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Melissa Hortman was the best of us….The Big Beautiful Bill is the worst of us.

Melissa Hortman, the Minnesota legislator that was assassinated along with her husband, exemplifies how one person in government service can effect change for the good of many. She was the Speaker of the House in Mn in 2023, when Democrats controlled both the House and Senate by narrow margins. Her leadership paved the way for free lunches for public school students, protection of reproductive rights, increased funding for pre-school programs, restoration of voting rights for ex-felons and paid family leave. Her message to colleagues was “Do as much good for as many people as possible.”  She led selflessly and worked across the aisle to to enact bipartisan legislation whenever possible. One of these policies resulted in police reform and banning the use of chokeholds. Her final legislative act was the most courageous. In a evenly divided House, she agreed to be the single Democratic vote that took away subsidized healthcare from undocumented MN residents so that a balanced budget could be passed and saved thousands of state workers from a government shutdown.

If Ms Hortman were alive today, only 2 weeks after her death, she would be appalled by the Big Beautiful Bill and the vast number of people that it will harm. This time we won’t be taking healthcare away from undocumented people, but from American citizens. As the cost of groceries continues to rise, we will take away subsidized food programs that many Americans depend on to help feed their families. Many Planned Parenthood sites will need to close as they lose Medicaid funding for contraception and cancer screening. It is expected that 1 out of 4 nursing homes will close, especially those in rural areas of the country as they are more heavily dependent on Medicaid funding. Since 40% of births are funded by Medicaid, many women will be unable to access prenatal care. In rural areas, that percentage is 50%.

This legislation should be retitled. “Do as much harm for as many people as possible”. Reward those who already have too much money and harm the poor, elderly and children. If you look back on history, this has always been a recipe for disaster and never one for good. America has been at it’s best when we are united in caring for each other and advancing policies that provide a hand up for those who are less fortunate.

We have important work to do in the next few days. Call you Senator/Representative and explain why you are opposed to this bill. Talk to friends and family about what is in the bill and why you are concerned. Sharon McMahon’s message in “The Small and the Mighty” is that ordinary individuals, through consistent, concerted effort, can create significant change. She emphasizes that even small actions, when done by many people, can have a powerful cumulative effect. If you haven’t yet read the book, I would strongly encourage you to get a copy. She is a MN author who provides hope for what we can accomplish.

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My Families’ Journey with Modern Medicine

Memorial services for departed family members are often a time to connect with relatives and hear family lore that you may have forgotten. And sometimes those stories of old provide insights into how far we have come and lessons that can be learned.

I was at a memorial service for an elderly uncle (age 93 when he died) when his son reminded all of us that his dad had lived a much longer life than expected due to the strides made by modern medicine. Those family members in the generation prior had all died by age 65 of heart disease. My uncle and his brother (my father) also had early onset heart disease but benefitted from medication, cardiac bypass surgery and cardiac stents. My uncle also developed kidney failure, which was managed with medication prior to his passing.

Viewing the family photos that day reminded me that our family had not always been so fortunate. The first born child of my aunt and uncle had been a daughter who subsequently died at age 2, probably related to influenza and dehydration. Another female cousin had suffered the effects of her mother’s exposure to Rubella (German Measles) while she was pregnant. My cousin had developmental delays, deafness, small head size and poor speech. Much of her life was spent in a group home.

Between 1960 and 1999, deaths due to pneumonia and influenza among infants decreased from 314 per 100,000 live births to 8 per 100,000. As of May 15, 2025, the Centers for Disease Control and Prevention (CDC) reported that 226 children had died from the flu during the 2024-2025 season. This is the highest number of pediatric flu deaths since the 2009-2010 influenza pandemic. This is not because we don’t have the tools to protect these children; it’s because we have lost sight of the need for everyone to be part of the solution by getting vaccinated and decreasing the prevalence of the disease.

Due to a vaccine campaign, Rubella was officially eradicated in the US in 2004. Unfortunately, we are seeing record numbers of measles cases (1024 so far this year, along with 4 deaths) due to inadequate vaccination rates in children. When do we cross the line between individual rights and our failure to prevent harm to others?

