Daily Archives: February 4, 2021

DENVER, Feb. 4, 2021 /PRNewswire/ --Great governance is an intentional focus on creating the conditions to assist citizens in achieving their fullest potential. Our role is to understand the public desires and strive to maximize well-being returns for their investment into the community.

Great governance is so much more than what one person does or says. It's about the inspiration that comes from collaborating with people who share values and principles. -Ian McCormack, Strategic Steps

The partnership among Strategic Steps, It's Logical and ResourceXbrings a new vision of great governance that endeavors to address the responsibility of local governments to identify demands, determine how to deliver them, and at what scale; to respond to those demands with programs, services, amenities, and facilities; and then to check that the demand is met to the ability of the local government. This process is a loop, where one period's results will help inform the next period's plans. This new partnership considers each step within this loop to ensure adequate emphasis and attention to each responsibility area.

Join us Tuesday, February 9, 2021, at 10:00 AM CSTto learn more about developing and applying the core concepts of great governance in your organization.

To have many years of our collective passion for great governance come together in this way is an amazing opportunity for our companies and clients.-Kelly Rudyk, It's Logical

This new partnership brings together a wealth of expertise and experience across North America. Elected officials, local government leaders, and citizens seek solutions that benefit their community. This new vision for great governance delivers that outcome through practiced and proven technologies and methodologies.

What I find most compelling about the "Great Governance" vision is the feedback loop. From establishing a vision and business plan, prioritizing resources to fund it, executing and delivering services, and then getting feedback to inform and adjust and get better at fulfilling the value proposition to our citizens.-Chris Fabian, ResourceX

The ultimate goal is to build communities to which people want to move and in which families want to remain. The growth of well-being in the community results in more of a whole community where individuals freely return value to their neighbors and friends.

Media Contact:Liz JohnstonResourceX[emailprotected] 817.676.6830

SOURCE ResourceX

https://www.resourcex.net

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Great governance is a wise practice wherever it lives - PRNewswire

Around a dozen adults and children are waiting patiently for their check-ups. Sitting behind a small table, Etienne Esua listens to the patients, dresses wounds and pricks fingers to perform rapid malaria tests.

When a test shows that a person has malaria, but the symptoms are not severe, I treat the patients with drugs, Mr Esua says.

The consultations are taking place on the veranda of an ordinary house in a village in the South-West region of Cameroon. Mr Esua is not a medical professional, but a community volunteer trained by Mdecins Sans Frontires (MSF) to provide basic healthcare to some of the regions most vulnerable and hard-to-reach communities.

Violence displaces people which hinders access to healthcare

For the past four years, Cameroons North-West and South-West regions have been rocked by armed violence between government forces and non-state armed groups, which has displaced more than 700,000 people. The humanitarian needs are huge.

Displaced communities face difficulties accessing basic services, including healthcare. The crisis has severely affected the public health system. Many health centres have closed or are not functional; medical workers and facilities are being directly targeted by violence; and insecurity is hindering the supply of drugs and medical equipment.

Given this high level of insecurity, humanitarian organisations like MSF face serious problems to reach displaced communities, who often hide in the bush for their safety.

Healthcare in the community, by the community

To provide medical aid in such challenging conditions, MSF has set up a decentralised model of care in the South-West and North-West regions, which is delivered directly in the community, by the community. It relies on volunteers like Mr Esua.

Community health volunteers are the bridge between the health facilities that we support and the vulnerable communities that dont have access to health centres, says Yilma Werkagegnehu, MSF field coordinator. Communities dont have access either because they are displaced, because health structures are closed or because they cant afford to pay for medical services.

MSF currently works with 106 community volunteers in several health districts near the towns of Mamfe and Kumba in the South-West region. Similar activities were conducted in the North-West until December 2020, but have been put on hold following a decision from the authorities to suspend MSF activities in the region until further notice.

People from communities trained to treat those in need

Community health volunteers have been recommended and selected by community leaders and are trained by MSF to detect and treat simple diseases like uncomplicated cases of malaria and respiratory tract infections, malnutrition and diarrhoea. They also learn how to carry out health promotion activities to prevent people from getting sick and how to look out for signs of sexual abuse and psychological distress. While they might not be medical professionals, these volunteers are still trained to adhere to medical ethics, and to treat those in need, regardless of background.

