10 things your primary care physician won't tell you

From Smartmoney.

1. "They should put me on the endangered-species list."
A good primary-care doctor — someone to coordinate your health care, help choose your specialists and be the first to diagnose just about any problem — is the key to good medical treatment. But they're getting harder to come by. According to a 2007 study, it took new patients in Massachusetts an average 26 days to land an appointment with one. Why? Fewer med students are going into primary care: Interest is so low that the number of primary-care internal medicine residency positions dropped by more than 50% in the past decade. "We're not really getting the best and brightest in primary care," says Kevin Pho, a Nashua, N.H., physician who writes the blog Kevin, MD. "And that's where they're needed."

Cherrie Brunner of Syracuse, N.Y., knows this all too well. She had such trouble finding a new doctor that she stuck with her old one despite problems — when she had blood in her urine, for example, she had to wait a week for an appointment, and the office then tried to cancel. But find a new GP? "I want to," says Brunner. "But when friends say, 'my doctor's great,' he won't take new patients." (Brunner's doctor had no comment.)

2. "I'm the pauper of my profession."
One big reason fewer medical students are specializing in primary care is pure and simple economics. In 2006 primary-care doctors earned an average of $171,519. That might sound like a lot to most working people, but it's less than half of what dermatologists made that same year. And the call of more-lucrative specialities is only likely to get louder for today's residents: According to one study, the income of primary-care doctors, adjusted for inflation, actually fell by 10% between 1995 and 2003. "Students are not dummies," says Pho. "They graduate with $130,000 in debt; why should they go into primary care?"

The income of primary-care doctors is under such pressure these days because general practitioners are paid roughly $30 to $70 for each patient they see regardless of how long the individual visit. That scale, based on Medicare reimbursements, has changed little since 2000. "Reimbursement for primary care is lousy," says John Ford, an assistant professor at the David Geffen School of Medicine at UCLA. "They put a premium on volume, not on spending time with patients."

3. "Sorry, your 12 minutes are up."
These days it seems like a visit to the doctor involves little contact with an actual doctor. Instead, most of the time is spent explaining problems to assistants and having blood drawn by nurses. Indeed, doctors have been beefing up their support staff — physician's assistants and nurse practitioners — to help them squeeze in more patients. They say this assembly-line approach is necessary because they get paid about the same for each patient no matter how long it takes. It certainly has been effective; some doctors are able to see 40 patients a day. That's one every 12 minutes. And it doesn't show signs of slowing: According to one survey the average number of patients doctors saw grew by 7.5% from 2004 to 2005.

While this system isn't inherently bad, it can be abused, says Ford. Assistants may have a different philosophy from the doctor, leading them to treat problems differently as well. Communication can break down, causing confusion about medications, and a misdiagnosis by an assistant is always possible. Some doctors do take things to the extreme: In the Massachusetts study, 41% of patients had an appointment during which they never saw the doctor.

4. "I hawk for Big Pharma in my spare time."
Your physician relies on his best judgment when deciding what drugs to prescribe. And influencing that judgment is big business. Market-research firm IMS has found that the pharmaceutical industry spends $7.2 billion a year targeting doctors with ads and sales representatives. That translates into $8,000 in marketing money spent on each of the 900,000 doctors practicing in the U.S. today. "The introduction to pharmaceutical representatives starts as early as medical school, and it never really stops," says Pho.

The real amount is certainly much higher, since these figures include only journal advertising and salaries of sales reps, not their expenses. Drug reps give away pens, cups, hats and shirts, and buy office staff lunch, all in hopes of nabbing time with the doctor. But that's just the beginning — drug companies know doctors are more likely to take their cues from other doctors, so they sponsor weekend seminars at expensive resorts featuring presentations by physicians. Drug companies pay these docs to give informative talks about medical conditions — for which the company's drug gets pitched as the best remedy.

5. "Sore throat? You might be better off going to the mall."
When Mary Furman got a call from her daughter's school at 10 a.m. one day last year, she was sure it was strep throat, but her pediatrician couldn't see the girl until 4. Furman decided to try a new clinic she'd noticed at a nearby Wal-Mart; they were in and out with a prescription in under an hour.

