Enclothed Cognition

In celebration of National Midwifery Week, Medelita presents daily entries from the journal of Becky Carlton, BSN, CNM, an American midwife recently in Libya during the ongoing revolution. May 19, 2011 10:19pm The docs today were telling me how you can tell what kind of munitions are coming round. Dr E, who is a sharp, angular, opinionated whip of a doctor was describing it to me. “Pshzzooooooooow-CRACK is grad missile!” (This one, I’m too familiar with) “Pshoooooooooow……………..(long pause) Boom, is houn” (mortar) “boom, boom, boom, Boom BOOM BOOM is NATO!” It’s so funny when she says it…we were all laughing. But in the end, most people here have lost something precious. If not their homes and families, at least their peace of mind and security. They are feeling more comfortable now that the bombing is farther away most of the time, but there is no question that they are traumatized. We, on a much smaller scale, are affected, too. Anytime a door slams, many of us jump or cringe. Even when G__ opens a soda, it makes me jump. He always apologizes. He was there, when the missiles were exploding around us. There are things a person can do to protect themselves. G and I have taken to leaving the windows down when we are in the car. If there is a blast, better to just get shrapnel, than shrapnel plus glass. Our house windows are taped up with clear packing tape while we wait for the anti-blast film. When we dive for cover in the hall, we shut doors and have removed the interior ones with glass in them. In reality, the house structure is not that much safer, but I feel safer there. If you are in a car and shelling begins, you are actually supposed to leave the car. Oh, that would be hard to do! We have been feeling safer the last few days, but it is false security. The front line is not secure and we are not out of range. Medelita Guest Blogger: Becky Carlton, BSN, CNM. Becky is currently working as the Midwifery Dean at Gimbie Adventist Hospital in Ethiopia. Becky has been doing missionary work for many years, with such organizations as the Peace Corps and Doctors without Borders (MSF).

In celebration of National Midwifery Week, Medelita presents daily entries from the journal of Becky Carlton, BSN, CNM, an American midwife recently in Libya during the ongoing revolution. May 9, 2011 4:22pm I read this last night and started laughing uncontrollably. It’s actually a story about Nepal, but it could be a snapshot of my life in Africa—absurd and, somehow, outrageously funny. Thomas Hale on impromptu outpatient clinic activities: “…since Cynthia by this time had begun holding gynecology clinic in the examining room, I set up shop in the crowded waiting room. One man had an anal condition, so everyone had to face the wall while I examined him, his behind to the window so there’d be enough light. The only problem came from the giggling spectators looking in from outside.” The imam sings over the mosque loudspeaker, bombs explode in the distance (some rattling the windows) and we all sit with our computers compiling statistics, writing reports, organizing stock data, and wondering what our cook and his wife will make for dinner. It was a rather slow day at the hospital. Monday is Statistics Day, epidemiological week 18, and data collection took up lots of the day since we were obliged to drink tea several times. We had a nice set of twins this morning in Delivery. One boy. One girl. Can’t complain about that. It is good to have time to sit and chat with the staff. Many have symptoms of post-traumatic stress. We must remain neutral in our position regarding the Libyan conflict, but I think it is somewhat therapeutic just to let them talk. Many come to work as they have for months without pay because it is easier to not think about what has happened to them if they have things to keep their hands busy. The city citizens have organized themselves in some remarkable ways. In most places, a conflict like this would push prices up to ridiculous levels. Somehow, they managed to actually drop prices (petrol is .25/dinar/liter while it would be about12 dinar/liter in the US right now ($4.50) Food is being distributed to different districts free of charge to the people and someone delivers hot food for the hospital staff and patients daily. They are all sharing and donating to the cause. I talked to a pharmacy student today in the outpatient pharmacy. She was telling me that her family’s house was destroyed, so they moved to their other one. Then that one was destroyed, so she and her family are living in a school with dozens of other families. (while writing this I have moved into the hallway—the designated “safe room” of the house since the explosions are close and loud and scaring me a little. I’m still really jumpy after last night). I believe in the value of the project we are doing and I think the risk we chose to take by coming was a calculated one. I do ask myself, though, when I’m lying on the floor against the wall protecting my rib-cage and listening to the explosions coming closer, why am I doing this? In the end, I’m happy to be here. I love the project, the expat team, the staff, and the patients. It’s a great project and wonderful adventure. I only hope we can make a real difference in helping them recover. Medelita Guest Blogger: Becky Carlton, BSN, CNM. Becky is currently working as the Midwifery Dean at Gimbie Adventist Hospital in Ethiopia. Becky has been doing missionary work for many years, with such organizations as the Peace Corps and Doctors without Borders (MSF).