In 2020, community volunteers provided more than 150,000 free medical consultations in the South-West and North-West region.

The community health volunteers are paid incentives for their work and receive backpacks filled with medicines. They meet regularly with MSF supervisors to discuss their work, get advice and share medical data. Their backpacks are refilled before they return to visit remote communities, often walking for several hours a day.

Being able to refer patients to MSF facilities

If a treatment is beyond their capacity, community volunteers can refer patients to MSF-supported health facilities where they receive free treatment if they meet certain criteria, such as children with severe malaria, women with complicated pregnancies, victims of sexual violence or patients with intentional injuries.

One of the referred patients is a seven-year-old girl named Dorcas. She is sitting on a bench next to her mother outside the MSF-supported Presbyterian General Hospital in Kumba, South-West region. Her left leg is in a cast.

The girl was injured in a traffic accident and was referred to the hospital by one of our community volunteers, says Dr Guisilla Dedino. She was assessed in the emergency room and was diagnosed as having an open fracture of the left leg. An MSF surgeon operated on her; she is making progress, with the fracture showing good signs of healing.

Challenges of healthcare in a conflict context

Travelling from remote villages to health facilities is a major challenge for many people, due to insecurity, bad road conditions and lack of transport. MSF offers a free, 24-hour ambulance service that operates seven days a week, collects eligible patients at designated pick-up points and takes them to MSF-supported health centres and hospitals.

Where we cannot go, MSF provides money for public transport so that patients can reach health structures or pick-up-points. Managing a decentralised model of care and ambulance service is not easy in an insecure environment such as South-West Cameroon.

Our community volunteers are sometimes harassed by armed men, says Paulo Milanesio, MSF emergency coordinator for the South-West region. We are in constant dialogue with different stakeholders to guarantee their safety.

We need everyone to understand that community volunteers and ambulances provide a much-needed lifeline for vulnerable communities who would otherwise be deprived of medical care, Milanesio says.

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Healthcare in the community, by the community in Cameroon - Cameroon - ReliefWeb

Following Governor Andrew M. Cuomo's 2021 State of the Stateproposalto increase homeownership rates in communities that have been adversely impacted by redlining, the Governor today announced the findings of a new report by the New York State Department of Financial Services on redlining in the Buffalo metropolitan area. Buffalo remains one of the most racially segregated cities in the United States decades after the practice of redlining and other forms of housing discrimination were banned by law. DFS' report found a distinct lack of lending by mortgage lenders, particularly non-depository lenders, continues today in Buffalo neighborhoods with majority-minority populations and to minority homebuyers in general.

Redlining includes such illegal practices as refusing to do business in a neighborhood based on the racial or ethnic composition of a neighborhood's population, or imposing more onerous terms on home loans in a particular neighborhood in a discriminatory manner. The population of the city of Buffalo is approximately 47 percent white, 36.7 percent Black, and 11.6 percent Hispanic or Latino, and the population of the metro area is approximately 77 percent white, 12 percent Black, and 5 percent Hispanic or Latino. According to a recent report, in the city of Buffalo, 85 percent of people who identify as Black live in neighborhoods east of Main Street, which is where areas that were redlined in the 1930s are located.

"Underserved communities, especially families of color, continue to face housing discrimination, in the form of limited access to mortgage lending, facing a roadblock to achieve the American dream,"Governor Cuomo said. "The report reaffirms the importance of the State of the State proposal to increase access to mortgage loans to close the racial wealth gap to help us build back better for a fairer New York."

Superintendent of Financial Services Linda A. Lacewell said,"The findings of this report are particularly troubling. Homeownership is a critical path to building wealth and economic stability, and the data is clear - families of color, particularly African Americans, do not have equal access to mortgage lending in Buffalo compared to white households. We now have the opportunity to right some of the wrongs of the past by looking at the entire problem and formulating solutions so the legacies of segregationist policies do not continue into the future."

The Buffalo market includes banks of all sizes, from large global banks to small local and community banks. The prominence of nonbank mortgage lenders focusing only on mortgage lending has increased significantly, with nonbank mortgage lenders originating 37 percent of mortgages in Buffalo between 2016 and 2019. Nationally, nonbank lenders have overtaken banks as the source of the majority of mortgages.

The DFS investigation analyzed Home Mortgage Disclosure Act data for Buffalo and surrounding areas.

