting goals and maintaining resolve, but the one I’d like to focus on here is the value of community.  A group of like-minded and supportive practitioners can help keep you motivated, especially when barriers start appearing in your path.

The great Vietnamese philosopher Thich Nhat Hahn wrote “A good [community] is crucial for practice.” He continues “A good teacher is important, but sisters and brothers in the practice are the main ingredient for success.”  Of course, he may be referring to a different type of practice here, but I would venture that even he would not object to expanding the meaning more broadly to include many types of practice.  Especially those practices with the ultimate goal of self-improvement.

If one of your self-improvement goals is to add more movement to your life, a group can be a huge help to keep you on that path.  A recent article in the Washington Post  cites two new studies that demonstrate the value of even “light activity” as being “helpful for outcomes like daily functioning, mental well-being, good quality of life and so on.”  Improved methods are now being used to conduct such studies.  In the past they have mostly been based on self-reporting which is notoriously inaccurate.  But with new technology such as Fitbits and similar activity tracking devices, more objective data can be collected.  The result of these 2 studies show that the benefits of movement, even light movement, are far more impressive than previously thought.  In fact, these studies found that “the most active subjects had a 50 to 70 percent decline in mortality during a defined follow-up period compared with the least active, most sedentary participants. Previous self-report research had pegged this benefit at about 20 to 35 percent.” This is comparable to the health benefits gained by non-smokers vs. smokers.  So it is particularly significant.

Interestingly, these studies tracked individuals (male and female) in their late 60’s and 70’s.  The researchers believe that the results will correlate to younger people also.  But the results add further evidence to support the notion that it is never too late to start moving.  Furthermore, any movement beats being sedentary.  The studies show that “all physical activity counts toward improving health status. You don’t have to play basketball for an hour or run three miles to accrue benefits. You simply have to move . . .”

One great way to do that is to join a group.  That’s what exercise classes provide – a group that is working together to keep moving.  Classes also provide a specific time and place for this activity.  You can set that time aside in your schedule and like any other appointment.  Not only will this help you remember, but it can also help you keep other appointments from interfering.

The word “yoga” is translated as “union” from Sanskrit.  This can mean many things.  It can mean union of mind and body.  Or union of movement and breath.  For this purpose I would suggested that “union” can also refer to a group that practices together.  This is true not just of yoga, but of any group that practices movement together.

Recently one of the members of our Pilates group was sick.  We missed her while she was gone and worried about her sending healing energy for her quick return.  When she got better we were elated to have her back and welcomed her accordingly.  As part of a group your well-being becomes important to others as well as yourself.  Of course, your friends and family will also benefit from your good health, but wouldn’t it be great to have a supportive group to share your efforts with.  You can and should continue to move on your own, but a group can encourage that also.  The more you move, the better you will feel which will encourage more movement.  So if you’re still hoping to at least try to fulfill your pledge to yourself, let a group help you.  We all need each other.  Take advantage of the benefits of community.

INFLUENZA ACTIVITY WAS AT “WIDESPREAD” LEVEL AGAIN IN SOUTH DAKOTA THE PAST WEEK

South Dakota Influenza summary for the week ending January 20, 2018 week 3

·      348 new confirmedcases of influenza were reported last week.   1,427 confirmed cases cumulative so far this season:  1,276 Influenza A and 151 Influenza B.  *Lab confirmed:  PCR, culture or DFA. The number of laboratories using rapid confirmatory tests has increased, which may account for some of the increase in confirmed cases observed this influenza season.

·      22.35% positive rapid antigen tests reported statewide (931 positives out of 4,166 individuals tested last week).    Total 15,824 tests performed so far this season.

·      43 new influenza-associated hospitalizations reported last week (Bon Homme, Brown, Butte, Codington, Davison, Hamlin, Hutchinson, Lake, Lawrence, Lincoln, McCook, Meade, Minnehaha, Oglala Lakota, Pennington, Tripp, and Turner counties).  Total of 238 hospitalizations so far this season.

·      Three influenza-associated deaths reported last week (Kingsbury, Marshall, and Turner Counties). Total of 12 deaths so far this season.

·      3.96% of clinic visits were for influenzalike illness (ILI), 30.04% of ILI visits were children 4 years of age and younger.

·      2.91% of K12 students were absent due to any illness, range 0% – 22% absent (157 schools reporting).

