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MNAAP Newsletter

Reflections on Caring for Refugees in Lesbos, Greece

boys at fireBy Chuck Oberg, MD

As President Trump’s proposed U.S. refugee travel ban continues to work its way through the courts, I make a plea for benevolence and tolerance rather than that of fear.

I recently returned home from working in the refugee camps in Lesbos, Greece. I was volunteering with the Boat Refugee Foundation, a Netherlands based NGO.

I spent the majority of my time in the notorious Moria Refugee Camp. The camp is beyond description and is a surreal mix of an interment camp and shanty, squatter community encampment. Based in an old army compound, it is defined by the steel gates, high fencing and barb wire from the outside and an amorphous sea of tarps and tents on the inside. The weather had turned brutally cold. Over a foot of snow was followed by freezing rain. The cold and dampness penetrated to the bone. Food queues, inadequate unsanitary toilet facilities and ubiquitous garbage were the norm.

There are over 4,500 refugees. They had traveled from Syria, Iraq, Iran, Afghanistan and Pakistan from the Middle East. They came from across the African Continent with families from the Democratic Republic of the Congo (DRC), Ghana, Uganda, Somalia, Eretria and Sudan. In addition, I treated families from as far east as Bangladesh and west from Haiti and the Dominican Republic.

Almost all had experienced trauma. Some beaten, shot, tortured, and raped and all had experienced the stress of living in unlivable conditions. The complaints were a blur of physical, mental, and spiritual aliments.

Yet there was a palpable hope that one day things would be better with aspirations of a better future. Daily they expressed their gratitude that someone would listen as they shared the story of their journey, affirmed their worth, acknowledged their struggle and celebrated their humanity. You could see it in their eyes and their smiles that each was seeking a better life for themselves and their children.

I saw no terrorist. I just saw families, children, men and women–all vulnerable and suffering. So let us remember that our kindness will make us safer than any ban.

Legislative Update: 6,000 Bills and Counting

“When they come back, the real work begins,” said Gov. Mark Dayton as legislators began the Easter/Passover break on April 10.
Despite being almost three quarters complete (as of this writing in mid-April), the most difficult and consequential pieces of the 2017 legislative session yet remain. While almost 6,000 bills have been introduced in both houses of the legislature this session, the year’s most important task – crafting a two year biennial budget – remains on legislators’ “to do” list.
Both the House and Senate have passed budgets that fund state government, including the Health and Human Service (HHS) programs. As is always the case with budget bills that span more than 700 pages, there are pieces that the MNAAP can strongly support, and there are elements that we forcefully oppose.

Most directly, the Senate HHS funding proposals cuts physician reimbursement for services provided under MinnesotaCare and Medical Assistance by 2.3% in 2017 and by 3% in 2019. The House takes a slightly different approach, counting on new client eligibility verification tools and efforts to reduce hospital readmissions to save state resources. Should these mechanisms not create the savings the authors intend, reimbursement to physicians and other providers would be cut by up to $204 million. These cuts, on top of Minnesota’s already anemic payment rates, represent a real threat to continued access to care for Minnesota’s most needy children and families.

There are bright spots in the budget bills. Both the House and Senate include funding for several MNAAP priorities.

Eric Dick headshotChildren’s mental health receives significant attention, with funding for school-linked mental health grants, text-based suicide prevention programming, and support for first episode psychosis training.

Minnesota’s yawning racial and economic health disparities also receive some attention with funding included for nurse home visiting programs for prenatal and postpartum follow-up for at-risk parents, another MNAAP priority.

The House and Senate both fund the Safe Harbor program, an effort to prevent child sex trafficking while supporting victims.
Foster families also receive support via several programs that aim to assist foster children who are not adopted.

When session began, there were real concerns that the MNAAP would be forced to play defense to preserve hard-fought wins on a number of issues, as well as preventing dangerous proposals from becoming law. There are legislators at the Capitol who seek to roll back the newborn screening program, repeal a minor’s ability to receive health care in certain limited instances without parental consent, and make Minnesota’s already-weak immunization law even weaker. And while harmful bills regarding some of these issues were introduced, I’m happy to report that none of these proposals gained traction this session.