History can educate us as to the progress we have made in medical treatments as well as remind us how privileged we are to live presently. In the late 1800’s, bovine tuberculosis was the primary cause of infant mortality. Pasteurization of milk has obliterated that disease. Around that same time, entire cities in the western US, such as Colorado Springs, were established as a place for tuberculosis patients to breath fresh air, rest and recover. This treatment did not change the course of their disease. The development of antibiotics not only cured those with tuberculosis, but also reduced the chance that their family members would develop the disease.

Whooping cough, or pertussis, is a highly contagious bacterial infection that affects the respiratory tract. Infant mortality from pertussis in the United States was 4.5 deaths/1,000 in 1900 but decreased to 0.003 deaths/1,000 by 1974. Infants are most susceptible in the first 6 months of life, when they are not fully vaccinated and have less immunity. Vaccinating pregnant women has been found to increase immunity in newborn infants, as the mother’s immunity passes thru the cord blood. Unfortunately, many pregnancy women are now declining this immunization and we have seen increasing rates of hospitalizations.  Nationally, 35,435 cases were reported in 2024, a significant increase compared to 7,063 cases in 2023, according to the CDC. Ten children died from pertussis, while many more children will suffer life long complications of respiratory compromise due to the disease.

The history books are shouting at us to read them and learn from our past. We don’t want our children to live in a world that is less healthy than what their parents and grandparents experienced.

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I Was a DEI Hire

The majority of Americans picture an inner city person of color when DEI is mentioned. In 1979 (when I graduated from high school), I lived the concept of a DEI hire before the acronym was conceived and I was the opposite – white, female and rural. Out of 34 high school graduates in my small town, only 2 of us went on to a 4 year college. We didn’t have a high school college counselor and neither of us had parents who had attended post secondary school. Researching colleges, scheduling interviews and filling out financial aide forms was a solitary experience.

The college I attended was located in a rural part of the state but the majority of students were from larger cities. My classmates had access to advanced classes in high school that I did not. Freshman year college calculus was my personal nightmare while for most of the students was a review course from high school. A full year of Spanish senior year of college was my initial exposure to a foreign language and squeaked out a C+, despite numerous extra hours in the listening lab. The college acceptance committee reviewed my application knowing I would struggle that first year and gave me a spot despite that information.

My parents did not have the financial resources to afford a college education. Attending a tech school and graduating with a trade was their experience with post secondary education. A liberal arts school with a pre-med major did not compute with a means to repay my extensive college loans. The college would have made a better bet for repayment with a family that had the means to afford their child’s education.

While most of my classmates were spending summers and holiday breaks on unpaid internships or vacations with their families, I was waitressing, nannying and cleaning houses to earn enough money to afford books and spending money. My medical school application was bereft of research or internship experiences and yet I was placed on the waiting list at the University of MN Medical School at a time when only 27% of medical students were female.

Despite this, all of the above is what kept me moving forward. I had very few who thought I could succeed but I realized if I worked harder than those around me, I could attain what came more easily for them. Proving the statistics wrong and knowing that I wanted a different life than the life of most of my high school classmates helped me to succeed. I see that in the current DEI hires. They often work/study harder despite less opportunities in their early careers. Whether they are female in a majority male profession, male in a majority female profession, a person of color or from an immigrant community, these are the people who I can relate to.

Paul Wellstone, the late MN senator from 1991-2002, said it best. “We all do better when we all do better”.

My favorite tshirt!
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We All Need To Do Better

Earlier this week a physician friend and I ate a wonderful meal at a somewhat pricey Minneapolis restaurant. Since we had both grown up in a similar part of rural Minnesota, we reminisced about how our lives had changed over the past 40 years. Both of us grew up in families where eating out at a restaurant or taking a vacation were not part of our daily lives. Food budgets were tight and supplemented with summer garden produce as well as local meat and dairy. It would have been impossible for our young selves to imagine a future where we could both afford and appreciate the meal we were eating.