Walk-in clinics are springing up across the country. They're run by nurse practitioners, who diagnose simple maladies, like strep throat or flu, and provide prescriptions, medical advice or referrals if the problem is beyond their scope. These clinics have caught on in part because they're fast and don't require an appointment, says Steven Cooley, a physician and CEO of SmartCare Family Medical Centers in Denver. They're also cheap — $40 to $60 a visit, versus $150 for a doctor or $300 for an ER visit — and many take insurance.

Today there are about 460 such clinics, but analysts expect the number to jump to 4,000 by 2009. When visiting one, says Jim King, president of the American Academy of Family Physicians, ask to have your records forwarded to your doctor, and be sure to tell him about any medication prescribed at the clinic.

6. "I hate technology."
It's almost impossible to imagine anyone doing his job these days without a computer — except your doctor. Although billing and other systems may be computerized, when it comes to medical records, many GPs still prefer pen and paper. New electronic medical-record systems can print out clear prescriptions that are cross-referenced with medical databases to avoid incorrect dosages or dangerous drug combinations; hospitals can access patient histories in case of emergency; and care can be better tracked over time. But as a group, primary-care physicians have been slow to adopt the technology: A recent study found that only 28% use these systems. Why? They can cost up to $70,000, and cash-strapped GPs see little payoff.

For most patients the benefits of the technology are huge. It eliminates prescription errors due to illegible handwriting. It ensures that patients get the right dosage. Records won't get lost. It reminds doctors when they need to monitor their patients. And specialists and others can easily forward electronic records to your GP. "I'd seriously consider changing doctors if he didn't have an electronic records system," King says.

7. "Your insurance company is calling the shots."
these days doctors have more freedom to send you to a specialist or order expensive tests than they once did under managed care. But that doesn't mean the system is fixed. For starters, your insurance provider's pool of doctors may lack, say, a great cardiologist, King says. And with increased deductibles, it's often the patient who foots the bill for a referral or an expensive test.

Insurers also still wield the power when it comes to hospital stays, says Jerome Epplin, a geriatrician and clinical professor at the Southern Illinois University School of Medicine; he has recommended that a patient spend four days only to have the insurance company overrule him, refusing to pay for the last day and sticking the patient with the bill. "We are powerless over it," Epplin says. "It's incredibly frustrating." Mohit M. Ghose, spokesperson for America's Health Insurance Plans, an industry trade group, says, "When I hear physicians speaking like this, it tells me that physicians need to be working more closely with plans to understand what the guidelines are."

8. "My legal history is none of your business."
Today's insurance plans give patients a wider range of doctors to choose from, but patients don't have any more information to help them decide. "If insurance companies really wanted to bolster patient choice, they would give patients the ability to make informed choices," says Peter Lurie, deputy director of the health research group at Public Citizen. The best information about doctors is off-limits to patients. It's the National Practitioner Data Bank, which state medical boards and hospitals use to do background checks, and it includes information on disciplinary actions and malpractice payments.

To find out if your doctor has been sued, you'll have to go down to the local courthouse, but if your doctor has moved around, you'll get only part of the picture. The best publicly available information is tracked by state medical boards, many of which publish this information on their Web pages. If yours doesn't, you can pay $9.95 for a report from DocInfo.org, a site run by the Federation of State Medical Boards.

9. "If you're over 65, don't bother me..."
As troubling as things are in primary care, the situation is worse when it comes to treating elderly patients, especially those on Medicare. Doctors who specialize in geriatrics are certified by the American Board of either Family or Internal Medicine, and they're increasingly rare. Right now there is just one geriatrician in the U.S. for every 5,000 seniors, about half of what we should have, according to the American Geriatrics Society.

The problem is that fewer medical students are choosing this subspecialty: Last year only two-thirds of geriatric fellowship programs were filled. That's because treating older patients who have multiple, often complex problems is about the worst way a doctor can make a living. Medicare doesn't compensate much more for a 45-minute appointment with a patient with dementia, hearing loss and a half-dozen other maladies than it does for seeing someone for a simple checkup. "It is fiscal suicide to go out there and say, 'I am a geriatrician,'" Robinson says. "You get the patients that require the most time that pay the worst."

10. "...unless, of course, you're willing to pay extra."
unfortunately, the shortage of geriatricians is worsening. As med students shy away from geriatrics, the number of people over 65 is set to grow faster than ever as boomers retire. The American Geriatrics Society estimates that by 2030, there will be a shortage of about 36,000 geriatricians in the U.S., up from 7,000 today.

