Monday, April 23, 2018

Standing up for immigrants worldwide!

The phenomenon of human migration is among the most complex and massive global crises of our time; it is the greatest cause of human suffering and the tragedies humanity is experiencing in our day. 

It is a very complex phenomenon because it forces to the surface all the unresolved challenges faced by humanity in making this world more humane and just; it brings to the fore the urgency of creating genuine solidarity among all the countries and peoples worldwide. There is administrative and outright governmental corruption in various countries; social inequality; social injustice, plus a thousand forms of violence and death, epidemics, famine, intolerance, racism, and various other forms of discrimination, etc.

The number of people involved, the sheer size of the worldwide migration phenomenon, already transcends all borders, races, creeds, cultures, and ideologies. The migration and refugee crisis has become a part of daily life, creating the Dantesque dimensions of a living hell on earth. The crisis is subhuman and apocalyptic in the suffering it inflicts upon men, women, children, young people and the elderly, all of whom, for the greatest variety of reasons, were forced to leave their homelands to look for a better future abroad—to try to begin new lives in strange and foreign lands, many of which are nakedly hostile to the newcomers.

This phenomenon of mass migration affects all of us. All humanity is united in the good as well as implicated in the evil inherent in how the world responds to the crisis. Sadly, the search for and implementation of fundamental solutions to the crisis are postponed indefinitely: everyone, leaders and citizens alike, are wholly lethargic in their response to the worldwide tragedy—all of us simply prefer to avoid dealing with the problem.

Those who are the primary victims of this migration phenomenon are—for the most part—men and women on the fringes of society, suffering the shame of their position of being people who are unwanted. They are the products, the victims of what Pope Francis calls "the culture of discarding;” the throw-away culture; they are what he labeled "the disposable." They are men and women who have become impoverished because they are being denied all access to social services and social opportunities; they are simply "discarded" because they aren’t important players in the hyper-productive economic machinery that drives this globalized world.

The causes of this painful and massive migration phenomenon are many; they range from people’s desperate search for better economic conditions, to displacements under duress due to political or religious persecution, as well as other forms of violence which make remaining in their homeland impossible.

Examples of this phenomenon today are the huge masses of migrant and refugee populations that are making their way—often at the cost of risking their lives—from Africa to Europe; from Syria and Iraq to Europe, for example; and then there are people from around the entire world, including Latin America, trying to make it to the United States.

This complex, massive worldwide problem calls upon all of us to find solutions of equal magnitude and complexity: the crisis, first of all, calls for solutions in the countries of origin; and then for a strategic response to ameliorate the double suffering of those who have been uprooted from their countries of origin and then meet with hostility in new lands where they are decidedly unwelcome, even as they try to rebuild their broken lives. The countries that take in the greatest number of migrants must be able to call on the rest of the world for vital help in finding ways for the newcomers to integrate in their new homelands and build a new, dignified way of life. 

Until today, this phenomenon—which is so dramatic, so tragic, so visible, causing so much pain and bringing about so much social upheaval and individual suffering—this phenomenon which calls for such an urgent response, has been met with lack of action, with indifference, with governments badly failing to coherently and dynamically making a response to the crisis a priority.

The primary causes of the crisis are neglected or ignored: bureaucratic inefficiency and administrative corruption; social injustice; inequality in the distribution of resources, goods, services and social opportunities. What’s more, the very factors that force so many millions to emigrate also turn destination countries into hubs of misery, even as they continue to regularly attract thousands upon thousands from all corners of the earth, each and every day.

Neither the current politicians in each country of departure of these large migratory masses—who are, so often, victims of massive corruption—nor the governments of the country where the migrants seek to make their new home, nor the international agencies and entities charged with care of the most vulnerable—such as the European Union, the United Nations, the World Health Organization, the International Monetary Fund and the World Bank—are succeeding in resolving the current migration phenomenon through adequate humanitarian means. Instead, war-mongering and the show of military might are on display.

It is urgent, therefore, that we find ways to restore to all those affected their dignity as people—not with welfare programs, but through solutions that promote and sustain human development.

It is also urgent that faith-based institutions representing the gamut of creeds and religions contribute to comforting the suffering migrants; let their service and prophetic mission set the tone for secular governments. Religious leaders must fearlessly and consistently denounce all the aspects of the migration crisis that undermine human dignity, that impede the ability of all men, women and children affected by the crisis to lead dignified lives, as individuals and communities. Sad to say, the opposite is true today, with so many religious leaders having become co-conspirators of silence, demonstrating a glaring indifference to the migrants and refugees. 

We must create a world that serves as a great table of plenty at which all people have a seat, and where all are in solidarity, partaking in equal shares of the abundant life. This vital task should bring all of us together in unison and harmony. The failure to build a more humane global community, marked by solidarity, is a grave moral defeat, which should fill us with shame. So far, governments and civil society have done precious little—there is so much, so much more that we must do to bring comfort and healing to our migrant brothers and sisters from all around the world.