Among other things, the DFS analysis found:

Report recommendations include:

These recommendations are timely and critical in light of the continued fight for racial, social and economic justice. Populations in historically redlined neighborhoods also continue to experience economic disadvantage including lack of access to quality financial services, more environmental hazards, lower life expectancy, and worse health outcomes than the overall population, which the COVID-19 crisis has further aggravated.

Settlement with Nonbank Lender

The Governor also announced that DFS settled with Hunt Mortgage Corporation, a nonbank mortgage lender. DFS' investigation found no evidence of intentional discrimination by Hunt Mortgage or a violation of fair lending laws. However, DFS found that weaknesses in Hunt Mortgage's fair lending and compliance programs and lack of sufficient attention to fair lending issues contributed to the company's poor performance in lending to people of color and in majority-minority neighborhoods. In a good faith effort, Hunt agreed to take significant steps to improve its service to the entire community, including the following:

DFS continues to investigate several other lenders and will announce findings as those cases are resolved.

To review the full report, including charts of lenders' performance, visit the DFS website.

To review the Hunt Mortgage settlement agreement visit the DFS website.

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Governor Cuomo Announces Findings of New York Investigation of Redlining in Buffalo - ny.gov

After having read The Black Market this summer, I was itching with questions for author Charles Moore on how he accomplished this endeavor of single-handedly solidifying his place in the art world, the world of publishing and in the context of history in general not only as a Black man, but as a scholar and thinker. The book breaks down the monolithic stereotypes of who a Black collector, artist, or gallerist should be. Turning every page with fervor and determination to zero in on components I may be missing in my own career as all three, I instead felt sanctified down to the very last pages of the glossary. As a guide to collecting, it is a therapeutic tool toward self reflection on personal legacy. It gives confidence to someone like me with imposter syndrome as a woman of color in the art world. It solidifies that I am, indeed, in the Black market.

Capturing the multihyphenate nature of contemporary collectors and arts workers is its most important anecdote. I started my own small collection by purchasing artwork from my peers at the School of Visual Arts and curating independent exhibitions, but always felt that I was spreading myself thin as an artist, curator and gallerist and didnt have the prestigious connections to give objects the care and prominence they deserve. Now, I feel refreshed about the future of my presentations and conserving the stories and objects of my community. Seeing many of my friends, colleagues and clients in the book made me excited that my experiences are now being inserted into history and archived. The Black Market proves that establishing common goals to create more accessible spaces and investments is the secret to success in the art world as a person of color, and in turn gives room for those multifaceted endeavors. It also reinvigorates the importance of an artists practice to have institutional presence and conceptual research rooted in prestige, rather than turning away from it because of past harm or intentional intimidation towards our communities.

When I first met Moore it became clear that we had similar goals to define Black historical legacy and institutions while staying true to our communities needs. The Black market is small, interconnected, and contrary to popular belief, quite accessible, yet coexists in many forms of practice. The Black Market illuminates the prospect of art professionals creating their own platforms and schools of thought and making themselves seen, without asking for permission.

Storm Ascher: When did you start writing about art?

Charles Moore: My first unpublished work was my first essays at Harvard. I wrote about Kiki Smith and her recurring use of Little Red Riding Hood as a theme. I also wrote an account of my experience at the National Museum of African American History & Culture: its collection and the architectural design of the building. Shortly after graduating in summer of 2019, I ended up meeting with one of the editors of Artnet for lunch. We talked about some ideas on writing about artists. Ed Clark happened to be having his first major solo show with an international gallery, Hauser & Wirth, that October. The first article I published commercially was an exhibition review of that Clark show.

SA: Youve written for so many publications: meeting and interviewing art world professionals. How did you decide to compile all of this into a book?

CM: Writing on an exhibition or an artist profile is quite different from what you find in the book. I always thought about writing books though, and I even tried once and gave up, but I knew Id come back to it later. I started reading a lot during the lockdown because I had nothing to do, as I was set to start a doctoral program at Columbia University, but not for a few months. After talking to a lot of people in the art world, I realized that there were some gaps in the literature. A lot of the books on art collecting had this assumption that you knew a lot about art already, and although I do know a lot about art, I felt like if you were a new collector, then you might be intimidated by how they structured the book. So I decided it might be a good idea to write a book about collecting in my way.

The Black Market by Charles Moore. Cover art by Keviette Minor.