South Dakota Dept of Health

 

Season

Dominate virus

Deaths

Hospitalizations

Confirmed cases (Culture, PR, DFA)

Peak week

2017-2018

Pending

12

238

1427

Pending

        2016-2017

A(H3N2)

44

965

2,078

February 3rd week

2015-2016

A(H1N1)

9

161

786

March 2nd week

2014-2015

A(H3N2)

63

793

1,703

January 1st week

2013-2014

A(H1N1)

14

239

659

January 1st week

2012-2013

A(H3N2)

38

365

993

January 2nd week

2011-2012

A(H3N2)

17

164

505

March 3rd week

2010-2011

A(H3N2)

20

290

860

February 3rd week

2009-2010

A(H1N1) pandemic

24

431

2,303

October 2nd week

2008-2009

A(H1N1)

4

134

525

March 1st week

2007-2008

A(H3N2)

22

361

684

February 4th week

2006-2007

A(H1N1)

6

132

400

February 3rd week

2005-2006

A(H3N2)

11

 Not reportable

636

March 2nd week

2004-2005

A(H3N2)

42

 Not reportable

684

February 3rd week

Median (2004-2017)

 

20

290

860

February 3rd week

Influenza surveillance website:  http://flu.sd.gov.

National Synopsis:   Influenza activity increased in the past week in the United States.   49 States reported Widespread Activity for past 3 weeks. Nationally, 84.2% influenza A and 15.8% influenza B of 2,209 positive specimens tested in public health laboratories.

Influenza activity by state:

–    WIDESPREAD (highest level) influenza activity in 49 states; including South Dakota;

–    REGIONAL activity in 1 Guam;

–    LOCAL activity in  District of Columbia & Hawaii;

–    SPORADIC activity in US Virgin Islands;

–    NO activity in 0 states.

Our neighboring states:

–   WIDESPREAD activity: North Dakota, Minnesota, Iowa, Nebraska, Colorado, Wyoming, Montana and
South Dakota.

SD Dept of Health website:  http://doh.sd.gov/   SD Dept of Health Facebook:  www.facebook.com/SDHealthDepartment


IMPROVING OUR MEDICAID PROGRAM A COLUMN BY GOVERNOR DENNIS DAUGAARD

 South Dakotans believe in self-reliance.  The pioneers who settled this state over a century ago, as well as the natives who preceded them, understood the need for self-reliance. In fact, they knew no other way. Those who came to Dakota sought freedom and a fresh start. They understood, though, that freedom requires responsibility, because they could only survive by taking care of themselves.

As a second key value, South Dakotans believe in hard work. It is simply a part of our culture. When we promote South Dakota as a good place to do business, we promote the work ethic of our people.  Those who do business in South Dakota and elsewhere will attest to the fact that South Dakotans know how to work. There’s also a sense of pride that comes with having a job to do and being able to provide for your family.

The Trump Administration recently indicated it is willing to consider state work requirements for Medicaid participants.  The federal government just approved a work requirement as part of Kentucky’s Medicaid program, and I have asked the Department of Social Services to pursue a work requirement for able-bodied adult South Dakotans enrolled in Medicaid here.

This would not apply to every South Dakotan on Medicaid. Our Medicaid program today covers roughly 82,000 children; 23,000 aged, blind or disabled persons; 1,000 pregnant women; and 13,000 very low-income parents. The work requirement would apply only to very low-income parents who aren’t already working or caring for a young child. This would place the work requirement on approximately 4,500 individuals in South Dakota.

By July 1, South Dakota will submit a proposal to seek approval for the work requirement, starting with a two-year pilot. If approved, we will begin with 1,300 Medicaid recipients who reside in Minnehaha and Pennington counties – where there is the greatest availability of employment and training resources. Pending approval, we will begin a voluntary program in these counties in July.

The Department of Labor and Regulation will enroll participants automatically for individualized employment and training services to help them find jobs. For those who earn enough to transition off of Medicaid, we will provide assistance – such as child care subsidies – to ensure their long-term success.

All work has dignity, and work is an important part of personal fulfillment. By making this adjustment to our Medicaid program, we will continue to help persons in need, while helping find jobs for those able to work, and also find that sense of pride and accomplishment which accompanies work.