Sunday, April 1, 2018

Easter: New and Abundant Life for All

DURING this time of year, the Catholic world prepares for the celebration of the most important holy day of the liturgical year: Easter—the Resurrection of Jesus Christ.

This essay will explore two aspects of this feast, two very important meanings that this holy day has for all of humanity, for the Christian world, and for our North American society.

First, the confession of faith in the Resurrection of Christ has a historical basis or reflection in the transformation of life experienced by the first Christians; these men and women recognized and proclaimed to each other and to non-Christians that they had become new men and women, with a transformed mentality. They were now able to understand the whole life project of Jesus of Nazareth; and now they could live out its principles and put them into practice, fueled by a new vision of God, of the world, and of the “other,” their neighbor.

Some of the disciples who had accompanied Jesus in his travels and ministry—his first witnesses, his intimates, but who clumsily did not understand him, and instead denied and abandoned him—now were sent into the world. Two thousand years ago they began their mission proclaiming that Christ was alive, that he lived in them because he had radically changed, renewed, and transformed their lives. Now they were living out, in its fullness, the commandment to love; they recognized that all men are brothers, children of the same Father in heaven—just as Jesus had taught and shown them.

How much we all need this each and every day: this personal renewal and this transformation in order to become better human beings, to transform ourselves—to move forward. This is precisely what the word Easter means in Hebrew: "to step," to step over and let go of resentments, fears, small and big hatreds, this focus on differences, intolerance, discrimination, quarrels, divisions, and all forms of violence and death. We all need to move forward toward new ways of understanding and living life--new, renewed and transformed ways of relating to each other. This makes coexistence possible, a coexistence that, even if it is not always fraternal, is at least humane and civilized!

For all of us, the first meaning of the Christian Easter is new life. And how much does this message of Easter not apply, with so much urgency and necessity, to our American society, in the here and now?

We are surrounded and distressed by a thousand forms of violence and death in our homes, our streets and our schools. We are overwhelmed by unemployment and dread of the future, fear of diseases and political uncertainty; then there is the use of drugs by so many people, especially the young, and the destruction addiction wreaks in so many families; plus, there is the loss or distortion of traditional values because of the primacy of having over being, the pursuit of pleasure and power at all costs—regardless of the means—as the ultimate goal of human existence, etc. 

This reality threatens to suffocate the potential of human life and harms and hardens the coexistence of all of us in contemporary society. The situation clamors—with great urgency—for a transformation, a change, a metanoia, a new life. It clamors for people whose lives are transformed as well as the reconstruction and renewal of institutions so that they become more just, more supportive, and more humane.

Second—and inseparable from the power of Easter to transform lives—the confession of the Resurrection of Jesus signifies a triumph of life over death, a step away from failure and toward victory. Thus, Easter also stands for an "abundance of life" as the ultimate destiny of human kind, of every man and woman who comes into the world.

Today’s many ills, as mentioned, that afflict and distress individuals and society at large, call us to a daily task; we have a calling to progress from the bad to the good, from the inhuman to the human and humane, from the mediocre to our best selves, from lies and errors to the truth and honesty, from the twisted and confused to a clear conscience. We can make such progress through our words and in our actions, building up—through that step forward, that transformation, that novelty in our lives—the room for abundant life.

Let us embrace abundant life, so that, in our nation, it can manifest itself in the realms of law and politics, in economics, and in the quality of inter-communal and interpersonal relations, in the world of art and sciences, in the exercise of our professions and in all our daily tasks, and so too in the world of entertainment, recreation and sports, in our religious practice, etc.

Our society—proud of and enriched by so many material achievements—is the stage for so many accomplishments and the reason for so much hope for so many who have come here or dream of doing so. Yet, at the same time, within and without or borders, there are so many who are suffering the pain of unfulfilled dreams, unfulfilled longings, and dashed hopes; the pain of a thousand injuries inflicted by unjust and inhuman ways of life. All of this demands from us that we embrace a new life—and invite others to do the same—to embrace Easter’s promise of an abundant life, the prosperous, full and happy life for which we all yearn.

Let it be Easter then every day. Let all our days witness our passage from the old to the new, and from scarcity, and petty and precarious ways of life, to a truly abundant life!

Sunday, March 25, 2018

The brave new world of digital health care still needs doctor’s personal touch.

LAST MONTH two major publications devoted significant coverage to the growing, unstoppable trend toward telemedicine and other digital forms of measuring, recording and responding to individuals’ healthcare needs—all for the sake of convenience, accuracy and cost-cutting. The Economist (Feb. 3, 2018) headlined its news analysis with “Doctor You—a digital revolution in health care is coming—welcome it.” The Wall Street Journal (Feb. 25, 2018) published a lengthy feature on “What the Hospitals of the Future Look Like;” the subhead read: “The sprawling institutions we know are radically changing—becoming smaller, more digital, or disappearing completely. The result should be cheaper and better care.”

Optimism abounds. And, yes, there is plenty of reason for it. The Economist notes that the “fundamental problem with today’s system is that patients lack knowledge and control” regarding their medical condition and treatment options; “access to data can bestow both,” the article proclaims.