Though the situation seems dire, there are ways to guarantee qualified care. One approach is to see a good primary-care doctor who is also a geriatrician long before you need one. Epplin says that in southern Illinois, not many doctors accept new Medicare patients, but when their existing patients go on Medicare, they keep them. Other approaches can be costly. In Sarasota, Fla., where Robinson practices, many doctors provide "concierge" service: Patients pay an annual retainer of about $4,000 in exchange for their doctor's cell number and upgraded access. Other physicians in Florida have begun asking patients to pay an annual administrative fee of about $200 or $300 to help them continue to provide individualized care. These pricey options aren't what most people have in mind when they think of health care reform, but they may be the only way to maintain ready access to a good doctor.

Investors flock to Malaysia's Super Corridor

KUCHING, Malaysia (MarketWatch) -- It's called the MSC, the Malaysian Super Corridor, and it's attracting the investment attention of big money and institutions all around the world.

Malaysia is poised for enormous growth. Predictions for the economy in 2008 are robust. Venture capitalists and developers are investing in real estate, technology and communications. The country is looking like it will become a major business hub in years to come.


Take a look at Kuala Lumpur. Built out of the jungle, the city is thriving with shopping malls like the KLCC and the famous Petronas Twin Towers attracting people in droves. When I was there, business meetings and conferences were being held all over. Pete Sampras and Roger Federer were holding an exhibition tennis match and the city pulse was on par with that of New York. The hotels and buildings are sparkling new, and more are going up every day.

If the MSC takes hold it will be a force to be reckoned with. Here's why: Malaysia is just Western enough to attract investors from Australia, Europe and the U.S. And it is just Eastern enough to attract investors from China and Japan. China is already taking the lead. A local businessman told me that Chinese interests control about 50% of the businesses near him.

The Malaysian government and the MSC, an organization in its own right, aren't keeping the place a secret. Advertisements are all over the international news networks and the local papers.

The Malaysian government sees the MSC as its big chance to compete on the international level. It boasts a hub, or corridor, that is being developed rapidly and attracting businesses ranging from real estate to telecommunications to technology. It is sparking job growth, stock growth, economic growth -- growth with a capital G.

To be sure, Singapore, its neighbor, has already proven to be a major business success. Malaysia faces competition from the rest of the world as well as very little infrastructure to begin such a 21st century endeavor.

Jungle transformation
Besides, the MSC will ravage the land here more than it already has. Malaysia is a pristine place, full of jungle and unspoiled natural resources. That will all change if the various stages of the corridor take hold and envelop the states of Sabah and Sawarak, where myriad species roam wild.

Officials from the state of California were visiting when I was in Kuala Lumpur, vetting the MSC. They said they are interested in pursuing relationships in the area -- potential investments and sharing of resources.

What will attract people here are the prices. Malaysia is cheap. A two-story compound of a home on Sawarak is about $100,000. You can get a full dinner, including appetizers, drinks and dessert for a little more than ten bucks.
In terms of stock prices, Malaysia has followed Asia and the rest of the world of late, seesawing. But values are said to be available.

The Malaysian government admits that the MSC will corrupt land, but says the economic benefits of jobs and industry will outweigh that and help its people.
It won't be up to them, however. There isn't enough local wealth to put Malaysia in riches. It knows that. It needs outside investors to reach the type of growth it has in mind.

That means it will have to rely on the business strategies of foreign firms to propel its growth. And that may not so neatly mean jobs for the Malaysian people. There is a huge influx of Indonesian labor in the country. Outsourcing capital also means outsourcing the management of the economy to an extent.

By those rules, the market will win, even if that means at the sacrifice of the people and the land that it is built upon. Whether the MSC will fulfill the high hopes the Malaysian government has remains to be seen. One thing is for sure: It will have a dramatic effect on how things are here.

Prizes not patents on drugs?

(Fortune) -- What to do about the high cost of drugs? A cadre of academics and economists has a radical new answer: Take away the exclusive product patents the government grants a new drug and replace them with one-time cash awards to the innovating company.

Not surprisingly, this is one prize Big Pharma says it doesn't want. Even so, the idea of "prizes not patents" is gaining support and sparking a heated debate over the price of medical innovation.

Here's how the so-called "prizes not patents" scheme would work, according to its supporters: The federal government would set up an $80 billion innovation fund, and rather than grant exclusive patents, officials would use the pot of cash to reward each company's new drug discovery with a one-time prize. Regulators would then take the new drug's formula and place it in the public domain, where any other drugmaker can copy it, make a duplicate medicine, and rush it to market. The hope is that the ensuing market competition would generate dramatically lower prices for new medications.

