A girl from a religious family in a rural community that was home-schooled until starting at a strict Catholic school in 6th grade and has not looked at porn…yeah, she had no idea what sex is or that what her 3-years-older-than-her boyfriend wanted was actually sex.

It’s hard to have that conversation with a 17 year old who just gave birth to their second child. There’s children out here having children because we have fuckall for sex ed in this country and human instincts and desires aren’t going to go away. I have met pregnant teenagers that knew that sex before marriage was bad and would send them to hell, and that sex is where babies come from…but didn’t know that “sex” is when “he puts his thing into me where I pee from down there” because no one ever explained to her what sex actually is.

…except that we do know what gets put in every medication. Every ingredient has to be registered and tested, and if they change the formulation at all, they have to test it again to make sure it’s safe.

The problem with that is that there are already too many children in need of good homes and some of these parents are very good in every other respect. The people who push anti-vax stuff need to be made into public examples, but the rank-and-file believers are usually just well-meaning dupes.

They see that rash as not that scary, and the rash is honestly the mildest part of the disease. Measles can cause encephalitis (brain swelling) and kill the child, it can cause pneumonia and kill the child, they can recover from the illness and be completely fine for a few years until the virus reactivates and their entire central nervous system becomes intractably inflamed and they seize until they die. And there’s nothing we can do about any of those complications besides things like IV fluids or ventilatory support because there are no antiviral medications effective against measles, so we just have to hope the child’s immune system wins.

It’s definitely a starfish situation. You won’t be able to save all of them, but you can make a difference to each individual that you help. It’s my guiding principle in medicine for everything from preventative care to resuscitation. I can’t save every patient, but I can do my best to help the one in front of me, and previous failures do not prevent future successes.

Kids are a really big commitment in a different way because of the psychological and cognitive needs of the child, and it would be a lot better for the kiddos if the parents have their spoons together before the kid arrives. It can be very chaotic and damaging for the child if the parent is getting their stuff together during the developmental periods. This especially goes for pregnancy because mental illness and substance use during pregnancy can seriously affect fetal development in some cases and it can even lead to miscarriage or stillbirth if things aren’t sorted out fast enough.

So, maybe having kids might be more viable for fathers, but it’s still not a great idea because disengaged fathers can be damaging to both the baby and the mother.

I’m pretty sure they did recently develop a vaccine for Ebola that they are trying to distribute in the affected areas of Africa, but I’m afraid that US governmental funding, the WHO, and American-based NGOs were involved, so who knows if the money exists for the manufacturing and distribution anymore.

I spent SO MUCH TIME during my pediatrics clinical rotation explaining vaccines to new parents. In some cases, I sat there for a literal hour and debunked myths and conspiracy theories in order to get the parents to consider maybe doing a delayed vaccination schedule. I’m a medical student, so my time is basically worthless and I viewed this as a good use of it, but it was so incredibly frustrating to have to do over and over.

For other folks who know anti-vax parents (new or not), here’s the best line of argument I came up with:

Vaccines have been around for a very long time now, and the only changes we’ve made to them recently is to make them better and safer. The preservatives in them like the mercury compound are perfectly safe, but we’ve still worked hard to improve the manufacturing process to minimize the need for those preservatives and make the vaccines as pure as possible.

Vaccines are made of little fragments of the virus or bacteria, or a modified, significantly weaker version of the pathogen to give your child’s immune system a chance to see it before the real thing shows up. It’s like giving your child’s immune system a wanted poster or a punching bag to practice on because it has to make special tools to fight each different pathogen.

The reason we load kids up with so many vaccines in the first year or two of life is because their immune systems are still growing and it’s an optimal time to introduce things for it to prepare for, and we want to give them some protection of their own before the antibodies from mom run out around 6 to 12 months of life.

We have decades of data showing that vaccines are safe and effective, and the complications and side effects are so minor compared to the problems that can come from the disease. And it’s usually around 1000:1 ratio of complications from the disease versus complications from the vaccine, and the vaccine complications are almost always less severe than the complications from the disease.

If you refuse vaccination for your child for reasons besides an anaphylactic allergy to the ingredients, you are gambling your child’s life with most of these diseases, and it would have been an entirely preventable death. Vaccines are very hard to make and we have prioritized making vaccines for the diseases that kill children. We don’t bother making vaccines for things that are just a nuisance, so the vaccines we have exist for very good reasons. For the most famous example, measles has about 5 different ways it can kill your child that are impossible to treat or prevent once they have it, and many ways to cause permanent damage. The known and most common side effects of the measles vaccine are pretty mild and can be easily treated with medications we have available.

Edit: Fuck it. I’ve decided that I’m going to use some of my copious (/s) free time writing a children’s and parents’ book about vaccine safety with this argument. I will self publish if I have to and give it out in family medicine and pediatric clinics if it kills me.

I worked in a nursing home/assisted living facility for a little while for minimum wage. I quit when I found out that they were expanding the memory care unit without increasing staffing requirements. Most of my 8 hour shifts were by myself caring for 9 adults with severe dementia that required help with everything…and they were talking about increasing that to 13 residents. I left because I did not want to be responsible for one of them falling and getting hurt while I’m stuck trying to clean up another one that forgot how to use a toilet about 10 years ago.

There is no proposed solution. The proposed solution is for the poor people to just die already.

There are many healthcare facilities here in America that would pay minimum wage if they could get away with it (and many of them do). Hospital administrators and managers hate the word “union” with a fiery passion and will fight tooth and nail to prevent their workers from forming or joining unions.

And this is part of the problem with the reduction in Medicare and Medicaid reimbursements. The community hospitals and clinics are already strapped for cash to pay their workers well enough, and if the majority of their patients are on government-funded insurance, then the cuts to that insurance will mean that the hospitals and clinics (and thereby the workers) get paid even less than before.

It’s like that in some other countries as well. In the UK, the NHS funding has been whittled away to the point that people with the means to do so are turning to private healthcare because of the wait times and the physicians are going on strike because of the poor pay and working conditions.

Healthcare around the world is a house of cards right now, and we really didn’t do anything to reinforce it in a meaningful way during/after the pandemic. The next pandemic is going to be quite bad.

Given that my background includes working as an ER tech, I am planning on writing some pieces about EMTALA and its implications. Everything you brought up is spot on (if sometimes a little understated) in my experience.