US has the second worst infant mortality rate in developed countries

[Rachels]

Good heavens. I'm not even sure what commentary to make. This is shameful.

http://www.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/

And quotes from here:

http://www.gainesvilletimes.com/news/stories/20060531/opinion/99449.shtml

"The annual study found:

# The United States has more neonatologists and neonatal intensive care beds per person than Australia, Canada and the United Kingdom, but its newborn mortality rate is higher than any of those nations.

# Minority mortality rates are exceptionally high in the United States. The odds of newborn infants dying were 3.4 times higher in blacks, 1.5 times higher in Hispanics, and 1.9 times higher for other minorities, when compared to the rates for white births.

# African-American babies are twice as likely as white infants to be born with low birthweight, to be born premature, and to die at birth. The mortality rate for African-American babies is 9.3 per 1,000 births."

-Rachel
Mama to Abigail Rose
5/18/02
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Nursed for three years!

and Ethan James
10/19/05
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"When you know better, you do better."
Maya

[daniele_ut]

I believe it is sad that ANY infant has to die in this world, no matter the place. This is one of those taboo topics on most birth boards that I've visited. As an expectant well-educated mother in a large cosmopolitan city, with access to excellent healthcare, I never, ever suspected that I would leave the hospital without my child. No one, understandably, wants to scare expectant mothers, so when it happened to me, I thought at first that I was the only one. But sadly, it does happen a lot, too often. Personally, I think there are many factors at play. In this country there is a great disparity between rich and poor and many don't have access to quality health care or understand the importance of good prenatal care. I think the rise in multiple births, which are usually premature, is a huge factor in this as well. Women in this country have access to more fertility treatments than ever before, which can often lead to high order multiples born very early.

I'm glad that articles like this are written, because more needs to be done to prevent infant deaths. I participate in the March of Dimes Walk America to raise money to prevent premature birth. I volunteer for SHARE to raise awareness of infant death.

I think it is important to note that not all infant deaths are preventable. My daughter's death was a result of a birth defect and wasn't preventable, but my son's premature birth very well could have been prevented. In another part of the country or in a developing country, without access to a NICU, he might have diedas well.

I wish the article did more to address the solutions, rather than just citing statistics.

[egoldber]

This isn't exactly "new" news, and the info has been around for awhile. The US has actually improved a little bit as compared to recent years. I have a few thoughts.

First, the US is an extremely heterogenous society as compared to any of the other 9 countries in the top 10. Those other countries are all relatively small and have much better health care systems in terms of providing access to good prental care to ALL pregnant women.

Another complicating factor in calculating the statistics is that not all countries "count" neonatal deaths the same way. In the US, any live birth over 500 grams is counted, and some countries do not count all births that way. Most neonatal deaths are among preterm babies, not full-term babies, so this difference in counting would account for a lot of differences, although I will freely admit I have no idea how the other countries in the top 10 count neonatal deaths.

But the lack of access in this country by many women to adequate prenatal care is simply tragic. This need is especially important for at risk populations and I think the increased neonatal death rates among populations traditionally underserved by the healtcare system demonstrates the need to better serve those populations.

I think the fact that our prenatal care here is "OB based" rather than "midwife based" exacerbates the problem. OB care is expensive and midwifery care is relatively cheap by comparison. So by relying on OBs for "routine" prenatal care, it makes it harder to reach those populations since the cost is very expensive.

I too never dreamed I would be one of those people who would not be taking home a live baby. It is one of the taboo subjects and many people feel like it will never happen to them, when in reality it is a far mor common tragedy than we like to admit.

[bubbaray]

I agree with the PP that its probably hard to interpret the results directly to the US -- are all the countries counting the same thing?

I'm not sure all hospitals in LA are necessarily not as sterile as those in the US. I have a Mexican friend who tells me that the quality of care for those who can afford private medical/hospital care is actually better there than in NA. Not sure about SA. And, FWIW, DD was at a hospital in the US in March while we were on holiday. It had won some sort of award as being one of the top 100 in the US. DD's room in the ER was DIRTY. There was dried blood on the floor and bedside table. It was NOT sterile or even remotely clean. ICKY.

Comparing US infant mortality rates with other western countries would be interesting.