Such policy notions would have little traction if not for the overwhelming feeling that drugs are too costly. Drug treatments are becoming an increasingly larger part of the U.S. healthcare budget. And as baby-boomers begin to sign up for Medicare's new prescription drug benefit, taxpayers and politicians are fretting the costs. Americans spent $274 billion on prescription drugs in 2006, an increase of 82% over spending in 2000. Medicine prices have risen faster than the rate of inflation in each year of this decade.

According to a study by the AARP Policy Institute, the average senior citizen taking four brand name medications saw a cumulative increase of $1,461 to fill prescriptions between 2000 and 2006. Reform advocates fear that increasing costs can limit patients' access to life-saving drugs. Some of the most expensive drugs, in fact, are those for cancer treatment.

Moreover, some policymakers believe prizes would solve more than just high prices. They say the plan would create an incentive for companies to research and develop medicines diseases that are more prevalent in developing countries - ailments drugmakers currently considered to be less lucrative.

If the new patent scheme sounds downright Soviet, that's because it is. Actually, the old Soviet Union tried awarding prizes for innovation, but according to most Russian policy experts, the system failed to generate scientific creativity. Supporters of this new plan point out, however, that the Soviet's were too stingy, and didn't offer large enough prizes.

The prize plan is gaining new clout in recent months. Nobel laureate economist Joseph Stiglitz advocated the idea in a recent syndicated column. "[T]he patent system with all of its distortions has failed in so many ways," Stiglitz lamented. Last month, Vermont Senator Bernie Sanders introduced the idea in the form of the Medical Innovation Prize Act of 2007.

Earlier this month on the presidential campaign trail, John Edwards promised to make drug patent reform a part of his healthcare agenda. The former North Carolina senator told a gathering in New Hampshire that the plan would "create a different dynamic for drug companies and particularly for breakthrough drugs in big areas like Alzheimer's, cancer, etc." "We'd offer a cash prize for research and development of these drugs, but they don't the patent," Edwards explained. "So, we eliminate the monopoly."

Big drugmakers shudder at the idea of more government involvement in their business. "A prize system could interrupt the flow of funding needed to guarantee research success and could inject the government into decisions about research priorities," says Ken Johnson, senior vice president of PhRMA, the drug industry's main lobbying organization. Johnson insists out that the current patent system hardly grants the lucrative monopolies critics describe.

While it's true, for instance, that patents last 17.5 years, unlike other industries, drugmakers conduct an average of about 12.5 years of research on medicines before they can gain FDA approval. That leaves roughly five years of patent exclusivity for a drug company to recoup its industry average $800 million investment. "We believe that any weakening of the current patent system could be potentially devastating for patients," Johnson says.

The idea of government prizes for drug innovation is the brainchild of James Love, an economist who is director of Knowledge Ecology International, a Washington, D.C.-based think tank. Love has made a name for himself in the nation's capital as a consumer advocate, lobbying and working to pass legislation in areas including technology, intellectual property and health care. He is often criticized for being anti-business, but he believes his prescription for drug companies couldn't be more pro-industry.

"We're saying we want to give $80 billion a year to biotechs, Big Pharma," says Love. "Is that really anti-business? To me, it's a market-oriented alternative to an unproductive, ethically challenged system. Patients prefer a free market, but they don't like monopolies where you pay $100,000 a year for cancer medicines."

So where does the $80 billion come from? Love explains that the federal government spends more than $100 billion each year on pharmaceuticals via the Medicare prescription drug benefit, the Veterans Administration and the federal workers insurance plans. He says the prize plan "would easily pay for itself" with the savings achieved through lower prices for new drugs.

Under the Sanders bill, which Love co-authored, the innovation fund would have a board of trustees determining which innovations deserve prizes. As imagined by Sanders and Love, the board would be comprised of 13 members, including the administrator of the Centers for Medicare and Medicaid, the commissioner of the FDA, the director of the Centers for Disease Control and Prevention, nine presidential appointees (three representatives from the business sector, three private medical researchers, and three consumer advocates).

For every drug approved by the FDA, the board would determine whether and in what amount to award it's designers. Award payments could be staggered over as much as ten years, with no single drug being granted more than 5% (or $4 billion) of the fund in any given year. An 18% portion of each year's fund would be set aside to award research in neglected diseases, AIDS vaccines, and medicines for responding to bioterrorism.

