the Breakfast Club

Summer is the best season for lunch

in the balcony floating on the Seine

River gives its breeze to the heat

and the ardent gazes between youths

 

Wines and fruits are no longer needed

if you have plentiful love and laughs

Posing your most flattering angle and

“Would you pass me the sugar please?”

 

Did you end in happy and beautiful?

Or have you rewarded Renoir with more

oil and canvas?…Oh, why should I even ask?

Seize the day is the only thing we all share!

 

Worry wears layered clothing, so that 

if she accidentally flies to 

Greenland or Indonesia,

she is still warm, chill and fashionable.

 

Worry smells like Big Mac burger.

Seducing people with her luxurious

cheap. We all know she’s overdose, but

we convince ourselves she’s nutritious.

 

Worry murmurs all the time. She loves

making her murmurs into songs, and

dancing with them, like a thousand people 

are watching. Then she smiles and bows. 

 

Worry eats bacons in the morning.

But she can’t help herself not to stare at 

the label while chewing the crispy cure:

lactic acid starter culture not from milk.

 

Worry is a lottery retailer.

Her big satisfaction is when seeing

customers’ smiles, and imagining them

transforming into disappointment.

 

Worry secretly dreams about sacrifice.

She thinks If she disappears, people would 

stop wasting their lives on bad things

that are not and will never really exist.

You make coffee for me every morning.

You don’t know me.

My heart pounds when you 

gaze at me, no caffeine ever needed.

 

You call from work, to say you miss me.

You don’t know me.

I start missing you even

you are right in front of me.

 

You like to stroll with me in the evening,

in summer, fall, and spring.

You don’t know me.

Holding tight, we can melt winter over winter.  

 

You whisper you’ll catch a star for me,

patting me until I sleep like a baby.

You don’t know me.

You are already my galaxy.

You think you are good at loving,

Until the world falls apart when

No one dares to call your name loudly.

 

Hands on the ground you crawl to reach

Upon people’s feet, begging "let me

In, I'm falling for the last catch."

 

Tamed, played, coveted and planned but

Still inside the box there is hope.

At least you have me to be proud:

"I'm Taiwan and I'm not giving up!"

Kiwifruits march in formation

with camouflage of loss and anger,

with iron of target and eager.

Jungle is frigidly waiting while

silence is the only setting.

 

Nerves turn every caresses of 

tender leaves to Hulk’s punches.

The body gets hungry when dipping 

in swamp dressing, for crispy caesar,

but no one is victor.

 

Which one is louder, fierce volley or 

the final twenty-one salute?

You kept running, but there were no EXIT.

The last thing you see is moss on your

headstone, standing at the lonely green.  

Once upon a time, there was an old, retired hunter living in his hermitage.

One day, a tiger came for him. "Our forest is occupied," the tiger said, "please help us. All we want is a place that everyone could live equally."
"Why me?" The old hunter hesitated.
"All other hunters were defeated. You are our only hope." The tiger begged.
"What should I do?" The hunter asked.
"Just kill the cunning boss. Me and all other animals will fight our own battle and take our land back." The tiger answered rapidly. "All we need is a little help from your proficient skill." He added.
"Well then. I’ll give it a try." The hunter said.
"Your help is much, much appreciated, sir!" The tiger cheered. He took out a leather pouch, "I was not allowed to present this until you said yes. This is a magic pouch. When you fight the boss, reach your hand into it, and you can pull out whatever weapon you need. But it could only be used for three times." The tiger put the pouch on the table, took a bow, and left.

The hunter got off early next morning. He followed the routes the tiger told him and arrived the edge of the forest. Surprisingly, he found that either his journey or this destination was quiet and peaceful. He thought it would be full of beasts and tests, but instead he felt him wandering in a park. But still he proceeded, finally reached the center of the forest. It was a round lawn, and in the middle of it sitting the boss: a white stray rabbit.

