Month: November 2017

How doctors’ bias leads to unfair and unsound medical triage

Photo by Piron Guillaume on Unsplash

Philip Rosoff

When someone is sick or needs the help of a physician, who should decide what is appropriate – what blood tests and imaging studies to order, what medicines to prescribe, what surgeries to perform? Should it be the doctor, the patient or some combination of the two? Most people nowadays (even most physicians) support what is called ‘shared decision-making’, in which the doctor and patient (and often her family or friends) discuss the situation and come up with a joint plan. The doctor’s role is that of experienced guide, whose medical knowledge, skill and expertise help to shape the conversation and whose understanding of the priorities, values and goals of the patients steers the plan in a given direction to the satisfaction of all.

Unfortunately, in the real world, things don’t always work this way. Doctors and patients have a number of masters, both welcomed and uninvited. Insurance companies or other third-party payers often intrude into the decision-making process, limiting the choices of what services and products might be available: a sick patient often must wait for pre-authorisation for expensive diagnostic tests and procedures; pharmacy formularies restrict the kinds of drugs available for prescriptions, and so on. Furthermore, some doctors have personal interests in the interventions they recommend. Many surgeons make more money if they do more surgery, cardiologists earn more if they put in more cardiac stents and pacemakers, and drug companies have better profits if they sell drugs for chronic conditions that never get better and require lifelong medication (such as high cholesterol, hypertension and diabetes). Such practices contribute to the seeming inexorable rise in healthcare costs (and a host of adverse outcomes) in the United States.

Yet controlling cost without sacrificing quality has been a daunting task. One strategy might be to pay more attention to what patients need, and less to what they want, assuming that the two don’t overlap. Another is limiting the excess of doctors who prescribe because of conflicts of interest or acts of ‘defensive medicine’ – in other words, to protect themselves from lawsuits, not aid the patient.

How does one go about rationing care? Will faceless bureaucrats be denying granny her medication or access to an intensive-care unit solely because she’s old, or saying that Billy can’t get his conditions treated because he is disabled? Indeed, dread of rationing – as well as a healthy dose of old-fashioned fear-mongering by crafty politicians – is what inspired the meme of ‘death panels’, an unfounded canard based upon a misinterpretation of a proposed federal rule for Medicare. Nevertheless, the concept of rationing is still of concern because it implies restriction of a resource that could be beneficial.

Therefore, rationing doesn’t apply to interventions that can’t help anyone at any time – for instance, antibacterial antibiotics that won’t work because the patient has a viral infection. A better example of true rationing is the allocation of organs – such as livers, hearts and lungs – for transplantation. Organ transplantation requires rationing because the supply never keeps up with demand. We also ration drugs that can suddenly become scarce (a distressingly common problem).

But there are other forms of rationing that are problematic, too. The most common one, intrinsic to the US healthcare system, involves limiting the kind and amount of healthcare one can obtain based on one’s financial situation. Poorer people get less and worse healthcare than wealthy people. While the most offensive aspects of this arrangement have been mitigated to some extent in those states that expanded Medicaid under the auspices of the Affordable Care Act, there are still alarming numbers of Americans who have limited access to effective medical care. This is one of the chief reasons why the US population as a whole doesn’t get as much bang per buck as citizens of many other nations, and this form of rationing is blatantly unfair.

But there is another form of rationing that is more insidious still. This is the so-called bedside rationing, in which doctors decide, on an individual per-patient basis, what should be available to them, regardless of the range of services that their insurance or finances might otherwise allow. The problem with this is that it is readily susceptible to prejudice and discrimination, both overt and hidden. It is well-known that doctors, like pretty much everyone else, harbour so-called implicit biases that are readily revealed on the implicit-association test (available online).

This does not mean that physicians express overt sexism, racism, or others forms of bigotry – but rather that these unconscious beliefs about others can influence the kinds of treatments that they offer. Thus, bedside rationing can violate one of the cardinal principles of fairness – that clinically similar situations be treated similarly. So doctors could offer one patient (say, a well-off white person) with unstable angina and blocked coronary arteries the standard of care with cardiac catheterisation and stents, while offering just medical therapy to an African-American patient with comparable disease. And there is ample evidence that such differential treatment occurs.

So how does one ‘choose wisely’ and escape the moral pitfalls of bedside rationing? It turns out that this is an extraordinarily difficult to do, especially in a system such as ours where physicians have such discretionary power about what diagnostic and treatment interventions should be on the ‘menu’ for each patient. This can readily lead to too much and too little offered to patients for reasons that cannot be easily justified.

I think that the solution, at least in the US, might require a wholesale re-engineering of our healthcare system to minimise the financial incentives to overprescribe, and to protect or immunise against the biases that lead to inappropriate rationing at the bedside. The only way to reduce the frequency of these behaviours is to have a single-payer system that controls (to a certain extent) the availability of certain interventions, analogous to the way in which the organ-transplant system regulates who gets transplanted and under what circumstances.