I read this article this week: http://www.theglobeandmail.com/servlet/story/RTGAM.20060530.whealth0530/BNStory/specialScienceandHealth/home

I think it sets out some interesting comparisons in the quality of care between the US and Canada. Maybe the higher infant mortality rates in the US track to the lack of insurance and pre-natal care?


Melissa

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[calebsmama03]

>I think the fact that our prenatal care here is "OB based"
>rather than "midwife based" exacerbates the problem. OB care
>is expensive and midwifery care is relatively cheap by
>comparison. So by relying on OBs for "routine" prenatal care,
>it makes it harder to reach those populations since the cost
>is very expensive.

Really well said, Beth! I agree whole heartedly with your entire statement, but this point, I believe, is the crux of the issue!

Hugs to you!

Lynne
Mommy to C 3/03
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And Miss Purple, 5/05

[Saccade]

\Maybe the higher
>infant mortality rates in the US track to the lack of
>insurance and pre-natal care?
>

That's the usual assumption. One theory is that a single-payer health care system would help, as a start.

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[kijip]

While there has been some improvement, this is a sobering reminder of racism and poverty in the USA.

I live in a state that provides prenatal and delivery care insurance for free for nearly all uninsured or underinsured women showing proof of pregnancy and I just took it for granted that other states did the same but have come to find that is not the case. The rate in WA has fallen and some gains have been made to close the gap on the racial disparity has well. I am thankful that this program exists in WA and know many women who have used it.

[KBecks]

I'd be interested in funding innovative healthcare programs or private charitable organizations in the states with the worst track records (MS, AL, GA) -- that would address the problems in those states, and work to find best practices that may help the outcomes. (If I were Melinda Gates!) I'd also be interested in the federal govt offering grant money to state and local programs that focus on this issue and over time, can establish a track record of making a difference.

I also wonder how alcohol and drug use play into the US numbers, especially among poorer women.

[kijip]

>I also wonder how alcohol and drug use play into the US
>numbers, especially among poorer women.

Drugs and alcohol are issues that bridge all class lines. Having lived in a very active drug selling area that was in a poorer area of the city with mostly minority residents while in college, I can say that I know the buyers weren't all my neighbors. ;)

ETA- I do think that drug use plays some role and wanted to beat the $#@( of of a girl that I knew who did cocaine while pregnant to make the baby stronger. The baby died shortly after birth :( But lack of money was not that girl's problem.

[KBecks]

True, one of our wealthier counties has been in the news a lot for herion use, dealing and such issues. Crazy stupid.

[tarahsolazy]

Beth's got it right on the head with the counting issue.

If you have a 21 week baby in the US, and someone listens to the baby's chest, and there is a heartrate of 20 (normal is 120-150), that is counted as a live birth, and a neonatal death. A baby at that gestation is not viable, BTW. We are the only country that does this.

We also resuscitate and try to save much smaller babies. In the Netherlands and much of Scandanavia, and I think most of Europe, very few babies less than 27 weeks are resuscitated. Here, almost all 24 weekers and many 23 weekers are. 23 week babies have a 70% mortality rate, nationwide. 24 weekers have a 25-50% mortality, depending on the hospital. We are also far more aggressive here about resuscitating babies with severe congenital anomalies like Trisomy 18, Trisomy 13, renal aplasia, etc, most of whom die within the 28 days for neonatal deaths. So all of those babies are not counted as live births in most other developed countries.

Not that our system is all that and a bag of chips, of course. There are big problems. Primarily the things Beth said.

[brittone2]

We're lucky to have you here, Tarah :)

IMO there are still major problems here, primarily the dispartities between races and classes, but it is interesting to learn about some of the discrepancies in counting. I know you've touched on it briefly before Tarah, but thanks for the detailed explanation.

[aliceinwonderland]

This is very interesting and I did not realise the US did that; thanks.

Also, I think the US just has more babies than similarly developed countries, period. I know Some Western countries, Italy and Germany notably, have a potential problem with not enough babies being born (what constitues sufficient numbers of babies is up for debate, obviously). I think both Russia and Portugal are proposing cash/tax break incentives to encourage people to procreate more...

[brittone2]

I just read this is happening in Japan as well. They are having fewer and fewer babies.

[daniele_ut]

"If you have a 21 week baby in the US, and someone listens to the baby's chest, and there is a heartrate of 20 (normal is 120-150), that is counted as a live birth, and a neonatal death. A baby at that gestation is not viable, BTW. We are the only country that does this. "


Thank you Beth and Tarah for pointing that out. I had forgotten to consider that fact.