SA: So you already had experience art collecting yourself?

CM: Im a second-generation art collector. My mother collected art for years, as far back as I can remember; I would say my earliest experiences with art and art collecting were when in middle school, and a little bit of high school. She really didnt continue after that because she started to focus on real estate. But I never forgot those experiences and throughout my life, I was a frequent visitor of art museums. I lived in Europe for some time and visited art museums all over the world. I remember coming back from living in Italy for two and a half years in 2012 and watching the documentary, Exit through the gift shop, about an artist named Mr. Brainwash, and his experience documenting the works of street artists like Shepard Fairey. One of the narrators in the documentary is Banksy.

After an invitation to a wedding in Boston earlier that year led me to the ICA Boston, I exited through the gift shop and I saw a limited-edition print by Shepard Fairey. Obviously, his name was fresh in my mind and I could afford 50 bucks, so I bought it. From there, I began collecting more works by Fairey and a few other artists in the same genre. My experience and access changed over the years and I started to meet people, like art advisors, that shaped how I collect today.

SA: Actually getting into the structure of the book then, the first section highlights an artist from each decade from 1900 to 1990, then you transition to artists currently working. How did you go about writing to create this familiarity, this accessibility?

CM: Well, a lot of times in art collecting books, theres this assumption that you know all about art already and now you just need the blueprint to figure out how to collect it. And I thought, what would have been interesting for me 10 years ago, when I was thinking about collecting but hadnt started yet?I thought a sort of a primer, a brief introduction to art history would be helpful, and that highlighting one artist each decade for the last 100 years might be an interesting way of doing it.

An interesting tidbit was who I put in the 1960s spot. Its pretty hard to talk about Black artists in art history and not speak of Jean-Michel Basquiat. I actually wrote an entire section on him, and I decided to scrap it. He would be around the same age as Renee Cox right now since they were both born in 1960. Obviously, hes no longer with us, but then I thought, I never met Jean-Michel, and I know Renee Cox, and shes a brilliant artist. Why not include her in this project instead of him, and keeps with the theme of an artist born every decade? And thats why shes there. A really close friend of mine asked me, Why arent there photos in the book? I hoped this would encourage curiosity.

Renee Cox, The Liberation of Lady J and UB, 1998. Cibachrome print. Courtesy of the artist.

SA: I actually learned so much about Renee from this book specifically. The art advisors and the artist liaisons section was so informative, too. And most likely, something people would keep to themselves. Being a gallerist myself, I know that those relationships are so private. I respect that you brought these people out from under the radar.

CM: I think the entire book is about lifting up the hood and showing how the engine works. Some of the people who are best capable of doing that are art advisors and curators; theyll help you save a lot of time and a lot of money, and theyll help educate you, not only about art but the importance of art collecting and protecting the culture and all sorts of wonderful, wonderful things.

SA: So the art advisors were happy to be acknowledged and not behind the scenes?

CM: You know, Im kind of a behind the scenes kind of guy myself, as a writer, and I could totally understand and relate to the assumption of how they would feel. But I really do think they were excited about, not only the project, but about being more involved. We talked about some of the artists that I know personally, but a lot of the art collectors that are involved in the project were referred to me by these advisors. The project wouldnt exist without their generosity. And it would be nice to give them a little bit of the spotlight for that.

Kerry James Marshalls Untitled (Studio), 2014.

SA: The Black Market includes a big section about the art collectors who collect Black art specifically. I felt it was very indicative of the fact that anyone can become an art collector, and each of those stories of how they came to collecting gave me so much confidence. You dont have to be born in the art world, you dont have to start out with a lot of money. Was that your goal, to just break down this stereotypical idea of what a collector should be?

CM: You know one of the things that I think is a deterrent Its exciting to see headlines like, Kerry James Marshall sells a painting for $21 million in the auction. Most recently, an Amy Sherald work sold for $4.2 million after having an estimate of $150,000.

SA: That was such a low estimate by Phillips, by the way.

CM: Yeah, well I think those headlines are exciting, right? Fran Lebowitz said it best: If you go to auction, out comes a Picasso, theres dead silence. Once the hammer comes down on the price, theres an applause. And we live in this world where we applaud the price and not the Picasso. To me, that actually speaks very loudly on the exclusionary world of the art market. Although seeing headlines like that is exciting, how many people can buy a $4.2 million Amy Sherald painting? If you think that thats the only price point for art, then that may be a deterrent for collecting art. I really wanted to applaud the art collector, because only a couple of the collectors that I highlighted are millionaires (I think). Most of them have normal jobs like most of us have. That was the point I was making.