There has been a veritable explosion of wearable devices that measure blood pressure, for example; others can detect irregularities in heartbeat; other apps are in development that can—with the help of Artificial Intelligence—detect skin cancer and other potentially life-threatening conditions that, early on, do not manifest themselves in obvious, visible or dramatic ways. A digital early-warning system can prompt individuals to seek out medical care for preventive measures.

Care for the elderly is greatly improved by wearable devices that are capable, not only of measuring vital signs, but of detecting falls and sending warning signs to centralized monitoring stations. These, in turn, can dispatch emergency help or alert family members to take mom or dad to a doctor. In a similar fashion, patients of all ages, can have data pertaining to critical medical factors, such as diabetes, automatically sent to their doctors’ computers, prompting corrective instructions or, if needed, a visit to the doctor’s offices. Not surprisingly, Apple has announced plans to petition health-care organizations to allow iPhone users to download their medical records.

These innovations certainly give patients more autonomy in making medical decisions on their own behalf, while also serving as a safeguard to spot potential errors in medical records that could lead to inappropriate or unnecessary treatments. Overall, this digital revolution will save billions of dollars in unnecessary—or, no longer necessary—visits to doctor’s offices and the administration of medical tests.

As to hospitals, the Journal writes, these institutions, too, are developing monitoring systems that can sharply reduce the time patients spend in hospitals or emergency rooms by keeping a remote digital eye on the patients at home; again, the focus is on preventive care—catching conditions before they get out of hand. By some estimates, 30 percent of care traditionally provided in hospitals can be given at home.

More and more, somewhat parallel to the proliferation of no-appointment-necessary medical clinics, large hospital will make room for “microhospitals,” functioning as extended “intensive-care units, where you go for highly specialized, highly technical or serious critical care.” Patients with conditions that can safely be monitored remotely can recover at home. Doctors with various levels of specialization will operate “central hubs” to monitor both acute cases in microhospitals, regular ERs or less severe cases in patients’ homes.

Kenneth L. Davis, president and chief executive of Mount Sinai is quoted as saying: “We need a new model of care that focuses on wellness and prevention and keeps people out of hospitals.” Enormous savings and greater comfort for patients are in the offing.

As The Economist notes, “the benefits of new technologies”—such as wearable devices and downloadable personal health records—“often flow disproportionately to the rich. However, government and insurers have an incentive to provide the technology and self-care, at-home treatment options to poorer populations as well. Alphabet, the parent company of Google, has plans to wade through patient data in poorer parts of cities, where many residents are covered by Medicaid.

Hi-tech innovation at the service of the poor is also the hallmark of New York State’s revolutionary Delivery System Reform Incentive Payment (DSRIP) Program. DSRIP, a five-year program now its third year, provides superior medical care to Medicaid patients at greatly reduced savings ($12B-plus!) to the state’s taxpayers. DSRIP in on track to exceed its target of reducing unnecessary hospitalizations by 25 percent by spring 2020. The program is driven by the Value-Based Payment (VPB) or Pay-for-Performance model: doctors are being paid, not based on the number of hospital visits or tests, but on the longer-term health outcomes of their patients. (It’s promising in this regard that the government has created the Physician-Focused Payment Model Advisory Committee, with the potential of extending VBP models to Medicare.)

Electronic Health Records (EHRs) play a major role in DSRIP architecture; for the New York State Department of Health to track the health of populations, EHR data are integrated with Medicaid claims in order to paint the state of health of large communities. Just as is necessary in the commercial, privately-insured universe touted by The Economist and The Wall Street Journal, EHRs for each patient served under DSRIP must be painstakingly produced, maintained and constantly updated. This process ordinarily demands a great deal of time on the part of physicians, who are glued to their computer screens, rather than being focused on the patient before them.

In sum, the vital personal relationship between physician and patient, between doctor and the patient’s family, has little chance to be established. The personal touch, the human encounter that forms the foundation of an authentic patient-doctor relationship goes missing. That obviously is true for all forms of remote monitoring of patients’ health, no matter how accurate or efficient.

At SOMOS Community Care we have developed a solution; SOMOS is the only so-called Performing Provider System (PPS) mandated by DSRIP that consists of a network of independent physicians; the other 24 PPSs are hospital-based. To free our doctors from the demands of data entry and record keeping, we have dispatched teams of Community Health Workers (CHWs) to our practices, to record patient data themselves or train office staff to do so.

As a result, the doctor—often living and working in the very communities with whom he shares a cultural and ethnic background—is free to pay full attention to patients before him; what’s more the CHWs make home visits, as needed, ensuring that patients keep up with their medical regimen and keeping the doctor abreast of family and housing circumstances that may impact the health of patients and their families.

In this fashion, our doctors assume the role of the family doctors of old—leaders of the community in whom patients can put their trust, in whom they can confide, and by whom they are understood, by whom they are truly known. This new iteration of the family doctor takes full advantage of today’s digital revolution in health care, but without sacrificing what has always been essential for an individual’s overall well-being—quite literally, the personal, healing touch. Such cannot be transmitted in digital fashion, no matter how sophisticated the technology.