It’s a much different story for the 20% of Minnesotans that are food insecure or the 18% that rely on an emergency food system to fill their plates. Although grocery prices have decreased since the onset of the Covid pandemic, they are still 30% higher than 2019. Children in these households may often go to school hungry, which affects their ability to learn. Food can also be considered medicine, as healthy food choices can prevent many chronic diseases.

At the same time as we are experiencing unprecedented food insecurity, 40% of the food that we grow in America ends up in a landfill. Consumers, not grocery stores or restaurants, are the biggest culprits contributing to this waste. We purchase more than we can use, often overfill our plates and seldom eat leftovers, resulting in $1500 of food wasted each year for a family of four. That wasted food fills up 20% of our landfills and breaks down into methane, a potent greenhouse gas that is 21 times more powerful than carbon dioxide.

Now for the good news. There are wonderful organizations in Minnesota that work to rescue food from grocery stores as well as stock food banks with healthy choices. Last week I had the chance to volunteer at two of them; Food Rescue US and Second Harvest Heartland. Using an easy to navigate app, I can sign up for a food rescue, picking up food from a grocery store that is nearing the end of its shelf life and transporting it in my car to a nearby food program. Second Harvest uses volunteers to pack boxes of food assembly style to be distributed to participating organizations.

Funding to these organizations is in jeopardy. The proposed reductions in SNAP benefits to individuals and federal funding grants to the organizations is causing this threat. We are the richest country in the world and yet we tolerate letting 20% of our population worry about where they may get their next meal, while throwing away 40% of the food that we grow. The irony is incredible.

As individuals, we can only do so much to change what we see as wrong in this world. Reading this article may help to increase awareness of the problem and compel you to volunteer. Donations of money to food banks are always appreciated as the dollars can be used to purchase food in large quantities for a much lower price.

My contribution is that I have committed to hosting a dinner at our house once a month for 3 months, with donations for the meal going to the above organizations. The first dinner will be Friday, March 28th with homemade soups, sourdough bread and dessert. If you would like to attend, please email me @ jaegerleslee@gmail.com. And try to waste less food in your everyday lives!

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We are all Immigrants

Earlier today I drove thru the Irish Canyon in northwestern Colorado that contained Indigenous rock art from 400 AD. It is estimated that the ancestors of the current Indigenous Americans crossed the Siberian peninsula 30,000 years ago. Most of us are much more recent immigrants to America.

The importance of immigration to America and the how and why of our ancestors arrival needs to be viewed from the lens of history to better understand our current circumstances. I was allowed a peek into the reality of what many Asian women immigrants experienced when I saw “The Heart Sellers” at the Guthrie Theater. The play features two women, one Filipino and one Korean, who came to American with their husbands following the passage of the Hart-Celler Act in 1965. Immigrants in STEM fields were prioritized, drawing in many immigrants that were doctors, nurses and engineers. Due to concerns over an increase in immigration from non European countries, many of these immigrants faced discrimination from their new neighbors. Sound familiar?!

Following the end of the Vietnam war in 1975, 1.2 million refugees have immigrated to America. They came not for highly skilled jobs, but because their lives were in danger from the Communist government as many of these Vietnamese had assisted the Americans in the war. The same was true of Afghani refugees 40 years later as they fled the Taliban government. My own daughters are immigrants from Korea and China, due to social factors in their birth contries.

In one night at the play, I was touched by three of these immigrants. My friend, who accompanied me to the play, was a young child when her family fled Vietnam. My colleague’s mother was a nurse who traveled from the Phillipines to the Mayo Clinic for work and ended up marrying a local man and raising three daughters in a new country. One of the actors in the play was a Chinese adoptee who had attended culture camps with my daughters.

All of these women had left part of their heart behind when they immigrated to America. As one of the women in the play quoted, “I thought the Hart-Celler act referred to selling a small piece of my heart each time I remembered something I had left behind; family, traditions, food, friends. My children will never have the same relationships or memories that I had as they grow up in this country.”

