One of the most publicized, least popular tax nuances in America is beginning to crumble this week. The so-called tampon tax—or, rather, the fact that menstrual hygiene products are not exempt from sales tax—is history in Chicago, where the city council unanimously voted on Wednesday to classify pads and tampons as medical necessities, not luxury items. The day before, the New York State Assembly passed a similar bill, also with a unanimous vote. Making women pay extra for their periods is a stance no smart politician seems willing to take.
The revolt against the tampon tax is a worldwide movement: Canada became the first country to exempt menstrual hygiene products from its sales tax last June, and British women are bleeding through white pants in protest of the products’ taxation in the EU. As I write these words, Prime Minister David Cameron is lobbying against the tax at the EU summit in Brussels. Several other U.S. state legislatures, including those in Wisconsin, Utah, Ohio, Michigan, California, and Connecticut, are considering proposals like New York’s this year. Massachusetts, Pennsylvania, Minnesota, Maryland, and New Jersey already exempt the products, but every other state with a sales tax classifies tampons as luxury items or non-necessities, which makes them subject to the same tax as chocolate-covered pretzels, snap bracelets, and iPads.
Arguments against the tampon tax practically make themselves. Since necessities make up a larger proportion of poor folks’ spending, sales taxes can be considered regressive; they make it even harder for people in poverty to eke out a comfortable, dignified living. And inconsistencies in state tax codes abound: Some states, like Connecticut and North Dakota, don’t tax pads meant for incontinence, but still tax pads meant for periods. (The former, but not the latter, are classified as medical goods.) The idea that tampons and pads are not “necessities”—a category that includes mustard, food coloring, and Fruit Rollups in New York—may be a relic from the days before tampons and disposable pads, when most women used washable strips of cloth to absorb their menstrual fluid. Few women continue along that route today. Periods involve bodily fluids, which carry implications for public health and sanitation. If that’s not a medical need, what is it?
But the fight to exempt menstrual products from sales tax, easy as it’s proving to win, may be misdirected. From a state’s perspective, the taxes garnered from menstrual hygiene products add up: The California state legislator who introduced the state’s proposed anti–tampon tax bill estimates that California women pay $7 per month for menstrual products, and menstruate for about 40 years. That means about $20 million in taxes from tampons and pads per year for California. But each individual person pays a relatively tiny tax on each box of tampons. Let’s take Tennessee, which has the highest rate of combined state and local sales tax in the U.S.: 9.45 percent. Using California’s estimate that women pay $7 per month for tampons, Tennessee women pay about 66 cents in tampon tax per month. That’s $7.94 per year—not a small amount for someone living in poverty, but not a huge benefit over the course of a year, either, once the tax relief comes.
In a Washington Post opinion column, Catherine Rampell pointed out that ending the tax on tampons isn’t a particularly efficient way of helping poor people who menstruate since it gives “a break to billionaires” who menstruate as well. Instead of carving item-specific exemptions from the sales tax, she wrote, states should just give more cash to the poor. This argument might not sway tampon-tax advocates who care more about helping poor women afford necessary products than about milking billionaires for a few cents each month (especially if states can make up for the lost tampon-tax revenue with increased demands on those billionaires). But Rampell’s right—a direct cash transfer would be a better way to address the unfairness of the sales tax on menstrual products.
It’s hard to get any legislature to pass an increase in cash benefits for the poor, though. Here’s a more politically feasible idea: The government should make menstrual products eligible for purchase with food stamps or Medicaid. In most places, it’s far easier to get food stamps than cash assistance; some poor women already end up trading their food stamps for tampons at willing bodegas, paying extra for the convenience. The Department of Agriculture may prove unwilling to use its food-stamp funds for non-food items—but if menstrual products are truly a medical necessity, as an increasing number of U.S. jurisdictions claim they are, they should be covered by Medicaid. Food stamp cards would be the easier route, since they’re already accepted as tender at grocery stores that sell menstrual-health products, but it wouldn’t be too hard to make it so a woman could take her Medicaid card to a pharmacy counter along with a box of tampons or pads, just as she would to pick up prescription drugs.
