Framing: Beautiful Microbe, Beautiful Molecule

Before I started down the health science path I studied communications. In communications, there’s an idea called “framing.” Framing is a theory that’s often applied to the media and how it shapes public opinion about certain topics. The concept is that how you talk about a specific topic (ex. healthcare)—such as the tone you use and the details you include (or leave out)—can shape other people’s perceptions of the topic.

I’ve noticed that several of my science professors use framing as a teaching tactic. And, despite knowing exactly what they’re doing, I still fall for it.

I’m currently studying microbiology and organic chemistry. There’s a lot of new information to learn and for organic chemistry there are a few new thinking skills I’ve been practicing—such as being able to think about molecules in 3D. It’s an interesting challenge to train your brain to be able to rotate different molecular structures using only your imagination. I’m lucky enough to find microbiology and organic chemistry fascinating, but still it’s hard work. That’s where the framing comes in.

My organic chemistry professor introduces particularly complex or tricky molecules as “beautiful molecules.” “This is a beauuuutiful molecule,” he’ll say. He’ll also start a new chapter by saying “This is an important chapter. This is very cool…let me tell you why.” And, somewhere in that explanation of how awesome the challenging topic is, he’ll make a few comments about needing to practice the skills he’s about to show us. “But I will teach you how to…” he will conclude.

My microbiology professor does the same thing. I always know when he’s preparing to introduce a particularly complex metabolism, process, or cycle used by bacteria because he’ll pull up a picture of a microbe and say “This beautiful microbe…”

Those are current examples, but my general chemistry professor did the same thing. His word for hard concepts to learn was “interesting” rather than “beautiful.”

So what’s going on with this inappropriate use of descriptive words? Framing. Why? Because it works. As absurd as it sounds, it’s way easier to fight with a beautiful molecule than a molecule that’s “annoying” or “difficult” or “challenging” from the very start. I don’t think microbes are necessarily beautiful, but I approach them with much more interest and forgiveness when they are presented to me as “beautiful” rather than “ugly” or “evil” or “bad.” And, when trying to complete long chemical equations, it is a lot easier to complete the “interesting” problem than it is the “hard”, “tricky”, or “terrible” problem.

What’s my long-winded point? Before I dove into science I heard that it was “hard” and “confusing” and “dry” and “boring” and many other potentially negative adjectives. Sometimes I completely agree. But, most of the time, I do think it’s amazingly interesting. I think we’d do a lot of young people thinking about their future (and older people looking for something new) a service if we framed science as something wonderful. Sure, there is plenty about it that’s hard, and even monotonous, but most of it (all of it maybe) is not beyond most people’s reach. We’ve just conditioned our population to think science is either too complicated for them or not something they’d find interesting by describing it as scary, trying, and a thing that only geeks and brilliant people do. It’s worth a frame-shift around science. Why? What better way to find answers to medical questions, renewable energy questions, etc. than having more people researching and exploring those topics?

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Energy Levels

Atoms cling to, share, or pass electrons. They do whatever it takes to make themselves more energetically stable—not reactive and content as they are.

I think we have some lessons to learn from atoms and their energy lowering endeavors—let’s say we are the atoms, the electrons are aspects of our lives, and the energy state is our emotional state.

In the world of negative electrons and positive atom nuclei, the more energetic the relationship (imbalances in charge, which basically means repulsion and attraction forces aren’t equal) the less stable and the more likely the atom is to undergo change. Electrons in high-energy states, unstable, cause chemical reactions from little ones like putting baking soda in vinegar to big ones like bombs exploding.

I’ve noticed a similar situation in my own life…and those around me. The higher the energy (emotion)—whether it be negative like stress as deadlines and huge projects loom or positive like an awesome vacation—the more reactive we are. Of course, our fizzing reactions might be petty arguments and our explosions could be bouts of extreme agitation, but nonetheless we are more likely to respond dramatically when our emotions are high or low.

The thing that’s clever about atoms is that they are willing to exert themselves to achieve a more stable state. In other words, they will do the atomic version of sweat it out—to ensure they’re living in a happy medium. And, they’ll go to great lengths to defend and maintain a stable state once they have it.

