Blood Cancer Research Annotated Link Page—Including Eastern & Natural Medicine By J.D. Meyer

1. http://www.hematology.org/Patients/Cancers/ Three Kinds of Blood Cancer: (1) Leukemia, (2) Lymphoma, and (3) Myeloma.

2. https://www.ncbi.nlm.nih.gov/pubmed/25136372 “Treatment of acute lymphoblastic leukemia from traditional Chinese medicine.” Highlights from Abstract: “Methotrexate (MTX) is a drug used in the treatment of various cancer and autoimmune diseases……Therefore, MTX can inhibit the synthesis of DNA. However, MTX has cytotoxicity and neurotoxin may cause multiple organ injury and is potentially lethal…..Our results show that the TCM compounds adenosine triphosphate, manninotriose, raffinose, and stachyose could have potential to improve the side effects of MTX for ALL treatment.”

3. https://en.wikipedia.org/wiki/Adenosine_triphosphate “ATP is a complex organic chemical that provides energy to drive many processes in living cells, e.g. muscle contraction, nerve impulse propagation, chemical synthesis. Found in all forms of life, ATP is often referred to as the “molecular unit of currency” of intracellular energy transfer.[1] When consumed in metabolic processes, it converts either to adenosine diphosphate (ADP) or to adenosine monophosphate (AMP). Other processes regenerate ATP so that the human body recycles its own body weight equivalent in ATP each day.[2] It is also a precursor to DNA and RNA, and is used as a coenzyme.”

4. http://www.itmonline.org/arts/leukemia.htm TREATMENT OF LEUKEMIA USING INTEGRATED CHINESE AND WESTERN MEDICINE, by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon. Highlight: “While specific nutritional approaches have not been developed for leukemia, certain general methods can be applied:
a. Make sure the individual is receiving adequate basic dietary nutrients, such as proteins, fats (preferably unsaturated), and carbohydrates. Monitor body weight and muscle strength, and take further action if there is not improvement, including recommending easy-to-use concentrated nutrition sources.
b. Provide additional nutrients and a high level of antioxidants using supplements (11). General anticancer substances may be tried, including flavonoids (quercetin, genestein, tea polyphenols), minerals (selenium), and vitamins (high dose vitamins A, C, and E). Even if these fail to produce a cancer-inhibiting action, they may provide other benefits for persons in the age group that suffers from chronic leukemia.
c. When possible, use Oriental dietary techniques to match the dietary components to the symptom/sign pattern (12). For example, use cooling foods for fevers, astringent foods for sweating, yin-nourishing foods for yin deficiency patterns, etc. Make sure the suggestions include using foods that can reasonably be obtained and prepared.”

5. https://blog.yinyanghouse.com/posts/one-more-reason-to-eat-your-veggies-significant-leukemia-risk-reduction Highlight: “Their analysis found that there was a significant decrease in leukemia risk as the vegetable intake was increased. Interestingly, they did not see a significant raised risk from red meat, poultry, fish, or fruits. The primary factors in elevating the risk were frequent intakes of “fat, deep-fried, and smoked” foods. They concluded that “diets rich in vegetables and adequate amount of milk reduce the risk of adult leukemia.

6. http://www.a-healthy-body.com/the-top-10-health-benefits-of-turmeric-plus-how-to-use-it-in-everything/#comment-92 “The Top 10 Health Benefits of Turmeric (Plus, How To Use It In Everything).” The most relevant benefits vs. cancer are probably #3 “Turmeric helps boost your immune system” & #5. “Turmeric can help treat and prevent cancer.”

FOOTNOTE (Initial Reaction): “I’m sorry to hear of your father’s illness. If my health research turns up anything, I’ll let you know. CoQ10 is great for cardiovascular diseases, and Dr. Peter Langsjoen of Tyler is one of the major authorities on CoQ10 in the world! But that may not apply for cancer.”

“Skillful Teaching through Facilitating Discussion—Teaching skills is an essential pillar of a competent CHW and CHWI,” a lecture by Dr. Shannon Cox-Kelley, summarized by J.D. Meyer

This was the first lecture at the 2018 Community Health Workers Conference for the NE TX CHW Coalition, July 13, 2018.

The NE TX CHW Coalition Conference featured two main lectures and three breakout sessions. The first main lecture was by Dr. Shannon Cox-Kelley –Dean of Health Science–who teaches in the Community & Public Health degree program at NE TX Community College. She received all of her degrees at Texas A&M at Commerce and is a noted online distance educator.