WARMING – UP AND COOLING DOWN

By Peg Ryan
Mile High Pilates And Yoga

Winter is officially upon us.  January 1 has come and gone.  You’ve finally managed to drag yourself to the gym.  Now faced with the realization of how much time has passed since you last tried to work out you try to make up for that lost time by diving in with both feet.  And both arms.  And your back and shoulders.  You remember what you used to be able to do and think “I can do that.”  But, before you know it you’ve overdone, possibly even injured yourself, and your resolve to “get in shape” gets relegated to some mythical future date when you’ll somehow be better able to manage it.  Like when you’ve lost weight or your knee gets better or you find a better pair of shoes, etc. etc.  You know the drill.  There is a litany of excuses you can draw upon for this purpose.  But no matter how much you wish for a better version of yourself, wishing will not make it happen.

Time to come up with a better plan.  If you’ve showed up at the gym or on that walking trail or in that exercise class, then you’ve already taken the most difficult and important step.  That is, you’ve made the decision that you really want to do this.  You’ve also set the time aside and made the commitment to follow through.  Bravo!  Now is not the time to get discouraged.  But perhaps it is time to rethink your strategy.

It’s always difficult to remind yourself that whatever shape you’re in didn’t happen overnight.  If you’re in good shape, it’s probably because you’ve made a regular effort to maintain it.  If that’s not the case, then your best approach is to start slow and give your body some time to adjust.  This provides the perfect opportunity to tout the benefits of a good warm-up.

According to the American Heart Association,

“warming up and cooling down are good for your exercise performance . . .  A good warm-up before a workout dilates your blood vessels, ensuring that your muscles are well supplied with oxygen. It also raises your muscles’ temperature for optimal flexibility and efficiency. By slowly raising your heart rate, the warm-up also helps minimize stress on your heart.”

A warm-up generally consists of performing an activity at a slower pace.  Although most sources usually advise warming up for 5 to 10 minutes prior to planned activity, the Sports Medicine Information website advises that a good warm-up can last anywhere from 20 minutes to half an hour.  In my opinion, longer warm-ups are a good thing, especially as we age.  In fact, if you are new to exercise or returning after an absence, you might want to consider doing your first few workouts entirely at warm-up pace.  Just take your planned activity slower and with less intensity.  When you’re ready to increase the pace and/or intensity you won’t have to force yourself.  It will just naturally feel right and you’ll know you’re ready.  Just have a little patience.  Starting slow now will mean more success in the long run.  Remind yourself of that every time you’re tempted to push too hard.

Your warm-up can include some gentle stretching of your muscles towards the end.  Most experts agree that muscles should be warm before you stretch them.  Quoting again from the American Heart Association : “Stretching allows for greater range of motion and eases the stress on the joints and tendons, which could potentially prevent injury.”  According to the Mayo Clinic, “Warming up may also help reduce muscle soreness and lessen your risk of injury.”  It’s well worth the extra time if might take.  Those extra minutes might save you from days or even weeks of inactivity from soreness or injury caused by overdoing too much too soon.

If you do manage to move from a warm-up to a more intense form of movement, then cooling down is equally important.  Our friends at the American Heart Association have thoughts on this subject, too.  They advise that

“After physical activity, your heart is still beating faster than normal, your body temperature is higher and your blood vessels are dilated. This means if you stop too fast, you could pass out or feel sick.  A cool-down after physical activity allows a gradual decrease at the end of the episode.”

Cooling down is similar to warming up in that you perform your activity at a slower pace for an additional 5 or 10 minutes following your main activity.  This is especially important, and often overlooked, when your activity is a sport such as basketball or tennis.  But it is just as critical after brisk walking or jogging.  If you’ve been lifting weights, try walking around the gym and doing some slow stretching following your workout.  If possible, a good way to warm up for and cool down from a gym workout is to walk to and from the gym.  What a concept!  O

The goal here is not to add yet another layer to your “to do” list, but rather to encourage you to keep your movement intentions on that list.  Don’t let your resolve drop off because of unrealistic expectations.  Although any activity you choose is better than none and the best activity is the one you’ll do and stick to, this is a good time to put in a plug for classes.  Most classes allow for warm-up and cool-down periods.  This is certainly true of my classes.  Even if you prefer some other type of activity, trying a class can give you an idea of how to warm-up and cool down so that you can do it on your own if that suits your needs.  Find what works for you, take it slow and keep at it.  Practice is the key to improvement.