Of course, unlike livers and hearts, what needs to be rationed in the US is money and what it can buy. We could save money by efficiencies of scale and decreasing the waste and administrative costs that contribute at least 25 per cent of the total cost of what we now spend. Can we totally eliminate ‘bad’ rationing? No, of course not. But Americans should do all they can to avoid the moral tragedy of being the wealthiest nation on Earth that chooses dumbly, not wisely, about healthcare. Aeon counter – do not remove

Philip Rosoff is professor of paediatrics and director of the clinical ethics programme at Duke University Hospital in North Carolina. He is the author Drawing the Line: Healthcare Rationing and the Cutoff Problem (2017).

This article was originally published at Aeon and has been republished under Creative Commons.

Gun violence in the US kills more black people and urban dwellers

A man changes a flag to half-staff near the First Baptist Church of Sutherland Springs.
AP Photo/Eric Gay

Molly Pahn, Boston University; Anita Knopov, Boston University, and Michael Siegel, Boston University

On Nov. 5, just 35 days after the deadly Las Vegas shooting, a man walked into a church in a small Texas town and murdered 26 people with an assault rifle. The coverage dominated the news.

But the day before, even more people – 43 – were shot to death in cities and towns around the country. And nobody really seemed to notice.

Shootings kill more than 36,000 Americans each year. Every day, 90 deaths and 200 injuries are caused by gun violence. Unlike terrorist acts, the everyday gun violence that impacts our communities is accepted as a way of life.

Of all firearm homicides in the world, 82 percent occurs in the United States. An American is 25 times more likely to be fatally shot than a resident of other high-income nations.

As public health scholars who study firearm violence, we believe that our country is unique in its acceptance of gun violence. Although death by firearms in America is a public health crisis, it is a crisis that legislators accept as a societal norm. Some have suggested it is due to the fact that it is blacks and not whites who are the predominant victims, and our data support this striking disparity.

Urban and racial disparities

Within the United States, the odds of dying from firearm homicide are much higher for Americans who reside in cities. Twenty percent of all firearm homicides in the U.S. occur in the country’s 25 largest cities, even though they contain just over one-tenth of the U.S. population. Data from the Centers for Disease Control and Prevention show that of the 12,979 firearm homicides in 2015, 81 percent occurred in urban areas.

There is even more to the story: CDC data also show that within our nation’s cities, black Americans are, on average, eight times more likely to be killed by firearms than those who are white. The rate of death by gun homicide for black people exceeds those among whites in all 50 states, but there is tremendous variation in the magnitude of this disparity. In 2015, a black person living in Wisconsin was 26 times more likely to be fatally shot than a white person in that state. At the same time, a black person in Arizona was “only” 3.2 times more likely than a white person to be killed by a gun. The combination of being black and living in an urban area is even more deadly. In 2015, the black homicide rate for urban areas in Missouri was higher than the total death rate from any cause in New York state.

These differences across states occur primarily because the gap between levels of disadvantage among white and black Americans differs sharply by state. For example, Wisconsin – the state with the highest disparity between black and white firearm homicide rates – has the second-highest gap of any state between black and white incarceration rates, and the second-highest gap between black and white unemployment rates. Racial disparities in advantage translate into racial disparities in firearm violence victimization.

Americans are 128 times more likely to be killed in everyday gun violence than by any act of international terrorism. And a black person living in an urban area is almost 500 times more likely to be killed by everyday gun violence than by terrorism. From a public health perspective, efforts to combat firearm violence need to be every bit as strong as those to fight terrorism.

The ConversationThe first step in treating the epidemic of firearm violence is declaring that the everyday gun violence that is devastating the nation is unacceptable. Mass shootings and terrorist attacks should not be the only incidents of violence that awaken Americans to the threats to our freedom and spur politicians to action.

Molly Pahn, Research Manager, Boston University; Anita Knopov, Research fellow, Boston University, and Michael Siegel, Professor of Community Health Sciences, Boston University

This article was originally published on The Conversation. Read the original article.

Get to know about Kris Wu, the first Chinese artist to reach No. 1 on iTunes

Rapper, model, and actor Kris Wu is making waves in America as the first Chinese artist to reach the top spot on the US iTunes charts with his single DESERVE, a collaboration between him and Travis Scott.

Wu, who moved to Vancouver as a kid, has blown up since his time in K-pop boy band juggernaut EXO–he’s starred in xXx: The Return of Vander Cage and Valerian and the City of a Thousand Planets, reps Burberry as the brand’s first non-British global ambassador, and is killing it on Weibo and Instagram, among other accolades. He’s also only 26 years old.

I-D’s Taylor Glasby interviewed Wu about his big iTunes recognition and where he sees entertainment going as it relates to representation and his own brand. Here are four key takeaways from the interview.

On reaching #1 on US iTunes:

“I always want to be the pioneer when I do things..if I hit the Billboard top 100, I’ll be the first Chinese male artist to do it, I think. I’d treat my entire team to a vacation!”

On the responsibility of being a trailblazer for Chinese artists in America:

“I want to set an example to the youth but at the same time, this is me, this is what I do. I say I want to be a pioneer but some things just happen, then they work out and I get more ambitious, and there is responsibility. It doesn’t get so big like, I’m representing the people of China…no way. But I want to make my fans and myself proud.”

