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Thursday, July 4, 2013

Thank God for Mississippi

I have attended quite a few medical conferences over the years where health professionals from states that are struggling to improve their healthcare ratings remind the crowd that they may be bad, but Mississippi is worse.  They may be 48th out of 50 on obesity levels, diabetes care, low birth weight; but they end their speech with: “Thank God for Mississippi!” 

These words draw a chuckle from the crowd because Mississippi ranks last or ties for last on rating systems.  United Health Foundation and The Commonwealth Fund both place Mississippi as having the worst score on numerous measures and Mississippi has held this position for over 10 years.

So I was very glad when Cheryl Hamill, RN MS Clinical Outreach Coordinator from UMMC School of Nursing in Jackson, Mississippi reached out to me.  Dave DeBronkart recommended me as a good choice of speaker for a potential keynote speech.  The focus of this event would be heath literacy. She thought my background and health mission focus would be a good match for the needs of their mostly rural and very underserved population.

Now with most busy conference planners after this initial outreach and securing my agreement to present, the planner would hand me off to a subordinate.  Cheryl is not like most conference planners.  She kept me in the loop through two very informative planning conference calls with the speaking team.  She communicated changes and new ideas through 177 emails in a six-month period.  She friended me on Facebook and I began to know her as regular person.  She joined twitter and began to tweet.

She was very organized and willing to try new things, which is such an unusual combination.  Upon hearing my explanation of the importance of twitter in patient advocacy and the power of using twitter hashtags in communication during a conference, Cheryl decided to encourage all attendees to open twitter accounts prior to the event and raffle several prizes only eligible to those who “live-tweeted” the event.  She even helped organize a pre-event tweet chat focused on how to “live tweet” a conference.  I provided twitter guidance online as well as through a 1(800) number Cheryl set up just to facilitate tweeting.

Cheryl did not stop there. When I suggested we complete the conference by hosting and “unconference” session, she wholeheartedly endorsed the idea.  So Bonnie Westra PhD, Associate Professor University Of Minnesota and I would teach the concept of open space to 89 unconference virgins in a little less than two hours. 

That is what I call a brave conference planner.

On Monday June 17, 2013 we would meet just outside of Jackson Mississippi and discuss health literacy in this state.  Our day began with Libby Mahaffey, PhD, saying opening remarks focusing on Cultural Awareness & Health Literacy...the Journey Continues. Next we would hear from Deb Washington, PhD, RN, Director of Diversity-Patient Care Services, Massachusetts General Hospital. Deb was an amazing speaker.  Her power point deck had a crisp easy to read large font and she expounded on the difference between the Democrat belief in system design and Republican philosophy of individual responsibility within healthcare.  She also showed us an advertisement from her Sky Mall magazine that informed travelers how to pack a suitcase with a built in compartment checklist for every need.  We need this kind of organization in healthcare, she told the crowd.

Next Tonya Moore, PhD, RN, Chief Learning Office, UMMC spoke about Mississippi county health rankings and spoke in-depth about internet access within the state.  She would soon introduce me and I would find out that she is the grand niece of Medgar Evers.  She mentioned my mission focus of improving patients’ rights in relation to the history of civil rights.  I was so very honored.

This was a special day for a keynote.  This day was the fourth anniversary of my late husband Fred Holliday’s death.  I could think of no better a crowd to share our personal story with on such a day, for I was in a room of those who had suffered and they understood pain.

When Terry Davis, PhD, Professor LSU Health Science Center began to speak she had the most amazing videos to share of patients with low health literacy being interviewed.  One of the most poignant was of a young mother who did not know what a milliliter measurement was when dosing her children with ibuprofen.  We also heard an elderly lady tell us she never bothered to read the warning labels.  (On one of her bottles of medication she was advised not to drive and she had driven to the appointment)

Then I began to paint “The View From the 50 Foot Patient.”

The view from the 50 foot patient

The title of this piece was based on a corporate phrase and a B-movie title.  I have been to quite a few events where I hear the phrase “Let’s take the 50,000 foot view.” I must admit I want to roll my eyes, because if you are taking this view you are in a highflying jet and way out of sync with those of us living in the daily grind of healthcare.  I also felt a kind of exploitation of the b-grade movie when we watched the videos of those with poor health literacy. It made me think of the poor heroine of that film when no one would believe her due to her past history of alcohol abuse.   So our lovely patient kneels down dressed only in a banner of drug warnings like some contestant in a pageant no one ever wishes to enter.

 this banner

Behind her is a cloud of warning based upon the presentation of Melissa Stewart, DNP Faculty of Our Lady of the Lake College.  She showed us her UPP (Understanding Personal Perception) to gauge a patients understanding using the image metaphor of a range from a bright sunny day to a deeply cloudy sky.