Fear Of Falling

Photo: Geralt/Pixabay.com

By Peg Ryan
Mile High Pilates And Yoga

Winter has only just begun and already I’ve heard about several incidents of injuries from falls, at least one of them serious.  Of course, anyone can fall at any time of the year, but it seems like winter is a particularly dangerous time when ice and snow accumulate all around us. Some falls result from what we call “black ice”.  This is that devilish condition when a thin layer of ice on asphalt is invisible to the eye.  When encountered it can cause supports like feet, bicycle tires or even autos to slide perilously.  Another insidious form of hidden ice occurs frequently in my area where daytime sunshine causes standing snow to melt and then refreeze when the sun goes down and temperatures fall.  This condition can be particularly precarious when another layer of snow falls on top obscuring the ice layer below so you don’t know where it is until you step on it.

Although older adults seem more prone to falls, and many studies show that the consequences of falling for older adults can be particularly dire, no one is immune from falls.  There are many articles featuring suggestions for preventing falls.  All you have to do is Google “Fall Prevention” and you will find examples.  But I would like to focus on the causes that I see most frequently and that I think can be at least partially addressed with training.  First and foremost is failure to pay attention.  Our modern lifestyle seems to encourage hurrying.  We worry about slowing down when there are people behind us.  Or making that car wait for more than a few seconds while we cross a street.  Something distracts us and we forget to pay attention to our surroundings.  Have you ever been looking down at your feet (or your cell phone) and suddenly been hit in the head with a tree branch?  Admittedly I’m guilty of that one.  So the first piece of advice I would give is slow down.  Look around you in all directions.  Be aware of your surroundings.  Make sure your next step is on firm ground.  Sometimes I will take my foot and just slide it back and forth in front of me to make sure my next step is not on ice.  That car that’s waiting for you to pass is most likely not going to run you over.  And no matter where you’re going, the extra few minutes will not make any difference in the long run.  Unless they save you from injury.  Then, in fact, the extra few minutes might make a huge difference!

The second most frequent cause of falls I’ve observed or heard about is not taking proper precautions.  For example, not wearing appropriate shoes.  You think “I’m only going out for a few minutes.  I can make it in my high heels.”  Perhaps that’s a little extreme, but you get the picture.  You get away with it once and think it won’t be a problem the next time.  And maybe it’s not.  Until it is.  Wouldn’t it be better to just take that extra few moments to be safe.  I could go into a big rant here about the footwear industry and how it encourages us (especially women) to wear inappropriate shoes, but I’ll save that for another time.  Suffice it to say that most of you know what works in these situations.  It often comes down to the choices you make.  It’s also important to remember that just because you’ve been careful to clear your own walkways, this may not be the case everywhere you need to go.

There are many reasons why people fall.  Some of them are related to physical conditions or side-effects of medication.  If you have these types of concerns hopefully you will get professional advice on how to deal with them.   But so many falls result from preventable circumstances that it’s worth another reminder.  This provides yet another reason to tout the benefits of movement practices.  Mind-body practices like yoga, Pilates and others can help you to learn to pay more attention to the way you move.  These practices help encourage strength, flexibility and balance.  We think of balance as being able to stand on one foot.  But practicing balance exercises can also be a way to strengthen the muscles that will help you catch yourself and avoid falling.  Or help you get up if you do fall.  Holding onto something because you fear falling might be helpful, but wouldn’t it be better if the muscles that support you were stronger.

Mobility has been described as more than just being able to move, but also maintaining strength through a full range of motion.  Stability is the quality that enables one to retain or regain position when impacted by an external force.  So, for example, if you’re standing and something pushes you, you’re ability to recover your position would be a way to measure stability.  So you can see how mobility and stability go hand in hand.  Then there is flexibility which might be described as the quality of being able to bend without breaking.  Clearly all of these traits are also necessary components for good balance.  If you feel stronger and more stable you will also gain confidence.  Fear can make us tense.  Tension makes us brittle and rigid.  Rigidity is the opposite of flexibility. Tension zaps energy and strength.  So learning to relax can be as important as all the other elements of balance.  Breathing practices, also an important component of mind-body practices such as yoga and Pilates, can help relieve tension and encourage relaxation.  They also help you slow down and recognize that few circumstances merit the hurrying we often feel is so necessary.

Finally, being in good physical condition might not prevent a fall, but it will certainly help you recover from one.  And cultivating more conscious awareness of your mind and your movements can help you in all aspects of your life.   If you haven’t tried it yet, it’s never too late.  If you can move and breathe, there is a practice for you.  Take the time to find one.  You won’t be sorry.  And it just might save you from yourself.