Tuesday, March 6, 2018

Five Years with Pope Francis

FOLLOWING the historic and surprising decision by Pope Benedict XVI to resign from the pontificate, first announced on Feb. 11, 2013, the conclave of cardinals elected a new Pontiff. A Jesuit and the former archbishop of Buenos Aires, Jorge Mario Bergoglio who chose the name Francis as a sign that his Petrine ministry would be a tribute to and would aim to fulfill the mission of the Poverello of Assisi: Saint Francis. 

March 13, 2018 will mark the fifth anniversary of the election of Pope Francis; he is the first Jesuit Pope, the first from the Americas, the first from the southern hemisphere, and the first from outside of Europe since the Syrian Gregory III, who reigned in the 8th century. 

Without a doubt, the first five years of this unique pontificate have seen the realization of the dream of St. John XXIII. St. John, when he so wisely and joyfully convened Vatican II on Jan. 25, 1959, had a vision and Pope Francis is making it a reality: his unique style of ministry has brought fresh air and renewal to the Church. As the Greek philosopher Protagoras said: "Man is the measure of all things." And the style that Francis has imprinted on his pontificate reflects the essence of his own humanity, his Christian, priestly and Jesuit life. This essence can be summarized in three words: nearness, humility and mercy. Better still, a single sentence captures the core of this papal reign: the pontificate of Francis has been a ministry of nearness, humility and compassion. 

This pontificate has been near to the realities that Francis himself calls peripheral realities, both geographically and human, pertaining to the whole of society as well as to the ecclesial community itself. These are peripheral realms where those most in need of the light of the Gospel and the compassionate and merciful love of God live and suffer; Pope Francis insists that the Church’s disciples of Christ are called to convey God’s love to those discriminated against in a thousand ways—because of their creed, race, origins, sexual identity; these are the poor among the poor, the marginalized, the rejected, the impoverished, migrants, the divorced, etc. 

It is this closeness to the realities of all men and women around the world from which Pope Francis crafts the catholicity or universality of the Church. It is a closeness that translates into dialogue and openness to all the realities of the individual and the realities of all people. 

This pontificate is humble, simple, transparent, open, frank, coherent—a friend to all. This is the personality of the man Jorge Mario Bergoglio, which is lived out and manifested in all the deeds and words of Pope Francis. They are many—his gestures; they are novel, austere, refreshing, disrupting, prophetic and full of the joyful and humble evangelical meaning that Francis has delivered throughout these five years in charge of Peter's barque.

These are gestures that—in coherent fashion—accompany all of Francis’ talks and homilies; there is the acknowledgement of himself as a sinner and his consistent acknowledgement of the sins of the Church; his constant petition for us to pray for him; the choice of his papal residence and the car in which he travels; there is his closeness to the sick and incarcerated, as shown in the washing of their feet on Holy Thursday; the choice of his vestments and ornaments; the manner of his presentation as the Bishop of Rome; his vindication as a man of the common people, etc. His is a humble closeness to all of humanity that is recognized by the entire world and paid tribute to by the hundreds of covers of the most important magazines around the world. 

This papacy is merciful: compassion and mercy most particularly characterize the revelation of the love of God for human beings shown by Jesus of Nazareth. If one thing characterizes the exercise of Peter's ministry by Pope Francis, it is his insistence on mercy in all his gestures and all his preaching. Mercy is so characteristic of the life and work of Francis that, to celebrate the 50th anniversary of the closing of Vatican II, he called on the whole Church on March 13, 2015 to celebrate an extraordinary Holy Year and Jubilee of Mercy. 

This distinct personality and nearness to the marginalized—this ministry that is both humble and compassionate—does not impede or diminish Pope Francis’ authority, wisdom, strength, determination and courage to push for (and face opposition to) the radical reforms that are urgently needed within the Vatican Curia and the Catholic Church at large. 

This spirit of humility and compassionate closeness to those most in need of God’s love is of course evident and manifest in all the writings of this pontificate, the hundreds of talks, letters, homilies, etc. Add to these his messages delivered during his pastoral travels and in his larger texts. Among these stand out: 

Encyclical Letters: 
  • Laudato si (On Care for our Common Home)
  • Lumen Fidei (on the Light of Faith) 

The Apostolic Exhortations: 
  • Amoris Laetitia (on love in the family)
  • Evangelii Gaudium (on the proclamation of the Gospel in today’s world). 

Nothing remains, but to: 

Celebrate and express our gratitude with enormous joy and Christian jubilation for the blessings given to the world and to the Church during these first five years of the pontificate of Francis. 

Ask that there be many more years to come, in which—as the head of the Church—Francis will accompany us with his humble and compassionate nearness. Respond to his constant request to pray for him, so that God may grant him wisdom, health and strength in his Petrine ministry. 

Follow him, listen to him and try to imitate him in pursuing the authentic Christian life. 