On befriending  fellow xXx star Vin Diesel:

“When I first met him on set, I was a little scared, like is he gonna be cool with me? But he was super nice and ever since then we’ve been close. You wouldn’t imagine that we’d be gaming at home, like on internet games all night. Every time I come to LA, he tells me to come over and chill. He gives me advice, he introduces me to good people. We’re like family now.”

On Asian representation in Hollywood: 

“You know what, recently I actually had an offer for a lead male in a Hollywood movie, and not an action movie. I can’t tell you what it is because I said no to it–I don’t have any time and I’m doing music–so yes, I do see it happening. Not in the next ten years, but the next two or three. Five max.”

Make sure to read the entire interview at I-D.

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With BTS’ AMAs debut, America finally wakes up to the power of the Asian pop star 

It’s been a long time coming for K-pop fans, especially the ardent fans of boy band BTS. In May, the group snatched up the Billboard Music Award for Top Social Artist, beating out stateside mainstays like Selena Gomez, Ariana Grande, Shawn Mendes and Justin Bieber. Their win served as a prelude to their biggest moment in the American spotlight yet–a full performance at the American Music Awards this past Sunday.

When I watched this performance live, I felt like the reaction the entire crowd had must have been what it was like for audiences to see The Beatles for the first time in the 1960s. There was a different energy building up to the performance, and that energy kept building throughout. It was eye-opening for me, and it should have been eye-opening to any concert promoters, stadium owners, and record labels. BTS is ready to explode onto the American scene.

But, despite BTS and other K-pop groups and solo artists having intense fans that span age groups, social classes and racial lines in America, American mainstream music coverage has largely steered clear of giving these artists press. Now, thanks to the electric AMA performance, America has to reckon with the power of not only BTS, but Asian pop stars as a whole.

The musical glass ceiling 

The boys of BTS on the AMAs red carpet. ABC/Facebook

K-pop and Asian singers in general have had it tough finding success and respect in America. Even when BTS won their Billboard Award, there were viewers (seemingly mostly superfans of the losers) who delved into racist, xenophobic rhetoric because their fave lost. The general consensus of these superfans, according to Paste Magazine‘s Martin Tsai, was that BTS stick to Korea.

“Of course, the two Canadian nominees in the category (Bieber and Mendes) have eluded this knee-jerk outrage and xenophobia, as has just about every Brit in American pop history from the Beatles to One Direction,” he wrote. “It’s the type of blowback that ensues whenever a person of color upsets the cultural status quo—as when Barack Obama first ran for the presidency, when Jeremy Lin first played for the Knicks, or when Takuma Sato won this year’s Indianapolis 500 and prompted the now-fired Denver Post sports writer Terry Frei to tweet how that made him ‘uncomfortable.’ Indeed, the American soundscape has proven to be a final frontier for Asians and Asian-Americans to find their footing.”

Tsai writes about how many Asian and Asian-American singers have tried their turn at breaking into America’s discriminatory music industry with varying degrees of success. Kyu Sakamoto’s “Sukiyaki,” for instance, is the only Billboard Hot 100 chart topper by an Asian singer, and that was in 1963. (The song later became a hit for the group A Taste of Honey, who covered it in 1981, yet another chapter in the push-and-pull between black and Asian diasporic experiences in America.)

The crossover hit most people remember with some freshness is Psy, whose “Gangnam Style” became a viral sensation. However, his follow-up single didn’t do near as well, and for many in America, “Gangnam Style” was always seen, as Tsai describes, “a novelty song.” Psy’s appearance, for better or worse, also helped him gain short-lived success in America; unlike BTS, who are young and look and behave like living Ken dolls, Americans saw Psy with the same stereotypical lens used on most Asian men–Psy is goofy, funny and, to the audience, seemingly unaware of why he’s seen as such, which makes him more of a target for racial stereotypes. (However, Psy a bad boy jokester-critic in Korea, is the complete opposite of “unaware”; he was America’s Favorite Asian until word got out about how Psy had performed songs protesting the U.S. military, particularly over the beheading of a Korean missionary by Islamic extremists in Iraq. Even “Gangnam Style is a protest song of sorts, criticizing the upscale Seoul neighborhood Gangman’s needless opulence and materialism.)

Psy’s success in America does, sadly, hinge partially on the goofy stereotype he was able to fill. Think back to American Idol–out of the number of Asian contestants that have tried out, how many do you remember as being 1) actually good 2) actually handsome and 3) actually taken seriously? The closest to ever reach the level of being taken as a legit artist was Anoop Desai, and even then, the judges (and the coaches, quite frankly) weren’t ever sure of what mold he should belong to. When he did sing his preferred genre, R&B, it was often taken as a surprise or even a joke. The cover he became known for, Bobby Brown’s “My Prerogative,” was looked at as part-sideshow, part-participation trophy. Despite the crowd (and Anoop’s hormonal fans) screaming for him, his performance was still seen as “Can you believe this Indian kid is gyrating and singing black music?”