Love's proposal is grand, but he believes that Big Pharma is facing a strong headwind as government grapples with ways to pay for its health programs. "It's either going to be price controls or prizes," he says. "Prizes are more market driven." Clearly, if industry wants to avoid this scenario, they had better start fashioning some new ideas of their own.

What if Jesus were Indigenous?

Today is the feast day of Kamehameha IV and Emma, both Anglicans and monarchs of Hawaii before its annexation. I have a reflection on these two which is in progress, and will be posted on Dec 2.

Meanwhile, I ask, what if Jesus were Indigenous?

“Our offerings places are sacred to us,
and the spiritual beings take care of us.
We know the land, the spiritual beings know us here.
If we leave our offering places, we will not be able to survive.”

Jack Hatathlie, Navajo Medicine Man

Indigenous peoples very often derive their identity from their land. I'm not sure to what extent the Hawaiian people did so. However, it is certain that the Hawaiians are now a minority on their ancestral lands, much like the Native Americans, the Canadian First Peoples, the Maoris and the Australian Aborigines. In the past, the church has supported dispossession of Native peoples, and attempted to reeducate them.

Can we come to see Christ in Indigenous Peoples? Humankind spits on its own common heritage if we do not.

This Lentz icon depicts Jesus and Mary as Navajo people. Jesus is strapped to a traditional cradleboard. Around the sides and bottom of the painting is a Rainbow Yei, a guardian god and a common feature of Navajo sandpaintings. Traditionally, sandpaintings were destroyed by dawn the next day. One Navajo artist eventually broke that taboo to preserve his heritage. At one point, the Hawaiian people had a taboo against men and women eating together; this taboo was broken by their own people before Christian missionaries arrived.

Harvey Milk

No one has greater love than this, to lay down one’s life for one’s friends. - John 15:13 (NRSV)

From Robert Lentz:

Harvey Milk was the first openly gay person to be elected to high public office in the U.S. He was not a professional politician, but ran for City Supervisor in San Francisco because he felt ordinary people were being pushed aside there by monied interests. "It takes no money to respect the individual," he said. "The people are more important than words." As supervisor he fought consistently for the rights of all of those without a voice. These people included blue-collar workers, the elderly, racial minorities, and gay men and women.

The day of his election, Harvey tape-recorded his last testament, in which he acknowledged that he would most probably die violently. The last words of that message were "You gotta give them hope."

Do you know what it's like for lesbian, gay, bisexual, and transgender people to have one of their own numbered among the saints?

Harvey Milk is a martyr to the LGBT community, and Harvey Milk School in New York is named after him. He was Jewish, and I'm not aware that he was particularly religious. He's not on the Episcopal Church's calendar of Lesser Feasts and Fasts. However, he's a saint, and I'm going to prove it.

He came to be known as the Mayor of Castro Street; the Castro is a prominent gay neighborhood in San Francisco. It didn't used to be that way, having been Scandinavian from 1910-1920, and then Irish working class from 1930-1960. In 1975, Harvey opened a camera store, and began a life as a gay activist.

"We must destroy the myths once and for all. We must continue to speak out and most importantly every gay person must come out. As difficult as it is, you must tell your family, you must tell your relatives, you must tell your friends, you must tell your neighbors, you must tell the people you work with, you must tell the people in the stores you shop in, and once they realize that we are indeed their children and that we are indeed everywhere, every myth, every lie, every innuendo will be destroyed once and for all. And once you do you will feel so much better."

I find it interesting, by the way, that the LGBT community in the US has co-opted the term "queer" to refer to themselves. "Queer" used to be an insult. Many older LGBT folk - and some of the younger ones - I know are still uncomfortable with it.

In contrast, gays in Asia, specifically Taiwan, Hong Kong, and parts of mainland China, co-opted the term "Tong Zhi". Tong Zhi is Mandarin for "comrade", as in Comrade so-and-so. It is a polite salutation, rather than an insult. If anyone asks to illustrate how Asians think differently from Westerners, I sometimes give this as an example.

However, there's a time and a place for everything. There's a time to fit in. There's also a time to confront.

In Harvey's time, the police, the psychologists, and the priests were the main enemies of the LGBT community. Police made sting operations and arbitrary arrests. Psychologists propagated theories of impaired sexual development. Priests called homosexuality an abomination. Harvey confronted them.

