Jacqueline's Thoughts

      Wow! Another exciting woman!  I am enjoying reading this book!  Johnye has some roots that I am familiar with.  I can now put some context to things that I have done all my life.  One thing that Johnye did, that was asked of me as well, is using handles when addressing adults.  She used labels like Aunt Irma and Mamma Johnye.  I have always been asked to used labels like that as well.  I never had anyone explain to me why.  I just thought it was just something that we did.  I remember one time, when I was about thirteen or so.  I called my Uncle David by David.  He corrected me and said that my Mom could call him David, but I could not.  I was mortified!  I had never been corrected by my Uncle.  I understood that it meant a lot and after reading this chapter, I now know why.  It is a sign of respect.  I know that my Mom always told me to call friends by Ms. or Mr. before their name.  I always thought it was silly.  Some people never corrected me so I was not always good at it.  But, as I look back, I can't remember whether the expectations were different due to race or not.  I would hope not!  My father was a doctor and I do remember that he was adament that I call his professional friends by Doctor... , not Mister.  He always said that they had gone to school for a long time and deserved to be called Doctor.  I remember when dates would come to pick me up.  If they called Dad mister instead of Doctor, that was not good.  I learned to tell friends ahead of time that Doctor was what was expected. 

       I really appreciated the emphasis that Johnye put on the relationship that she had with her patients.  She knew that the trust and mutual respect was important for getting the patient the help they needed to heal.  That also reminded me of a story that my mom tells about my Dad.  When I read this chapter, I felt a kinship with her heritage from Alabama.  However, my heritage is quite different.  My Dad was in private practice in Michigan.  His partner delivered Mom's first child.  My sister, Michelle, arrived over one month early.  Mom had been having contractions and the partner sent her home thinking that she was nowhere near ready.  But that afternoon, in rural Michigan, Dad called his partner and asked him to check her one more time before he left the office.  He failed to do so.  So, when Mom came in a little while later, she was too far into her delivery for normal procedures.  They used Ether (which they knew was not a good choice, and could harm the child) as anesthesia.  My Dad was so distraught that his partner had disregarded is wishes.  Needless tosay, they didn't stay in Michigan much longer.  About nine months later, my father was recruited to start a residency program at the University of Alabama.  He was nervous about moving so far away from his family and friends.  But, he received a call from then Gov. George Wallace.  I know there are so many negative things that George Wallace was known for. But, that call was a good one for my family.  We moved to Tuscaloosa six months later.

      Dad stayed with the residency program for two years.  His first resident took over when he left for private practice.  One thing that my Mom tells me was that when Dad got a call in the middle of the night, he would always shower, shave, and dress in a coat and tie to go to the hospital.  I remember those times.  I asked Mom why Dad did that.  She said that Dad wanted the families to know that a "professional" was taking care of their family member.  He wanted them to know he cared enough about them that he wanted to put his best foot forward.  He stayed in private practice as long as he could.  He enjoyed working with people from diverse backgrounds.  He worked with coal miners, and many others in our hometown. He even traveled to nearby towns that didn't have a regular doctor.  He had to get out of private practice when the Medicaid and Insurance companies strengthened their regulations that Dad thought prevented him from doing what he needed to do to treat his patients.  I admire how Johnye found the balance between helping those who needed her help and doing private practice.  I hope that when I have children, I will raise them to have the respect that these women (and my Dad) had.  It is a special gift to be a healer.  You are in a position of power because you have knowledge that everyone else wishes they had especially when they get sick.  But, it takes a special person like Jennifer and Johnye to use that gift with dignity and respect to others when they are most vulnerable.