[egoldber]

>I live in a state that provides prenatal and delivery care
>insurance for free for nearly all uninsured or underinsured
>women showing proof of pregnancy and I just took it for
>granted that other states did the same but have come to find
>that is not the case.

By federal law, every state has a similar program. However, having a program and having a GOOD program that is accessible and well understood by the population it is meant to serve is not at all the same thing.

Last year, my neice had a baby. She was 21, in college full time, and uninsured. She qualified for her state's (Kentucky) free medical program. But she does not have a car. Going to an appointment was an all day extravaganza for her involving 2 bus transfers. She also had to schedule these appointments around her classes. Going to WIC to get her other benefits was another office and yet another bus ride(s) away.

Due to her inexperience with medical offices, she found much of the jargon and terminology unfamiliar and frightening. She understood almost nothing about what she was told in regards to nutrition and other basic prenatal information. The staff at the clinic and other agencies were often very rude and condescending to her. Her OB was terrible at communicating with her. The system is confusing and convulated to say the least.

After her baby was born, there were NUMEROUS miscommunications at the hospital resulting in mix-ups in her baby's birth certificate, SSN, her assigned pediatrician, etc.

People who do this kind of outreach work with at risk populations need to have the proper training in how to educate the people they work with. And also about the other support services that may (or may not) be available to them. How this system works is simply a travesty, IMO.

[ppshah]

I understand there are systems problems in the US..but where does individual responsibilty factor in? Or do we no longer hold individuals responsible for the decisions they make in life?

[HannaAddict]

What if someone (married, responsible, non-drug taking or smoking adult) was pregnant and lost their job or their husband lost their job through no fault of their own? How long could the "average middle class" family afford afford the $1,200 - 1,400+ a month premium (before deductible and co-pays) to pay for health insurance?

Or a family without health insurance could use a midwife and have an uneventful birth and still face a $100k+ tab for two weeks in a NICU for a term baby after an episode of hypoglycemia two days after birth. I just think focusing on "individual responsiblity" does not get to the root issue of how health care services are paid for and delivered in this country and how that impacts mortality statistics like this. The problem isn't limited to those people who make poor personal choices. And even if the parent does make a poor choice, should the infant suffer the consequences?

Kimberly

[psophia17]

"What if someone (married, responsible, non-drug taking or smoking adult) was pregnant and lost their job or their husband lost their job through no fault of their own? How long could the "average middle class" family afford afford the $1,200 - 1,400+ a month premium (before deductible and co-pays) to pay for health insurance?"

DH and I were both unemployed shortly after DS's birth. We had health insurance up until DS was 3.5 months old. We couldn't afford any kind of premium, COBRA or otherwise, for more than one month. My parents paid it for us until we could get coverage through NY's free healthcare program. Here in Canada, there are problems as well, but everyone gets healthcare, and coverage for a family of 3 is roughly $100 a month in BC.

[KBecks]

I'm not sure, but I *think* that Medicare or Medicaid covers all children in the US. I heard that on a message board, and I don't claim to know much about the programs.

So, someone who is unemployed and pregnant could possibly be covered by those programs.

My biological half-sister, whom I recently met for the firs time, had her 2nd son on Medicare/Medicaid. They have no health insurance and are expecting their 3rd, and somehow she's getting prenatal care and has had ultrasounds. I have no idea how it's getting paid for, but they're apparently qualifying for some program. She lives in GA, one of the states mentioned with a bad track record. She and her husband were unmarried when the 2nd son was born, so she was a single mom w/o health insurance at that time.

As for personal responsibility, I find it odd that my DH and I, who have insurance and pay a lot for it, are tightening our belts this summer to pay our estimated $3k / $4k in deductible and co-pays and 10% of our share to cover our #2 son's birth. But, we can afford healthcare although it is expensive, and I'd rather pay myself and have some choices than be on assistance. I think the cost of births varies widely by insurance programs. We have a PPO. A friend has an HMO and will pay less than $500.

I agree though that making programs available to people is important, as well as some hand-holding and education. However, I think that the medical community can only do so much, and a social worker or public health nurse might be good to help with the follow-ups and things like that.