Beyond #MeToo, Brazilian Women Rise Up Against Racism and Sexism

Alvaro Jarrin, College of the Holy Cross and Kia Lilly Caldwell, University of North Carolina – Chapel Hill

Women’s empowerment recently got a big boost at the Golden Globes, but the United States isn’t the only place having a feminist revival.

In 2015, two years before the #MeToo campaign got Americans talking about sexual harassment, Brazilian feminists launched #MeuPrimeiroAssedio, or #MyFirstHarrassment. In its first five days, the hashtag racked up 82,000 tweets detailing the chronic sexual harassment of women in this South American nation. It soon spread across Latin America in Spanish translation as #MiPrimerAcoso.

The viral success of #MeuPrimeiroAssedio spurred a spate of social media activism in Brazil, where despite decades of feminist efforts gender inequality remains deeply entrenched.

With #MeuAmigoSecreto – #MyAnonymousFriend – women documented misogyny on the streets and at work. Tagging #MeuQueridoProfessor – #MyDearTeacher – university students outed sexism in the classroom.

And when the weekly news magazine Veja described the wife of Brazil’s president, Michel Temer, as “beautiful, modest and a housewife” in April 2016, feminists transformed that stereotype into a meme showcasing empowered women.

Temer came to power following the impeachment of Brazil’s first female president, Dilma Rousseff. Many saw Rousseff’s ouster as misogynistic. Feminists were determined that Brazilian sexism would no longer go unchecked.

Black Women’s Bodies

As race and gender researchers, we’ve been watching Brazil’s feminist resurgence closely to see whether it reflects the needs of Afro-Brazilian women, who make up 25 percent of the population.

Though the country has long considered itself colorblind, black and indigenous Brazilians are poorer than white Brazilians. Women of color in Brazil also experience sexual violence at much higher rates than white women.

For example, domestic workers, who are predominantly Afro-Brazilian, have been systematically harassed by their male employers. This centuries-old power play dates back to slavery.

Since both of us have recently published books – “The Biopolitics of Beauty” and “Health Equity in Brazil” – examining the impact of Brazilian medical practices on black women, we are particularly interested to see if Brazilian feminists will tackle two issues that particularly affect black women: health care and plastic surgery.

These may seem unrelated to each other and to black women’s rights, but in Brazil they are deeply intertwined. All Brazilian citizens get free medical care under the Sistema Único de Saúde, the national health care system.

Despite universal access to health services, black women do not always receive the best care. Though Brazil’s colorblind approach to health has resulted in scant documentation of differential health outcomes by race, one study found that black women are two and a half times more likely to die from an unsafe abortion than white women.

The startling discrepancy probably reflects a lack of high-quality prenatal and obstetric care for black women, which is a problem in U.S. hospitals as well. Discriminatory treatment by medical professionals, which includes a lack of attention to the specific health needs of black Brazilians, also factors in.

Black activists have also pointed out for decades that Afro-Brazilian women have higher rates of sterilization and abortion, which in Brazil is mostly illegal – and thus very risky.

Overall maternal health is also markedly worse among black women. In Brazil’s impoverished northeast, which has the country’s highest concentration of African descendants, black women are 10 to 20 times more likely to die in childbirth than white women.

The ‘Negroid Nose’

Medical doctors may neglect black Brazilian women, but plastic surgeons pursue them. Since the 1960s, Brazilian cosmetic surgery has been included in Brazil’s national health care system.

In Brazil, white beauty standards remain the cultural ideal. That means many Brazilian plastic surgeons operate on the basis that more European features – facial features in particular – are better.

Specifically, our research has found, they tend to target black women’s noses, which they deem a “problem feature” in lectures, publications and websites.

In conversation, some doctors even expressed their belief that the “negroid nose” is a “mistake” caused by racial mixing. Fortunately, they would add, it’s nothing a nose job can’t fix.

This occurs within a broader culture, familiar to women worldwide, of bombarding all Brazilian women with opportunities to “improve” their imperfect bodies. Brazilians are among the top consumers of plastic surgery in the world. It is estimated that more than a million cosmetic procedures are carried out every year.

Some Brazilian plastic surgeons refer to their jobs as helping women achieve “the right to beauty.” When, in 2016, a famous plastic surgeon who promoted this idea died, his obituary read like that of a national hero.