National PA Week is celebrated every year, from October 6-12. It is a time to support, celebrate and recognize PAs, and increase public awareness of the PA profession. In the United States, Physician Assistants are a relatively new addition to the healthcare industry. The first class of PAs graduated on October 6th, 1967 - a date later adopted by the AAPA as National PA Day. However, the concept of a Physician Assistant was not new to the world as a whole. In 17th century Europe, German military medical assistants were utilized extensively on the battlefield to confront the serious lack of doctors against the number of wounded. Peter the Great soon saw tremendous potential in this system and introduced "Feldshers" into the Russian armies around 1650 - shortly after the war of Austrian succession, which inflicted heavy losses to the Russian Cavalry. Over the next century, practice within the armies and navies of Europe to train and appoint young soldiers or sailors as doctors assistants became more common. However, it wasn't until the mid-20th century that the concept of the Physician Assistant officially came to the United States. In 1959, the US Surgeon General had identified a shortage of medically trained personnel, and two years later, Dr. Charles Hudson, in the Journal of the American Medical Association, called for a "mid-level" (a term no longer in use) provider from the ranks of former military corpsmen. In 1965, Dr. Eugene Stead, Jr. introduced a two-year Physician Assistant program, and the first four physician assistant (PA) students, all ex-Navy hospital corpsmen, began training at the Duke University Medical Center. Reader's Digest wrote an article that year about jobs in the health care industry and mentioned the development of the PA program at Duke University - which caused a flood of inquires from ex-military candidates. Over the next few decades, the Physician Assistant profession grew at an extraordinary rate and today, there are over 81,000 certified PAs in the United States. Medelita is a PA-founded company, and as such, PAs have a special place in our collective hearts. In celebration of National PA Week, we will be highlighting exceptional Physician Assistants from all over the country, in many different specialties and with a variety of achievements.

In celebration of National Midwifery Week, Medelita presents daily entries from the journal of Becky Carlton, BSN, CNM, an American midwife recently in Libya during the ongoing revolution. May 8, 2011 7:08am In Misuratah, Libya, I sit on the marble patio of the beautiful house we are staying in and listen to the sounds of people waking up. It is cool and I am thankful for the sweater that I put on. Roosters crow in the periphery and a light breeze wafts north-eastward. It would be a peaceful place to have my morning quiet time, but I hear shelling in the distance. Black billows of smoke from the flaming city diesel reserve blow in the sky over the house. I wonder to myself how many of those parachuted mines dropped into the city last night and who will find them today and in the weeks to come. I yawn. Plans, nerves and sleeping on a blanket on the floor hinder normal sleep. Another five staff arrived yesterday with pharmacy stock. We were supposed to find another house for our team, but have not been successful so far as the city citizens are now moving north as the fighting line moves south. With 22 of us now, there are five in my room and it is cozy. Really, who can complain, though when the townspeople are 5-6 families in home? I debate with myself whether I post this for people to see since my family is likely to read it and be nervous. The project is with Doctors Without Borders (MSF) and we are trying to help the city maximize maternity and pediatric services in the new, too-small facility that they have found themselves in since last Saturday. They moved main services twice due to heavy shelling and finally landed in a small hospital with 18 beds. In this culture, women are accustomed to going to the hospital to deliver, but due to difficulty in movement and security, many are delivering at home with their frightened female relatives. Imagine if, all of a sudden, American women were forced to face shelling or have their babies home or both! High rates of previous c-sections increase the risk for many. In the hospital, where the staff have shown remarkable resilience and ingenuity, they deliver sometimes 20+ patients a day using two labor beds and two delivery beds. Sometimes we don’t have a place for a woman to go after she gets off the delivery table and she has to sit in a chair for a bit before we discharge her. Today, some volunteer engineers start moving containers onto the hospital lot to increase our capacity. We plan to move the outpatients to bungalows outside and to hopefully open up new beds for our patients. We would also like to have a place to put post-op patients where we can keep a better eye on them. Pharmacy order needs organizing into a useable pharmacy…lots to do today. Better go look for some breakfast…have a lovely, safe day! Medelita Guest Blogger: Becky Carlton, BSN, CNM. Becky is currently working as the Midwifery Dean at Gimbie Adventist Hospital in Ethiopia. Becky has been doing missionary work for many years, with such organizations as the Peace Corps and Doctors without Borders (MSF).

