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Endings Are Beginnings

Updated: Nov 29, 2023


By Lisa Merritt MD



I travel a lot.


It is always an ironic moment when I luck out with that extra leg room treat, sitting in the exit row, and they ask us “are you willing to assist in the event of an emergency?” Most often inwardly I smile and think,” they’ll be looking for me if something happens anyway”, while I am also aware my seat mates are generally just gleeful for the extra leg room, for that privilege, for that moment, sure, they’ll agree to a usually unlikely scenario. As the “Covid Emergency” is officially declared coming to an end, I thought about how many near empty flights I was on during the pandemic travelling to serve a whole different ‘front line” battling an invisible foe with devastating impacts on patients, families, healthcare systems and communities. I thought about how we redefined and celebrated “essential workers”, in addition to doctors, pharmacists, nurses, EMTS, Firefighters, police,respiratory therapists and plethora of hospital and clinic staff, to include farmers and grocers, community pharmacies, postal workers, truckers and transportation workers, utilities workers, those who serve the backbone, keeping the country functioning. People who answered “yes” and ran towards the conflagration known as Covid-19 blazing across the land, decimating generations and in successive waves picking off vulnerable babies, elders and those with chronic health issues as well as unvaccinated previously robust young and old.


Physicians, as part of our training in this country, along with the military and other professions, take an Oath of Service. We say “Yes” when others think about maybe they might change their seat and not have that responsibility on their head. Our organization, MHI, said “Yes” when this siege descended, and yes, we, too, suffered casualties as an organization and as individuals within our circles of family and friends. The Work was initially to flatten the curve through masks, handwashing, distancing, education, optimization of chronic health conditions and then to obtain equity in immunity through accessible vaccination campaigns. Then the bridging across badly broken gaps in care, preventive screening, long haul Covid effects and large-scale Mental health challenges. It was also connecting across thin limited virtual networks of longstanding partnerships to keep providing supplies, food, medications, health information and linkage to care while most others shut down and waited out the storm. Most of all, it was keeping Hope alive, through virtual and “hybrid” efforts, we reached and taught and held hands with thousands over the last 3 years.


MHI continues to say “Yes” as best we can. Last month, we celebrated culmination of a decade and a half of community based participatory research with a convening on our Environmental Justice Collaborative project. With over 100 in attendance, we felt part of Malcom Gladwell’s, “Tipping Point” as we move our EJ report findings forward. Health care has dramatically shifted in the country and globally since I became a Board Certified Physiatrist on this day 33 years ago. The US is facing a shortage of over 100,000 physicians and there are “Maternity care deserts” where over 2 million women live with limited or no access to maternity care. Out of pocket health care expenditures rose at the highest rate in decades and we know 56% of Americans believe that health care is handled “poorly”, 74% believe prescription medication costs are handled poorly and amongst BIPOC populations 60% express extreme concern about access to quality care. We see that every day in our care navigation program. We are grateful to the Sarasota Community Foundation and then Sarasota Department of Health for grant support of this successful program over the last three years. As this program ends, we are also grateful to Project Hope which saw fit to expand support of our disaster response efforts to include support for continuing our Diabetes and lifestyle educational efforts.


Around 20% of younger adults are rationing their insulin due to financial considerations,we are grateful for recent policy changes helping defray those costs. We know all too well the extreme costs in complications, loss of productivity and caregiver demand that uncontrolled Diabetes can cause. Some of us on the team have lost younger family members from ravages of Diabetes complications, further driving our commitment to our Lifestyle Improvement classes.


Endings are also beginnings, as we know from nearly 3 decades of work across the country, we enter another phase of reorganization and adaptation, adjusting our sails during times of change and challenge. Our long standing relationship with NCF is in a precarious state given recent events, as we wish more MHI Scholars well while they move on in their life journeys. Dr Elliot Roth noted in the recent PMR Foundation news that “Diversity makes for better research”, noting that “they have greater abilities to solve complex problems, use creativity and innovate quickly relative to groups that are more homogeneous.” MHI multicultural teams and collaborations epitomize such principles in our work addressing a variety of social determinants of health. Unfortunately politics and semantics create an increasingly inhospitable environment for us and our work, no matter how admirable the goals.


Always keeping perspective, not surprisingly, on a recent flight, late at night, settling into that coveted exit row, just getting into a snooze, the announcement came over the loudspeaker, “if there is anyone with medical experience, please come to aisle 22 immediately, we have a person down!”. At 33,000 feet. And before I was even fully awake, years of reflex again kicked in and I was in motion, heading down the aisle, to offer assistance, consolation, use acquired knowledge to help, mitigate and advocate. I sat with the frightened lady and her husband, concerned son translating as I took her pulse and asked, “what seems to be the problem…?” and a nurse also came up and we went about helping stabilize her and stay the course. Kind helpfulness. This is what we do, wherever and however, we can.


“Nowhere to Go: Maternity Care Deserts Across the US” March of Dimes, October 2022

PNHP Spring Newsletter 2023

Aapmr The Physiatrist February 2023

CDC multiple data resources


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