Dr. Cox-Kelly cited four occasions to use discussion: (1) Evaluate evidence. (2) Formulate application of principles. (3) Foster motivation for further learning. (4) Articulate what has been already learned—theory behind the discussion.

Memory is linked to how deeply we think about something. A research interest cited in Dr. Cox-Kelley’s biography really clicked with me: “the impact of educational attainment on health outcomes in diverse communities.” My disabling condition is COPD, but as a Master’s degree holder and former all-level teacher (mainly Developmental English/Writing: the Pre-College Composition course), I’ve learned to study my conditions. (Yes, I have other health issues). I write Word Press articles on health and make binders full of info on medicine, ER reports, and journal articles.

Returning to Dr. Cox-Kelley, she notes that relationships are key, and we have a need to know why and how information is needed. The CHW Instructor could start with controversy like a “devil’s advocate,” but one should announce it in advance to maintain trust. Uncertainty arouses curiosity; switch sides. Focus on solving problems rather than the solution.

Many students are passive and quiet since we’re taught to memorize in secondary education. An increasingly popular practice is to flip the class and have the lecture at night on You Tube or something like it. Then the classroom becomes a place for total discussion. This flip improved passing rates at Dr. Cox-Kelley’s junior college. Think, don’t memorize.

How to start with questions means to start with desired outcomes. Factual questions increase problem-solving. Application and interpretation questions find connections. Problem questions can induce critical thinking. Comparison questions can evaluate readings.

Dr. Cox-Kelley cites principles behind case studies: (1) Increase focus. (2) Break cases into sub-problems. (3) Socratic questioning, and (4) Lead students toward intended outcomes. Once again, passive students can be a possible barrier, as well as failure for students to see value.

Dr. Cox-Kelley cited Discussions as a Way of Teaching, by S.D. Brookfield and S. Breskill (1999) as a fine relevant book. Students can experience a fear of looking stupid and the inability to consider alternative sides because of emotional attachment. Are they trying to find a correct answer or explore? Helping emotional reactions includes asserting the value of discussion and keeping opinions and verbalization in perspective. To conclude, collaboration is better than competition.

“Skillful Teaching through Facilitating Discussion” lived up to its subtitle of teaching skills being an essential pillar of both the Community Health Worker (CHW) and CHW Instructor (CHWI). Furthermore, Dr. Cox-Kelley’s lecture reached out to teachers looking for a second career or a stimulating cause in retirement.

Dealing with a Bad COPD Exacerbation & Maybe Dodging an E.R. Visit (4th Edition)

By J.D. (“Joffre”) Meyer
Those of us with COPD (Chronic Obstructive Pulmonary Disorder) live with the strong risk of an exacerbation that is severe enough to go to the Emergency Room by way of ambulance. I developed asthma 18 years before COPD too. We face a mix of lung spasms, excess chest phlegm, and a low FEV (Forced Exhale Volume). Asthma-COPD Overlap Syndrome (ACOS) is known for increased breathlessness and sputum–but a better response to inhaled corticosteroids.

It’s typical for me to have some coughing and wheezing when I awake, and sometimes after a walk. Choice #1 is using an asthma rescue inhaler, such as Combivent or Pro-Air. It’s like a “Bud Light” version of the nebulizer, as both use albuterol. Combivent is stronger, and it also has ipratropium. But the likelihood of its effectiveness goes downhill if our attack is more than simply mild. Rule #2 is not to take the long-term inhalers during an acute attack, such as Advair or Symbicort, and Singulair.

So we go for our dear friend, the nebulizer, and pour a vial of albuterol or albuterol-ipratropium in the receptacle. We get “Albut-Iprat” when our condition becomes worse. I just started getting Combivent, the stronger “Albut-Iprat” inhaler. Our next choice is mask or “pipe.” Most say the pipe-like hose is better because we get more of the medicine. So here’s my first original suggestion. If you wear the mask, put your oxygen canula up your nose (assuming you own one). Really tired COPD sufferers may have difficulties with the pipe. Lately, I’ve switched back to the pipe-like breathing tube. Furthermore, I’ve started holding a lozenge in my mouth while I inhale my albuterol from the nebulizer. The lozenge is menthol and maybe eucalyptus too. That way, the cooling anti-inflammatory elements of the lozenge shoot directly to your lungs, as opposed to staying in your mouth and keeping you from coughing phlegm. My guess has been approved by real doctors!