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Teresa's Tidbits

http://www.healthgrades.com/directory_search/physician/profiles/dr-md-reports/dr-johnye-ballenger-md-f516fca7.cfm  I liked the map.  It shows the places that are referenced in the chapter.  I particularly remember Jamaica Plain.

http://www.yelp.com/biz/ballenger-johnye-md-cambridge  acclamation of patient.

http://fundrace.huffingtonpost.com/neighbors.php?type=name&lname=Ballenger&fname=Johnye  campaign contribution.

http://www.newsmeat.com/fec/bystate_detail.php?zip=02114&last=Ballenger&first=Johnye campaign contribution to Georgia congressman, John Lewis

http://www.newsmeat.com/fec/bystate_detail.php?zip=02114&last=Ballenger&first=Johnye  picture of Ballenger and information about her cause.  Go down at least half-way in order to see the picture.

http://www.boston.com/news/globe/health_science/articles/2006/05/15/her_rx_equal_parts_humor_respect/?page=2  very interesting interview with Ballenger.  She talks about respect a lot in this article.  Be sure to return to page 1.  The article is GREAT.  It also references her inclusion in Lawrence-Lightfoot's book.

http://query.nytimes.com/gst/fullpage.html?res=950DEEDD103CF930A15753C1A96F948260  just an article in which Ballenger is quoted.  Thought it would show that she is important beyond her Boston community.

 http://www.childrenshospital.org/about/Site1394/Documents/IB_all.pdf

      Jacqueline you should be writing a book.  I am fascinated with your story.  I grew up in the era of George Wallace.  It was a disturbing era.  As I read your thoughts, I reflected upon that time in my life.  I remember being very anxious about what was happening around me.  My parents had always tried to shelter my sister and me from the meanness and madness of the world.  As a result, I was not very sophisticated about the ways of the world.  It seemed from my perspective that the whole world had turned upside down.  The '60's brought such changes;  color television, The Beatles, drugs, Haight-Ashbury, Twiggy, Timothy Leary and LSD, riots, Vietnam, women's liberation, Woodstock,  John F. Kennedy and then Martin Luther King's assassinations, and so much more.  All of this flew in the face of convention.  I honestly believe that that is when respect was abandoned.  It seemed there was no middle ground.   

      My small town in Northeast Tennessee had always seemed such a safe, nurturing place.  Suddenly the world's events were thrust onto us whether we wanted them or not.  Up until that time, I can remember addressing my elders with a yes ma'am or no sir regardless of color.  I don't know what would have happened if I had done anything else, but I know I certainly didn't want to find out.  Even through desegregation, we were all civil to each other.  There were no riots or disturbances to bring the national spotlight down on us like we read about in the newspaper. Kansas and Alabama might as well have been in another country. The events taking place there seemed so far away and unbelievable.  I can remember attending school with many different students.  Life went on without any notice of differences.  I can remember walking down the halls of my school and life seemed to go on as usual.  The worst thing that happened was a "Yankee" girl from New York City who made fun of all of us.  She called us (the whole school) mountaineers.  It is possible and most probable that events happened that I was not aware of, but as far as I could tell from my perspective it was more class than culture that affected me and my peers.   Rich/poor, popular/not, pretty/ugly, put-out/virgin, jock/nerd, these were the issues that dominated my little corner of the world at that time.   All that we were seeing on television had yet to filter down into our community, but eventually we would all be affected.  Life would never be the same.

     Life was never the same for Johnye Ballenger after she began attending St. Elizabeth's Catholic school as a young girl.  Ballenger, the physician described by Dr. Lawrence-Lightfoot in the chapter, Healing, knows a thing or two about giving and receiving respect.  "Johnye believes .that respect breeds respect."(p.65)  Once again, my belief is reinforced.  She speaks of taking on the role of teacher, advocate, and model of good behavior.  She works to overcome what she calls institutional rudeness as she helps her patients to obtain the best health care available.  She insists that her younger patients meet a standard of behavior and she models her expectations for them and their parents.  She teaches those who will soon become physicians themselves the ways of reaching out to those they treat in a respectful, loving, human manner.  She does this through her motto of "...give the care that I would want if I were the patient."  I believe like Johnye that if we practiced more of the 'Golden rule' - do unto others as you would have them do unto you, our world would be a much more loving and mentally healthy place to be.  How we could change the world if we would but practice respect.  There would be such a healing taking place.