For poor people, menstrual products shouldn’t just be tax-free—they should be free, period. Some advocates have drawn comparisons to products men use—condoms, Viagra—that aren’t taxed, as an argument for a tampon exemption from the sales tax. But neither condoms nor Viagra is essential to hygiene or part of an involuntary biological function; menstrual products should be even easier to obtain. The tax on tampons and their exclusion from Medicaid and food stamp programs are a double burden on people who face other economic barriers: women with dependent, menstruating daughters, for instance, and lesbian couples, who require twice as many menstrual products and are twice as likely as straight couples to depend on food stamps. Defeating the tampon tax will be an undeniable symbolic win for women and people in poverty with nominal per-person effects. In the best-case scenario, it’ll codify tampons as a medical necessity, which will pave the way for Medicaid-covered menstrual products in the future. In the worst case, this nominal success will be a distraction from more systemic solutions, an excuse for conservative legislators to further ignore the brutal indignities of economic insecurity.
Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. It usually occurs when sexually transmitted bacteria spread from your vagina to your uterus, fallopian tubes or ovaries.
Pelvic inflammatory disease often causes no signs or symptoms. As a result, you might not realize you have the condition and get needed treatment. The condition might be detected later if you have trouble getting pregnant or if you develop chronic pelvic pain.
Signs and symptoms of Pelvic inflammatory disease might include:
When to see a doctor
See your doctor or seek urgent medical care if you experience:
If your signs and symptoms persist but aren't severe, see your doctor as soon as possible. Vaginal discharge with an odor, painful urination or bleeding between menstrual cycles can be associated with a sexually transmitted infection (STI). If these signs and symptoms occur, stop having sex and see your doctor soon. Prompt treatment of an STI can help prevent PID.
Treatment of pelvic inflammatory disease (PID) addresses the relief of acute symptoms, eradication of current infection, and minimization of the risk of long-term sequelae. These sequelae, including chronic pelvic pain, ectopic pregnancy, tubal factor infertility (TFI), and implantation failure with in vitro fertilization attempts, may occur in as many as 25% of patients. 
From a public health perspective, treatment is aimed at the expeditious eradication of infection in order to reduce the risk of transmission of infection to new sexual partners. In addition, identification and treatment of current and recent partners are indicated for the further reduction of sexually transmitted infections (STIs).
The pelvic inflammatory disease affects approximately 1 million women per year in the United States alone and has a variety of causative organisms. Because the diagnosis of PID is based on clinical judgment, health care providers need to be guided by the CDC recommendations for diagnosing and treating PID. Because presenting symptoms are often vague, the health care provider should assess female patients for risky behaviors that may lead to PID and should use screening data when making clinical judgments and differential diagnoses. Whenever possible, female patients with PID should be treated as outpatients. If diagnosis and treatment are not performed in a timely manner, PID may cause sepsis, septic shock, and even death. Even if they survive, as many as 15% to 20% of these women experience long-term sequelae of PID, such as ectopic pregnancy, tubo-ovarian abscess, infertility, dyspareunia, and chronic pelvic pain. The best treatments for PID are interventions that lead to prevention and early detection. The critical care nurse has an important role in recognizing the variables that may lead to PID-related sepsis and in encouraging health-seeking and health-maintenance behaviors among women with these diagnoses.
Medical evacuation of Sepsis patient
Patient with sepsis needs to be medically evacuated to a tertiary care center either by ground or air ambulance.
What sepsis does to Body
To begin with, you may have felt
like you were developing a flu-like illness. You may have:
• felt very cold and shivery
• felt very hot and looked flushed
• had a high temperature
• had aching muscles
• felt very tired
• have had sickness and/or
diarrhea (upset stomach)
• not felt like eating
• seemed confused or drunk,or
had slurred speech.