My former insurer (Humana) had a nice program where you signed up when you were pregnant, and a nurse would call about once a month, or at whatever frequency you wanted, to answer questions and chat about how you're feeling, exercise, diet, etc. etc. I found it very useful during my first pregnancy, and wonder if something like this would be a lower-cost way to reach out to people who may need some extra help.

[kijip]

>By federal law, every state has a similar program. However,
>having a program and having a GOOD program that is accessible
>and well understood by the population it is meant to serve is
>not at all the same thing.

The nice thing about the WA state program is that it covers all of the best hospitals vs. sending all low income mothers to a not so nice clinic and hospital. My SIL in FLO got sent to the worst clinic hospital I have ever seen whereas in Seattle, the women on this program were mixed right in with private insurance patients in birth classes and major hospitals with all private room birth centers. Also, there is a big public awareness of it - most people, especially those already getting public assistance know about and know to sign up. The Infant Mortality Prevention Network has set up an information sharing system between most agencies and charities working with low income mothers that promotes everyone from social workers to administrative assistants at charities and agencies to sign up mothers that they come into contact with.

>Last year, my neice had a baby. She was 21, in college full
>time, and uninsured. She qualified for her state's (Kentucky)
>free medical program. But she does not have a car. Going to an
>appointment was an all day extravaganza for her involving 2
>bus transfers. She also had to schedule these appointments
>around her classes. Going to WIC to get her other benefits was
>another office and yet another bus ride(s) away.

This is a huge issue. In my state (I work with new families at a family support charity so I have a lot of hands on experience here) women can get free transpotation with Taxi vouchers which helps a lot vs. having to wait for 4 busses.

[kijip]

>I'm not sure, but I *think* that Medicare or Medicaid covers
>all children in the US. I heard that on a message board, and I
>don't claim to know much about the programs.

Some states are eliminating child's health coverage or greatly reducing it. Even if they are eligible for Medicaid :( Medicare is for retirees.

>As for personal responsibility, I find it odd that my DH and
>I, who have insurance and pay a lot for it, are tightening our
>belts this summer to pay our estimated $3k / $4k in deductible
>and co-pays and 10% of our share to cover our #2 son's birth.
>But, we can afford healthcare although it is expensive, and
>I'd rather pay myself and have some choices than be on
>assistance. I think the cost of births varies widely by
>insurance programs. We have a PPO. A friend has an HMO and
>will pay less than $500.

We have always made insurance a budget priority regardless of cost and drive the cheaper car, spend less money, save more money to prove it. Come July the coverage level at my husband's work is being reduced and the premiums are going through the roof. To the point that now that we are not TTC, it does not make economic sense- we would be paying thousands more than we already are per year for the benefit of about 5 visits total per year per family barring a disaster like MS, breast cancer or an accident. SO we are dropping that coverage, buying catastrophic insurance for 1/4 of the cost that has a $10,000 out of pocket maximum per year. Then we will pay as we go for regular coverage. But there are 2 points that make this feasible for us: A- we would be able to handle $10,000 if the worst happened and B- We can pay the monthly premiums. But we are 2 wage earners supporting just one child and we both make a lot more that minimum wage. A new employee at my husband's work would be making about $9 per hour for the work my husband gets three times as much for after commission. The jobs are all 35 hours a week MAX. TWO workers EACH making what annulizes to $16,300 a year before taxes would have a snowball's chance in heck of supporting 1 baby in this housing market after childcare, rent, transpotation. Paying the $600 a month Macy's employees will be paying after this summer for insurance would be impossible unless they got free housing or something. If one parent became ill, they would not even be able to afford their rent. So what to do? Sign up for state insurance because it is cheaper and covers more. Macy's is basically counting on most doing what we are doing (buying differnt insurance if they make enough $$) or qualifying for state insurance if they are newer employees with a worse contract.

>I agree though that making programs available to people is
>important, as well as some hand-holding and education.
>However, I think that the medical community can only do so
>much, and a social worker or public health nurse might be good
>to help with the follow-ups and things like that.

Working in non profits, as I have for 5 years (3+ focused on families) I can say that FAR less hand holding is needed than we might think. People generally make the best choices that they have available to them (man, I am too much of an economist ;) )

On this note, I had a PHN call me after Toby was born and it really bugged me, but that is just me.

