Kia ora tatou
We’re now into autumn here, but the weather has continued to be warm and sunny; winter is going to come as a shock to us I think. I hope it’s warming up nicely in New Zealand and Australia.
It’s a busy time of year here. It’s harvest festival time, which coincided with Halloween at the end of October. For weeks, the shops were selling pumpkins of all kinds and sizes, along with pumpkin beer, ‘boo’ (ghost-shaped) chips, and Halloween greeting cards. Shop windows were well decorated, some with excellent ceramic displays of moving ghosts and vampires. Houses too have been decorated with mock spider webs and spiders, paper ghosts, pumpkins, and skeletons. On Halloween day, the streets were filled with families, with people wearing all sorts of costumes – I saw witches, superheroes, fairies, angels, ghosts, and southern belles – carrying various (but especially pumpkin) containers for treats.
The mid-term elections have also been on, with much campaigning having gone on for weeks for all seats in Congress, and the various senate seats, governorships, and state legislature positions up this year. California will have a new governor in 2011, as current Governor Arnold Schwarzenegger comes to the end of his term. Across the country, the Republicans picked up many seats in Congress, and they will be the majority party in Congress come January. The Democrats still hold the Senate, however. The changes are likely to make it harder for President Obama to continue with his policies, including in health care, which has many health care reform proponents very worried. California bucked the Republican trend, however, electing Jerry Brown (Democrat) as the next Governor.
Californians also got to vote on a series of ‘Propositions’, like the New Zealand referenda that are held now and then. One of the propositions this year was on whether California should legalise recreational marijuana use (marijuana use for medical purposes is already legal for those with a doctor’s recommendations). The focus was very much been on the benefits from reducing law enforcement costs and from the extra taxes legalisation would bring, with very little focus on health issues. However, even if the Proposition had been passed, the federal government had said that marijuana will remain an illegal drug under federal law, and it would go to court to stop the Proposition law from taking effect. As it was, Californians rejected the proposition – 54% to 46%. Another Proposition, if passed, would have suspended air pollution controls – Californians also rejected this proposition, by 61% to 39%. Another Proposition was about whether to change the required two-thirds majority to pass the state budget to a simple majority – this Proposition passed, by 55% to 45%.
And of course sports loom large here as they do in Australia and New Zealand. The local baseball team – the San Francisco Giants – won the National League championship series and therefore went on to play for the ‘World Series’ title (ie. national US title) against the Texas Rangers. Our local bakery was selling SF Giants cupcakes and many shops and houses have had ‘Go Giants’ signs out alongside their Halloween decorations. Seen as a rag-tag team of misfits with a variable performance record, the Giants went on to win the World Series 4 games to 1, in what was a great series of games to watch.
San Francisco then held a huge parade for the team. We joined hundreds of thousands – if not a million – people downtown to watch the parade; all those involved with the team were there, along with marching bands, earlier famous team players in vintage cars, and current team members riding in motorised cable cars. Schools seem to have closed for the day, very few people could have been left working, and the crowd got right behind the team to support their win, with the team also thanking San Francisco for their long support. Links to some of the photos are at the end of this blog. It was great to be there but a bit of a nightmare then getting back home, with trains and buses packed!
On the health reforms front, the Philip R. Lee Institute of Health Policy Studies at the University of California, San Francisco, where I am based, is currently running a series of seminars on health care reform. The second seminar involved a panel discussion, moderated by PRL IHPS Director Professor Claire Brindis, and including Andrew Bindman (Professor of Medicine, Epidemiology & Biostatistics), Mark Laret (UCSF Medical Center) and Diane Rittenhouse (Associate Professor Family and Community Medicine).