As your condition became worse:
• your blood pressure might have dropped because your illness caused you
arteries and veins to become larger. Your blood had a bigger space to fill and
so your body struggled to keep your blood pressure at a normal level
• your heart tried to help by beating faster
• you might have felt breathless and /or were breathing very quickly
• your skin might have been cold and pale, have had an unusual color or rash,
or it might have been mottled ( marked in ‘patterns’ or patchy in color)
• your skin might have been hot and flushed.
Depending on where the infection started, you would also have had other symptoms, for
example, if you had pneumonia, you would probably have had a bad cough as well.
As the sepsis progressed, your blood pressure might have
become very low and this would mean that:
• your organs will not have got enough blood and oxygen. this will have
damaged the cells in the organs causing them to fail. the kidneys,
lungs, brain and heart are particularly at risk from this
• you won’t have needed to urinate (pass water) as much as you normally do
• you may have found it very difficult to breathe
• your skin may have darkened in patches and begun to blister
• you may have become very confused and you might have become unconscious
• you may have swollen up with fluid, which would have made you much bigger than
your normal size and meant you looked very different. this might have been frightening
for you and your relatives to see. this swelling happens because your blood vessels
the wrong places leak out of your skin.
By this time, you will have needed urgent medical help and will probably have been
taken to a Critical Care Unit (also known as an Intensive Care Unit) in hospital.
Why do you need to be evacuated to a Tertiary care center by Medical Flight
Critical Care is where most ill patients
in a hospital are treated and nursed.
In Critical Care:
• you can be carefully watched and monitored, including
checking your pulse; blood pressure; breathing;
oxygen levels; how much liquid you take in and
how much you urinate (how much water you pass).
These checks are all very important because staff
can quickly change your treatment as needed
• staff can give you treatment including support for your
major organs, like your heart, kidneys and lungs
• there are highly trained doctors, nurses and
physiotherapists who look after you, and support
your relatives by explaining what is happening
• nurses look after fewer patients, so there may be
one nurse looking after only one or two patients.
What treatment will I receive after a Medevac to a Hospital
Sepsis is treated by:
• giving you strong drugs to help you
beat the infection. These include
antibiotics, antifungal or antiviral
drugs depending on what caused the
infection. Sometimes it is necessary for
the medical team to try different drugs
to find the ones that will best treat
your illness, and you may have got
temporarily worse or better as the new
drugs were introduced
• supporting your body's organs until
they can begin to recover. This
includes helping your blood pressure
(with extra fluids or strong drugs) and
organs (such as a machine for your
kidneys, which is called dialysis or
• helping you to breathe. oxygen may have
been given using a tight fitting mask, a
high flow device inserted into your
nostrils, or a hood that looked like a
space helmet. if you become very ill, you
will have had a breathing tube down your
throat. if you needed help breathing
for some time, you will have had a
tracheostomy. this is where a small hole is
made in the front of your neck so that a
breathing tube attached to a ventilator
(breathing machine) can be put into it
• making sure you have enough food and
liquid. this is done by putting a thin tube
up your nose and down into your stomach
or by putting a tube in your hand or arm
called a drip to give food and fluids
• you will have be given painkillers if
you needed them and strong drugs to
keep you drowsy or asleep, making the
treatment more comfortable for you.
What other Medical Help would I receive in a Tertiary care center
There will have been a whole team of doctors, nurses, physiotherapists
and other medical staff who will have treated you, looked after
you and tried to make you as comfortable as possible.
The nurses will have spent the most time with you and they will have done things like:
• checking how you were responding to treatment through
watching your blood pressure, oxygen levels etc
• giving you the drugs that you needed
• washing you and changing your bed sheets
• turning you often so that you didn’t get bedsores and moving
your legs and arms so that you didn’t get too stiff
• put a catheter in. This tube would have been put in to
your bladder to allow urine to be collected
• if you had a breathing tube or tracheostomy, you will have needed the phlegm to
be removed from your lungs as you were not able to cough strongly. This would
have been done by using a suction tube which was put down the breathing
tube. It would have made you cough and retch while it was being done.