And for the good of the Church and the entire world: AD MULTOS ANNOS POPE FRANCIS! 

Saturday, January 27, 2018

Pope Francis in Chile

Thirty years after the pastoral trip of St. Pope John Paul II to Chile, the current Pope Francis undertook his sixth visit to Latin America, this time visiting Chile and Peru (between January 15 and January 22) during different historical, social, and political circumstances, that are always changing, of course. On the last papal visit in 1987, for example, Chile was under the military and dictatorial regime of Pinochet. Today, Chile lives in a regime of democratic government.

Enlightening the minds and hearts of men and women of good will, Pope Francis, in his mission and style, confirms and encourages the faith of Catholics, and helps clarify - by the light of the Gospel of Jesus Christ - today's problems, of the men and the peoples he visits. He presented the Good News of Jesus with current themes, very near and very close to the feelings and the deepest, most intimate, and most current experiences and urgencies of the life of each audience.

With the emotion of a Catholic and with the pride of being Chilean, with the fresh joy of the encounter with Francis and with gratitude to God for the privilege of having been present in this Apostolic Journey as a special guest of the Chilean government, let me emphasize here, very briefly, the thoughts, the themes, the strong ideas, and the most important moments, of the speeches delivered by Pope Francis to the Chilean people, transcribing his very words to preserve them - just as they were delivered, without interpreting them or changing them, for our reflection and Christian life.

At the MEETING WITH THE AUTHORITIES, THE CIVIL SOCIETY AND THE DIPLOMATIC CORPS at the Palacio de la Moneda in Santiago de Chile on Tuesday, January 16, 2018, the Pope reminded all Chileans of the challenge that should enliven the days of this Nation in its present and near future: "a great and exciting challenge: to continue working to make this democracy, as your forebears dreamed, beyond its formal aspects, a true place of encounter for all. To make it a place where everyone, without exception, feels called to join in building a house, a family and a nation. A place, a house and a family called Chile: generous and welcoming, enamored of her history, committed to social harmony in the present, and looking forward with hope to the future. Here we do well to recall the words of Saint Alberto Hurtado: “A nation, more than its borders, more than its land, its mountain ranges, its seas, more than its language or its traditions, is a mission to be fulfilled.”  It is a future. And that future depends in large part on the ability of its people and leaders to listen.”’ And, added the Pope: to especially listen: 

  •  “TO THE UNEMPLOYED, who cannot support the present, much less the future of their families;
  •  TO THE NATIVE PEOPLES, often forgotten, whose rights and culture need to be protected lest that part of this nation’s identity and richness be lost;
  •  TO THE MIGRANTS, who knock on the doors of this country in search of a better life, but also with the strength and the hope of helping to build a better future for all;
  •  TO YOUNG PEOPLE, and their desire for greater opportunities, especially in education, so that they can take active part in building the Chile they dream of, while at the same time shielding them from the scourge of drugs that rob the best part of their lives;
  • TO THE ELDERLY, with their much-needed wisdom and their particular needs. We cannot abandon them. 
  • TO THE CHILDREN, who look out on the world with eyes full of amazement and innocence, and expect from us concrete answers for a dignified future.”

And, at this moment of his intervention, Pope Francis added a request for forgiveness that was very just, necessary, and anticipated by the Chilean people in this Apostolic Visit: "Here I feel bound to express my pain and shame, shame at the irreparable damage caused to children by some ministers of the Church. I am one with my brother bishops, for it is right to ask for forgiveness and make every effort to support the victims, even as we commit ourselves to ensuring that such things do not happen again.”

In the Homily of the Eucharistic Celebration FOR PEACE AND JUSTICE at O'Higgins Park in Santiago de Chile on Tuesday, January 16, 2018, he reminded us that "the Beatitudes are not the fruit of a hypercritical attitude or the “cheap words” of those who think they know it all yet are unwilling to commit themselves to anything or anyone, and thus end up preventing any chance of generating processes of change and reconstruction in our communities and in our lives. The Beatitudes are born of a merciful heart that never loses hope. A heart that experiences hope as “a new day, a casting out of inertia, a shaking off of weariness and negativity” (Pablo Neruda, El habitante y su esperanza, 5) and he added that "peacebuilding is a process that calls us together and stimulates our creativity in fostering relationships where we see our neighbor not as a stranger, unknown, but rather as a son and daughter of this land.”

During his brief visit to the Women’s Penitentiary of Santiago, the Holy Father reminded the inmates that " losing our freedom does not mean losing our dreams and hopes.... Losing our freedom is not the same thing as losing our dignity.... No one must be deprived of dignity." He also said that "public order must not be reduced to stronger security measures, but should be concerned primarily with preventive measures, such as work, education, and greater community involvement.”