In celebration of National Midwifery Week, Medelita presents daily entries from the journal of Becky Carlton, BSN, CNM, an American midwife recently in Libya during the ongoing revolution. May 7, 2011 7:00am During the night I gradually became aware of shouting, loud explosive noises and eerie light. Some people left their beds to be in the hall, but by the time it registered for me, it was already over. I rolled under the bed next to me. In the end, it would probably happen so fast we’d not have time to react. The Libyans joke, “If I can hear the bomb, it is not for me!” Sad. True. Turns out that someone on the pro-Gaddafi side got an explosive of some kind and lobbed into one of the fuel reserve tanks in the port. Seventy-five million liters of gas make quite a sound when exploding. Ironically, my sleeping mind told me that it was merely an Ethiopian thunderstorm. Things were slow at the hospital yesterday since Friday is a rest day. Sadly, the MSFF pharmacy had a fire last night. Nothing was destroyed, but everything is black with ash and the clinic will have to be cleaned and painted before use. What the Libyans have done was really quite remarkable. I doubt we’d have set up a decent hospital in the States after moving twice due to shelling. They adapted well. Now, they need organizational support and more beds. My other concern is the apparent complete disregard for sterile technique. These are highly educated medical people, but it almost seems there is no belief in microbiology. Sterility doesn’t exist, nor is there any attempt to create it. Will need to explore this further since it seems pervasive and to be accepted even by the senior consultants. Heavy bombing right now (18:36) for the last hour or so and probably through the day, but it’s hard to tell what is bombing and what is shelling inside the hospital. To feel better, I tell myself it’s construction or thunder. I pray that people will not be hit. 10:35pm Shouting on the porch “…bomb…!” Everyone ran to center of house to lie down. The psychologist and Field-Co were sitting on the porch and saw an explosion high in the air, then they saw little parachutes falling from the sky. This would be consistent with the picture of the landmines that a doctor showed me yesterday. We all lay on the floor for a few minutes, while they told us what they saw. When do you get up? I guess a mine won’t blow until you step on it anyway or drive over it, etc. Good honk! How will I sleep now? Heavy shelling during med meeting and all evening. Seems very close! Very frightening! Everyone runs inside to hide in the inside hallway with our hearts racing, but there is really little we can do. The hits are random anyway. Not feeling very brave tonight. Medelita Guest Blogger: Becky Carlton, BSN, CNM. Becky is currently working as the Midwifery Dean at Gimbie Adventist Hospital in Ethiopia. Becky has been doing missionary work for many years, with such organizations as the Peace Corps and Doctors without Borders (MSF).