The woman in the play share many of the same stories that current immigrants, legal or illegal, are experiencing. They are moving to this country because we have a need for their skills in the construction, landscaping and agricultural industries and they are unable to live peacefully or feed their family in their home country. Each immigrant leaves part of their heart behind in order to create a better future for their family, while suffering the indignities of their neighbors scorn and working for low wages in manual labor jobs that no one else wants. They pay taxes that contribute almost 100 billion to our economy and 25 billion in social security, most of which they will never benefit from if they remain undocumented.

Our immigration system is broken and neither Democrats nor Republicans have been willing to have an honest conversation about our need for immigrants in this country and how we can develop a system that serves our needs as well as providing humanitarian work and living conditions. It will only be when many of the undocumented immigrants have left, that we will truly understand what we have lost. And then it might be too late.

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The Rocky Road of the ERA

Early this morning I delivered a baby girl; she may have less rights as she grows up than I did when I graduated from high school in 1979. Hours after the cesarean delivery, I was part of a rally at the MN state capital to encourage the passage of the ERA in the 2026 MN general election. The amendment would not only protect equal rights for women, but also include strong protections against discrimination based on race, color, national origin, ancestry, and disability.

Why is this needed? At the same time that I was at the state capital for the rally, hearings for Pete Hegseth for Dept of Defense were happening in our nations capital. He would like to eliminate women from serving combat roles in the military, prevent women in the military from seeking an abortion if they are stationed in a state with abortion restrictions, and has been credibly accused of sexual assault. Women’s rights in all three of these scenarios are subject to his decisions and certainly not equal to his rights.

Title Nine was passed in 1972, affording female athletes equal opportunities to men in schools. In one season, my small intramural girls basketball team went from intrasquad scrimmages to traveling by bus to neighboring towns for games. This law of equality enabled young girls to enjoy and excel in sports, paving the way for household names like Steffi Graff, Caitlin Clark, Simone Biles and Mia Hamm. Without the equality of Title Nine, there would not have been a scaffold for these athletes to climb to success.

Since the demise of Roe v Wade, we have seen an imbalance in womens’ rights to control their reproductive health. While men have no consequences if they walk away from an unintended pregnancy, women are left financially, emotionally and physically responsible for their decisions. Our society continues to hold women primarily responsible for preventing the pregnancy, while also limiting the availability of birth control options.

In Minnesota, women earn $.81 for every dollar earned by men. Traditional female careers such as teaching and childcare are underpaid compared to engineering and construction. If a family member or child becomes sick or needs long term care, it is often the woman who interrupts her career to provide care. America’s reluctance to subsidize childcare means that many women leave the workforce early in their careers, as they are unable to afford daycare. Very few men interrupt their careers for this reason.

Ninety-one percent of sexual violence victims are female and 99% of perpetrators are male. Yet again, women are often blamed for allowing the assault to occur; dressing too provocatively, walking in an unsafe neighborhood, drinking too much. Women are shamed when they report an assault because they didn’t do it soon enough, failed to get a medical exam, or are trying to smear a political candidate (Pete Hegseth and Brett Kavanagh!). Men are given every excuse imaginable; drunk, boys will be boys, she didn’t say no enough times, she wanted it.

Passing the ERA won’t immediatly change the imbalance of rights in this country. However, similar to Title Nine, it will allow slow but steady progress so that maybe when that little girl born earlier today has her 18th birthday, she can see a future where she has equal rights to her older brother.

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My Year of Un-Retirement

It has now been one year since I stepped away from a 33 year full time job that I loved. As a physician, I knew the statistics; average age of retirement is 65, many retired physicians lose their sense of purpose/identity, outside interests our minimal due to their career workload, 25% of physicians are divorced. I was 63, had more than enough outside interests to keep me busy and was still married. However, I realized that much of my identity was invested in my profession and I still enjoyed the job – just not being tied to a weekly schedule. I also felt the need to give back to the rural communities in Minnesota where I grew up and started my education. Following college, all of my education and work had been in metro areas. 50% of rural American counties lack an Ob/Gyn physician and there are twice as many Ob/Gyn physicians per 100,000 people in urban areas as compared to rural.