Speaking of phlegm, keep a plastic can with a lid handy, such as my old Folger’s coffee can, the regular 10.3 oz. size. Don’t even consider swallowing that phlegm. I’m not trying to be funny because it’s not. Don’t expect to be able to run to spit in the nearest toilet or sink either. Make sure you drink enough water too–a likely weak area for most people. 1.5 liters daily should be enough since other fluids are okay; vegetables and fruits are full of water too. I use an attractive purple jug for my water, so I’ll notice it better! I can keep the squirt cap on when I take my many morning pills. Then I remove the cap for water guzzling! Now I’m exploring fruit-flavored water to increase my likelihood of really hydrating. Furthermore, local water systems have been breaking down lately!

Now let’s look at the OTC (over-the-counter) medicines. For your chest congestion, take some guaifenesin; that is, Mucinex or a generic version. COPD is a mix of emphysema and bronchitis. Bronchitis is like having a perpetual chest cold while emphysema is a destruction of the lung sacs and a lack of elasticity in the lungs.

What if you have nasal congestion? A saline nasal spray will open a constricted nose. Later I submitted this article to COPD Breathing Buddies of Facebook, and I was warned about Sudafed. This drug may reduce nasal congestion, but Sudafed can raise your blood pressure, which may happen anyway during a COPD attack. In the past, I added Mullein leaves (gordolobo), eucalyptus leaves to my morning coffee drip bin before I got health insurance but lived next door to a Mexican botanica. My goal is to reduce inflammation. Garlic pieces and ginger slices work too.

If you have severe or moderate COPD, take your Daliresp pill. I have allergies to Bermuda & Johnson Grass, so I have allergy pills to take–an OTC generic equivalent of Claritin called Loratadine, a non-drowsy tablet and now Montelukast, my newest prescription. Montelukast is actually the pill version of Singulair, and one of the cheaper lung-related prescriptions. I keep a daily pill reminder box by my bed, as I have a total of six per day–not all bad lungs related. By the way, since you’re taking all these pills have a water bottle next to your bed. The more water you drink, the more the mucus will be thinned.
Here’s my second original tip. If you have a C-PAP machine for sleep apnea, you can use it when you’re wide awake to force air into your inelastic, sagging emphysema-ridden lungs! Don’t overuse your nebulizer; try a wide range of strategies to stop the COPD attack.
Lately, I started taking Vitamin D and magnesium. I read a wonderful booklet about the benefits of magnesium for the lungs after my move of February 2018.

Please check out my methods for battling severe COPD exacerbations! Maybe I have a higher tolerance for pain than many, or a fear of walking home from the E.R. before sunrise? I wrote this article after coping with a severe attack lasted for 1 hour & 40 minutes; editing followed the intial blog!!
And when you quit choking, take those long-lasting spray/powders: Advair or Symbicort and Singulair or whatever.

Consider calling your G.P. M.D. later for an office visit. After this epic COPD attack, I got a shot of Salumedrol, a steroid, at her office. Then I got prescriptions for prednisone pills and a Z-Pac antibiotic.

“Asthma-COPD Overlap Syndrome (ACOS),” Footnotes & a Commentary from a Patient (6th Edition), by J.D. Meyer

 

“Asthma-COPD Overlap Syndrome (ACOS): A diagnostic challenge,” was a Top 100 WebxMD article for 2015. http://onlinelibrary.wiley.com/doi/10.1111/resp.12653/full It caught my attention because I’ve had this condition for ten years; however, I never heard the two described as a unit in this manner! Three symptoms stood out on my first reading: increased sputum, more dyspnea (breathlessness), but better response to inhaled corticosteroids. At once, I told all my local health connections about ACOS. This article was written by three doctors in the Far East: Vietnam, Korea, and Japan. “Tho, N. V., Park, H. Y. and Nakano, Y. (2015), Asthma–COPD overlap syndrome (ACOS): A diagnostic challenge. Respirology. doi: 10.1111/resp.12653.”

Furthermore, a Google search for ACOS yielded nothing unless I entered the complete term. So the breakthroughs didn’t happen around here—adding to this disabled Developmental English/Writing—ESOL teacher’s sense of urgency!