He couldn’t believe what he saw, but in front of him this bunny who settled herself on a big flat rock was giving orders to all the wild rabbits: some to make her food, some to massage her, and some to entertain her. He glanced through the rest of the forest, and saw there were tigers, foxes, deers and all other animals, hiding and fearing in the distance.

He stepped into the lawn, walking straight to the boss rabbit. "I don’t know who you are, I don’t know why you are here, and I don’t know how you end up acting like this. But I come here by a request and I must keep my promise." He explained to her. "I am going to defeat you."
"Human." The boss rabbit shrugged. "I know you people well. Too well." She said. "Let’s see if you can beat my fellows first." She nodded to the wild rabbits, they quickly formed together and casted a net, trying to catch the hunter. The hunter took out the pouch, reached his hand into it and pulled out a knife. But instead of sweeping it toward the wild rabbits, he cut off the net and ducked away. The rabbits didn’t stop, they ran forward and pounced on the hunter. He reached into the pouch again, pulling out a gun. But instead of bullets, he fired a bigger net and caught all the rabbits.

The hunter dragged himself toward the boss rabbit. "Now it’s only you and me." He gasped.
"Weird. You are the first one who doesn’t try to kill us." The rabbit wondered.
"I can see they are innocent," The hunter said, "and so are you."
She raised her head and looked at him. "Well, my former owners didn’t think so." She lowered her head. "I was once a gift. Then a burden. Then a trouble. Then a garbage…Luckily I learned how to survive. And how to conquer…All by myself." She raised up her head yet again, this time her eyes were sharp. "Kill me, or you’ll never win this battle!"

The rabbit jumped off the rock and started hopping around. The old and tired hunter tried to catch her but he couldn’t even keep up with her steps.
"If you just want to catch me, you’ll never defeat me!" The rabbit paused on another rock, waiting until the hunter got closer and ran off again. She circled the hunter and giggled, appearing to enjoy this chasing game.
The hunter suddenly stopped dashing. He bent forward, picked up a large rock and threw it to the rabbit. The rock didn’t hit her but fell on the ground beside her. The rabbit’s smirk vanished. "Now you’re for real!" She uttered. The hunter kept throwing big rocks, but the rabbit easily dodged through them. "Get a better weapon won’t you? Use that pouch! Aren’t you supposed to be good at killing, hunter?" She yelled, bouncing left and right, up and down. The hunter ignored her advice. Soon there were more and more rocks surrounding the rabbit. However, little by little her feet slowed down, finally she was trapped by the circled rocks, too tired to escape.

The hunter walked toward her, and took out the pouch.
"I’m not only good at killing, but also good at making traps," the hunter said. He reached into the pouch and took out a delicate basket paved in a soft fleece blanket, with carrots in it. "A trap to set you free." He bent down, showing her the comfortable nest. "Come home with me, then you will never be alone. I will never be alone."

The rabbit was stunned. She stared at the hunter for a long, long time. Finally her eyes softened.
"I don’t like carrots." She murmured.
"Then what do you like?" He asked.
"Cabbage." She answered.
"Lesson learned. Don’t worry, I’ll prepare the freshest juicy cabbage when we come home. I’m also good at gardening." He said.
"…Not too watery." She demanded.
"Sure." He replied.

This stray rabbit tilted her head, pondering for a while, and hopped into the basket. When they walked away, those distant animals first peeked at them, then stepped out, and finally celebrated their freedom with the wild rabbits.

They all lived happily ever after.

After my wife passed away six months ago, I tried to keep myself busy. But somehow I just couldn't forget about her. I couldn’t move on.

I went on a business trip to Philadelphia. My wife loved art but I didn't, so I never went to a museum with her before. This time I decided to go to the Philadelphia Museum of Art, one of the places she always mentioned that she wanted to go with me.

I wandered around the museum, eventually making my way to a rounded square with exhibits from many famous painters: Van Gogh, Monet, Cezanne..., well, I must admit I didn't know much about them and actually, I wasn't interested at all. When I was about to leave, I saw a Renoir painting of a knitting woman. She looked exactly like my wife. I was stunned. I stood in front of it and stared at her all afternoon.