I spent 2024 researching how I wanted to live for (hopefully) the next 20 – 30 years. When the retirement age was set at age 65 in 1935, the average life expectancy was 66. Putting up your feet and relaxing for a year seemed like a great option. The current life expectancy for women is 80 years. That’s too many years of “relaxing”! And because more of us are living longer, there is increasing information about how to spend the time we have in our older years to stay healthy, productive and happier.

The Blue Zones refers to regions of the world where people live longer and healthier lives than average. All 5 of these parts of the world share many of the same characteristics:

  1. Move naturally – activities of daily living rather than working out at the gym. Gardening, biking, walking.
  2. Purpose – having a reason to get up in the morning
  3. Downshift and reduce stress – meditation, yoga, religious services, prayer are only a few
  4. 80% rule – stop eating when you are 80% full, not “stuffed”
  5. Plant based diet, especially beans – adding meat for flavor to a dish, rather than eating it as the main focus of the meal
  6. Wine – 1 glass a day with friends and food
  7. Faith based communities – While denomination doesn’t matter, socialization and belonging to something greater than an individual person does
  8. Loved ones first – aging parents are kept nearby and visited often. This is one trait that I am sure to inform my kids.
  9. Right Tribe – belonging to social circles that support health behaviors.

I would add #10 Volunteer. My experience, backed up by research, is that volunteering reduces stress and increases positive, relaxed feelings by releasing dopamine, the feel good hormone in our brain. You often meet new people, expanding your social circle while moving more than you would at home.

Everyone is different; some people are more than ready to say goodbye to a job that was not fulfilling or induced more stress. Some people need to keep working well into their 70’s before they can afford to step away from work. Some people have physical or mental health issues that prevent them from enjoying life. I am fortunate to love my job, have a financial cushion and remain physically healthy. I have found that working in rural Minnesota as an ob/gyn physician 7-9 days a month keeps my brain active while also boosting my dopamine levels, as both the employees and patients are thankful to have additional staff. It requires me to keep moving as well as giving me a sense of purpose.

Having some extra time in the day has allowed me the luxury of more homecooked meals and perusing plant based recipes. Sharing those meals with friends and family is one of my greatest pleasures. I joined a hiking group, continue to maintain both a flower and vegetable garden, mountain and road bike. My passion is reading and I look forward to book club discussions. Now that Covid is behind us, I have resumed international medical volunteering and made a trip to Vietnam this fall to teach. The travel bug is alive and well in my brain, allowing me to envision and plan new adventures.

We have spent too much of our working life looking forward to this phase of our time on earth. In order to create the best retirement possible, consider your interests/abilities and make a plan. Move, eat healthy and socialize. Enjoy a glass of wine as you watch the sunset. Finally, consider how fortunate you are to have reached this age and have choices. Many around the world are not so blessed

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The New Face of Immigration

Americans sent a strong message in the recent election; they want to limit future immigration to the US as well as deport millions of undocumented immigrants. Although I don’t agree with the extreme nature of this reckless decision, it was a free election and the other side won. Ironically, I spent the week post election with a large group of immigrants from throughout the world on a medical education and teaching trip in Vietnam. Volunteers were Vietnamese immigrants who had escaped political persecution and were now returning to help the population that had been left behind, Indian immigrants to the UK who were committed to providing healthcare resources to the developing world, a Tunisian woman who grew up in France and was now working in the UK and a physician from France who had immigrated to the US and is now working in Seattle. And those were only the ones I got to know well as the team encompassed over 30 volunteers.

Over the next 4 years we need to determine a way forward to better improve the lives of those undocumented immigrants who may be deported from the US or the immigrants who may no longer have opportunities to escape political persecution or gang violence in their home countries. Helping them to help themselves in their home country may be more palatable for many Americans than seeing the same family walk down their street.

For those of us who work in the medical field, there are always volunteer opportunities abroad to educate. However, those opportunities come with a time and cost commitment as well as being able to be comfortable being uncomfortable. Change is slow and takes ongoing relationships and teaching to enforce behavior changes when you are not there. We pay our own travel and lodging/food expenses and usually a stipend to the organizing institution. Any time away from work is vacation or unpaid time off. Please consider contributing vacation hours if you work with someone who may be considering such a trip or making a donation to a non-profit that supports medical education and teaching abroad. My role is with Health Volunteers Oversees.