How will I feel during my Medical Flight or when I am critical in an ICU in a tertiary care center
You may have no memory of your time in Critical Care or Medically evacuated to a Critical care center, or you may have
very confused memories of what happened to you there. The strong
drugs and your treatment will have affected your body and mind.
You may have:
• felt slightly aware but didn’t know where you were or what was happening
• had nightmares or thought things were happening which were not
real. These can feel so real that it can be very frightening. You may
have not realised you were in hospital and your mind may have
tried to make sense of what was happening, by making you think
things like you had been kidnapped or were being held captive.
Experiencing this confusion and hallucinations is called delirium
• been unable to talk or let people know what you were feeling
• have found it very difficult to sleep or have had
strange dreams when you did sleep
• not known what time of day it was, or how many days had gone by
• felt calmer when your friends and family came to
see you even if you weren’t fully awake.
How long do I stay in Critical care center
The length of time you have to
stay in hospital will depend on
how ill you are and how long
you take to get better. You will
only leave Critical Care when
you no longer need special
drugs and machines to support
your body and when you are
strong enough to cope on a
general ward. It can take
weeks of treatment in hospital
and once you are home, you
will slowly get better but it may
take up to 18 months to feel
strong and well again.
Moving to a Step down-ward and when will you be taken back home by HI Flying Medical Team
Sometimes it can feel frightening to leave the Critical
Care Unit to go to a general ward, or leave the general
ward to go home. These changes are happening
because you are getting better, but it can be a difficult
time for you and your relatives because there is
no longer the one-to-one nursing that you had in
Critical Care, but you still feel far from being well.
Many hospitals now have a team of Critical Care doctors
and nurses who will visit you on the general ward after
leaving Critical Care to make sure you are ok. You may
have met them when you were very ill before you were
sent to the Critical Care Unit. They are called the Outreach
Team or the Patient at Risk Team. They will be able to
answer any questions you have about what happened to
you in Critical Care, your treatment or any other worries
you have. If there isn’t an Outreach Team at your hospital,
speak to the ward nurses about any concerns you have.
After Safe Medical Transport home by HI Flying Team
What will happen when I go home?
You may be given a rehabilitation plan by your physiotherapist to help you
get strong again. If you haven’t been given one, look at the ‘Where to go for
help’ section at the back of this booklet for information that can help you.
Generally, when you get home:
• you will be very tired and will need to sleep and rest a lot. You have been
seriously ill and your body and mind need time to get better
• you will be very weak, will have lost a lot of weight and may find it difficult
to walk around. You may also find it tiring talking to people. Begin by
building up your activity slowly and rest when you are tired
• your skin may be dry, itchy and peel. it may help to put moisturizer
on your skin. Your nails may also break easily. Your teeth may feel brittle
and becoming damaged.
• you may notice changes to your hair and some may begin to fall
out some weeks after your illness. it is unlikely it will all fall out, it usually
just gets very thin and then starts to grow again
• it can help to have special nutritional drinks, like Complan® or Build up®
to help you put on weight again. You can get these on prescription by
asking your GP or you can buy them from a chemist or supermarket
• you might find it challenging to eat again. slowly by having
small meals and healthy snacks when you feel like it.
it can feel very frustrating once you are home because all the things you
could do easily before – walking, eating, even breathing – can suddenly feel
very difficult or frightening. You have to remember how ill you have been and try and see that you have made progress, even if it does not feel like it sometimes.
How do I feel now - A little Different
You might feel lots of different things
after your illness, for example:
• very upset or crying a lot
• not caring what you look like
• not wanting to see your friends
• getting cross very easily
• scared at how ill you have been or
worried that you might get ill again
• have upsetting memories of your time
in Critical Care or have flashbacks
(sudden powerful memories) of
what just happened to you
• have bad dreams or nightmares
• confused about what did happen and
what was real and what wasn’t
• feeling things will never be ok again
• anxiety – feeling much more
worried about things than usual
• depression – feeling miserable,
unmotivated or not enjoying the things
that you usually do.