After I went back home, I couldn't get rid of that painting. I searched for photos of it online, bought art books and posters of it. But none of them gave me the feeling like that original piece. Even my wife's own photos didn't. I felt there was something inside that painting. I felt there was a soul.

I quit my job in California, found a part-time work and moved to Philadelphia. I went to the museum every weekend, doing nothing but staring at that painting, at her.

One time when I was there as usual, I heard a baby crying. She was about a year old, being held by an old lady. I surprisingly found that every time she passed by this Renoir painting she burst out crying, but when they walked away she stopped. Even that black, twisting Picasso painting of a woman's head didn't scare her. I had heard that babies' souls were closest to the world before birth and after death. I couldn't help myself and walked to the baby, "you see something?" I asked. The baby nodded, with tears on her face.

I was fully convinced. I joined the membership and went to the museum more frequently. I felt I was with my wife, at her favorite place. I forgot how many days I had abandoned myself to the place and to the painting.

Until one day, when I was leaving for the restroom, I glanced over at a person. A lady about my age, staring at another Renoir's painting of a boy. I moved closer to her, and found the boy looked quite like her. They had the same eyes and same bitter smile.

I walked to her, "you see something?" I asked. She turned to me, a little surprised, then she nodded.

After so long, this was the first time she and I really "saw" a person, again.

We moved to New Mexico, bought a cottage, and lived together. There was only one painting in our house: a landscape by Georgia O'Keeffe.

I long to see my first love story. It was in my 8th grade when I fell in love with the most good-looking boy in the class. When I say "see" I I really mean it. I want to go back to the past and watch the whole scenes like a theatre audience. I want to stand in the school hallway right beside him and the younger me and listen to him saying "I like you"; I want to walk with me and him when we had our first date in a bookstore, maybe try to pick a lovely bookmark with secret messages on it, and slip it into the boring gift I bought him; I want to be at my house, watch him kiss me the very first time, and whisper to myself "kiss him back you fool!" ; I want to be on the street that night, witness the stupid me saying sorry to him again and again because she kissed another boy. And maybe slap the younger me on the face, then cry with both of them. I think I long not just to see my first love story. I long to stop it. To change it. To start all over again and laugh in the end. But none of these I can do. I can't even "just" see. I long to see...

In these four chapters there are three of them continue discuss about knowing the audience of the Health Literacy (HL), so I would keep using the same title this time.


Literacy

After reading this chapter I really think that the author should put it in the first chapter instead of the 21st.

The 2003 U.S. National Assessment for Adult Literacy (NAAL), which is the most recent and comprehensive measure, defines literacy as using “printed and written information to function in society, to achieve one’s goals, and to develop one’s knowledge and potential”. There are three type of literacy within it: prose literacy, document literacy, and quantitative literacy. And there are four levels of literacy: below basic, basic, intermediate, and proficient. Here is the research result of each literacy and level:

	Prose Literacy	Document Literacy	Quantitative Literacy
Below Basic	14%	12%	22%
Basic	29%	22%	33%
intermediate	44%	53%	33%
Proficient	13%	13%	13%

The author also lists out the four skills that a reader needs:

1. Print skills——knowing that certain letter combinations have specific sounds
2. Fluency——reading speed and accuracy
3. Vocabulary——knowledge of common, everyday words as well as those more rarely used
4. Comprehension——integration of all these skills

Although the reason of reading at a below basic level might be physical, mental or cognitive, on average literacy skills start to decline when people reach 55 years old. (I will introduce HL of older adults next)

Health care requires literacy. From prescription labels, health history forms, self-care instructions, wellness information, to even the sign of “Radiology Department”, rather than the “X-ray” that we usually talk in hospitals.

The author suggests that the “partnership of healthcare organizations and adult education programs” could improve health understanding. I think this research proofs her statement.