Interestingly enough, I’ve actually interviewed Desai way back in 2009, sometime after his season’s American Idol tour ended. Back then, he said he had actually quit his degree in college and moved to Atlanta to pursue music full-time. I’d hoped we’d be able to see Desai on the big stage soon, promoting his own album. So far, not yet.

For what it’s worth, it seems like Asian artists are taken way more seriously on The Voice, in which your voice, not your looks, are what goes into you being picked. Take for instance Tessanne Chin, a Chinese-Jamaican artist who was able to release her second album and major release Count on My Love and sing for President Barack Obama. Or Judith Hill, a biracial Japanese-African American artist who had not only sung with Michael Jackson and was featured in the Oscar-winning documentary, 20 Feet from Stardom, but was able to release Back in Time, a CD produced by Prince after her stint on the show.

Still, what’s holding Desai back is the same thing that has held back many Asian and Asian-American artists–the stereotypes many music execs still have when it comes to Asian artists and Asians in general. In 2007, The New York Times profiled Harlemm Lee, a Detroit native of Chinese and Filipino descent who was looking to make it big as a singer. However, after landing a spot on 2003 NBC singing reality show Fame and gaining a record contract–his second in his music career, Lee never achieved the success he was hoping for. As of the time of the article, Lee was working as a secretary. 

“In terms of finding an advocate in the industry, the Asian thing has been the critical factor,” he said. “You don’t fit.” On his MySpace page, he wrote, “I was told over and over again by countless label execs that if it weren’t for me being Asian, I would’ve been signed yesterday.”

Asian artists today: BTS and beyond

Microsoft Theater/Twitter

Thankfully, it seems like a groundswell of support for Asian artists has been building in America, possibly leading to BTS’ big AMAs moment. Buzzfeed’s Tanya Chen released a list of 21 Asian American artists music fans should know in 2013, including rapper Dumbfoundead, whose music video “SAFE” took on the movie industry’s whitewashing and discrimination against Asian actors.

NPR’s Mallory Yu wrote about this year’s SXSW Asian-American showcase, spearheaded by LA-based nonprofit Kollaboration. And last year, Splinter News declared K-pop star Eric Nam as the first K-pop artist to actually make it big in America. It’s important to note that Nam, like many American-born Asian superstars before him, had to go overseas to find fame back home; he’s originally from Atlanta, and as Isha Aran wrote, “has a cultural fluidity that–at least by American audiences–is rarely seen from K-pop stars.”

BTS is primed to be in a position to bust open the doors for all of the Eric Nams, Girls’ Generations, 21E1s, and Dumbfoundeads on both sides of the ocean, and the AMAs is just one of the biggest glass ceilings to crack.

I remember my mom talking about how she used to mark her calendar for video release dates by Britney Spears or *NSYNC, and wake up to watch MTV,” wrote Jordyn, a BTS superfan in Las Vegas, to The Fader‘s Owen Myers. “It was something I could never relate to, and I thought that it was lost on our generation. When I saw the first video from BTS, I finally understood what she meant.”

“They are terrific and the most popular K-pop band in the world right now,” said Susan Rosenbluth, senior vice president at Goldenvoice/AEG Presents, whose firm promoted BTS’ international “Wings Tour”, to Paste.

“I think if they wanted to cross over and do more, they will…I think it will take certain things like winning awards, being in the general-market eye, so to speak, by marketing their brand in the U.S. more, in Mexico more, in other parts of the world more than just on the internet, and by virtue of the music that they put out in the future. [If] they wanted to sing more in English, they could.”

From what the band has said in interviews, they are looking to put out more English-spoken content. And, if their breakout performance from the AMAs is any indication, we certainly haven’t seen the last of BTS in our neck of the woods.

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Crazy Rich Asian fashion, as shown in “Crazy Rich Asians” first look photos

Crazy Rich Asians is promising audiences the most expensive looking film of 2018! (Well, one of them, if Black Panther has anything to say about that.) Most definitely, we will see tons of fashions, tons of labels, and tons of money. But can you, the plebeian, have the Crazy Rich Asians clothes? Yeah…but you still might have to take out a bank loan for some of these. But yes, you can live the Crazy Rich Asians life. Check out these fashion selections as shown in the exclusive Entertainment Weekly first look photos and see what you think.

The Meet-Cute Trench Coat

Wool trench coat | ASOS | $135

None of us have seen Crazy Rich Asians yet, but we already know what this scene is about, right? Everything about it says “New York City Romantic Comedy Meet-Cute.” All of our dreams–living a fabu life in New York, dating a wealthy man (this wealthy man, Nick Young, played by Henry Golding), eating ritzy food in an expensive restaurant–have come true in this one scene. Also a dream: a great trench coat.

This belted trench coat from ASOS carries the urban elegance that I feel best reflects this particular scene in Crazy Rich Asians. This coat has a bit more drape than the coat in the image, but it has that monied, yet lived-in look that I feel is best suited to getting your “I’m a normal girl in a rich fantasy” lifestyle on.