Of course, he did not personally confront them with violence. For the most part, violence against the police would have been a bad idea, although Stonewall, where gays, lesbians and crossdressers fought back against the police at a raid and taunted them. This was before Harvey's time.

Harvey instead confronted his adversaries in the public square, in politics. People said he was mad to run for public office as an "avowed homosexual." He did anyway. Eventually, he became city supervisor of San Francisco. Once there, though, he acted as a comrade as well as a confronter.

"Our cities must not be abandoned. They’re worth fighting for, not just by those who live in them, but by industry, commerce, unions, everyone. What we need is a neighborhood where people can walk to work, raise their kids, enjoy life. That simple."

His time in office was sadly short. Late in 1978, the conservative board member Dan White resigned from his post. He was a vociferous opponent of George Moscone, the liberal mayor. However, he apparently changed his mind, and asked Moscone to reinstate him. Moscone, under pressure from other liberals on the board, refused him.

On November 27, 1978, White came to City Hall and demanded to speak to Moscone. Moscone refused him. White had crawled in through a window to avoid the metal detector, because he was carrying his policeman's service revolver and ten extra rounds. He shot Moscone, and then he went to Harvey's office. He confronted Harvey angrily, and shot him five times.

That night 40,000 people, men and women, old and young, gay and straight, kept candlelight vigil outside City Hall. A recording that Harvey made was played:

"This is to be played only in the event of my death by assassination.

I realize that a person who stands for what I stand for, an activist, a gay activist, becomes a target or a potential target for somebody who is insecure, terrified, afraid, or very disturbed themselves.

Knowing that I could be assassinated at any moment or any time, I feel that it's important that some people know my thoughts.

I stood for more than just a candidate. I have never considered myself a candidate. I have always considered myself part of the movement, part of the candidacy. I wish I had to explain everything I did. Almost everything was done in the eyes of the gay movement."

He also said, "If a bullet should enter my brain, let that bullet destroy every closet door."

"...Gay brothers and sisters,...You must come out. Come out...to your parents...I know that it is hard and will hurt them but think about how they will hurt you in the voting booth! Come out to your relatives...come out to your friends...if indeed they are your friends. Come out to your neighbors...to your fellow workers...to the people who work where you eat and shop...come out only to the people you know, and who know you. Not to anyone else. But once and for all, break down the myths, destroy the lies and distortions. For your sake. For their sake. For the sake of the youngsters who are becoming scared by the votes from Dade to Eugene."

Many LGBT people I know have been colonized by the church in some way. To colonize a country means to come and settle among and establish political control over the indigenous people of an area. To colonize a people means to discredit their worldview and their epistemology (way of knowing things), and to establish a foreign one. Many LGBT people have been colonized by religion.

So, many of them are in the closet to themselves and/or to their religious communities. They put up with abuse to stay in the good graces of a God they think despises them for their sexual orientations or gender identities. Many have left and would rather die than return. Perhaps Harvey was one of the latter.

And yet, I believe Harvey has something to teach Christians about the Resurrection. There's no evidence that he believed in God. And yet, he was not afraid to lay down his life for his friends. He knew he was likely going to be killed at some point - he premeditated his tape recording, just as Dan White arguably premeditated his murder. He went willingly. He was not a Christian, and yet his actions were those of one who believes in the Resurrection. As a universalist Christian, I believe that the Resurrection is for all people, everywhere.

Whether Harvey knew it or not, he was serving Jesus Christ, foreshadowing Christ's actions. Harvey was paving the way for LGBT people to come out in political life. Lentz' icon shows Harvey Milk as a servant of God, paving the way for LGBT people to come out in religious life.

But through Harvey, Jesus is decolonizing the LGBT community. To decolonize a country means to withdraw from a colony, leaving it independent. To decolonize a people means to cease to poison their hearts and minds and souls against themselves. Jesus doesn't set us free from homosexuality. Jesus sets LGBT people and the church free from homophobia and transphobia. Jesus decolonizes, and sometimes he uses servants who do not know Him to do so.

Sojourner Truth

I included a collection of diverse names of people who worked and some who gave their lives in the cause of civil justice an freedom. The names are placed behind the image of Sojourner Truth. The bottom section of the paining is mad e up of a repeated phrase from the famous speech she gave in 1851 at a women's rights convention in Akron, Ohio. I used symbols to convey a sense of ancestral histories and cultural perspectives.
James Watkins, Kalamazoo, Michigan
Bachelor of Fine Arts, Western Michigan University

Do you know what it's like for people of color to have one of their own numbered among the saints?