Definition of Terms

I printed this article and started highlighting and making notes. Fortunately for me, many of these technical terms corresponded to familiar brand names for my many ACOS drugs. Symbicort is a Long-Acting Beta2-Agonist (LABA) and an Inhaled Corticosteroid (ICS). A LABA is a long-term brochodilator while an ICS decreases inflammation. Rinse your mouth with water after each use, and don’t swallow the water; spit it out. I was switched back to Advair (another LABA +ICS drug), which has bee my usual inhaled corticosteroid. Both drugs are used for asthma &COPD. A Muscarinic Antagonist is also a bronchodilator, such as tiotropium (Spiriva) and aclidinium.

Spiriva, an inhaled capsule, is used for COPD, including emphysema and chronic bronchitis. Later, I was switched to Montelukast, the pill version of Singulair.

There is only one PDE4 inhibitor—Daliresp (roflumilast), and it works against excess bronchitis and phlegm. Daliresp decreases the number of exacerbations in severe COPD, and it’s not a bronchodilator. Daliresp decreases lung inflammation and prevents COPD flare-ups. Don’t use Symbicort, Spiriva, or Daliresp for an acute attack.

For an acute attack, use your “inhaler,” such as ProAir and Proventil; they’re examples of Short-Acting Beta2-Agonists (SABA); both are albuterol. Proair will open the airways and prevent a bronchospasm. You could go for your nebulizer for an acute attack, especially a bad attack. Our albuterol vials for the nebulizer could be called an”extra-strength” SABA. Iprat-Albut (Albuterol & Ipratropium) are two bronchodilators for the COPD patients’ nebulizer. For two decades, I was on pure Albuterol for my nebulizer. Now my inhaler is Combivent–a stronger ipratropium-albuterol inhaler.

Atopic is an allergic reaction, often hereditary. Atopy is a feature of ACOS and associated with a higher prevalence of chronic cough and sputum production, according to Tho, Park, and Nakano. Eosinophilic airway inflammation means there’s a higher than average number of white blood cells. It can be detected in mucus if it’s tissue eosinophilia. Tho, Park, and Nakano note that ACOS patients have higher sputum eosinophil counts than those with COPD alone, but sputum count profiles may change over time. Blood eosinophilia is over 500 in a microliter of blood. I found these definitions at Medicine Net and the Mayo Clinic websites too.  Much of the drug definitions came from the pharmacy’s medicine sheets themselves.

Economic Burden & Disability

Tho, Park, & Nakano note that the percentage of ACOS patients visiting the ER or admitted to hospitals is significantly higher than COPD alone in South Korea. A United States Medicaid population reports that ACOS patients have a higher rate of utilizing any service versus asthma or COPD alone. Moreover, the average annual medical cost for an ACOS patient in the US is $14, 914–much higher than asthma, $2307 or COPD,  $4879. ACOS is common in the elderly. It features more dyspnea (breathlessness), wheezing, and more frequent exacerbations. The respiratory quality of life and amount of physical activity for those with COPD alone.

Addendum to Tho, Park, & Nakano

Using my peak flow meter to check my forced exhale volume (FEV) always has been one of my strong points in managing my ACOS. I check my peak flow meter before I go for a walk, and if I’m under my usual low moderate level of impairment, I head for the albuterol nebulizer. Check my article https://www.newscastic.com/news/forced-exhale-volume-fev-lung-disease-your-peak-flow-meter-1155949/ The “whole story” includes a link to an About.com article on Pulmonary Function tests, by Deborah Leader, RN, COPD Expert.

Returning to the Tho, Park, and Nakano article, we see that a staggering 49% of smokers develop chronic bronchitis and 24% get emphysema or COPD. “Smoker’s cough” is worst upon arising. Dyspnea increases as the disease worsens. Quit smoking or else!

Guaifenesin (Mucinex) has been one of my favorite OTC medicines for years because it’s an expectorant. You can find a cheaper generic version in the dollar store too. Warn the doctor if you smoke, or have asthma or emphysema. It thins the mucus, so it’s less sticky and easier to cough up, according to www.drugs.com/mucinex.html  Take guaifenesin when you have a cold, bronchitis, flu, or allergies–whatever got your chest full of phlegm. Still drink plenty of fluids. www.webmd.com/drugs/2/drug-63818/mucinex-oral/details I’ve been told by my doctor to take a larger than average dose of guaifenesin during an ACOS attack.