Eccentric rich girl pajamas

PJ Salvage Dogs & Hats Flannel Pajamas | Dillards | $68

In Crazy Rich Asians, Awkwafina plays Goh Peik Lin, Rachel’s (Constance Wu) kind, loving, rich friend from college. In this scene, it looks like Rachel has surprised her friend, since Peik Lin is meeting Rachel in her awesome dog print (silk?) pajamas.

You too can have some awesome silk pajamas, and for a fraction of a fraction of the price of Peik Lin’s expensive pajama set. These from Dillard’s, made by PJ Salvage, have dogs in kerchiefs and cowboy hats, making this set adorable, eccentric, and fun.

 Daytime party glam

Shape gold sequin halter top jumpsuit| PrettyLittleThing | $90

Sonoya Mizuno plays Araminta Lee, the fiancee of Nick’s very rich friend (in case you hadn’t caught on yet, everyone’s loaded in this film, including Rachel, although she doesn’t know it yet until the sequel, China Rich Girlfriend). Unlike Nick, who doesn’t flaunt his wealth, and Peik Lin, who is just a shopaholic but otherwise nice person, Araminta looks like she drips money and loves to flaunt it. Why else would she wear a party-ready gold sequin jumpsuit in the daytime?

This jumpsuit from PrettyLittleThing evokes Araminta’s luxe lifestyle. The black stripes also heighten the expensive look of this jumpsuit.

 Luxe beading

Embroidered dress | Sherri Hill | $1,550 (various sellers)

Nick’s mother Eleanor Young (Michelle Yeoh) also looks like she loves being monied, doesn’t she? Her nude and teal-beaded jacket and dress (I think) combo gives off old money and class. What it doesn’t show is how she’s uppity–throughout the book, Eleanor has a chip on her shoulder about how Rachel is just middle class.

The appliqué in this dress made by Sherri Hill echoes the blue beading in Eleanor’s surely bespoke outfit. The beaded appliqué in this dress gives an updated appearance to traditional appliqué, which can look mature, depending on how it’s treated. Here, the appliqué gives this dress an upscale, chic look.

The wedding dress to end all wedding dresses

Topaz sparkle tulle bridal ball gown | Lazaro | $4000-$5000 (various sellers)

Araminta’s wedding dress is all bespoke–from last I checked, it’s supposed to be bespoke Valentino. It’d have to be to have feathers, a high-low ruffle skirt, gold, pastel pink, beading, and nude illusion all in one dress.

However, I was able to find a dress that would mimic the expensive, fantasy wedding feeling you get from Crazy Rich Asians that you can buy…if you save up beacoup money for it. From what I hear, folks who are in the market for a Kleinfeld dress spend at least $3000, so this dress from Lazaro is within the ballpark (as you know, the sky’s the limit for wedding dress prices).

This particular dress has the gold beading, pastel pink, nude illusion bust and ruffles, much of what’s in play with the bespoke dress. You can have Aaraminta’s look, after all!

What do you think about the fashion in Crazy Rich Asians? Give your opinions below!

I’m a librarian in Puerto Rico, and this is my Hurricane Maria survival story

Condado, San Juan, Puerto Rico.(Photo by Sgt. Jose Ahiram Diaz-Ramos/PRNG-PAO)

Evelyn Milagros Rodriguez, University of Puerto Rico – Humacao

I’ve always been fascinated by storms, particularly Puerto Rico’s own history of them. I think it’s because I was born in September 1960 during Hurricane Donna. In its wake, that storm left more than 100 dead in Humacao, the city where I am now a special collections librarian at the University of Puerto Rico.

In 1990, Israel Matos, the National Weather Service Forecast Officer in San Juan, told me that, “The tropics are unpredictable.” That comment only increased my interest in storms. Now, with the people of Puerto Rico still reeling from Hurricane Maria more than a month after it hit the island, his words seem prescient.

Today I have – if not the honor, then the duty – to describe, firsthand, what it is to live through the aftermath of the worst storm of this brutal hurricane season.

Academic crisis

Since the storm I haven’t been able to go to work at the library on the Humacao campus. At 88,000 square feet and three stories, the biblioteca is the biggest building on campus, and it’s among the worst damaged by Maria.

The library at the University of Puerto Rico, Humacao.
Evelyn M. Rodríguez, Author provided

It’s mold-infested and the roof is leaking, so there’s a lot of work to be done in both repairs and cleaning before students can use it. The mold has gotten into our collection – from books and papers to magazines – and most of the furniture and computers will have to be replaced.

According to the general damage report for the University of Puerto Rico, the infrastructure in all 11 campuses of the university system suffered severe losses.

Héctor Rios Maury, chancellor of the University of Puerto Rico’s Humacao campus, speaks to staff and students after the storm.
Evelyn M. Rodríguez, Author provided

The Humacao campus, located on the island’s eastern side, was the hardest hit, with damages calculated at more than US$35 million. Classes will start again on Oct. 31.

Students at the Río Piedras campus, which has been partially closed since Hurricane Irma skirted Puerto Rico on Sept. 6, have had only a week of class so far this year.