SA: Do you think it is important for Black collectors to also collect non-Black art?

CM: I think that is up to the collector. Nevertheless, I do think its important for Black collectors to know and understand the work of non-Black artists. If you cant talk about contemporary art without mentioning Warhol, Rothko or Basquiat, then you should know all of them. It could help you understand why Kanye chose Condo to do the cover of his album; why Fairey was selected to design the campaign poster for Obama or why Louis Vuitton collaborated with Murakami/Kusama to design handbags, and Dom Perignon with Koons.

Amy Sherald in her studio in 2019 with works in progress. Photo by Kyle Knodell.

SA: So, who is the Black market? Who is this book meant for?

CM: Well, I think I do a decent job of highlighting the contributions that Black artists have made into the canon and helping write about a few of those stories. I think the book also, as you so duly noted, gives the reader a peek into the art world, in the way of art galleries, museums, auctions, art fairs, art schools, artists residencies And then theres a carefully curated group of Black collectors. I talk about their journeys. Specifically, I wrote this book in a tone that allows for anyone with the curiosity about any of those subjects to learn from this book. And anyone who is curious about culture, is who this book is for.

SA: Of course, this could be read by anyone, but the title clearly gives way to a Black audience to find their voice in the world of collecting. Why is this so vital right now?

CM: There are many books on art collecting, that dont necessarily give an obvious suggestion on who those books are for. But the collectors they interviewed, and the art works within their collections state pretty clearly who theyre talking about and who might find the narratives and stories interesting. Now, I have read most of those books, and this is not to say they arent interesting, well-written and informative. They are. Ive learned from reading those books. However, if one picked up those books and pondered why none of the collectors were Black, and the majority of the artists discussed in those books werent Black, there could be an assumption that inspiration could be lacking for a Black person reading. They may ponder why they cant see themselves in those stories.

I wrote this book from this perspective: Im Black. The scholar I asked to write the foreword is Black. The artist I commissioned to design the cover is Black. Every collector I interviewed for the book is Black. The art advisor, artist liaison, gallery owner and two art students are all Black. I wanted the book to be from their eyes, their gaze, their experiences and their influence. Again, anyone can pick up this book and learn from itjust like any of those other books on art collecting. And this one, The Black Market, even more so. Because I wrote this with two assumptions in mind of the reader: They may have little or no experience in the art world, and they are intelligent and sophisticated.

SA: Why is it so important to document your experiences and solidify your legacy?

CM: I was once told, If its not written down, it didnt happen. History is always told by the victors. I choose to write because Ill be part of those who tell the history. I also want to preserve my own legacy in this space by writing about the stories I want to tell. I want to write about the artists I admire, and inspire a generation by telling them about the art collectors who own pieces of this culture.

This interview has been edited for length and clarity.

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Charles Moore's The Black Market Gives Aspiring Collectors the Power to Define Their Own Legacies - Cultured Magazine

Dr. Rene A. Middleton has announced her intent to step down as dean of The Gladys W. and David H. Patton College of Education at the end of June 2021. Dr. Middleton has served as dean and tenured professor of Counselor Education for the last 15 years.

Under Dean Middletons leadership, the Patton College has experienced great success in preparing generations of educators and human service professionals for service. She successfully led academic realignment and expansion of the Patton College in 2010, integrating programs from the former College of Health and Human Services to better serve the state of Ohio and meet the needs of local and global communities.

During Dean Middletons tenure, McCracken Hall evolved to become the state-of-the-art home for Ohio Universitys Patton College of Education through a $32.8 million-dollar comprehensive renovation and expansion. The renovation was made possible by a transformational gift from Dr. Violet Patton, BSEd '38, LHD '11. Additionally, the College set a new milestone in donor development under Dean Middletons guidance, exceeding one million dollars gifts in pledges each year since 2013.