Some of the key points I took from the seminar included that:
• Research on alternative models of service delivery has played an important role in showing how things can be different and the potential improvements in quality and reduction in cost that might therefore be achieved by reform, particularly in primary health care and the ‘patient-centred medical home’
• There are significant challenges involved in implementing such complex reform, with changes in roles, responsibilities and regulations at both federal and state level; much of the implementation now lies with states
• Millions of currently uninsured people are expected to obtain insurance coverage over the next few years
• This increased insurance coverage will have a large impact on the demand for doctors, nurses and other health professionals – at a time when there are already significant shortages of trained staff, including in primary health care; ensuring the best mix of staff and the best use is made of clinical staff are therefore key challenges
• There are also challenges ahead for those who currently provide services to people who are uninsured: Will their clients continue to use these services and how should the services evolve? Will other service providers be able to deliver care effectively to this group, which often have specific social and cultural needs?
• There is a need for payment reform to ensure payments are fair, and this will play a major role in reducing cost-shifting between programmes
• The medical schools will need to train more people, but they also need to consider the role that non-physician caregivers might play, given the current and likely doctor and nurse shortfalls, and the need for training to promote increased team work
• There remain significant challenges for the legislation and its implementation – but even if legislative changes watering down the reforms are introduced as a result of the Republicans dominating the House of Representatives from January 2011, President Obama is able to veto these. However, funding appropriations to implement key measures may very well be affected, altering the reforms significantly.
We have also continued to do some more travelling. This included a trip to the South West USA. We visited Arches and Canyonlands National Parks, with their beautiful massive red rock formations, and Monument Valley, part of the Navajo Nation, also with beautiful rock formations, and made famous in various western movies, including ‘The Searchers’ directed by John Ford and starring John Wayne and ‘Back to the Future III’.
One of my favourite spots was Mesa Verde National Park, with its cliff dwellings built by the Ancestral Puebloan people – these are the ruins of amazing stone villages set into caves and under rock overhangs on high cliffs, built in the 1200s. We were able to walk down to one of the cliff dwellings and experience what it was like to live in these incredible places. 
My other favourite spot was, of course, the Grand Canyon. We visited the more popular South Rim. This was as awe-inspiring as we’d hoped – it’s 446km long, and up to 29km wide across to the North Rim, with layers and layers of different coloured rock making for a stunning sight. The canyon itself is thought to be about 17m years old; the rocks at the bottom are 2 billion years old, about 1.6km beneath the canyon rim. The Colorado River, responsible for carving out the canyon, looked so very tiny from the top of the canyon. The South Rim has a Trail that runs for 19km and is very easily walked along, and there are many trail walks down into the canyon, as well as the famous mule rides down; the walking back up is the challenge, especially given how hot it is on the canyon floor. 
We’ve also recently visited Lake Tahoe, in the Sierra Nevada mountains, about four hours drive north-east of San Francisco. The Lake is a lovely blue colour and very clear, surrounded by huge granite mountains. Again there are lots of walks up into the mountains from here, as well as a Scandanavian-inspired castle (‘Vikingsholm’) to visit, camping and swimming in summer, and ski-ing in winter. It was well worth the drive out there, though it was getting pretty chilly at the end of October when we did this trip!
Well that’s all my news for now. I do hope everyone is well and that you have all had a productive 2010. My thoughts go out especially to those living in Christchurch – I do hope that repairs to your homes and workplaces are going well and that the aftershocks will soon stop. Many people here are aware of the quake and have asked how things are; for many who have visited New Zealand, Christchurch is one of their favourite cities and they’re concerned about how the city and its population are doing.
Best wishes, and enjoy the last weeks of 2010!
Jackie
Here you can see pictures of the Parade for the San Francisco Giants, one looking down Market St towards the Ferry Building, the other overhead of the Civic Centre, in front of City Hall.
http://www.sfgate.com/cgi-bin/object/article?f=/c/a/2010/11/04/MNM51G6DMS.DTL&object=%2Fc%2Fpictures%2F2010%2F11%2F03%2Fmn-parade04_PH10_0502503201.jpg
http://www.sfgate.com/cgi-bin/object/article?f=/c/a/2010/11/04/MNM51G6DMS.DTL&object=%2Fc%2Fpictures%2F2010%2F11%2F03%2Fba-giants04_para_0502505306.jpg