I propose, just like atoms, it’s worth it for each of us to build into our “to-dos” a little bit of energy maintenance. Atoms maintain stability by shedding or attracting electrons…what are the electrons in your life?

The Do-Good High

Did I tell you I’m an EMT? I’ve been running for about 5 months. Long enough to have learned a thing, maybe two. Let me tell you about the do-good high.

There’s a certain kind of person who becomes an EMT and sticks with it. Hint: It has nothing to do with your age, background, or future.

It boils down to what I call the “do-good high.”

There are EMTs who want patient experience so they can then become nurses and doctors. There are others who like sirens and driving large vehicles with lights. Many EMTs want to give back to the community. Others like the satisfaction of saving lives. Whatever the reason, the thing that makes all EMTs the same is that they get a thrill from doing good.

Whether it’s helping a little old lady after she’s fallen or bringing a person back from the dead through CPR, the folks who stay in emergency medicine are there because they’ve caught the do-good bug. When the alarms go off at 3 a.m., waking you from a dead sleep, and the dispatcher comes over the speaker: “56-year-old male, vomiting and diarrhea…”† I think a normal person would choose to go back to sleep. Not an EMT.

The EMT answers the call. Why? Partly it’s our duty to put on our uniform and leave the station as fast as we can, but there’s also something beyond obligation that makes us go. Even in the grossest of circumstances, like when we pick up that vomiting and pooping man and sit with him during the 30-minute ride to the hospital, we helped turn a bad night for him into a slightly better night.

The feeling you have sitting in the back of an ambulance as the sirens holler and you hustle to your patient is something like that of standing on the start line of a giant race. Your heart goes just a tad bit faster and your mind zips through the possible scenarios that could unfold once you arrive at the scene. Then you reach your patient and a calm descends upon you. There’s a human in distress and what’s ailing them is your puzzle to solve. You might be the one who saves their life. But even if you aren’t called upon to be a hero, you can ease their distress by helping them breathe or reassuring them as you go to the hospital. Seeing your patient’s face relax or their color return after you help elicits an adrenaline rush that starts in your center and spreads out to every corner of your body. It’s a high like that from scoring the winning goal or beating a chess genius at their own game, but it’s better because it lingers. This rush and joy that rapidly overtake you after helping a patient is the “do-good high.” All EMTs get it. It’s what keeps us coming back.

 

†Fictional dispatch that captures the essence of a typical call. HIPAA and other privacy measure prohibit sharing patient information.

Springtime Rambling

My goodness how quickly time passes. It’s hard to believe that the last time I wrote was in the dead of a cold, dark winter—the hallmark of New England. I won’t bore you with the reasons why there was no time to write for so long, except to say that I know a great deal more about equilibrium, acid-base reactions, electromagnetism, circuits, batteries, optics, quantum mechanics, and special relativity than I did in February. Science.

Spring arrived in Vermont with the timidity of a mouse crossing a barren stretch—one step forward, three steps back. But, the soft, new leaves are starting to unroll; the grass needs to be cut, the flower gardens need weeding, and the fruit trees fill the air with soft scents. It’s the lilacs more than the tulips and daffodils that make me think the warm weather will stay a while.

The winter was long and cold. I dared not count the gray days that melted into rainy days between frost and flowers. It goes without saying that spring is a time of new beginnings and the return of the sun.

How I missed the sun! When I went on a walk today rays of golden light danced on the path between the yellow-new, pink fresh leaves. The spirals of young ferns lined the walkway and the damp mix of old leaves and new growth saturated the air. I paused on a bridge over where the river meets the lake. There in the flooded marsh lands a fish swam almost lazily in circles. It was over a foot long. A fin lined its back waving back and forth like a ruffle along its spine as it waved its tail. What a bold fish to be out in the open in eagle, kingfisher, and heron territory!

I’m sure you guessed, but the sun makes me think of Paraguay. I completed my one-year anniversary of my return to the States in April. This is my first full spring in Vermont in many years. And the humming of the frogs, bugs, and birds make me think that this coming year will not only be as productive as the last, but more hopeful.