Through Dean Middletons vision, the college experienced steady growth in both faculty and student diversity through programs like the Patton Colleges innovative and progressive HOPE program, which is designed to prepare pre-service teachers to incorporate culturally relevant pedagogy into their own teaching styles. The Colleges Brothers RISE (Rallying to Inspire and Shape Education) initiative, which was created under Middletons purview, is a retention program designed to help recruit and retain African American males into the profession of teaching and thereby empower future generations of diverse learners and educators. Dean Middleton was also instrumental in the development of the Universitys Black Lives Matter Series, a n educational series with the goal of enhancing knowledge about racist and anti-racist behaviors among citizens of the University and global communities.

Dean Middleton has been the consummate academic leader and a strong advocate for both the Patton College of Education and the education profession throughout her years of service, said Ohio University Executive Vice President and Provost Elizabeth Sayrs. Her commitment to collaboration and her intentional actions to increase and support diversity and student success has helped place the Patton College as a nationally recognized college, and her innovative approach to teacher and counselor education has made an impact on the fields of education and mental health locally and beyond.

With more than 100 faculty members serving more than 2,100 undergraduate and 800 graduate students, the Patton College has prepared generations of educators, practitioners and human service professionals to be leaders over the past 125 years. Home to several excellent programs, the College comprises five departments: Counseling and Higher Education, Human and Consumer Science Education, Educational Studies, Recreation and Sport Pedagogy, and Teacher Education. During her tenure, Dean Middleton led the successful adoption of a reimagined clinical model of teacher preparation that engages in a community-fostered approach to place teacher candidates in educational settings that benefit all stakeholders. The Patton Colleges award-winning Clinical Model of Teacher Preparation was recognized nationally by the American Association of Colleges in Teacher Education (AACTE) and the National Network for Educational Renewal (NNER).

The Patton College has earned top rankings for its undergraduate and graduate programs with several ranked among the highest in the nation and continues to distinguish itself through partnerships that address social, economic and educational issues affecting communities worldwide and impacting American students ability to learn in our public schools. Under Dean Middletons leadership, the Patton College successfully increased in national rankings placed at or near the top 100 over the last eight years.

Dean Middleton was instrumental in establishing the rigorous, inquiry-based Connavino Honors Program, which offers intensive research experiences to high-achieving students who gain opportunities for increased leadership, professional development, and intensive classroom experience with a core group of faculty through the program.

Dean Middleton, who was awarded the prestigious Pomeroy Award in 2017, is highly respected nationally as a dean of education. She has been an institutional member of the AACTE since 2006 and served as AACTE Board Chair in 2017-18.

A tenured professor of Counselor Education with 29 years of teaching experience, Dean Middleton received the B.S. in Speech and Hearing from Andrews University, the M.A. in Clinical Audiology from the University of Tennessee, and the Ph.D. in Rehabilitation Administration from Auburn University. Prior to assuming the deanship in August 2006, Dr. Middleton served as the director of research, human resource development and outreach for Auburn University's College of Education in Auburn, Alabama.

Im extremely proud of what our students, faculty and staff have accomplished during my time as dean, Middleton said. Together, we have set the Patton College on a robust path of rigor, access and inclusivity. There is a bright future ahead: Lets Continue To Go Out and Do Great Things!

Plans for continuity of leadership for the college will be shared at a later date.

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Dean of The Gladys W. and David H. Patton College of Education Rene A. Middleton announces intent to step down - Ohio University

In 2016, Kim Bowles, then 35 years old and a mother of two, was facing the loss of both breasts due to cancer. Going into the surgery Bowles told her doctor she did not want breast reconstruction, instead to leave her chest flat.

Her decision, clearly communicated to her surgeon, was not honored. I brought photos, I brought a witness, I did everything I could to protect my choice, said Ms. Bowles, who lives in Pennsylvania. Instead, the surgeon left two flaps of skin in case she changed her mind. Ms. Bowles experienced flat denial, the response of a surgeon, who for whatever reason, does not honor a patient's wishes.

Despite the surgeon, Ms. Bowles "went flat" andstarted an organization called Not Putting On a Shirt (NPOAS), whose primary purpose is to teach women how to tell their doctor they want to be flat, not reconstructed, and to advocated for a women's right to have all the information on all the options available to her.

Research into patient outcomes, historically, found that women who had reconstruction were "more satisfied" either with silicon breast implants or recon Authors of a 2013 survey said women who have had successful reconstructive surgery are significantly more satisfied with their decision than those who opted for mastectomy alone.

But what a team from the University of California, Irvine studied seems to be singular.

