Integral Education: The CIIS Blog

Island of Bones: A Letter From Key West

By BRYNN SAITO, program coordinator for the Department of Writing, Consciousness and Creative Inquiry

An island is a place of constant change, contained.

Key West is a two-by-four mile landmass about 160 miles southwest of Miami and 90 miles north of Cuba. It sits atop America's only living and very treacherous coral reef, a sharp juxtaposition to the more idyllic aspects of the place: the baby blue seawater, the jolly locals, the summery weather. Ostensibly, I've come here for a 10-day writer's conference, The Key West Literary Seminar, held annually on the island. More to the point, I've come to escape my stateside life (as many have come here to do)—filled with the usual run of stress, questions, and complex attachments.

By day four on the island, the city I've fled begins falling away. I've established a routine: waking in the mornings to rooster calls and shaking tamarinds; bike rides through Old Town; Cuban sandwiches and strong coffee on the beach; and returning every night to the garden patio of the hotel, for writing, smoking, talking with other visiting writers.

I once read about a therapist who advised her patient to “take a geographic” and travel elsewhere for a short period of time. In doing so, the patient would realize that there was no escaping his problems—that he carried them everywhere—and he'd promptly return home to begin the work of addressing them. Although I agree that there's no breezy escape from oneself, I also believe in the deep connection between self and place, and the transformative power of a new landscape. The places I've lived—from the fishing village in Ecuador, to the cramped garden apartment on the Lower East Side—have mapped themselves on my body. They've broken me open with their strangeness, and challenged me, and in doing so, I've changed.

But Key West is not a place I'm living—I'm a guest. A tourist. I'm somewhere between Hemingway (who lived here in the 1920s) and the spring breaker from UVA walking Duval Street with a cup of beer and T-shirt that reads I'm Going to My Happy Place. "We move on through history with our man-made efforts to forget, but the land remains," writes Deborah Jack. A visual artist who exhibited with The Arts @ CIIS, Jack is deeply interested in memory and place. Many have passed through the island since the arrival of Juan Ponce de Leon in the early 16th century—the Spaniards, the British, the Americans; pirates, shipwrecks, hurricanes, and rainbows. But in pre-Columbian times, the Calusa people, an indigenous population living along Florida's southwest coastline, inhabited this land. Cayo Hueso is the original Spanish name for the island of Key West, which translates to "the island of bones," thus called because it was once covered with the bones of the Calusa. The land sings many stories for those who will listen.

On my last day on the island, two fellow writers and I wake up at 6 am to ride our bikes to the White Street Piers to catch the sunrise. The island is dark. Strong cool winds have descended overnight, harbingers of a storm. It’s 6:32 am and the herringbone sky above the sea begins to lighten. All of us are startled by how bright the sky gets before you can actually see the sun; the sky livens with dawn's promise before the sun even shows her face.

Here, at the southernmost tip of the Florida Keys—an archipelago of 1,700 tiny islands—we can chase the sundown every night, then greet it again every startling morning. That’s the thing about an island: it’s a whole world, in waiting, vulnerable to both the wind’s will and the fiery beauty of setting sky. Locals are keenly aware that the next great Gulf-bound hurricane could mercilessly sink this whole place. What then of the island of bones? Perhaps any—or every— place is bound for erasure and change, outlasted only by our own memories, and the maps we’ve made with our bodies and imaginations, and the stories we tell with our words and art.

Inadequate Health Insurance Translates to More Emergencies: When Research Hits Home

By MEG JORDAN, PhD, RN, CWP, program chair and core faculty, Integrative Health Studies program. Meg is also a clinical medical anthropologist and editor in chief of American Fitness Magazine

If you don’t have health insurance, you are 40 percent more likely to die than those with private insurance. But what’s the risk if you’re among the growing numbers of underinsured? Although the statistics aren't available, the everyday reality is that insurance policies with inadequate coverage can be just as bad.

As a university professor in the health sciences, I give many talks, nationally and internationally, on the state of health care in the U.S. Just this week I was scheduled to present at the National Wellness Institute on the status of health coaching in the U.S. An emerging profession dedicated to helping people turnaround unhealthy habits, health and wellness coaches are part of the solution to our nation's rising medical costs. So far, they're outside the reimbursement system of health insurance, but I'm on a national team of leaders and educators hoping to reverse that.

I've also argued long and hard that true reform of an ailing sick care system requires both individual commitment to change (since almost half of all health care costs relate to personal behavior) and supportive policy change and overhaul within public and private sectors.

Today that argument came home with a forceful reality. My firstborn, a college graduate who works two jobs, seven days per week, in order to pay off massive student loans and afford her rent in Denver, pays a large co-pay premium every month (over $350) at her meager $10-an-hour job as a pastry chef at a major four-star hotel. The health insurance offered by the hotel is so inadequate, she and her co-workers wind up foregoing reasonable medical care in order to avoid paying inordinate out-of-pocket expenses. Studies confirm that people will ration their own needed health care when faced with high deductibles.