It is a new beginning because I’m taking my learning out of the classroom. Not so long ago I started running as an EMT. I’m still quite a newbie, but I’ve learned that every patient is a puzzle, and that solving each puzzle is more thrilling than anything else I’ve yet encountered. To realize what I can do to help someone by looking at a few measures—for example breathing, pulse, and blood pressure—is far more interesting than piecing together the clues of a physics exam question.

I’ve been thinking these days about how much I’ve learned since last spring. This time last year, I could not have told you what a healthy blood pressure was or if 5 was basic or acidic on the pH scale. Today I know those things and a great deal more. But, for some reason, Plato’s Socrates and his comment about what makes one wise has been on my mind as I take my spring walks, a translation of which reads:

“I am wiser than this man, for neither of us appears to know anything great and good; but he fancies he knows something, although he knows nothing; whereas I, as I do not know anything, so I do not fancy I do. In this trifling particular, then, I appear to be wiser than he, because I do not fancy I know what I do not know.”

The more I learn about the human body and illness the more I realize how much I don’t know. And what I’ve come to see, now that the frost has cleared, is that the doctorhood quest will not end when I pass my last board exam. It’s a quest for knowledge and better understanding that will only end when I stop practicing medicine. And despite the weight of learning so much for so long, the length and breadth of my journey does not seem daunting. I know that even if there are stretches like a Vermont winter as I make my way, they will always be followed by spring. After spring comes summer. And summer is full of life.

Photo Credit: my father

 

Teaching Sex Ed

I never imagined myself teaching sex education before Paraguay. But since late August sex education, focusing on HIV prevention, has been the center of my work world. And, it is some of the most gratifying work I’ve done in my ever-elongating life. What I enjoy most is watching how my students giggle more knowingly rather than awkwardly and show greater confidence as we work through sexual health topics. During my first class, my students wouldn’t say words like “penis,” but now they can tell me exactly how and for what one uses a condom with only a slight smirk betraying underlying tension.

Just like in the States, many families and schools in Paraguay skim or entirely skip sex education because adults are embarrassed or don’t know how to discuss the topic with youth. As a result, “sex education” is learned through experiment. It’s not that experiment is entirely bad but when it comes to sex, experiment without some basic knowledge and protection can often lead to unwanted pregnancy and sexually transmitted disease.

Because I’m using a program that focuses on HIV prevention, I talk about condoms a lot. As you know, they are the only form of birth control that prevents pregnancy and STDs. Just like in the States, condoms are under utilized in Paraguay even though they are widely available and often free. You might ask, “Why?”

Unlike in the US where there is a poisonous link between condoms and religion in some circles, the officially Catholic country of Paraguay, for the most part, does not view condoms as a negative thing. Myths and mistaken beliefs about condoms are one reason many Paraguayan men are reluctant to use condoms. Myths like one can not feel pleasure during sex when using a condom. Another, and perhaps more important reason, is that many people, both genders, are too embarrassed to talk about sex or get information about how to protect themselves that they just go for it. It takes confidence to get a condom and then ask your partner to use it. And, that’s where I think sex education enters the picture.

Sex education is partly explaining how things work, like how to use a condom, and telling what resources are available, like the different forms of birth control. But, I think almost more importantly sex education is a time to clear the air and help young people become more comfortable talking about their bodies. I like to think that my students don’t only learn how to protect themselves from HIV, but also become self-advocates so that if faced with a partner who asks them to take a sexual risk they don’t like they can stand up for themselves. One can know about all forms of protection and the ins-and-outs of sex, but if one is too nervous to say what he or she wants in the moment it does no good.

 

You’re not fat, so why do you exercise?

Paraguayans in my site love to comment on my weight periodically…you know just in case I’m not aware of the current state of my own body. And as much as they like to say I’ve gained or lost weight, I’ve stayed about the same since I got here. Well, until recently. I turn 26 this I year and I decided that because I’m now closer to 30 than 20 I should stop putting off my body goals. In July, I started to take steps to lose weight by my birthday in October. At the same time, a friend asked me to run a 10 km race with her for fun. The race brought back my running bug, which I lost sometime in 2012. The point being two fold. First, I’ve started controlling what I eat and how much. Second, rather than just exercising in my house—which I did consistently for most of my service—I started running. Now, everyone in my community can see me exercising.