One of the major themes in the Bible is that God liberates. God brings the Israelites out of slavery in Egypt. Repeatedly, God sets the Israelites free from foreign slavery. They turn repeatedly to other gods, but they are finally willing and able to worship God alone.

However, people of color, and particularly indigenous peoples, will tell you that being physically free is only part of the problem. I told you earlier this year about Harriet Tubman, a conductor of the Underground Railroad, who always had to bring a gun along to shoot any of the escaping slaves who wanted to return to their masters. Sure, many slaves did a simple economic calculation and decided that returning and being punished was a bit better than being caught, tortured, and killed.

But it's more than that: slavery blights the mind and soul as well as the body. There are large parts of us that want to remain slaves. Additionally, religious establishments over time have manipulated images of God to justify the status quo of oppression. When the Spaniards came to Mexico and Latin America, for example, they conquered the native peoples, and justified it through false interpretations of the Gospel.

For example, Saúl Trinidad and Juan Stam, writing in Faces of Jesus: Latin American Christologies, outline a few depictions of Christ in Latin America that are defective, and that are intentionally or unintentionally used as the "opiate of the people," to keep people from challenging oppressive social conditions. There is the Santa Claus Christ, the dispenser of gifts. Accept Christ, and you get gifts, such as healing at a service. There are some Evangelicals who preach a gospel of prosperity - accept the Gospel and God will reward you financially. Or the magic potion Christ, the Christ who miraculously cures problems, as in this sermon quoted in the book:

Christ seeks to enter into the human heart, says the evangelist. When Jesus enters a sinner, there is direct contact with God. Jesus takes over that person's interor life, and he or she receives the supernatural power to conquer temptation ... God provides for your needs ... Are you sick? Sick with sin, sick from nerves, sick from anything? Then know this, that God has prepared for you a perfect heaven, a place of peace, love, happiness, and justice.

Another, and slightly related, false image is the passport Christ, where acceptance of Christ is a "lottery ticket" to escape to heaven from earth. Also linked to this is the asocial Christ, the dualistic Christ who demands withdrawal from the world. Certainly, conservative American Evangelicals also preach this sort of Christ.

Well, Jesus does give. But Christ doesn't give trivialities. And Christ also demands: service, sacrifice, discipleship. Liberation from material and physical deprivation is important, but it must come alongside spiritual liberation.

Sojourner Truth's story is one of spiritual liberation. Like Harriet, she was born a slave, named Isabella Baumfree. A year before New York mandated emancipation, her owner, John Dumont, promised her freedom. However, he was a harsh and cruel man, and he reneged, claiming that a hand injury made her less productive.

She spun him 100 pounds of wool to fulfill her sense of obligation. And then, she escaped with her infant daughter Sophia. She left behind Thomas, the man Dumont forced her to marry, and her other children Peter, James and Elizabeth, who were bounds as servants until they were 20.

She later met Isaac and Maria Van Wagener, a Quaker family. They took her in, and bought her services from Dumont for $20. She lived with them until New York's Emancipation Act took force, and had a life-changing religious experience that made her a devout Christian. Public Broadcasting Service, an American public media service, reports that she was swept up in the Second Great Awakening, a Protestant evangelical movement that emphasized living simply and following the Holy Spirit.

In 1827, newly-free Isabella considered returning to the Dumont farm to attend Pinkster, a celebration of New York slaves. She was saved from joining her ex-master by a frightening vision of God, followed by the calming presence of an intercessor, whom Isabella recognized as Jesus. With Jesus as her soul-protecting fortress, Isabella gained the power to rise above the battlements of fear.

She did not go back. There likely are slaves who escaped, and decided out of fear to return to their masters. Do you know what St. Martin de Porres, a half African saint and healer said when his priory was in debt? "I am only a poor mulatto. Sell me. I am the property of the order. Sell me."Parallel to that, people who have been colonized in modern times, like people in the Global South, often revisit the patterns of oppression they have been subject to upon minorities in their own cultures - a modern equivalent of returning to one's master. But Isabella did not go back. God had decolonized her.