And since most plastic surgery is covered under Brazil’s public health system, our research uncovered, surgeons have found it lucrative to develop procedures targeting the entire topography of the female body.

Treatments that aren’t paid by insurance come with long-term payment plans. For the poorest patients, doctors have made plastic surgery accessible by exchanging their professional services for permission to use these operations as a teaching exercise for young medical residents.

Taking Online To The Ground

Historically, feminist critiques of this industry were largely subdued. But plastic surgery is now in the spotlight of Brazil’s “Women’s Spring.”

In October 2017, one of Brazil’s biggest newspapers, Folha de São Paulo, ran an article extolling the “ideal vulva” and describing the surgical interventions necessary to attain it. Women lambasted the piece on social media, calling it “absurd,” “unacceptable” and “sad.”

The assumption that some vaginas are more desirable than others, feminist commentators pointed out, imposes the male gaze on the female body. Additionally, they argued, the article’s emphasis on “pink” vaginas and its suggested use of skin-whiteners was patently racist.

Black feminist bloggers likely started this particular line of critique. As early as 2014, they were denouncing Brazilian cosmetic surgery as “racism cloaked as science.” Plastic surgeons, wrote Gabi Porfírio in a June 2014 post on Blogueiras Negras, have become “experts at using demeaning terminology for the noses of black people.”

But in a country where only 63 percent of households have internet access, black feminists also have also used more traditional forms of protest to engage women of color.

A year before the hashtag #MeuPrimeiroAssedio would go viral, black feminists began working across Brazil to organize women who don’t generally participate in activism. Their efforts culminated in the Black Women’s March Against Racism and Violence and in Favor of Living Well in Brasilia, the capital.

There, 50,000 Afro-Brazilian women of all ages and backgrounds came together to denounce violence against black women – not just sexual violence but also deadly abortions, mass incarceration and medical neglect. It was the first ever national march of black Brazilian women.

The first-ever national march of black Brazilian women had ‘living well’ as a central demand. Brazilian Ministry of Culture

In a country that has long ignored inequality, the protest put race squarely on the feminist agenda. By contrasting the diverse forms of violence black women face with the idea of “living well,” the Black Women’s March voiced an alternative vision of racial and gender justice for Brazil.

The ConversationIn doing so, they join #MeToo, #MeuPrimeiroAssedio and a whole chorus of female voices around the globe. Online and on the ground, Brazilian feminists demand equity from the surgeon’s table to the office.

Alvaro Jarrin, Assistant Professor of Anthropology, College of the Holy Cross and Kia Lilly Caldwell, Associate Professor, African, African American, and Diaspora Studies, University of North Carolina – Chapel Hill

This article was originally published on The Conversation.

Redefining Ritual

Photo: MAXKT/Pixabay.com

By Peg Ryan
Mile High Pilates and Yoga

Dictionary.com defines “ritual” as “a prescribed or established rite, ceremony, proceeding, or service”.  Other sources further clarify ritual as “a set of fixed actions and sometimes words performed regularly” or “a ceremony in which the actions and wording follow a prescribed form and order”.  Most definitions refer to ritual as part of religious observance, but I would suggest that the meaning is broader than that.  To me the term refers to any sequence of activities that is performed repeatedly at certain times in an established manner.

Rituals can be a source of comfort for people, especially at times when the way forward is not immediately clear.  For example, funerals are a ritual that people turn to when a death occurs.  It gives the survivors a path to follow which can help them acknowledge and begin to deal with the loss.  Having experienced death in my own family I understand the value of having a set procedure that dictates the expected order of events.  Sometimes this can become a way to postpone the actual process of grieving, but still it helps pave the way through the transition from the known to the unknown.  So ritual can be a good thing.

As with anything, though, when taken to extremes rituals can be harmful. Following rituals can become a ritual in itself.  Some people become so fixated on the process that they forget the meaning.  The need to adhere to the order of activities becomes so rigid that eliminating  or changing any piece of the ritual for whatever reason can be a cause for distress.  So as with anything, applying moderation is usually recommended.

We have just emerged from a season that is rife with rituals of all kinds.  Whether traditional or recent, there are rituals at every turn.  There are songs, movies and plays that are only performed at this time of year.   There is Black Friday and, more recently, Cyber Monday.  Add to that parades, decorating trees and houses, photos with Santa, Salvation Army bell-ringers, office parties, and distributing gifts to those less fortunate than ourselves.  All of these activities are every bit as ritualistic as the religious rites that also play a role in this multi-week celebration. Some of you reading this may scoff at the inclusion of these activities as ritual.  But they are all a part of our communal culture.  When participating in these rituals we are often able to set aside our differences and share an experience that is familiar to all.