On the same day, Tuesday, January 16, and at the MEETING WITH THE PRIESTS, CONSECRATED MEN AND WOMEN AND SEMINARIANS at Santigo Cathedral, he encouraged them to "renew our ‘yes’, but as a realistic ‘yes’, sustained by the gaze of Jesus.” He invited them to pray, saying “the Church that I love is the holy Church of each day.… Yours, mine, the holy Church of each day… Jesus Christ, the Gospel, the bread, the Eucharist, the humble Body of Christ of each day. With the faces of the poor, the faces of men and women who sing, who struggle, who suffer. The holy Church of each day.” And he ended his speech asking them: "What sort of Church is it that you love? Do you love this wounded Church that encounters life in the wounds of Jesus?”

At the
MEETING and GREETING OF THE POPE WITH THE BISHOPS OF CHILE in the Santiago Cathedral Sacristy, he told them that "the lack of consciousness of belonging to God’s faithful people as servants, and not masters, can lead us to one of the temptations that is most damaging to the missionary outreach that we are called to promote: clericalism, which ends up as a caricature of the vocation we have received.”

On Wednesday, January 17, in the Homily of the Eucharistic Celebration FOR THE PROGRESS OF PEOPLES at Maquehue Airport in Temuco, the Pope addressed especially the members of the Mapuche people, as well as the other indigenous peoples who live in these Austral lands: the Rapanui (Easter Island), the Aymara, the Quechua and the Atacameños, and many others... and at this airport in Maquehue, in which serious human rights violations took place. The Pope called for our construction - as artisans - of unity and the recognition of (original) cultures without violence, saying that "
the unity sought and offered by Jesus acknowledges what each people and each culture are called to contribute to this land of blessings” and that “you cannot assert yourself by destroying others, because this only leads to more violence and division. Violence begets violence, destruction increases fragmentation and separation. Violence eventually makes a most just cause into a lie.”

In the MEETING WITH THE YOUTH, in the National Shrine of Maipú, he exhorted them to be "the protagonists of change. To be protagonists. Our Lady of Mount Carmel accompanies [them] so that [they] can be protagonists for the Chile of which [their] hearts dream.” And, he reminded them that "maturing means growing and letting dreams grow and letting aspirations grow, not lowering your guard…” He also said: "How much the Church in Chile needs you to ‘shake the ground beneath our feet’ and help us draw closer to Jesus!  This is what we ask of you, that you shake the ground beneath our fixed feet, and help us to be closer to Jesus.”

In the VISIT TO THE PONTIFICAL CATHOLIC UNIVERSITY OF CHILE, the same Wednesday, January 17, he recalled the importance of the identity, of the existence and mission of the Catholic University for national coexistence and for the construction of community, telling them that the construction of coexistence “is not so much a question of content, but of teaching how to think and reason in an integrated way. What was traditionally called forma mentis.…The university, in this context, is challenged to generate within its own precincts new processes that can overcome every fragmentation of knowledge and stimulate a true universitas.” And, added the Pope, we must "seek out ever new spaces for dialogue rather than confrontation, spaces of encounter rather than division, paths of friendly disagreement that allow for respectful differences between persons joined in a sincere effort to advance as a community towards a renewed national coexistence.”
Finally, in the Homily of the Eucharist in honor of OUR LADY OF MOUNT CARMEL and in the PRAYER FOR CHILE as a Farewell, in the Lobito Campus of Iquique, on Thursday, January 18, the Holy Father encouraged us all to "like Mary at Cana… be attentive to all situations of injustice and to new forms of exploitation that risk making so many of our brothers and sisters miss the joy of the party. Let us be attentive to the lack of steady employment, which destroys lives and homes. Let us be attentive to those who profit from the irregular status of many migrants who don’t know the language or who don’t have their papers “in order”. Let us be attentive to the lack of shelter, land and employment experienced by so many families. And, like Mary, let us say: They have no wine, Lord.”

After this wealth of prophecy delivered by the Pontificate of Francis in Chilean lands, nothing remains but:  
  • Regret, if the sensationalism and the media’s curiosity focused voraciously, rampantly, vulgarly and commercially on the subject of sexual scandals and on the person of a Chilean bishop accused of protecting a pedophile priest, a matter that the Pope himself denied and in which he came out in defense of the bishop and - as noted above – for which he asked for forgiveness. Sensationalism and curiousity that - in some moments and sectors, then, could overshadow and forget the wealth and importance of the visitor and his pastoral and evangelizing mission. 
  • To hope, with the construction and the active and generous contribution of everyone, that the Gospel’s seed watered in our Chilean Homeland by Francis bears - in the near future of our beloved Nation - good and abundant fruits.

Friday, January 5, 2018

Trust between doctor and patient is key to superior healthcare.
This fall, smack in the middle of the ongoing debate about healthcare reform in the U.S., a consummate medical professional published a remarkable book that pinpoints the structural imbalance that ails the country’s $3 trillion healthcare industry. 

In “Back to Balance—the Art, Science and Business ofMedicine” (Disruption Books), Dr. Halee Fischer-Wright, president and CEO of the Medical Group Management Association, writes: “We have lost our focus on strengthening the one thing that we know has always produced healthier patients, happier doctors, and better results: namely, strong relationships between patients and physicians, informed by smart science and enabled by good business practices that create the trust necessary to ensure that patients do what they need to do to achieve” good, long-term health outcomes.