I also take an over-the-counter allergy pill, for I’m allergic to Bermuda and Johnson grass. My choice is non-drowsy Loratadine Tablets, an antihistamine that’s another find at Family Dollar. Loratadine is a generic form of Claritin.

Beware of drinks with carbon dioxide (CO2) also, such as beer and soda. http://respiratorytherapycave.blogspot.com/2008/06/asthmacopders-should-avoid-pop-beer.html The ability to exhale carbon dioxide is vastly impaired for the bad lung crowd. “The normal human body breathes to eliminate CO2, producing 200 cc./minute. However, one can of soda has up to 1000 cc. of dissolved CO2. Most is absorbed by into the blood stream by the intestines.” This can lead to more dyspnea (breathlessness) in those with lung disease. Furthermore, beer can cause dehydration too–another cause of dyspnea. Maybe gas pills help; time will tell.

On the other hand, if you like alcoholic drinks and wish to be more careful, then try red wine. First of all, you won’t have to worry about bubbles. Red wine increases antioxidant status and decreases oxidative stress in circulation, mainly because of glutathione (GSH). The “French Paradox” is explained by their love of red wine lessening coronary heart disease despite a fatty diet. https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-6-27

In closing, there’s a rich amount of literature on asthma, bronchitis, and COPD. Learn to manage your illness before you continue to deteriorate, and get a pulmonologist if you don’t have one already.

MY MEDICAID ADVENTURE by Joffre (“J.D.”) Meyer

I have had COPD since December 2005 and asthma since 1987. I got on SSDI in March 2010, Medicare in November 2011, and Medicaid in July 2012. Not everyone goes through the same sequence. I checked into a neighborhood nursing home once I got on Medicare, so I could get two long overdue surgeries: hernia since December 2007 and a bad big right toe (either broke or a bunion) since spring 2010. Can you imagine what it was like to hold one’s groin when a COPD sufferer with little medicine coughed for four years?
I made sure that I was affiliated with East Texas Council for Independent Living (ETCIL) when I committed myself. I got a wonderful social worker/relocation specialist, Suzan Chapman, who I still see at downtown art events because her hobby is jewelry, and she’s a fan of the arts and Downtown Tyler too.
Getting out of the nursing home was dependent on getting on Medicaid. Unlike many, I got on SSDI and Medicare on my first try. My last job was a nightmare, so I got lung and mental status testing to be safe, and not end up under a bridge; thus I call my SSDI monthly check, “a bad lung/crazy check.”
While in the nursing home, I went to Pulmonary Rehabilitation at Trinity Mother Francis. This led to attending monthly Better Breather luncheons on second Tuesdays at TMF. It’s a group for those with lung and/or heart diseases. There’s always a guest speaker at our free luncheons.
Turned down for Medicaid the first time, I caught a bus to the records building of East Texas Medical Center’s (ETMC) records department. I provided the records of astronomical E.R. bills from 2008-12 to the nursing home social workers and got out quickly.
I relocated within walking distance from the hospitals in the east-central part of my hometown, Tyler. It’s known as Midtown or the Hospital District. Before checking out, I made sure I was part of Neighborhood Services, so I could get a 2/3 discount on my efficiency. It was great to reunite with a favorite prominent alumnus, Andy Davis, of the HBCU, Texas College, where I’d taught from 2001-06.
Now that I was on the outside, I could have a G.P. and a pulmonologist. I’d always managed to keep my albuterol flowing through my nebulizer since ’97. Having a rescue inhaler is an obvious necessity, but probably tougher now for the strugglers after the end of Primatene, the over-the-counter inhaler that cratered and rising pulmonary illness medicine costs. I started on Advair, the purple disk, while still teaching for the HBCU, but its expense meant sporadic help through service organizations.
My new lung medicines were a tiny pill called Daliresp, and Spiriva, the medicine advertised on TV with an elephant on the actor’s chest. My first pulmonologist prescribed oxygen canula for sleeping. Then the new pulmonologist, Dr. Luis Destarac, noticed my condition was more severe and sent for sleep studies.
Sure enough, I have severe sleep apnea and got a C-PAP machine. The C-PAP helps the apnea condition of waking up off and on unknowingly in my sleep because I quit breathing repeatedly! I bet the C-PAP is also good for the inelasticity of my lungs due to emphysema. Dr. Destarac is also an allergist, so I get allergy shots for bermuda and Johnson Grass primarily twice a month from his also very likable nurses, Esmeralda and Emily.
The G.P., Dr. Paula Bessonette, discovered that I have high cholesterol and require a Lipitor-type drug, as well as Vitamin D. Dr. Bessonette is so cool that she leaves some time open her day without appointments,so she can treat conditions like a COPD exacerbation to keep folks like me from automatically going to the expensive E.R. A recent eye exam caught the onset of macular degeneration, and combination vitamin/mineral capsule is arresting that condition.
My health hasn’t been this good in years–no E.R. visits since early January 2015! I used to go to the E.R. on a monthly basis. I’ve been a volunteer with the East Texas Human Needs Network (ETHNN), starting in the education and health committees before changing to the new transportation committee because I’m an avid bus rider. Then I was invited to the Community Health Worker (CHW) coalition.
Now I’m going through a disability rights group to see if I can have a trial work period, so I can start publishing my Developmental English/Writing textbook–already copyrighted and illustrated. Thus my adventure with Medicaid is about to have a new chapter!