Many of us have daily routines that border on ritual.  This is certainly true for me.  I rarely have to look at the clock after getting out of bed since most days I perform the same tasks in the same order every morning.  There are slight variations depending on my schedule, and, of course, circumstances can arise that require alterations, but usually I follow a specific set of practices.  From time to time my usual routine is disrupted for one reason or another.  Sometimes the disruption is temporary, but a true life change can require crafting a new routine that fits the new set of circumstances.

If you examine your own life I suspect you will find activities that you try to maintain consistently at reasonably regular intervals.  When these are thrown off for whatever reason, it can leave you feeling a bit out of sorts or disoriented.  Think about all of the rituals in your life that you have adhered to for long periods of time.  If you’ve maintained them, they must be important to you for one reason or another.  But you weren’t born with the need for them.  It’s a process you’ve learned.  This means you can continue to learn new ones.

At this moment we are in the middle of another annual ritual:  the making of New Year’s resolutions.  Despite the fact that every day is a new day and a new opportunity, we are all urged to latch on to this particular date to make changes in our lives.  New Year’s resolutions often revolve around forming a new habit or routine.  Yup – a ritual.  Due to our modern lifestyle, it seems that the most common call is to exercise more and/or lose weight, but there are others.  Maybe you want to listen more attentively or meditate regularly or read more.  There are any number of ways in which we feel we need to improve ourselves and numerous articles on how to make resolutions that work. Making resolutions is easy.  Sticking to them is much more difficult.  So rather than talk about how to make the change, I’d rather focus on what to do when you realize that the best laid plans have somehow disintegrated.

When you recognize that a new ritual is not working and changes need to be made, it is important to think not only about the logistics (e.g., time of day, type of action, obstacles presented) and the various (valid, no doubt) excuses that can be made.  But it is equally or even more important to examine your reasons for wanting to incorporate this new routine into your life in the first place.  How much do you really want to make this change?  Why do you want to make this change?  Are you willing to rearrange something else in your life to accommodate the change? Or is the new demand not calling to you sufficiently to overcome the excuses?  There is no right or wrong here.  These should be decisions you are making for yourself.  The author Gretchen Rubin wrote a book called The Four Tendencieswhich theorizes that most people fit into certain personality categories.  Of course, these categories are not mutually exclusive, but often we find our tendencies toward one category or another.  If you’re interested, you can take the quiz on her website and see where you fit.  Are you  willing to adhere to your ritual whether or not anyone knows about it?  Or perhaps you are looking for approval from someone else.  Maybe you start to make the changes, but then begin to wonder if they really have any value.  Or suddenly you start to think “I don’t have to do this just because it’s expected of me.”  It’s all about being honest with yourself and deciding what is really important to you right now.

When you decide that you really do want to make the change you’ve laid out, but stuff keeps getting in the way, then it’s time to formulate a new plan.  This may mean pulling yourself out of your comfort zone.  Incorporating ritual into your life is similar to forming a habit.  There are varying theories on what it takes to establish a new habit, but most of them involve maintaining a practice for a period of at least 6 weeks.  From that point on, the theory goes,  you’ve established the routine, overcome some of the obstacles and begun to make the ritual a part of your life.  Those around you recognize that it has become a priority for you and, hopefully, will help you stick with it, or at least stop objecting.  An occasional variation from the routine due to circumstances will no longer stop you.  You’ll be able to get right back into your practice as soon as your able.  In fact, you may find that, as described above, you begin to miss the ritual when you aren’t able to complete it.  In my opinion, the key is wanting the ritual in your life enough to help you overcome obstacles.  Then if something arises that threatens to get in your way, you can always remind yourself that your ritual is important enough to you to find a way around the obstacle.  If the obstacle persists, change the ritual. This doesn’t mean to scrap it entirely.  Just find a way to make it work.  Remember, too, that small changes can be a good first step.

If nothing seems to work no matter how hard you try to find a way, then maybe the time just isn’t right for you to start this practice right now.  That’s OK, too.  But if you really want to do it, keep looking for that opening.  It may turn up in a way that you didn’t anticipate.  An open mind might be the most important requirement for finding your way to your best self.