Outside of medical help, another need is often safe housing. Habitat for Humanity works both in the US and internationally with families to build and maintain housing for themselves. When low or middle income countries are hit with natural disasters, they struggle for much longer to recover and often suffer from scarcity of nutrition in the early weeks after the event. World Central Kitchen is a wonderful organization that uses local restaurant staff as well as unused restaurant ingredients to provide free hot meals to the affected population as well as recovery workers.

At home, the ACLU will be kept busy protecting the rights of those who entered our country legally as well as highlighting human rights abuses that comes when families may be separated as they are deported. Financial donations will help to fund salaries and overhead costs

As 25% of our agricultural workers are undocumented, if a majority of these workers are deported or leave due to fear, grocery prices will increase as Americans will demand higher wages for the same work. That’s if you can find Americans to work in manual labor jobs. The cost of groceries was another factor in the recent election so those Americans who already were living paycheck to paycheck will be utilizing food shelves more frequently. Cash donations to food shelves go much farther than food donations as they are able to buy in bulk and only stock what they know will be used. Volunteering at a food shelf is an even better way to get to know why Americans are food insecure.

When attempts were made to repeal the ACA, it became ever more popular as Americans realized how much each of them benefitted. I hope this same can be true of immigrants; we may only realize their value when they are no longer a part of our communities.

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Swifties – Taylor has given you an assignment

The school year has started and now Ms Swift has added an important assignment for all of her fans. She wants you to do your own research regarding political candidates and vote in your best interests. Since the vast majority of Swifties are female and in their teens and twenties, I would like to highlight the specific topics that are most important to this demographic.

  1. Reproductive health care
  2. Climate change
  3. Support for working families
  4. Reducing the cost of housing and food
  5. Student Loans

Research should reveal a clear difference in the plans that each of the presidential candidates have put forward. One is grounded in reality and the other in magical funds that other countries will pay us. That didn’t work when Mexico was supposed to pay for the wall, and it won’t work now.

I have one more assignment for Swifties. Once you make your decision, please talk to your fathers, brothers and boyfriends about why these issues matter to you. Memes and TV ads often don’t change minds, but personal conversations can make others reconsider.

Finally….. VOTE

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If only every Dad/Husband could be Tampon Tim

For anyone who has followed this blog in the past, you may have seen my many posts about menstrual health needs in the developing world. Girls often miss 4-5 days of school each month after they start menstruating as they are unable to afford tampons or pads. Consequently, they frequently are unable to keep up with their school work and drop out of school within a few years. I have worked with Days for Girls to establish a sewing program in Haiti that employs women to construct reusable menstrual pads that are distributed at schools, while also providing reproductive health education. Keeping girls in school prevents early marriage/pregnancy, improving their lifelong earning ability and overall health.

What many Americans fail to realize is that access to menstrual supplies can be a struggle in this country. The average woman spends $2000 in her lifetime on tampons/pads, or about $12 a month. If your family is struggling to pay bills and afford food, menstrual products may become unaffordable. School nurses can attest to the number of girls that come to their office for supplies, not only because they can’t afford them but also because they have an unexpectedly heavy or ill timed period. If you ask any woman, she can tell you exactly where she was in school when this happened to her.

My Governor, Tim Walz, signed a bill in January that provides funding for tampons and pads for students in grades 4-12. The school can decide where they wish to place the products. 28 other states have similar legislation, but not all provide state funding for the menstrual supplies. This bill was a grass roots effort by high schoolers who saw the need, did the research (1/4 girls struggle to pay for period supplies) and contacted their legislators to create a bill to address the issue. As a former social studies teacher, Walz must have been proud of their efforts.

Gov Walz also seems like the Dad/Husband who would add tampons to his grocery list when asked and buy 2 boxes instead of 1, because he understands that there is always next month. He may even throw in some motrin for the cramps. Maybe if more young men were aware of the issues around periods, tampons and cost, there would be less stigma and embarrassment for young women to experience. And we could have more Tampon Tims.