Teresa,

I am reminded of something Rhina wrote on the bottom of one of my reflections that was a variation of the Golden Rule: "Treat others as they would like to be treated." I thought that was very interesting in light of all the discussions we have had about culture. The Golden rule is a great ideal but we have to be sure to acknowledge when people may see that differently than we do. I think shooting for being respectful of all people is a phenomenal start towards getting there.

Katy

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Katy's Thoughts

 I loved the opening line to this chapter," Respect is not something one can imitate, but something one must embody."(57) Wow! As we continue this book, it is apparent that respect is a way of living and that it is a concious choice that the characters have made. Johnye communicates respect through her gestures, acts, and energy and her career choice was driven by the desire to show respect.  I noticed that she makes effort to speak to her patients in the native tongue of her patients in language that they can understand. It is important for all of us whose job is interactive in nature to remember to avoid using field specific terminology or to talk over our clients heads. As an SLP in the school setting, I try to always find the balance of giving the right amount of information so that parents feel well informed but not confused. At IEP meetings this becomes vital to making the parent feel like they are part of the decision making process rather than as if they have no voice.  I also loved the little ways in which Johnye builds a relationship with her patients by addressing the needs of the whole family through little things like talking with siblings and being responsive.  I also like how she models the behavior she expects from them: she looks the person to whom she is speaking directly in the eyes and insists they do the same.  She is teaching social skills which are so often overlooked in todays society.  She also is very similar to Jennifer in that she sees herself as a guide and advocate for the people she works with. This is a touchy subject in the schools because advocate often has a very negative denotation of being unreasonably demanding. I see myself as an advocate for my kids as well but there is a point at which we can go no further if we would like to keep our position. Many decisions are made so far above the heads of anyone in the school. We may feel at times that we would love to put a bug in a parents ear when we see an injustice but that is not practical. I often find myself working in the system as Johnye said to try to make a positive change for my kids. I identified with Johnye when she was trying to make arrangements with the hospital to meet the needs of her patient and she hung up the phone angry and frustrated saying "Why should this be so hard?" I have felt that way many times!  I also think that educators are in a similar situation when she is identified as a atrategist and charmer dodging her way through the barriers that the bureaucracy places in her path. I often feel there are hoops through which I must jump to get kids help and you have to know the right way to approach each individual who can help you. I watched Grey's Anatomy one week when Meredith made the statement that she was using her "social currency" to get a kid some ears. Johnye uses her cultural capital (skills, charm, strategy, INFLUENCE, and knowledge of the system to work from the inside on the behalf of the patient. It seems that is the way it works in the school too and it disturbing to see how kids get treated when they or their parents do not have the currency which ultimately gets them the respect to advocate for their child. Who will advocate for them?  I love also the belief that "respect breeds respect." I have found it so true! As a professional, I identified with her goal of not trying to change the whole system but solving discrete problems pragmatically. I think that is crucial for us as educators so that we can keep from getting overwhelmed with the changes that we would like to make. Johnye is also doing her part to change the cycle by helping women see that they have the ability to advocate for themselves. On a completely different note, I was thinking about the picture of her relatives and her feeling that their dress demands respect. "Their clothes speak loudly of their dignity, their poise, their stature in the community." I was thinking about that in contrast to our beloved jean day and how casual the dress code has become at my school. Is this part of the reason teachers are not getting the respect we deserve. If we dressed more professionally would people assume we know more? I also thought about staff inservice and how we often roll our eyes on those days when I read the section about the fellows being inattentive to the speakers and Johnye made the comment, "We do to each other what we ultimately do to our patient." That really made me think about how we treat our colleagues and what we expect of our kids. I will close with another statement that I loved from this chapter,"look beyond the facade and see their souls."