Five weeks after Hurricane Maria, all the campuses have now reissued their academic calendars and classes are resuming, though in some places the first semester will run through January to make up for lost time.

A culture of catastrophe

Starting on Sept. 20, 2017, Hurricane Maria swamped Puerto Rico with 20 inches of rain and battered it with 150 mph winds for over 30 hours.

The resulting humanitarian crisis has been widely reported worldwide: 80 percent of the island is still without electricity and there is not enough drinking water.

Communications – radio, television, telephones and internet – are now recovering slowly, after weeks of near nonexistence. Having said that, it took me more than two weeks just to write this article, between finding somewhere to charge my laptop and locating an internet connection strong enough to research the data and send a file by email. Eventually I discovered a Starbucks near my house with both electricity and Wi-Fi. Nothing is easy.

What outsiders are unable to see, perhaps, is that an entire culture has arisen around the catastrophe caused by Hurricane Maria – one with typically catastrophic traits: material scarcity, emotional trauma, economic catastrophe, environmental devastation.

Puerto Ricans are now facing a dramatically different way of life, which means our relatives and friends in the diaspora are, too.

Nothing about life resembles anything close to normal. An estimated 100,000 homes and buildings were demolished in the storm, and 90 percent of the island’s infrastructure is damaged or destroyed. Not only are there shortages of water and electricity but also of food, highways, bridges, security forces and medical facilities.

It’s dangerous to venture outside at night. An island-wide curfew was lifted last week, but without streetlights, stoplights or police, driving and walking are dangerous after dark.

The official tally of missing people varies, with police tallies ranging from 60 to 80 right now. Considering Puerto Rico’s hazardous conditions and limited health care services, that number is sure to rise. We are well aware that epidemic diseases, including leptospirosis and cholera, could come next. Health concerns are further stoked by the delays and disarray of the various federal agencies tasked with handling this emergency.

A deep uncertainty looms over our futures. There is post-traumatic stress involved in surviving in an overwhelming situation like this, so as a people we’re now waking up to that psychological pain, too.

The outlook from here

In short, Hurricane Maria has changed the modern history of Puerto Rico. For those who, like me, are curious about such things, the last storm of this caliber was San Felipe II, in 1928.

Known in the U.S. as the Great Okeechobee Hurricane, that massive storm was so destructive that it basically plunged Puerto Rico and Florida into the Great Depression a year before the rest of the country.

The aftermath of the Great Okeechobee Hurricane in Florida, 1928.

In some ways, though, Puerto Ricans are well prepared for these challenges, for the history of the island is one of uncertainty and trouble.

Puerto Rico has never had a sovereign government. Instead, it has always been bound to some other larger and more powerful state. First it was Spain, which colonized our territory in 1508.

Then, since the 1898 invasion, it’s been the United States, a country with which Puerto Rico enjoys a tricky political relationship. That’s very clear right now, as the Trump administration wavers in coming to our aid.

Mired in uncertainty

Even before the hurricane arrived, Puerto Rico was facing uncertainty around another major challenge: bankruptcy. Considering lost pensions, jobs and savings, the real financial costs surely exceed by billions the official sum of $123 billion in unpaid government debt.

Hurricane Maria has deepened this economic crisis, creating a ripple effect that touches everyone across all levels of society.

Everyone is mired in uncertainty. What is the solution to this cascading set of problems? How long will recovery take? What could actually make life better for us? What will we miss? Will anything ever be the same?

Among all this concern and confusion, though, some things have become clearer since the storm. On this once-green island, the hurricane blew down and shredded thousands and thousands of trees.

The sky is more visible now. Houses once hidden are exposed, and we discern entire communities that that we rarely saw before.

A graffiti-scrawled reminder in Puerto Rico: ‘Behind the trees live a lot of people.’
Evelyn M. Rodríguez, Author provided

There’s graffiti popping up across the island, written by someone identified as “JC,” who reminds Puerto Ricans, as a kind of consolation, that “Behind the trees live a lot of people.”

Just as new environments are created in areas opened up by the hurricane, with trees and plants sprouting afresh, over time we’ll find that our current uncertainties also fade and transform. A brand new way of life is emerging among all Puerto Ricans – those who stayed, those who left, their relatives and their friends.

The ConversationLeer en español.

Evelyn Milagros Rodriguez, Research, Reference and Special Collections Librarian, University of Puerto Rico – Humacao

This article was originally published on The Conversation. Read the original article.

Exclusive Interview: “Charcoal” writer/director Francesca Andre talks colorism

Francesca Andre has a message for everyone with her short film, Charcoal. The main theme of her film is about colorism and its damaging effects on the black diaspora. Her two main characters go through a journey of self-acceptance and self-awareness, and that journey is something Andre hopes is replicated in her viewers.

I’ve had the chance to speak with Andre recently about her film (which you can learn more about in a previous article and the trailer below) as well as her opinions on how colorism affects us. I also asked about the Dove ad that sparked controversy, and how we can heal as a people from our societal wounds. Andre offers clear insight into her own journey towards healing and how we can continue the process of healing in our own lives. Here are highlights from that conversation.

