THE BLURT BULLY PULPIT: Rupa & The April Fishes

In which a
physician/musician contemplates health care.




album Este Mundo is poised for
release at a very interesting moment–there are surges of change rumbling under
the weight of archaic fearful stifling structures. As a doctor and a musician,
I have the great fortune of watching up close how people are reacting to change
in two
big money-making industries in the US. Fear of change and arguing with
reality seem to be big themes as both the music industry and health care
industry are wrestling with how to adapt to the realities each face. You can
witness the resistance to change in town hall debates around the US where the
new health care plan has been debated. There is overwhelming fear of change, of
ensuring access to health care for people in the US.


are the only developed nation with no assured access of health care for its
population. And we spend more dollars per capita on our health, in alternative
medicine and conventional medicine. We are hemorrhaging dollars at our
emergency rooms across the country as people come in extremis far advanced in their
diseases, instead of earlier when the disease could be more manageable as an
outpatient. To me, this issue is not political. It is not about socialism or
capitalism. It is about human rights and making the choice about the kind of
society we want to live


we pay more money as taxpayers for more expensive care when people arrive
advanced in disease processes to the ER, requiring ICU care, surgery or extreme
measures to keep them alive. They arrive to us at death’s door. I have seen
many people who do not have insurance come in at the last moment, almost
needing amputation, with diseases far gone. If there was a clinic they could
have walked into, it would have prevented the extreme and expensive care we
must give them when they come in at the last most critical moment. As
physicians, we are obligated
to treat anyone in the ER and everyone comes in. Everyone. We are paying for
their care with our tax dollars and soaring insurance premiums. Why not do it
in a more responsible, forward-thinking way? Instead of covering our costs from
huge skyrocketing ER expenses, why not
spread the funds around ensuring people could get care earlier so their
diseases don’t advance to the point of tragedy as often? We pay for it anyway.
That’s the reality. The question is HOW we want to pay for it. With foresight
or chasing figures? And I believe it would be less expensive and more humane to
give people easy access to health care early on.


then our leadership fails us. Obama shocked me when he said that his health
plan would cover everyone, but not undocumented people. Again, everyone comes
to the ER. I have seen that the greatest democracy is the human body, our
fragile and resilient existence. Regardless of nationality,
gender, sexuality, religion, social status–all these ideas that supposedly
divide us–as a physician, you see on a daily basis that everyone lives,
breathes, gets sick and dies. Something that has greatly shaped my music and
the content of our upcoming album has been meeting people
with advanced diseases who come to the hospital late because of fear of
deportation. To me, it is unacceptable that anyone feels so alienated from
their own bodies that they avoid getting help when they know they desperately
need it, especially in a country with such vast resources–enough
resources to carry on endless wars in foreign lands. We don’t live in a country
where resources are not available–we just chose to allocate them in terrible
ways. And most of the undocumented people who I have met came here to work, and
they do hard work, work that
most US citizens don’t like to do. They pick the vegetables that end up on our
plates. They clean the kitchens and bus our tables. They rebuild
hurricane-devastated American cities. To see this laboring group of people then
neglected by a health plan to me seems criminal and an obvious denial of


there is an overwhelming epidemic of ignoring reality–by our media, by our
leadership. We have an estimated 12 million undocumented people living in the US. Most of
them have come for work and if you open your eyes and look behind the scenes
you’ll find that the base of the US economy
is upheld by the sweat of people who come here clandestinely to work hard and
earn a better life for themselves and their families. This is a labor force
with no protected rights–not even the right to be healthy. We have not strayed
too far from our roots of slavery, only now it’s
more insidious because it is unnamed, unidentified and undocumented. If we are
going to profit off the labor of a group of people, it would be nice if we
could ensure their safety, dignity and health. This would require a radical
change–actually contending with reality. Not the idea of the United States of America
but the reality. This would require radical change.


we are living in a world where change is met with fear. Look at the record
industry responding to the reality it faces–data that is freely exchangeable.
One day, records will not sell. We need to imagine how to make a living as
artists and artist representatives. We must imagine how to make a living off
our value, our living breathing value. It is interesting to release a record
and hope for the ability to take care of the musicians and industry folks who
weave their careful lives with my dreams. How do we adapt in response to change
around us, taking in reality and imagining a more forward thinking future? How
can artists grow to take up the slack? How can the industry adapt? Innovations
offer opportunities and I prefer to approach them with optimism and imagination,
instead of reactive fear.


feels like a time of real possibility for deep change. And it takes simultaneous
careful observation as if through a microscope with a wide vantage point as if
through a telescope to move forward with clear direction. I am hopeful and see
this record as a document of where we are
these days, in this particular moment, surrounded by a mass global forced
migration of people in search of work, at this moment when the US is
rethinking its ethical core and digging up some ugly truths about our past and
present, in a time where old structures are failing and giving room
for something new to emerge. It is a good time to be traveling with music,
meeting people around the world–thinkers, musicians, cooks, doctors, taxi
drivers, hotel managers, mothers, sound engineers, day laborers, accountants,
children–taking in the stories, the perspectives and
trying to let the truths have their deepest resonance. It’s a fascinating time
to be alive in this world.



San Francisco‘s Rupa &
the April Fishes can be found at their MySpace page:
Their newest album,
Este Mundo, is out now on the
Cumbancha label,



Credit: Judith Burrows]


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