Older Adults

When people get older, they are much different than they were 2, 3 years old, as well as they were adolescences or adult. Some might still be able to walk, some, however, might be already hard to move by themselves. “Despite this diversity, a commonality as people age is that they are increasingly likely to be diagnosed with acute illnesses and chronic conditions.” Furthermore, three reasons make communicating health with older people more difficult than with others:

1. New words, new technologies and new concepts sometimes are hard to learn, even against their original understanding.
2. Being ill or weak affects their physical and cognitive function.
3. Realizing one’s own bodily irreversible degeneration makes them suffer emotionally.


Vision Problems

There are more than 25 million adults in the States report experiencing significant vision loss. The 1990 Americans with Disabilities Act (ADA) mandates that public facilities (like hospitals and health centers) provide reasonable accommodation for people in need. “These facilities must provide information in large print, audiotape, Braille formats, or have someone available to read information aloud.”

People who are visually impaired might have not only difficulty reading the words, but also “trouble distinguishing one medication from another because pill bottles are often identical in shape and size”. Although this is an old saying, we really have to put ourselves in their shoes to design a truly friendly environment.
 

Question for thinking

One simple strategy to “discover” patients at below basic literacy level is to “accidentally” hand them the print upside down and to see if they would turn it around. But how do we distinguish basic level patients since they usually “pretend” to be not?

The author spends 7 chapters talking about knowing the audience. I think in any field of literacy, the “reader” is always the most important subject. Considering the 500 words limit, I decide to stick to my four-chapter-one article strategy. Here are the four “audience”:

Children

In clinical settings, what is more complex about pediatric Health Literacy (HL) is that it must be considered in both parents’, caregivers’ and children’s HL. I think this is not only because, as the author states, that if you let children actively participate they would be more cooperative in treatment and be more honest about their health related behavior. But more importantly, as my past job in a hospital in Taiwan trained me, it is more “ethical” to let the patient himself/herself involves in the whole process. However it’s harder than adults, since children are usually ill and need to have unpleasant medical procedures. Using humor and real-life examples in hospitals might help the communication. For health children, provide age-appropriate education in school such as teaching them to read the nutrition labels is also an important HL skill training.


Culture and Language (the author has such great points so I decide to quote her saying directly)

As the author argues in the beginning of this chapter, “accessing, using, and understanding the U.S. healthcare system is difficult for almost everyone. But for people who speak limited English or come from other cultures, these tasks might seem impossible”. And, “as the U.S. population grows increasingly diverse, situation like these are becoming more common”.

US now has more Spanish speakers than Spain – only Mexico has more

Furthermore, even these people might be able to “talk about the food or weather”, but to discuss health condition? Not so well.

In addition, culture “impacts how people understand and make sense of health information”. The author gives two examples. First for some regions, health resource are scary, therefore they may not understand why blood pressure checks are routinely recommended. And second, in some cultures, patients are not the ones to make health decisions, so the “decision maker” must be included when discussing.


Emotions and Cognition

Since the author (and me) have talked several times about the influence of emotions in HL in my past articles, I would focus on the cognition part.

Cognitive problems, such as memory loss, dementia and mental illness, most of time will affect concentration, memory and communication, which are all important to literacy. The author provides some strategies to better communicate with these patients. One that relates to reading and writing is that to assist them writing a summary of what was discussed to help them memorizing and understanding.


Hearing Loss

For these patients, “literacy” could have a totally different meaning. Sign language such as American Sign Language (ASL); reading lips; or writing are some of the communicating systems. One thing to notice is that people usually think written information benefits all the hearing loss patients, “but this is not necessarily so—particularly for those who have been Deaf (with the capital D for distinguish)” since birth”, because they have never “heard” of those “words” like hearing people have to learn.

Question for thinking:

Cultural diversity—multicultural society seems to be the future trend of the States. How should both the education and health system “develop” for this change? (Big question, I know!)