No doubt, something is seriously amiss: among industrialized nations, the U.S. spends the most per capita, but the quality of healthcare and patients’ health outcomes rank lower than those in Germany, the UK, France, and a host of other developed countries. Fischer-Wright knows her stuff: the organization she leads “represents 40,000 practice administrators and executives in 18,000 health-care organizations across all fifty states, where more than 400,000 physicians practice, providing close to 50 percent of the health care in the United States.”

The “art of medicine,” she asserts, “is being crowded out by the science of medicine—and its emphasis on evidence-based procedures, well-meaning protocols, and advances in Big-Health-Data-churning information technology.” There is a relentless “focus on time-consuming but questionable quality metrics, endless billing procedures, and an adherence to process that doesn’t necessarily put patients first.” Case in point: the author cites findings that show that “the average physician now spends nearly two hours on paperwork [digital entries included] for every hour spent with patients, if they’re lucky.”

These factors “keep creating greater distance between patients and their doctors,” writes Fischer-Wright, who insists that “we need to bring the art, science, and business back into balance — with each side playing its part and no more to drive the healthy outcomes that we all desire from health care today.”

The art of medicine, she insists, hinges on trust, the authentic bond between doctor and patient. It is the vital importance of the “human side — the big-hearted, patient-focused, high-touch, active-listening, caring, compassionate, empathetic part of medicine that has been at the heart of the doctor-patient relationship from the very beginning.” 

“A trusting relationship between physicians and patients,” writes Fischer-Wright, “based on compassion, empathy and good communication can have a profound effect on patient health. Trust aids efforts to control diabetes, lower cholesterol, and control pain. Trust improves the mental and physical quality of life of cancer patients. Trust encourages people to get regular preventive care. Trust gives older patients better outcomes and more long-lasting independence. Relationships built on trust have been shown to reduce anxiety, depression, post-traumatic stress disorder, and a patient’s use of end-of-life care. These relationships are linked not only to lower hospital readmission rates for heart failure or pneumonia, but also to more successful treatment regimens, lower health-care costs and much higher patient satisfaction scores.” Trust is everything!

Hence, the book argues, the business and science of medicine must be de-emphasized in favor of more holistic and humane treatment and involvement of the patient, making room, quite literally, for the human touch.

Fischer-Wright proposes a number of intriguing remedies to bring the art, the business and the science of medicine into proper balance. Among them, a suggestion to “design medical care for healthier people instead of strictly for diagnosis and treatment of disease.” The human person is far more complex—emotionally and spiritually—than the sum total of his or her physical condition.

Also, she recommends: “ask the people the right questions, genuinely listen to the answers and then take the right action” for doctors to find out what their patients expect from medical care, without making assumptions. 
Finally, she calls for the creation of “empowered relationships that demand balance in the art, science and business of medicine”—the doctor, the billing person, the office assistant and the patient him or herself working toward a common goal.
Restoring the fundamental trust between doctor and patient is both the foundation and objective of these vital adjustments; it holds the key to putting “the needs of people at the center of the [health-care] industry again.”

As the CEO of a unique health-care network comprised of independent New York City-based physicians, I am most heartened by Fischer-Wright’s insistence on the primacy of the doctor-patient relationship. SOMOS Healthcare (formerly Advocate Community Providers) is a so-called Performing Provider System (PPS) operating under a mandate from the New York State Department of Health as part of its Delivery System Reform Incentive Payment (DSRIP) program. The initiative’s bottom-line objective is to save taxpayers some $12 billion in unnecessary hospitalizations by the end of the program’s five-year term in 2020.

That goal is achieved, quite simply, by providing better care in terms of prevention, diagnosis, treatment, patient follow-up with CHW handholding. This way, medical conditions may be avoided and managed, avoiding emergency room visits and hospitalizations that drive the burdensome cost of the Medicaid system. 

SOMOS Healthcare was formed by community physicians to revitalize the role of the community-based primary care physician. Like the family doctor of old, these physicians often live and work in the same neighborhood as their patients. Often, they speak the same language and share the same cultural background, ensuring sensitivity to the cultural context of patients’ wellbeing. That, we are convinced, is the key to creating an intimate, trusted bond between doctor and patient.

A cadre of specially trained staff and Community Health Workers at SOMOS Healthcare help to reduce the administrative burden of our network physicians by improving workflows, streamlining billing and maintenance of Electronic Health Records, and exchanging data with the Department of Health. SOMOS staffers are also in a position to make home visits and ensure that patients are following their medical regimes. Thus, our approach echoes the author’s recommendation that shifts the balance back to the doctor-patient relationship.

As to the encroachment of the science of medicine, our primary care physicians can readily refer their patients if specialized treatment is in order—but only after a thorough discussion and examination that takes into consideration possible cultural influences or mental health issues. Ours is a sharp departure from the impersonal, transactional, and test-driven practice of Medicaid medicine.