Jacqueline's Response to Katy: Wow, Katy! I forgot what a unique perspective you have in this area!  I don't know how you do it!  I do think that I would lose my job.  I just don't think I could stay quiet if I knew there was another possibility to getting a child additional help.  But, you are probably right.  You can make more of a difference if you just focus on helping this child as much as you can instead of trying to change the whole system.  As you talked about the Grey's Anatomy episode, I could so identify.  You want to call in your "favors" per se, but I find that I run out of favors before I run out of kids to help.  I wonder if you feel that the RTI process has been a help in getting students services or if it has been a hindrance.  From my school's perspective, it has been a hindrance.  I have a child who has language issue and some articulation issues as well.  He is eight years old and in first grade.  He was a Reading Recovery student from my first round of students.  He is in a class that is a team-taught situation.  There are 28 kids including 6 special education students.  I found out about 12 weeks into his program that he had been tested for speech in Augusta where he moved from.  He apparently didn't qualify because they thought his deficits were environmental.  He exhibits some self- stimulating actions but chewing in his tongue and rolling it around his mouth.  A succesful child ends the Reading Recovery program at a level 14-16.  He ended his program at a level 4.  The Speech Teacher gave me some things that I can do to try and collect strtategies for further assessment.  When I would give some of them, it took up 10-20 minutes of our 30 minute lesson.  However, I know that the classroom teachers have too much on their plates with 28 kids to try and collect any data. So, I believe he will be one who falls through the cracks.  Sad...but, what else can I do? 

  I also wonder about the dress code.  As many of you know, we have the ability to purchase jean day passes.  Well, I spent enough money so that I don't have to worry about it, this year...Bad, probably...but, it does make it easier to choose what you wear in the morning.  I would prefer if we went to school uniforms. I student taught at a school where the teachers and students wore the uniforms and it made life so much easier.  And staff inservices, Katy, you hit the nail on the head.  I know that I will want to take a break from learning when this program is over, but I don't think I could be done for good.  That includes staff inservices.  I'm the nerd that asks questions and shares thoughts. But, I also know how nerve racking it is when you are giving the presentation.  Again, if we took the "golden rule" idea, I think many people might change how to respond to those inservices...We have to respect each other as professionals before people outside our profession will respect us...

Jacqueline,

You are right, it is very hard to get help but there are rules that must be followed to get services. My job is important to the livelihood of my own family and I can not sacrifice that to save other people's kids. I help behind the scenes when I can and get parents in contact with people who can help them.  This does not happen very often at my school so I am lucky that I do not have to use my big favors often but I don't hesitate to do that when it is necessary.  I am happy with the amount of positive change that I am making on behalf of the kids I work with and I have so far been able to manage to maintain respect. If I were to ruffle feathers all the time, then that would not help the kids or me. To change the whole system will take a long time and it is not something that one person will do. It is important for us to help as many kids as we can and focus on that but it is our nature to always focus more on the ones we couldn't get to. We just try harder in the future. To answer your question about RtI, I feel that the intent is good but it was not rolled out effectively. The program seems to lack funding or maybe lacks funding in the right places.  I have mixed feelings about it. At our school, the referrals have been drastically reduced. I have only tested one kid this year.  Teachers are not completing the paperwork because they feel it is overwhelming and they feel they have no help.  Teachers must either be coming up with more strategies on their own to implement in class or they are ignoring the kids who do not fit the mold.  The positive of RtI is that kids get the chance to succeed in class with intensive strategies and intervention from Special Ed at Phase 3 before they are placed in a more restrictive class. I think the trouble at this point is due to overwhelmed staff and nobody knowing who should be doing what at each Tier. Speech and Language does observation at Tier 2 and gives strategies but at Tier 3 there is in class intervention by SLP's. Part of the problem with your kid could be inconsistency as well. When kids are transient, it is difficult to determine if there is a problem or if there has just never been consistent education and we have to determine if that warrants special ed placement. The letter of RtI allows for kids to get intervention services to see if they are effective before being placed. If they can succeed in general ed, that is great. If not, they get referred for testing. We can talk more about it Wed. He should be able to get some help after 6 weeks.

Katy