ETA: PPOs vary a lot. Yours has coinsurance of 10% and a deductible it sounds like. At the time that Toby was born our PPO was a $200 co-pay for the entire shebang from prenatal to labor to c-section to NICU to mama's complications. The insurance that we are opting out of would be 20% coinsurance with an INSANE monthly premium. I am just thankful that we are able to afford an individual plan that will protect us from the major surprizes and allow us a HSA for the out of pocket stuff. I daresay that I am very very lucky. I don't presume to think that others, who work just as hard as I do, are always so lucky.

[o_mom]

I'm sorry, but do you know how condescending this sounds?

I have friends who lost there baby due to complications from prematurity. They are both educated, employed, insured, she had great prenatal care and no risk factors. Yet, they still lost their baby. Are you saying that their baby died because of some choice they made?

Perhaps you should also consider that there is always a possibility that the most well planned of situations can go bad. Another friend's DH was notifed that his job was eliminated while they were at the hospital with their newborn. Certainly not in their plans.

While I think there are some choices that people make that could affect this, it is always a tragedy when a baby dies. I hope that what the PPs have pointed out about different statistics is true and that we are not doing such a poor job in this country.

[bubbaray]

I don't see how a newborn can be expected to bear ANY individual responsibility. The issue is infant mortality and if society wants to change that, society has to accept that newborns ALL deserve a good start in life, regardless of the circumstances (or choices) of their parents.


Melissa

http://b3.lilypie.com/rppJm7/.png[/img][/url]

[KBecks]

Katie, thanks for mentioning how you handle your health ins. I think I'm going to look into possibly doing the same. DH works for a small company and the premiums were just raised this year, they're quite high.

I think for the birth this summer, we'll come out even with what we're paying and what it would have cost to pay our own bills out-of-pocket -- barring a smooth birth without expensive complications.

Does your health insurer still get you the discounts on the services you use? That's one crazy thing I don't understand, is how the insurance companies are able to whack the prices so much, and how the prices must be artificial to begin with.

PM me if you want -- I'll email this to you as well. Anyway I'm not sure if going private would be a better deal, but possibly -- thanks!

[o_mom]

I was just having a conversation on medical billing last night. I was told that because of Medicare law, they have to bill everyone the exact same amount for the same service. They can then discount based on contracts with insurers or Medicare, but they have to bill everyone the same. Since Medicare and most insurers demand a discount, they have to set the billing rate higher so that they can actually break even after the discounts. This totally screws the self-pay patient. Many but not all hospitals will give a discount to self-pay people, but they have to ask and many don't know to.

[KBecks]

I didn't read the personal responsibility thing that way at all, I guess I read it as an expectation that people minimize the risk factors that they can control -- such as not using drugs, learning about basic nutrition, etc. etc.

But maybe I read it wrong. I just don't see the poster's intent as blaming parents who obviously have taken responsibility in their lives for the tragedies that occur, and could occur to anyone.

[Rachels]

The personal responsibility part bothers me because it gives those of us who think we're taking proper responsibility the sense that nothing like that could ever happen to us. And that's simply not true. It also suggests that if you make a poor personal choice and your baby dies, well, tough. I can't wrap my brain around that. When we say that individual responsibility is the crux of a mortality problem, what we're really saying is that there's not much we need to deal with on a larger social scale. Both are inaccurate.

-Rachel
Mama to Abigail Rose
5/18/02
http://www.gynosaur.com/assets/ribbons/ribbon_amethyst_36m.gif
Nursed for three years!

and Ethan James
10/19/05
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"When you know better, you do better."
Maya

[o_mom]

But it isn't worded that way at all. It comes across as a very flippant statement that the mortality rate is so bad because people aren't taking responsibility (whatever that means). There is no breakdown in the statistics of those who did everything right and those who didn't. Nor does there seem to be any allowance that not everyone has the means or the education to get and use the information.

[ppshah]

I'm sorry, I guess my language was not clear. I agree with many of the points made in this thread about infant mortality in the US. It may be we are comparing apples to oranges as far as the actual definition.
In addition our country is larger and more heterogenous than some others it's compared to. I also agree midwives are a great resource. During my medical school rotation on L&D, I got to spend a day with the midwives and birth was so much more relaxing. The midwife managed to coach a 16 yo through labor without pain meds or epidural and give birth without a tear. The best part was that everyone was so calm and no one was shouting "push, push".