Melissa's clouds

The second painting is based on the presentations of the second day especially Jonathan Vangeest, PhD, Chair Department of Health Policy and Mgt., Kent State University College of Public Health.  This painting is called “Altar Call."

  Altar Call

In this conference, unlike may others, the conversation of faith in was concert with questions of health and we benefited greatly from such dialog.  We also heard the powerful story of Jonathan’s medical history.  He was a promising student with an engineering bent when he was working in a workspace that all equipment was being sealed with a toxic sealant.  Due to his hours spent in such an environment Jonathan suffered frontal lobe damage, which resulted in life long epilepsy.  So within this painting a young Jonathan stares out of a stained glass window with the supervisor wearing a gas mask.  Jonathan also spoke about the marketing of McDonalds and how they used a friendly clown to convince children to come and bring their parents to eat at McDonalds.  So within the painting’s shadows I worked in an arched M and the clown’s face.

  the clown

To the left is another M.  It came from a speaker’s story about a local public health group that wanted to reach out to the “Mexican” population in their community.  They built an entire health literacy program in Spanish.  When they went to the community they realized the residents were Mayan not Mexican.  I finished this painting quickly as I need to help Bonnie host the unconference session.


The unconference session was marvelous with 9 different individuals pitching sessions. I was able to host a session on how to crowd fund in healthcare, introducing the attendees to the wonders of Medstartr and HealthTechHatch.  It was great.  Bonnie was a wonderful facilitator making sure every session concluded when it should so the next could begin.


 But everyone in the room learned it is not over until it is over.  Then the raffles were won and I looked at the amazing reach of the hashtag on Symplur.  You can see the analytics here and the transcript here.


The conference day finished and I thanked Cheryl for inviting me and I thanked God for Mississippi, not as some trite phrase or laugh line within a speech to inform.  No, I thank God for Mississippi.  I thank God as Jesus would.  For in the parable of healthcare Mississippi would be the tax collector, the poor widow, the leper and Jesus saw the greatest hope with such as these.   

The folks in Mississippi know what it feels to be the lowest of the low and from there anything is possible. Thank God for Mississippi.


  1. I feel like it should be "Thank God for Mississippi AND Texas" (and maybe Louisiana too). It's interesting to hear others say "well at least we're not as bad as" these states. It is very true that these states suffer from horrible health systems that result in depressing statistics on health outcomes. Living in Texas, I see this every day.

    But I guess one question that arises for me is why are we comparing to this low bar? Why are we not saying "too bad we aren't like Colorado" (my home - always ranking in the top for health statistics). Why aren't we asking ourselves how to achieve more instead of patting ourselves on the back for not being the worst?

    This seems to be a theme in healthcare (and truly among most policy such as education and environment). For instance, meaningful use measures - they set a rather low bar in my opinion. Those who met meaningful use standards are basically lauding that they have met a standard that they should have surpassed long ago. It becomes a "thank god we at least meet these standards." And in truth the standards mean very little either at the 50,000 foot level or at the millimeter between a patient and provider when they don't consider the context of care, the patient with the healthcare story that perhaps they cannot tell effectively because of their lack of (health) literacy.

    Why not change the rhetoric to "we need to do better" and "we need to set the standard" and "we need to help those who are at the bottom to achieve what we have" instead of "thank god we aren't like them"?

    I'm glad you went to Mississippi and to hear of such engagement. It is not a joke that Mississippi and their citizens suffer bad healthcare. It is not something to look down on. Because in the end, we are not promoting improved health when we say such hurtful things - we are sticking our tongues out saying "we're better than you are" when we should be saying "we all need to be better, how do we get to be the best"?

  2. Another thing, how in the heck did you get them to engage in twitter so effectively?!

    I go to so many local events on the health policy developed here. Coalition meetings, updates on our 1115 Medicaid Waiver, a community forum for a new health and wellness center are recent meetings. Because so many don't know what is going on in our community or can't attend events, I try to live tweet a bit about the information there.

    When I ask the organizations hosting these meetings if they even have a twitter account they say they do but don't use it because it takes too much time and effort(dumbfounding me). Or they say that no one cares if they do use it because most people aren't online. Some have accounts that just sit idly which breaks my heart when I know how effective a tool it can be. I don't know how on my own to change this mindset. I just keep tweeting and encouraging them to engage hoping they will one day.

    Seems though that you were so effective at this conference. I think we need to learn from this example and find a way to replicate it!