I think most people know the basic math of weight: if you eat fewer calories than you burn you lose weight, if you eat the number of calories you burn you maintain your weight, and if you eat more calories than you burn you gain weight. Depending on what you are doing weight gain can be muscle or fat. That said, I think many people in Paraguay and the US overestimate the power of exercise in this equation. If you want to lose weight the most effective way to do it is to watch what you eat. Why? Because it is hard to do enough exercise to burn more calories than you consume if you are eating many high-calorie foods.

We are now in late August. I am a little skinner, and Paraguayans like to tell me so, and they attribute it to my exercise. Well, actually, first they say it is because I am in love. A common Paraguayan wives’ tale is that you lose weight when you’re in love (I always thought it was the opposite…). But, after I assure them that I am still single they turn to the exercise excuse. While I was visiting a señora the other day she asked, “You’re not fat, so why do you exercise?” The question struck me. I do link exercise and body image, but for me the connection is muscle tone rather than jiggle or skin-and-bones not exactly weight. And, I exercise more because I feel like crap if I don’t, not because I’m worried about muscle tone. The señora’s question made me think about exercise theoretically, and why so many people don’t do it.

Obviously, it takes effort and time to exercise, but after considering those things I think there is a greater force preventing people from being motivated to exercise. And I think that force relates to how society talks about exercise. Many people, in Paraguay and the US, regulate physical activity to the castigation of the overweight and the amusement of a special elite class of “fit” people. Just as my señora friend’s question suggested, exercise is considered by many to have the single purpose of helping one lose weight. I see this belief as dangerous.

If I had been quicker on my feet I would have explained the following to my señora friend: You don’t have to be fat to exercise. You don’t have to be special. Nor do you have to do a specific type of exercise; all exercise is not equal but most ways of exercising are better than not exercising. Exercising helps your heart, your bones, your brain…everything.

I can’t remember what I told that señora, but I see a greater opportunity, based on her question, for public health wonks. Maybe we should focus less on telling people to exercise and focus more on changing how people talk about physical activity. After all, exercise is for everyone not as a punishment or as a chore but because our bodies need to move to work correctly. Exercise should not be thought of as extra. It should be lumped in with things like vitamins, necessary and required.

Soda

Soda is a bubbly drink that comes in many flavors and contains a pile of sugar. Sugar-free sodas replace the mountain of sugar with synthetic sweetener (even if you can stand the flavor of fake sugar, I suggest looking up the latest research on the effects of that before switching to zero-calorie drinks). Some sodas taste pretty darn good. Many people like carbonated drinks.

In Paraguay, soda with sugar is common (sugar-free sodas are less common here, so I’m not going to talk about them). Bus venders sell soda by the bottle and by the glass. A neat thing about soda here is you can by 2-liter glass bottles, which you then return to the place where you bought them. Actually, soda in glass bottles is very common in Paraguay…the only part of soda culture that I adore.

I’d be lying if I said that soda is drunk in moderation in my community. People guzzle down glass after glass of Coke, Niko, Piri, Fanta, Pepsi…I didn’t know there were so many brands of soda. It’s common for a family to down a 2-liter bottle after lunch (the biggest meal of the day). Like in the US, soda is served at parties and is a common “refresher” to go along with a snack or to drink while sitting with friends and family. The only thing that slows people down is that soda is usually drank with a common glass—so either one glass (or several glasses) is passed around to everyone or people take turns drinking a full glass, but only use one or two glasses for everyone.

The complaints about the health effects of soda are the same no matter where you are. Summary: Soda has too much sugar. The sugar rots your teeth, is generally bad for your body, and can make you gain weight in an unhealthy way. But, I find the knowledge of that to be lagging in Paraguay. I hear frequently from mothers and other caretakers of children that kids should not eat candy because it’s bad for their teeth. I hear people note often that sweets and carbohydrates make you gain weight. Very few people say anything about soda. Kids are infrequently denied a second, or third, glass of soda while they might be denied another cookie.