Charcoal can be seen at the Yonkers Film Festival Nov. 3-8.

The inspiration for Charcoal:

Colorism is something that has impacted my life at a very young age. It’s very common in Haiti—it’s not white people versus black people, it’s really lighter skin versus darker skin. At a very young age, I was made aware of that. When I was probably five years old, I received a dark-skinned doll. When I took it home, people started making fun of the doll, saying the doll is ugly. My mother being brown-skinned, my grandmother being lighter-skinned, and my grandfather and my father being darker skinned men, people just made comparisons to the skintones.

Colorism and the lasting effects of racism in the black diaspora:

We’re still dealing with the consequences [of racism] as a people when it comes to economic empowerment, how we are being perceived and anything else—colorism sits right in there. It’s still affecting us, we’re still dealing with it, it’s not a thing of the past. We’re still healing from it. Those of us who are aware and are making a conscious decision to talk about it. You can’t really talk about racism or the advancement of us as a people and not talk about colorism.

Here in America, [the Dove colorism ad] was a mainstream brand that everyone can see, but you have some smaller brands, when you go to Caribbean markets that are selling [similar] products. You have women making skin-bleaching lotion and selling it to other women. I guess for some people here, it’s not as blatant as it is in other cultures—if you go to CVS, you probably won’t be able to find it, right? But it’s happening. It never went away, at least from my experience; as long as I’ve been alive, I’ve always known about these products.

Even thinking about “good” hair,the hair is not closer to our hair texture. It’s something closer to European hair texture. But when you look at our hair and the versatility of our hair, to me it’s like, really good hair! It took me a long time to reprogram myself, my thoughts, and redefine what “good” hair was for me to access [my hair] and accept it, love it, and embrace it…I don’t have any problems with it now.

Francesca Andre

On how to heal from colorism:

I do feel like we need to start having conversations, and an important part of that is the healing part of that. I think you will see that you’ll find more women going natural more than ever. Here’s what’s fascinating: how so many black women did not know their hair period because they just haven’t been dealing with their hair…they did not know how to take care of their hair; it’s been processed. When they find out what products work on our hair and what they can do to make their hair do this and that. Again, it’s knowledge and healing and more women are stepping out. It’s not a strange thing now to see a black woman with natural hair in the workplace. There was a time when this wasn’t a thing. Now, more people are going natural, embracing it and being unapologetic about it. I feel like we’re going forward. Even with skintones, too—[online campaigns and phrases like] “My melanin’s poppin’,” #BlackGirlMagic—we are healing collectively. I hope the men are using those terms as well; I hope the men are healing because they are also victims of colorism. I hope that we as a people stop the vicious cycle.

…First of all, I think [the first step to healing is] knowing what colorism is. Many people don’t even know what colorism means. It really starts the conversation. It’s hard to change beliefs, but one way we can do that as a people is to talk—ask [about it] and dialogue. Increase representation [in the media] to make women more confident in who they are and how they look. As an artist and storyteller, the way I [change] people is including it and showing it, talking about it and not pushing it away…Whenever I see a girl with natural hair, I tell them “I love your hair” or “I love your twists”; I make it my job to remind them because all the messages they are receiving are the opposite.

How Charcoal can start viewers’ journeys toward self-acceptance:

I think there’s a universal aspect to it. I hope people feel inspired and hopeful. I hope people find some sort of healing or be the beginning of that journey. We all can relate to pain, and the characters go through that, but we can see how they overcome that.♦

This interview has been edited and condensed. 

Why America needs Marvel superhero Kamala Khan now more than ever

Katie M. Logan, Virginia Commonwealth University

During the first few weeks of the Trump administration, we’ve seen increased pressure on Muslim and immigrant communities in the United States.

In the face of these threats, which Marvel superhero might be best equipped to defend the people, ideals and institutions under attack? Some comic fans and critics are pointing to Kamala Khan, the new Ms. Marvel.

Khan, the brainchild of comic writer G. Willow Wilson and editor Sana Amanat, is a revamp of the classic Ms. Marvel character (originally named Carol Danvers and created in 1968). First introduced in early 2014, Khan is a Muslim, Pakistani-American teenager who fights crime in Jersey City and occasionally teams up with the Avengers.

Since Donald Trump’s inauguration, fans have created images of Khan tearing up a photo of the president, punching him (evoking a famous 1941 cover of Captain America punching Hitler) and grieving in her room. But the new Ms. Marvel’s significance extends beyond symbolism.

In Kamala Khan, Wilson and Amanat have created a superhero whose patriotism and contributions to Jersey City emerge because of her Muslim heritage, not despite it. She challenges the assumptions many Americans have about Muslims and is a radical departure from how the media tend to depict Muslim-Americans. She shows how Muslim-Americans and immigrants are not forces that threaten communities – as some would argue – but are people who can strengthen and preserve them.