In celebration of National Midwifery Week, Medelita presents daily entries from the journal of Becky Carlton, BSN, CNM, an American midwife recently in Libya during the ongoing revolution. April 29, 2011 8:17am If you had told me a week ago that I'd be where I am right now, I'd probably have laughed. Not that my life hasn't been an adventure so far, but who'd have thought Egypt in April? MSF (Doctors without Borders) called me at 7:15am on Friday, April 22. Yael said to my sleep-washed brain, "Can you go to Libya on Tuesday?" Now, I've always wanted to visit North Africa, but you have to keep in mind that a civil war just started in Libya. After some 40 years under the rule of Muammar Gaddafi, the people decided that they didn't want him in charge anymore. The situation is bad enough that they are showing clips on Libya and Egypt on American television. So, Yael is waiting for me to respond. My foggy brain is trying to make a snap decision. Ummmm....sure. It's only for a month. It'd be bad PR for MSF if I got blown up, so they probably won't let that happen. I'll probably not get another chance to ever visit Libya. Maybe I can help some people. Why not? I hum to myself, "I'm Libyan on a jet plane...don't know when I'll be back again...." Ever since I saw the song "Libyan on a Jet Plane" listed in a Philippine karaoke book, I've thought it was funny. Of course, I have an itinerary, but life is uncertain. You never know when you'll die in a car accident, bust an aneurysm or get blown up by a mortar. Now, I'm headed to Libya, in an Egyptian taxi. Life is interesting. April 30, 2011 11:13am In Benghazi, Libya watching Aljazeera news feed: Gaddafi claims to have the port in Misurata in his troops’ control. NATO claims there is no evidence for this claim. Gaddafi is saying that humanitarian workers trying to access the harbor should come by land to be “protected” by his troops or risk shelling. He has mined the harbor. This is not exactly the thing a person wants to hear just before setting out in a humanitarian aid boat headed for that port. Gaddafi’s tactics are well-aimed at the psyche, I’d say. We are planning to leave today for Misurata with a proposed 20-hr journey. Nothing like wondering if he’s actually mined the harbor to make a person nervous! I think in my head of the “worst night of my life” that happened back when I was 19 on a small boat traveling from Majuro in the Marshall Islands to the atoll of Ailinglaplap, some 200 miles away over open ocean. It might not have been so bad, but I’m pretty sure that I had Dengue Fever at the time. After a day out in the sun, a night out in the rain trying to sleep on a wooden crate, temp 103.3, my bones aching so badly that I thought they would explode, I almost wished I’d get washed overboard into the sea and disappear. I anticipate that this trip will be better. Met the other midwife today. Daphne. I liked her immediately. Things seem so normal in Benghazi, but a couple blocks away the buildings are pock-marked with bullet holes and the windows recently blown out. Gaddafi’s troops were stopped at a bridge 3 or 4 blocks down. As we drove into Benghazi yesterday, the main road was blocked by demonstrators who were “happy firing” anti-aircraft weapons and AK47’s. I could feel it in my chest when they blew off the anti-aircraft guns. Today, a car passed with a little girl hanging out the window. She smiled happily as she fingered her plastic machine gun. Things continue to disintegrate in Syria, now Uganda, and Yemen. The Arab world is a mess, and I sort of hope my parents are not seeing things about Libya in the news. Medelita Guest Blogger: Becky Carlton, BSN, CNM. Becky is currently working as the Midwifery Dean at Gimbie Adventist Hospital in Ethiopia. Becky has been doing missionary work for many years, with such organizations as the Peace Corps and Doctors without Borders (MSF).