The end of session is now in sight, as the Minnesota Constitution mandates that the session end no later than midnight on May 22. If you haven’t already contacted your elected officials to share your perspective on these important issues, now is the time to do so.

Legislators do want to hear from you, and your voice as a pediatrician is amongst the most credible and powerful.

Highest Attendance Ever at Pediatricians’ Day at the Capitol

More than 160 pediatricians and trainees advocated for children’s health issues at the Minnesota Capitol on Tuesday, March 21 with access to care for all children as the top priority.
Donning “The Kids Sent Me” buttons, they broke out into small groups and met with over 60 members of the House and Senate, leaving behind business cards and fact sheets.
Emceed by MNAAP President Andrew Kiragu, MD, the program included a presentation by Eric Dick, the MNAAP’s lobbyist, on the political climate at the Capitol, as well as a closer discussion of issues identified as legislative priorities for the chapter.

The chapter’s central priority for 2017 is access to health care and health equity. Specifically, MNAAP has been advocating support for the nurse home visiting program for at-risk parents and newborns, investmDSC04684ent in school-linked mental health services, and the Help Me Grow program. Dr. Kiragu also shared with attendees the enormous negative impact that the American Health Care Act (AHCA) would have on state programs that support child health.

The program concluded with remarks from Senator John Marty (DFL – Roseville), who has been a strong supporter of children’s health at the Capitol.
Check out the #PedsDay2017 Twitter stream for some great tweets and fun photos. We’ve also posted additional photos at

A special thanks to those who couldn’t attend in person but made a point to call or email their legislators. Your voice is equally important.

Although Pediatricians’ Day at the Capitol is over, advocacy is an ongoing process. Watch for the chapter’s bi-weekly legislative updates and opportunities reach out to the individuals elected to represent you about high-priority issues.

We’re stronger together. Thanks for joining us to #PutKids1st

Legislative Session Begins Amid Many Unknowns

Eric Dick headshotBy Eric Dick, MNAAP Lobbyist

There’s an old yarn that states that elections have consequences. That’s especially true when the results are so surprising and dramatic, as they were in 2016. Donald Trump swept into the White House and, with his strong coattails in Greater Minnesota, the Senate Republicans surprised many by gaining control of the Minnesota Senate. Minnesotans have once again chosen divided government, with the GOP now holding both the House and the Senate, while DFLer Mark Dayton remains governor.

There are tremendous unknowns facing health care and children’s health – both here in Minnesota and Washington, DC. How will the Congressional Republicans seek to repeal the ACA? Will majorities in Congress seek to turn Medicaid into a block grant program? What might that mean for kids and their health here in Minnesota? Closer to home, can agreement between Governor Dayton and the GOP Legislature be reached to avoid a government shutdown once summer arrives? How will pressures from increasing health care costs impact access to care for young patients? What’s the fate of MNsure and MinnesotaCare? And will new majorities in the legislature seek to change laws governing newborn screening, vaccines, or minor consent? Simply put, it’s too early to tell on all of these questions.

The work that will dominate the legislative session here in Minnesota will be assembling a biennial budget, having received the Governor’s budget proposal in January. Legislators will craft their own budget in response and – if things work as designed – the two sides will negotiate a final budget sometime in May.

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When Your Legislator is on the Other Side of the Aisle

MikeSeversonBy Mike Severson, MD, FAAP

Registering for this year’s Pediatricians’ Day at the Capitol, set for March 21, generated a reflection on my 20 plus years of advocacy.

I have always enjoyed Peds’ Day but recall early on the anxiety that visiting with my legislator brought. Visiting an environment daunting in scope and history, coupled with a frenetic urgency by seemingly experienced participants can leave one feeling a bit inadequate. Then, of course, facing the reality of scheduled meetings with legislators and whether I’d be up to the task generated uneasiness in those early days.

What I came to realize is that addressing the challenge of these encounters is pretty easy for pediatricians. If you think about it, these brief visits are a lot like the office visits we perform multiple times each day. We have a very brief amount of time to develop a sense of trust and rapport to deliver specific information about topics we know well. Remember, the legislator has been elected to represent you and hear your opinion.

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