In 1839, her son, Peter, took on a job on a whaling ship. From 1840 to 1841, she received 3 letters from him, although in his last letter he claimed he had sent 5. When the ship returned to port in 1842, Peter wasn't on board, and she never heard from him again.

On June 1, 1843, she changed her name from Isabella Baumfree to Sojourner Truth. And then, she left the Van Wagenens to preach about abolition. And, by the way, she only spoke Dutch until she escaped, and English was a late-acquired second language. And yet, she had the confidence to speak before hundreds of people.

During the Civil War, Sojourner recruited Blacks for the Union Army. In 1864, she met President Abraham Lincoln. In 1865, she rode the streetcars in Washington to help force their desegregation - shades of Rosa Parks.

Truth died on November 26, 1883, at her home in Battle Creek, Michigan. Her remains were buried there at Oak Hill Cemetery beside other family members. Her last words were "Be a follower of the Lord Jesus."

My brothers and sisters, Jesus wants God's kingdom to come about here, on earth. But that can't happen if we oppress one another. And make no mistake, oppression can easily extend beyond physical slavery. Oppression can take the form of empire. Economic and cultural domination can erode a culture's sense of self. That can cause a sense of threat that leads to authoritarianism. Look at Nazi Germany. The Allies exacted punitive reparations after WWI. The Nazis escalated antisemitism to genocide, built a war machine, and started conquering neighboring countries.

Paul, in his letter to Philemon, calls him to receive his runaway slave Onesimus. The Bible on numerous occasions fails to condemn slavery ... as Whites did in Sojourner's time. Sojourner could have gone back to her master. Today, we see formerly colonized countries replicating the patterns of oppression, like sexism, classism and homophobia, that they learned from their colonial masters. That is true colonialism.

But colonialism meets its match in Jesus, because Jesus decolonizes. Jesus decolonizes! Some Christians use Jesus to escape from this world, thinking that heaven will be better. But that way, empire wins. In contrast, empire could never destroy Sojourner Truth's soul. Jesus led her out of colonization and into freedom! And empowered by Christ she went to free others. Sojourner Truth shows for people of color all around the world, a vision of Jesus decolonized, and a vision of Jesus decolonizing.

Women in the Stone Church Meet Sojourner Truth
(Recollections of "And Ain't I a Woman?" speech, Old Stone Church, Akron, Ohio, May 1851)

Patricia Flower Vermillion is Writer in Residence for the Artists in Education program of the Virginia 11 Commission for the Arts. Her poetry has appeared in Theology Today, The Writer, Them a, Poet, and other journals. This poem was published in Theology Today Vol 53 No 1, 1996

Chosen, we are called
to champion uneducated women in chains.
Our horse hair underskirts keep silk
from touching the ground. Belgian lace
collars and bonnets are copied carefully
from Godey's Ladies Book; uniformly
steamed and pressed.

In the Old Stone Church, surrounded by men
who think we are deceived by the serpent
only our corsets keep us from collapsing. Suddenly, church doors open and bold breezes
process down aisles with a black broom woman.
Her unbleached cotton skirt stirs up twigs
and laughter. Queen of scarecrows, she pushes
chairs to a corner then extends herself
while ministers tell us, women-real women
must be cared for and helped into carriages.
When the dark broom rises
mill workers lock arms at elbows
to form whistling walls. She looks up
and sweeps silence across pews-preaches
prophesies, picks walls apart
with sharp straw words. In the end
ministers and mill hands applaud
and stones shout.

Scratched by horse hair skirts
light headed, laced tight
we are culture's captives
while Sojourner Truth
stands seventy two inches, head-to-toe free.

A brief interruption for a genocide alert

I've blogged a couple of times about the not so well-knownArmenian Genocide, and Turkey's denial of that genocide. It's important to pay attention to genocide, so that the perpetrators cannot deny their actions.

On Nov 25, 2006, the President of the Ukraine, Viktor Yuschenko, decreed that flags be flown at half mast to commemorate the Holodomor, a genocide directed at Ukrainians during the Soviet era. This was apparently in retaliation for Ukrainian resistance to farm collectivization. Estimates of the number of deaths range from 3 to 10 million. That's roughly the whole population of Singapore (4 million), or Michigan

Mike Parker has a video which explains the genocide.


I believe there's a letter writing campaign to pressure the US government to recognize the Holodomor as a genocide. There has been talk that the US government knew of the genocide as it was happening, but didn't want to antagonize Russia.