How did soda escape scrutiny?

Family Planning and Religion

HouseOne of the topics about which I will teach here is family planning. Before coming to site, I was concerned about the topic because of how polarizing it is in the US. I worried that there would be as much religious rhetoric against contraception and teaching sexual health in Paraguay as there is in the US. Paraguay is a Catholic country and I wondered if some of the same denial of basic health realities was present here as in the US. It is not.

Family planning and sexual health in Paraguay is not a subject cramped by religion. It is awkward and hard to talk about, just like in the US, but not because of religious beliefs. I find it awkward because of the power relationships between men and women here. And, well, because it’s just a hard subject to discuss eloquently.

In Paraguay, birth control pills and condom are free and offered at every public health clinic in the country. To get birth control pills a woman simply needs to go to the health clinic, request them, and present her ID. Sexual education is taught in many schools. I like to think Paraguay is transitioning to a family model that allows women to have the number of children they want when it makes sense for them. Paraguay isn’t there yet, but it’s on its way.

One thing I find particularly interesting about the relative ease of discussing family planning in Paraguay is that abortion is illegal. Period. Having one national set of laws in Paraguay that governs actions related to family planning makes it easier than in the US to know what can be said and can’t be said when teaching.

Drinking: Underage and Driving

DawnDrinking is just as common in Paraguay as it is in the US. The difference? Paraguayan private and public organizations haven’t sunk as many millions of dollars into raising public awareness about alcohol safety. The result? People are getting harmed.

You’ll see 15-year-olds get drunk in front of their parents, with beer their mother bought. You’ll see drunks finish their drink and hop on their motorcycle or in their car. Few people talk about the fact that driving is impaired by alcohol consumption, and fewer wear seat belts (ever) or opt out of riding vehicles operated by people under the influence.

You know there’s a reason why you’re not supposed to start drinking too young: it can affect brain development. As for drunk driving—if you’ve ever been sober while riding in a vehicle operated by someone who’s been drinking you already know it’s terrifying. According to one report, Paraguay has one of the highest motorcycle-related mortality rates in the Americas, with a rate of 2.5 deaths per 100,000 from 1998-2010. And according to another report, one of the highest traffic injury-related mortality rates in the Americas.

I get that people just want to have fun. But, do responsibility and fun have to be mutually exclusive? I think not.  My quandary: How can I help transmit this message in Paraguay? More difficult still: How can I help encourage behavior change to improve drinking safety?

Bad Habits

Paraguayan skyWhy is the knowledge that something is bad for you not enough to make you stop doing it?

I’ve been thinking about this question a lot recently. When I tell Paraguayans that I’m in Paraguay to teach about health they jump right in and tell me how bad the Paraguayan diet is. Paraguayans tell me their food “has a lot of fat” or that the food “is heavy.” They tell me that there are a lot of people who are overweight, have diabetes, or have high blood pressure.

Next, Paraguayans ask if I like their traditional foods like sopa paraguaya, tortillas, and mandioca. They tell me they want to lose weight, but then put three tablespoons of sugar in the milk they are going to drink with bread. They ask, already knowing the answer, if they should eat fewer carbohydrates if they want to lose weight. They explain how they don’t exercise or eat vegetables.

I don’t know if the people I talk to know that different foods have different nutrients or that balancing calorie intake and calorie burn is the center to weight control, but it’s clear they know what they are consuming isn’t the healthiest option.

If they know it’s bad for them, why aren’t they trying to change it?

  • Is it habit?
  • Is it that they don’t know how to cook different foods?
  • Is it taste preference?
  • Is it cost?
  • Is it cultural heritage?
  • Is it a lack of information or understanding about what makes food healthy or unhealthy?
  • Is it something I’m not seeing?

In the past, I wrote about developing public health programs that encourage change by focusing on the out-of-box-experience. But, as I work in Paraguay, it’s daunting. Clearly, a lack of knowledge isn’t the only thing at work here. But what can I do other than provide information?