we are not trying to please folks. we are trying to raise awareness and
make them think and make better decisions. It is most important to change
systems that stand in the way of serious improvements and progress.
Sometimes these are government systems and sometimes they are systems of
thinking.

In my own area of family medicine, primary care, rural health or physician
distribution, it would be nice to massively increase expenditures in these
areas, but until the nation makes a top priority at the earliest ages, any
other focus or funding is a mistake.

my focus continues to remain the earliest years and nurturing by someone
who is responsible, accepts the full responsibilities for this task and
hopefully treasures the moments provided. A mission trip in the poorest of
the poor, rural areas in Haiti remains vivid in my memory. The infant was
only months old and was dying. It was white, but because of albinism. The
Haitian villagers did not understand albinism, they just saw white. Even
the mother excluded the child. The aunt had basically adopted the child and
was sacrificing her meager existence and risking her life to feed and
nurture a child. Along with the albinism were other defects, including some
likely immune in nature. By the time we saw him, the child could barely
swallow and had days or weeks to live. I will never see a stronger example
of love, sacrifice, and the value of human life.

The perfect nurturing is, of course, an impossible task and we all do what
we can. Sometimes various systems stand in the way, and it is our duty to
change these systems.

Fathers can and do contribute, as in the case of my son until the state
busted in and took his child even though he was the stay at home nurturing
parent. Nebraska is not yet a state that has learned to figure out who does
the nurturing or the providing. To his credit he continues to maintain a
strong effort in this area despite every attempt by the state to tax him
(he makes less than she does), force him to seek better paying employment
(and risk his job), force him to stop college courses (losing his health
insurance too by the way), work additional hours, etc. And remind him with
every paycheck with taxes visited on the poor. All he hears about is horror
stories from those like him that did stay connected, but did not receive
credit for their time, support, housing, and other areas. It is more and
more difficult for young men and their relationship with government, a very
bad situation to have at the current time.  By the way, he was the one that
we were able to adopt at birth and had all of the first months of contact.

Yes I am aware of at least some of the challenges. I sit down with minority
females who will become physicians. They are in the midst of a huge
dilemma. Their parents have sacrificed much for them to become physicians.
Many have worked 2 jobs and managed to maintain a strong family. but this
strong family concept is a very difficult thing for them. They face the
difficult prospect of finding a man who shares this family concept and who
has spent the time in education and advancement. They face a demanding
professional career that will make it difficult for them to be the
nurturing involved parent that they had as a child. Those that make the
arrangements want me to do suture workshops with them. My preference is to
sit down at lunch sessions and minimally facilitate discussions in these
areas, the ones that are major concerns for them at this point in their
development. I don't have to talk about family and nurturing, they teach me
about these things.

In all lower income admissions, males have half of the admission
probability compared to females (black, rural, lower income origin) however
Hispanic females have even lower ratios of admission than males. I strongly
suspect that there are cultural areas that have yet to be addressed related
to these areas. More than a few have turned down prestigious colleges,
medical schools, and other offers. I do not judge them for their decisions
either way, but I do understand some of the reasons and can help review
these with others.

the US News and World Report article in June had many examples of how
others did it better. governments that provide time for the new family as
in Norway with paid time off, and your old job back. As is pointed out in a
number of books now on American women and family life -  In the US when a
woman takes time off to nurture and develop her children, she is penalized
with loss of the raises she would have had had, savings, concerns that the
kids might distract from work when she returns (still low pay, lack of
advancement)   and then there is the very real threat of divorce, lack of
support, etc.

When systems reward the basic destruction of nurturing, child development,
having a father around (welfare policy), and family, the damage is long
term and lasting.

People can overcome much, but systems are much harder to overcome,
especially for those most distant and different. In America, it is often
the ones that are making the most effort to overcome poverty that face the
worst of the challenges, and that is the most tragic of all.

Robert C. Bowman, M.D.
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for fun do a Google search on unreconstructed curmudgeon

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