There can also be other problems
after sepsis, such as:
• chest pain
• pain in the shoulders, back, arms and legs
• general weakness
• finding it difficult to move around
• finding it difficult to sleep
• not feeling like eating, or food
tasting different to normal
• finding it difficult to concentrate
or remember things.
Generally all these problems get better in
time and are a normal response to what
you have been through. Some hospitals
have Critical Care Follow Up staff to help
patients and families once you leave
Critical Care and when you go home. It can
really help to talk to someone who knows
about the problems you may be having.
What should I do now to Help Myself
What might help me once I’m home?
Once you get home, it may feel strange because even simple things can feel difficult (such
as climbing the stairs, talking with friends, getting yourself a drink) and you are likely to
feel a lot more tired than when you were in hospital – this is probably because you are
doing more now you are at home and your body is using much energy getting better.
It may help to set yourself small, achievable goals each week, like having a bath,
dressing, walking up the stairs. It might help to keep a diary so you can see
that you are getting better and stronger each week, even if it does not feel like it.
It might also help you to:
• Talk to family and friends about what you are feeling
• read your patient diary if you have one. Some hospitals help families to
keep a diary, and you could read this when you feel strong enough to
• write down what you remember about your time in Critical Care. You could try
to write something for each day and then ask your family to fill in any gaps
• find out about sepsis (by reading the start of this booklet) so you know what happened to
your body and find out what treatment you had. Ask your GP if you have questions about it
• speak to a Critical Care Follow Up nurse if there is one at your hospital. Even if there
isn’t one, you may be able to arrange to go back and see the Critical Care Unit, when
you feel strong enough, to understand what happened and where you were.
You should find it easier to cope with your feelings as time goes by and as you begin
to get stronger and get back to doing your normal activities. If you feel that you are
not getting better or are finding it difficult to cope, go and see your GP for help.
Are there any long term problems I might have after sepsis ?
Many people make a good recovery from sepsis and return to their normal, or
near normal, state of health within twelve to eighteen months of their illness.
However, sepsis can affect many organs in the body and sometimes they do not
work properly afterwards. The most common organs which can be affected are:
• the kidneys. Some people might always need support by a machine (which is called dialysis)
• the heart. This can cause chest pain, problems with your pulse or difficulty
when exercising (you might get out of breath easily). These symptoms can
normally be improved with medicines such as tablets or a mouth spray
• the brain, if it didn’t get enough oxygen. This can make you confused or not think as
clearly as you did before and you may find it difficult to concentrate or remember things
• the lungs, leading to breathlessness or aching pains in your chest. You
may not be able to walk as far as you did before your illness.
It is normal to feel upset after being in Critical Care, and you may feel anxious
or depressed. this should settle down in time but it can help to talk about how
you feel and what happened to you to friends, relatives, your GP or to a
professional counsellor. sometimes patients and their relatives can have extreme
symptoms of stress - this is called Post traumatic stress disorder (Ptsd) and can
happen months after your Critical Care stay. if you are struggling to cope, go to
your GP for help.
Teenagers and sepsis
If you are a teenager who has had sepsis, you may find it
difficult when you leave hospital and go home because:
• you may not be used to feeling ill
• it is hard to be so weak and tired when you usually have lots of energy
• your friends can’t understand what has happened to you
• you may have extra worries such as having exams to
do, or be about to go to university or start a job
• you may find it hard to concentrate or remember things which
is difficult if you are about to do exams. Talk this over with your
GP or your teachers who may be able to find ways to help.
It is important to realize that recovering from sepsis takes
time and patience, which is very hard when you are used
to being very active and going out with your friends.
Family, friends, teachers, and people at work can help by listening to
you when you want to talk and by letting you slowly join in with your
normal activities, even if you can’t do everything to start with.