A new attitude

Deanna Attai, MD, surveyed 931 women who went flat. Dr. Attai found that 74% were happy with their decision. But 22% of these women faced opposition from their surgeon for their choice, who in some caseslike Ms. Bowles surgeon, left skin for a future reconstruction, just in case. "We were surprised that some women had to struggle to receive the procedure that they desired, said Dr. Attai in a press statement.Her work was published in the journal Annals of Surgical Oncology.

Flat denial is more than disregard of the patients wishes, it can alter the surgerys outcome. Dr. Attai found that a high level of flat denial was the "strongest predictor of dissatisfaction with surgical outcome, meaning that women who did not feel supported were less likely to feel good about their post-surgery bodies. Notably, women who went to surgeons who specialized in breast surgery generally reported being happier with their outcomes.

According to Ms. Bowles, well-established ideas and beauty standards also drive flat denial. Women are supposed to have breasts, and that's part of a woman's value, she said. But, for a woman to appreciate that she is still a whole woman, breasts or not, is sort of radical.

Dr. Attai addressed this too, "We found that for a subset of women, 'going flat' is a desired and intentional option, she said in a press release, ...and should not imply that women who forgo reconstruction are not concerned with their postoperative appearance."

Kim Bowles, topless, founder of NPOAS. Photo by Charise Isis of The Grace Project, curtisty of Not Putting On a Shirt.

The Impact

Not only does flat denial, as Dr. Attai proved, make patients less happy with their outcomes, it can have ripple effects to other parts of life. It's a serious trauma that happens to women, explained Bowles, these are women who are typically either at high risk of breast cancer or are already in breast cancer treatment, they're looking at a future that's filled with medical treatments. For people like Bowles, and others that have their wishes ignored, there is a toll, having a medical provider violate your trust in such an egregious manner, it definitely affects you moving forward, she said.

Holdups and progress

Surgically, going flat requires skill, and doctors who are more comfortable with performing reconstructions might be less confident in a mastectomy alone procedure.

Another issue is that going flat is not an officially designated medical procedure. According to Ms. Bowles, there is no specific medical billing code, and this can pose a problem for surgeons getting paid. Surgeons that are doing extra work and spending extra time in the operating room to produce agood aesthetic result, they should be compensated, she explained.

But at least there is an official definition for going flat. In June 2020, the National Cancer Institute, due to lobbying from NPOAS, added a going-flat definition to its dictionary so patients could explain what they wanted. The new term: aesthetic flat closure. An NCI spokesperson said a team comprised of two scientists, two oncology nurses and others found the term to be a relevant addition to the institutes dictionary.

The official medical definition of "going flat" National Cancer Institute's Dictionary of Cancer Terms

Currently, there is a proposed bill in Vermont that would revise coding and billing standards.Medical Dailys request for comment from the bills sponsor, Representative Charen Fegard, was not returned by deadline.

Reasons for saying, no reconstruction

Breast cancer, according to the CDC, is the second most common cancer in women. The women in Dr. Attai's survey were, on average, in their late forties, white, married, and had private insurance. Dr. Attai acknowledged that her survey data were pulled from people who were active in online, going flat communities, which could lead to bias in the data.

Dr. Attai also assessed why women in her study elected to go flat. She found that some women who did so cited the shorter recovery time, while others believed that reconstruction was not necessary for their body image, and others wanted to avoid getting breast implants, for good reason.

In 2019 the FDA requested that Allergan, a breast implant manufacturer, recallsome of their implants. The recall was in response to research linking textured implants with implant-associatedanaplastic large cell lymphoma, a form of cancer. The FDA has been diligently monitoring this issue since we first identified the possible association between breast implants and ALCL in 2011," saidFDA Principal Deputy Commissioner Amy Abernethy, MD, PhD, at the time, "Based on new data, our team concluded that action is necessary at this time to protect the public health."

Some women worried about an implant have elected for no reconstruction, Ms. Bowles said. "I think there's a growing awareness of the complications of implant reconstruction that dovetails with the increased awareness of aesthetic flat closure as a legit, safe option," she explained.

Dr. Attai addressed this too, "We found that for a subset of women, 'going flat' is a desired and intentional option, she said in a press release, ...and should not imply that women who forgo reconstruction are not concerned with their postoperative appearance."

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Reconstruction Post-Breast Cancer Surgery Is Not a Given, Anymore - Medical Daily