I was never saying that if a baby dies it's because the parents made a poor choice. I've been working at a hospital as a pediatrician for years.....Even yesterday, I was heartbroken for this family whose infant has meningitis and the prognosis is poor. Just a few days ago they were probably laughing and cooing together.

However, I have also seen many parents that do make poor choices for their children. And, although children should not suffer because their parents make poor choices,that's just what happens. Maybe I'm biased after caring for newborns in a hospital where the AVERAGE age of the mother is 17. Where the social worker doen't even want to know about mothers smoking marijuana during pregnancy b/c that would be over 50% of the patients. So, I do think in individual cases, some of the reponsibility falls on the parents, but as far how much that contributes to the overall problem, I have no idea. But perhaps my comments are way off topic...so I will stop my rambling.

[kijip]

The thing with the catastrophic plan we are doing is that it has no maternity coverage. For us that works as I am getting an IUD this month and know that I will not want another child for at least several years. If a third child might be in the cards for you it might not be economically feasible to switch to a low cost plan. While the insurance may not save you much on an uncomplicated delivery, I just know that after Toby's $40K plus delivery I would not want to go without insurance for birth if a pregnancy was at all in the cards in the next few years.

To save on the out of pocket visits, dentists and vaccinations we are using a county heatlh care clinic near where I have moved in the suburbs and I am going to use my Planned Parenthood chapter for annuals. We will pay the full rate (as we make more money than the limit for a sliding scale) but they bill less to begin with. Where I am in the suburbs the clinic has no waiting list and is frankly as nice and as clean as our old, private ped family doctor in the city. As for hospital discount IME many/most do give a self pay discount, especially if you talk to the right person. I guesstimate that we will spend about $1500/year out of pocket plus $1992 for the catastrophic, just in case the unforeseen happens, insurance. Plus my complicated dental work and braces later this year that already would be out of pocket due to me reaching the max on our old dental insurance. Of course we will have to be prepared to pay the bill on random small things as well but I am willing to run that risk since we have a set out of pocket maximum that I can handle should the worst happen. The new insurance plans at my husband's work would run us almost $8000 a year in premiums alone then there would be HIGH co-pays, a higher deductible and coinsurance of 10%. A far cry from the $3000 a year we used to pay for insurance that basically covered everything with small copays and a $200 hospitalization copay. In a couple of years, I hope we have a better plan through work (J will be switching jobs in the near future).

[Saccade]

Thanks for the info on the stats! I had always wondered about this. So it's apples and oranges. Guess the media have their own reasons (a multitude of them, depending on the specific spin) for not pointing this out.

The business of not resuscitating under a certain age is also something I had forgotten. It can even vary from hospital to hospital within a region (I remember being on PICU/NICU night float at an outlying hospital where the policy was not to resuscitate babies who were under 26-27 weeks, when during the day I was working somewhere that tried to keep much smaller preemies alive -- it was a huge disconnect to go back and forth).

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[JulieL]

Just wanted to give a bit of support here as that has been my DH's experiance this last month in his L&D rotation, the average mother being 17 and so forth. Let's not forget that in some communities heathcare is still not taken seriously. While a girl may go to her OB appointments, she may not take her provider's advice and goes on to have unhealthy choices during her pregnancy - causing her pregnancy to be at a higher risk of problems. I see this as a community epidemic. This also spins right into eduction IMO. Here in St. Louis, many inner city residents will not take the free program of Parents As Teachers to help them with their parenting process, that would give them aids to all kinds of programs that I personally have used quite a bit, and the education for their infants. Why don't they take this free program (stats are quite low in the city of PAT participants), they are deathly afraid of social services. I have been told by those who work with PAT in St. Louis that even though they would never report a normal family to social services (only an abusive situation would ever be reported) that this is highly feared. I just think this situation has so many problems and so many places it needs to be taken more seriously.

This coming from a city where 2 years ago inner city schools were giving away free t.v.'s to inner city students just to show up the first day of school so they would get federal funding they need for those students.

My heart goes out to those in hard situations as my father was a single father of a baby girl whom both were abandoned by the mother in my first year of life. We barely made it living in very cheap housing straight in the middle of the city.

Discussion is the key though isn't it, and thinking of how we all can help in our own ways.