Invest in Costa Rica: A Long-Range Answer to the Central American Crisis that Rewards Good Governance, by J.D. Meyer

Central America: Suddenly our southern border is being besieged by immigrants from there—often children. We hear tales of homelands that have become failed states–full of poverty and gang violence—especially Honduras. But what about Costa Rica? I had heard about a couple of really good things about Costa Rica: ecotourism and high ratings in Happiness measures. I’ve never met a Costa Rican, despite teaching ESOL off-and-on during a 20-year period while meeting plenty of Salvadoreans and whatnot. So I decided it was time to introduce myself to Costa Rica through Wikipedia http://en.wikipedia.org/wiki/Costa_Rica
The New Economics Foundation (NEF) not only rated Costa Rica as first in its Happy Planet Index twice recently but also as the greenest country in the world. Costa Rica is “the only country to meet all five criteria established to measure environmental sustainability.” Costa Rica has made sustainability and environmental concern the fixture of its national public policy. This country used to have among the worst deforestation rates in the world until 1989, but now it’s almost zero. The ecological footprint is one-third of the US.
Around 25% of its land area is in protected areas and national parks–the best in the world and way above the developing world average of 13% and the developed world average of 8%. Costa Rica has 5% of the Earth’s biodiversity in only 0.1% of its land mass. No wonder Costa Rica has pioneered ecotourism, and that now earns more than its three cash crop exports: bananas, pineapples,and coffee. Costa Rica is second only to Mexico in tourism for Latin America.
Now we’re talking economics—the main reason for my topic. The Costa Rican central government offers tax exemptions for those willing to invest in Costa Rica. The three biggest manufacturers are (1) Intel (chip manufacturers), (2) GlaxoSmithKline (pharmaceutical, including my Advair!), and (3) Procter & Gamble. The giant Intel facility accounts for 20% of its exports and 5% of its GDP. Costa Rica is also trading with Southeast Asia and Russia, gaining membership in the Asia-Pacific Economic Cooperation (APEC). Costa Rica is the top destination in Central America for direct foreign investment since 2003, partly because the people are so educated. Costa Rica is a highly literate country– 94.9%. When Costa Rica abolished its army in 1949, it was said that the army would be replaced with an army of teachers.” Elementary schools and high schools are found throughout the country, and they’re free and guaranteed by the constitution. Public universities are considered better than private ones.
Costa Rica is healthy too with an average life span of 79.3 years, second highest in the Americas, and its health care system called Central America’s “great health success story.” Ranked higher than the US, Costa Rica provides universal health care to wage earners and has many hospitals and clinics. It even attracted $150,000 from foreigners (often the US) in 2006 in medical tourism for its proximity, quality, and low expense.
However, Costa Rica only has a GDP of $12,874; poverty is at 23% and unemployment is 7.8%, but inflation is only 4.5% They need help in infrastructure.
My point is for the US to encourage more investment in Costa Rica. Maybe we could ask Intel, GlaxoSmithKline, and Procter & Gamble what companies they’d like to see join them. How many times have we heard our civil engineers urge repairing highways and bridges in the US?Perhaps Costa Rica could save some Central American refugees from trying to move all the way to the often unfriendly US. Costa Rica is one Latin American country with more immigrants than those leaving.

Note: This essay was originally a talk given at the Tyler Spoken Word (July 6, 2014).