But her policy is among the more ridiculous, and for some reason rejects all gynecological expenses. As a result, a 28-year-old young woman with a troublesome IUD decides she can't afford the routine check with at an OB/Gyne office, after hearing that she will be charged about $500 cash upfront in order to have it removed. ("Sorry, we checked with your policy and they don't cover gyne.")

So what is the end result of systems like this? People don't get the care they need, and they are shoved along a continuum from prevention to crisis. My daughter had sudden pelvic pain two weeks ago, and wound up in an emergency department, where they made a decision to not do an ultrasound since "her insurance probably wouldn't cover it."

She limps back to work, holding her gut together, only to have the problem exacerbate. Today the pain was excruciating and again, she left work, barely making it to an ER. Internal hemorrhage was noted and she was rushed into exploratory surgery.

She had a ruptured ectopic pregnancy, one of the risks of certain IUDs, that required removal of the fallopian tube, and major clean-up of a pelvis filled with blood. Heavy doses of pain medication given in the ER complicated the amount of anesthesia needed for surgery; more problems ensued with overdose and nausea, creating a challenge for intubation.

In short, she joins the ranks of Americans who face crisis upon crisis, undergo tremendous pain and suffering, and incur huge costs—all because they don't receive preventive health care.

Who's to blame for this?

As a mother, I can practice tough love, and tell her she alone is accountable for choosing to work at this hotel, for selecting a lower-cost insurance that allowed her to take home slightly more in her paycheck, and for not taking out a loan in order to see a doctor earlier. Or, I could beat myself up for not making sure she had the cash she needed. However, she was fed up with asking her parents for help—a common situation for many late 20-somethings who struggle to be independent in this economy.

Being responsible for her choices aligns with the argument posed by conservative voices in Washington, D.C.: Our systems of entitlement require analysis and radical reduction. Absolutely.

Then another lesson at home kicks in. My brother, the insurance expert, taught me that all insurance works via the leveled waters of pooled risk. We each pay a little something so that both reasonable care of the near-healthy and crisis care of those in need can be managed. When non-participation by large numbers of people or unmitigated profit and payments to Wall Street throw that trusted model of pooled risk out of balance, insurance systems will fail to cover people adequately.

Another example—bear with me—this time with a former husband, a die-hard Republican, who railed against how "government can't do anything right." He suffered with a slipped disc for a year in the U.S. but couldn't work through a maze of barriers to see a specialist, and then was laid off and without any health coverage.

We moved to Vancouver, British Columbia, for a work opportunity for me, and within four weeks of arriving, two medical care cards arrived in the mail, along with a bill for $50 per month each. He complained about the bill, of course—here we were in "socialist Canada"—now without a choice, being forced to contribute.

I made a call to a clinic that day, expecting to have to wait six months for a Pap smear, like I did in Northern California, only to be told—"No, you can get one today. Just walk in any provincial medical clinic. You'll see one every few kilometers in Vancouver. No appointment necessary. Just bring your medical care card." I did. When I went to the desk to hand over the co-pay, the clerk didn't even understand what I was offering. No payment required.

When I told my husband what happened, he decided to test the system, and called for an appointment with a neurologist. He saw him in a week, and had an MRI the next week. He came home saying he was "rather floored—nobody at the hospital asked for any money." The end result? He continued to boast about America's greatness, but watched FOX news a little less. He also got help to change his diet and exercise more, and saw their physiotherapist once a week, alleviating the back pain.

Now we've all heard endless stories about the long waits and inferior care of these so-called "socialized medicine" systems in countries such as the United Kingdom and Canada. But any actuarial will tell you the basic requirements of large systems. Research shows how a universal system of coverage for a basic level of care is the right financial (and moral) decision for a progressive society.

I also know that a natural migration toward a hierarchy of care (tiers of wealth and privilege) will inevitably manifest. But I can live with that, as long as we offer a basic care for everyone. When everybody is in the pool, the cost comes down to $50 per month. When fewer participate, individual cost burden is higher. I feel like we need Ross Perot with his white board right now to explain this to Americans who have been dumbed down by ignorant political sound bytes.

Universal coverage addresses sick care. Preventive care is another matter. Arguments have been made that there are not enough dollars within pooled systems to cover the screening and preventive health services, but those arguments need to be nailed within the coffin of outdated, unproven old fears.

Spend a little time at prevent.org.

The Partnership for Prevention is a coalition of business, nonprofit and government leaders working together to make sound and reasonable evidence-based models of health promotion the national norm. The number of publications and resources available today on how and why prevention is our only solution is astounding.

I'm probably an unusual voice in their pack, since I want to see both this modicum level of care (universal coverage) for everyone, and a robust system of disease prevention, health promotion and wellness initiatives in place. But after spending time with my colleagues at the National Wellness Institute, I know we're capable of both quality sick care and extraordinary wellness incentives for individuals, businesses and communities to go the extra measure.

Our nation's health depends upon it. My daughter's life does as well.