There is one critical area, however, where we part ways with Fischer-Wright. At the core of DSRIP is a shift to a Value-Based Payment (VBP) or Pay-for-Performance formula: increasingly, compensation for doctors is pegged to the longer-term health outcomes of their patients. We respectfully disagree with Fischer-Wright’s rejection of pay-for-performance, even as efforts she has studied over the years may have missed the mark.

For SOMOS Healthcare, pay-for-performance is at the heart of enabling our doctors to be true to their calling of delivering patient-centered health care. For too long, fee-for-service has economically favored large hospital systems. A value-based formula ensures that incentives are appropriately aligned to reward physicians for personal, relationship-based, comprehensive care.

Those with the most to gain are the people — let’s not call them patients, which connotes illness — whose health and well-being are front and center. After all, shouldn’t our health care system focus on health rather than illness?

Over time, that extra effort will include the so-called social determinants of health, such as a patient’s housing and employment situation. It’s not a matter of what Fischer-Wright labels as using “money to force compliance,” but of recognizing and supporting the risk our doctors are taking as small business owners to link their professional success to the genuine well-being of their patients. That, too, is a matter of trust; rewarding virtue is a good investment.

Post-2020, when the DSRIP mandate ends, SOMOS Healthcare is poised to continue supporting our network of community physicians as a for-profit organization, one that likely will begin to address the needs of Medicare recipients as well as our base of Medicaid beneficiaries. As our operations expand and, hopefully, as other organizations in New York State and beyond follow our example, we are confident that Fischer-Wright will discover that pay-for-performance will be a crucial element in balancing the art, science and business of medicine — be it government-sponsored or commercially driven.

Friday, December 29, 2017

New Year…New Life!

For time immemorial, the arrival of a NEW YEAR has served as a catalyst for our renewed commitment to fulfill unfulfilled resolutions and to realize our unrealized hopes and dreams. This annual cycle of reflection and optimism is an engine of personal, family, and social history. 

The arrival of a NEW YEAR is like a balm, an oasis in the hustle and bustle of personal and social stories. It is an opportunity to pause and evaluate, reconsider, strategize, and redirect the path of one’s life with new fervor, insight, and motivation. 

Clearly, our view of history is not a fatalistic one predicated on a belief that human history is an inevitable succession of events that are recycled and repeated because nothing changes and everything -- as in a whirlwind, as in a whirlpool -- cyclically and spirally returns to the beginning. 

No. Our view of history -- heir to the philosophical conception of Heraclitus of Greece -- is one in which, as the philosopher himself said, "Nobody bathes twice in the same waters of the same river." In other words, we understand history as a succession of events that, linearly, reflect the unforeseeable decisions of human beings who, with their intelligence and freedom, shape and determine their personal history as well as that of their communities, organizations, institutions, and society at large. 

The fate of humanity, then, is not determined by hidden forces (the gods or the stars) that manipulate and control the course of events to an irremediable and immutable destiny – fatal and pre-determined. The story of every human being is constructed, freely and intelligently, in our daily decisions, in the anonymity and silence of our smallest tasks as well as in the grander narratives of our lives, be they noble or petty, generous or selfish, personal or civic. 

Our view of history is neither naively optimistic nor fatally pessimistic. It is true there are many reasons for confusion, sadness, and pessimism in the form of inequalities, inequities, and injustice, in the hunger and misery of so many in stark contrast to the abundance of the few. These shortcomings are evidence of a world in which human beings have not achieved solidarity, equality, trust, compassion, or even developed ways of relating to one other to envision the world as a great fraternal table in which each one of us has a seat. 

And yet, it is the hope of a better world that gives us strength, sustains us, and pushes us every day into our daily lives and being. We are men and women who live in the hope of a better tomorrow; it is this hope that marks our present. The belief in a better humanity refuses to die. 

Faced with reasons for pessimism and sadness, we need optimism to build a better world, a better society, better families, and better personal stories through our decisions both big and small, with our activities and daily tasks, starting with better values and better ways of interacting with each other. 

Inspired by a CELAM Document from the year 2000, For the Construction of the Civilization of Love, I propose that we start 2018 by saying NO to individualism, to consumerism, to the absolutizing of pleasure, to intolerance and injustice, to discrimination and marginalization, to corruption, and to all forms of violence. 

Instead, I invite you to say YES, with your words and in your deeds, with your attitudes and behaviors, to all forms of life, to love as a human vocation, to solidarity and to freedom, to truth and to dialogue, to participation and integration, to the permanent construction of peace and to respect for others, for differences, for cultures, and for the environment.

I invite you, at the beginning of this NEW YEAR, to prioritize human life over any other value or interest, to give primacy to the person over material things, to give priority to ethics over technique, to the testimony of life over discourses and doctrines, to service over power, to the worker over the job, the company or the capital, to the transcendent over all attempts to absolutize the here and now of the human being. 

I invite you to build a New Year that is NEW for the NOVELTY of our lives. There is much we have done, but much more we need to do to build hope in the midst of the despair that challenges us daily.