After inhaling a mysterious gas, Kamala Khan discovers she can stretch, enlarge, shrink and otherwise manipulate her body. Like many superheroes, she chooses to keep her identity a secret. She selects the Ms. Marvel moniker in homage to the first Ms. Marvel, Carol Danvers, who has since given up the name in favor of becoming Captain Marvel. Khan cites her family’s safety and her desire to lead a normal life, while also fearing that “the NSA will wiretap our mosque or something.”

As she wrestles with her newfound powers, her parents grow concerned about broken curfews and send her to the local imam for counseling. Rather than reinforcing her parents’ curfew or prying the truth from Khan, though, Sheikh Abdullah says, “I am asking you for something more difficult. If you insist on pursuing this thing you will not tell me about, do it with the qualities benefiting an upright young woman: courage, strength, honesty, compassion and self-respect.”

Her experience at the mosque becomes an important step on her journey to superheroism. Sheikh Abdullah contributes to her education, as does Wolverine. Islam is not a restrictive force in her story. Instead, the religion models for Khan many of the traits she needs in order to become an effective superhero. When her mother learns the truth about why her daughter is sneaking out, she “thank[s] God for having raised a righteous child.”

The comics paint an accurate portrait of Jersey City. Her brother Aamir is a committed Salafi (a conservative and sometimes controversial branch of Sunni Islam) and member of his university’s Muslim Student Association. Her best friend and occasional love interest, Bruno, works at a corner store and comes from Italian roots. The city’s diversity helps Kamala as she learns to be a more effective superhero. But it also rescues her from being a stand-in for all Muslim-American or Jersey City experiences.

Fighting a ‘war on terror culture’

Kamala’s brown skin and costume – self-fashioned from an old burkini – point to Marvel Comics’ desire to diversify its roster of superheroes (as well as writers and artists). As creator Sana Amanat explained on “Late Night With Seth Meyers” last month, representation is a powerful thing, especially in comics. It matters when readers who feel marginalized can see people like themselves performing heroic acts.

As one of 3.3 million Muslim-Americans, Khan flips the script on what Moustafa Bayoumi, author of “This Muslim American Life,” calls a “war on terror culture” that sees Muslim-Americans “not as complex human being[s] but only as purveyor[s] of possible future violence.”

Bayoumi’s book echoes other studies that detail the heightened suspicion and racial profiling Muslim-Americans have faced since 9/11, whether it’s in the workplace or interactions with the police. Each time there’s been a high-profile terrorist attack, these experiences, coupled with hate crimes and speech, intensify. Political rhetoric – like Donald Trump’s proposal to have a Muslim registry or his lie that thousands of Muslims cheered from Jersey City rooftops after the Twin Towers fell – only fans the flames.

Scholars of media psychology see this suspicion fostered, in part, by negative representations of Muslims in both news media outlets and popular culture, where they are depicted as bloodthirsty terrorists or slavish informants to a non-Muslim hero.

These stereotypes are so entrenched that a single positive Muslim character cannot counteract their effects. In fact, some point to the dangers of “balanced” representations, arguing that confronting stereotypes with wholly positive images only enforces a simplistic division between “good” and “bad” Muslims.


Kamala Khan, however, signals an important development in cultural representations of Muslim-Americans. It’s not just because she is a powerful superhero instead of a terrorist. It’s because she is, at the same time, a clumsy teenager who makes a mountain of mistakes while trying to balance her abilities, school, friends and family. And it’s because Wilson surrounds Kamala with a diverse assortment of characters who demonstrate the array of heroic (and not-so-heroic) actions people can take.

For example, in one of Ms. Marvel’s most powerful narrative arcs, a planet attacks New York, leading to destruction eerily reminiscent of 9/11. Kamala works to protect Jersey City while realizing that her world has changed – and will change – irrevocably.

Carol Danvers appears to fill Kamala in on the gravity of the situation, telling her, “The fate of the world is out of your hands. It always was. But your fate – what you decide to do right now – is still up to you … Today is the day you stand up.” Kamala connects the talk with Sheikh Abdullah’s lectures about the value of one’s deeds, once again linking her superhero and religious training to rise to the occasion. In both cases, the lectures teach Kamala to take a stand to protect her community.

Arriving at the high school gym now serving as a safe haven for Jersey City residents, Kamala realizes her friends and classmates have been inspired by her heroism. They safely transport their neighbors to the gym while outfitting the space with water, food, dance parties and even a “non-denominational, non-judgmental prayer area.” The community response prompts Kamala to realize that “even if things are profoundly not okay, at least we’re not okay together. And even if we don’t always get along, we’re still connected by something you can’t break. Something there isn’t even a word for. Something … beautiful.”

The ConversationKamala Khan is precisely the hero America needs today, but not because of a bat sign in the sky or any single definitive image. She is, above all, committed to the idea that every member of her faith, her generation, and her city has value and that their lives should be respected and protected. She demonstrates that the most heroic action is to face even the most despair-inducing challenges of the world head on while standing up for – and empowering – every vulnerable neighbor, classmate or stranger. She shows us how diverse representation can transform into action and organization that connect whole communities “by something you can’t break.”

Katie M. Logan, Assistant Professor of Focused Inquiry, Virginia Commonwealth University

This article was originally published on The Conversation. Read the original article.