Which medical professional do Ancient Egypt, the Greco-Roman Age, Medieval England, and Modern America have in common? The answer is 'Midwife'. Ancient Egyptian papyrus details Midwifery as a recognized female occupation, dating back to approx. 1900 BCE. In Ancient Greece and Rome, Midwifery included a wide range of women, including 'wise women' who continued folk medical traditions, trained midwives who garnered their knowledge from a variety of sources, and highly trained women who were considered female physicians. Throughout history, midwives have been known by many different names, ranging from iatrin? (Greek for nurse), maia (Greek for midwife), obstetrix (Latin for obstetrician), and medica (Latin for doctor). The actual term midwife, however, comes from the Middle English word midwyf, literally meaning "with-woman." Known primarily for assisting with childbirth, Midwifery is a health care profession that provides care to women throughout their lives. Today, more than 300,000 women a year in the US partner with midwives to navigate birth, puberty, menopause, and other normal life stages. Midwives perform physical exams, prescribe medications including contraceptive methods, order laboratory tests as needed, provide prenatal care, gynecological care, labor and birth care, as well as health education and counseling to women of all ages. National Midwifery Week was created by American College of Nurse-Midwives to celebrate and recognize American midwives all across the world. In celebration of National Midwifery Week, we're going to be hosting a series of posts from one of our colleagues, Becky Carlton, BSN, CNM - a midwife currently working in Ethiopia. Through Doctors Without Borders (MSF - Médecins Sans Frontières), Becky traveled to Libya earlier this year into the heart of a revolution. What is known as the 2011 Libyan Civil War began in February and is an ongoing armed conflict being fought between forces loyal to Muammar Gaddafi (the autocratic ruler of Libya who seized power in a military coup in 1969) and his regime and those seeking to depose him. With some details removed to protect the safety of those involved, Becky has agreed to share her experiences with us. I will be posting an entry from Becky's journal from Libya every day for National Midwifery Week - allowing us all a rare opportunity to see the medical frontlines through the words of this exceptional midwife. Journal From Libya: Part 1 Journal From Libya: Part 2 Journal From Libya: Part 3 Journal From Libya: Part 4 Journal From Libya: Part 5 Journal From Libya: Part 6 Journal From Libya: Part 7

I CONSIDERED WRITING THIS BLOG POST IN ALL CAPS but quickly reconsidered. It was harder to read, wasn't it? Seemed like I was yelling? It took up more space too - approximately 35% more space according a 1955 study by Miles Tinker. Miles coincidentally also noted that his study participants took far longer to read all-capital text than they did for lower case. Exactly forty years later (the world of capitalization seems as slow to evolve as the world of unisex scrubs), Colin Wheildon conducted another scientific study on "all-caps" and concluded that "Headlines set in capital letters are significantly less legible than those set in lower case." In the advent of internet communication, ALL-CAPS has even become the text equivalent of shouting. So with hard to read, sort of rude, and takes up more space staked against it, why do we still use all-capital text? [caption id="attachment_922" align="alignright" width="300" caption="Women's Embroidery - Caps vs. Lower Case"][/caption]For most, all-caps are a way to provide emphasis or clarity. In the case of embroidery, I'd venture to say the reason is mostly to ensure that letters are not misinterpreted and mistakes are not made. But on top of those aforementioned flaws, all-capital text doesn't look that great embroidered on a beautiful, professional, and sophisticated lab coat. Our script fonts, especially, do not translate well into all-capital text, as the pictures show. [caption id="attachment_923" align="alignleft" width="300" caption="Men's Embroidery - Caps vs. Lower Case"][/caption]As a company that truly does care about its customers, we go to great lengths to ensure that your garment is as perfect as possible. For that reason, when we see an embroidery request submitted with all-capital text, we tend to contact the customer to make sure it's what they wanted. 9 times out of 10, the customer was just trying to ensure that their name was not misspelled. The trouble with this is that once we flag an order for clarification, it gets taken off the projected timeline - delaying completion and shipment beyond what was stated at the time of the order. We don't want anyone having to wait longer than necessary for any product they purchase from us, so it's important to enter your embroidery requests EXACTLY (all-caps for emphasis!) as you wish it to appear on your coat, including capitalization, punctuation, etc... If you're not sure or you're worried about something not being clear, then give us a call! We're always happy to help - we embroider hundreds of garments every day, and as our embroidery liason, Cindy, might say, we've become 'Gurus' on the subject of what looks stunning and what doesn't.

Interacting with our customers on Facebook is one of the most enjoyable parts of my day. It's a privilege to be involved with our community of medical colleagues, experiencing firsthand the positive impact that Medelita has had in their lives. It's a pleasure, also, whenever I have the opportunity to give one of our fitted, beautiful, and sophisticated garments to a member of the deserving medical community.

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