SUMMARY
Getting a proper diagnosis and treatment for bowel disorders can be difficult enough for most anybody, but for people of color, there are a troubling number of additional challenges that must also be overcome living with GI disorders .
Today’s guest is Melodie Narain-Blackwell, a serial entrepreneur and founder of Color of Gastrointestinal Illness, a nonprofit advocacy and support organization for members of minority communities living with GI conditions. As someone who’s struggled herself with Crohn’s disease since she was 5 years old, she knows firsthand just how frightening and alienating these conditions can be. Today she shares her personal journey with us and discusses how others can take advantage of the community she’s been working to build.
You can find Color of Gastrointestinal Illness online here, and you can click any of the following to visit the organization’s Facebook, Instagram, Twitter/X and LinkedIn pages. More information about Melodie’s entrepreneurial ventures can be found here.
ReSources
- Color of Gastrointestinal Illness
- Bowel Health Conditions
- Crohn’s Disease
Transcript
Bruce Kassover: Welcome to Life Without Leaks, a podcast by the National Association for Continence. NAFC is America’s leading advocate for people with bladder and bowel conditions, with resources, connections to doctors, and a welcoming community of patients, physicians, and caregivers, all available at NAFC.org.
Welcome back to another episode of Life Without Leaks. I’m your host, Bruce Kassover, and joining us today, as always, is Steve Gregg, the Executive Director for the National Association for Confidence. Welcome, Steve.
Steve Gregg: Thanks, Bruce. I am really looking forward to today. We are very fortunate to have a really remarkable woman who has done so much in a relatively short period of time.
She’s an entrepreneur and really a leader in trying to help those that have traditionally been underserved in the African American community to learn more about bowel related problems. So this is going to be really exciting. I can’t wait to hear what she has to say and where she sees her organization going forward.
Bruce Kassover: Yeah, I really share that enthusiasm also. Today’s guest is Melodie Narain-Blackwell. And you know, if you looked up the word “dynamic” in the dictionary, I think that that she’d be right there, her picture, because she’s a serial entrepreneur, she’s been building businesses for more than 10 years, she just recently built a six-figure business – while battling illness – in less than nine months.
She finds a lot of strength in her faith journey as well, and she’s going to be talking with us about how she’s managed to overcome these health challenges and really thrive. So welcome, Melodie – thank you for joining us!
Melodie Narain-Blackwell: Thank you so much, Bruce and Steve, for having me here. I’m so excited to join this robust conversation.
Bruce Kassover: Excellent. Now, tell us a little bit about your background, your story, and how you got to be the person you are today.
Melodie Narain-Blackwell: Of course. So, as you know, and you mentioned, I was diagnosed with a bowel disease, which is IBD, inflammatory bowel disease, more specifically Crohn’s disease, in 2018. That did not come easily at all.
It took me approximately 30 years to get properly diagnosed. I started having issues around the age of five or six with being in the bathrooms for a long time. And I just thought that was normal. And my family, they, they didn’t know. They thought it was normal. I am multiethnic. My father is Indian and my mom is Black, and digestive diseases just weren’t a discussion at our table. It wasn’t a discussion in our family. So when I was 13, I started having rectal bleeding and I was taken to a gastro. And when I saw that GI, he first asked my mother if I was sexually active and then said after doing a flex sigmoid that I just had internal hemorrhoids and I should just eat fiber.
And for years, I would go to doctors. I had great health care. I don’t think I had any issues communicating the challenges that I’ve had. I’m educated and I have the ability to see top-tier professionals, and I was still never the afforded the opportunity to actually get properly diagnosed. It wasn’t until 2018 when I had uncontrollable amounts of rectal bleeding and abscesses and one burst.
And I was led into emergency surgery, and from there, I went through the proper diagnostic journey to actually get diagnosed with Crohn’s disease.
Bruce Kassover: Those sound like some pretty frightening symptoms. I mean, especially for a young girl to have to deal with. What was your emotional response? What did you think was going on when you first started to see some of these things happening?
Melodie Narain-Blackwell: You know, at first I thought the bleeding was like ketchup or something and then, or spaghetti sauce, and I monitored and then I finally had to tell my mom because I said something’s broken. I didn’t have pain, but there was something that wasn’t right. And when I shared it with her, she did the best that she could.
I will say that I managed between 5 and, still to this day, I managed stomach aches, but they were really intense and really, really, really bad. In my teenage years, I would sleep in the bathroom. I would sleep in the bathtub because it was metal and cold. So it would soothe my body from feeling like it was on fire.
And there were many nights that I slept like that and I would get up in the morning and go to school. And I even remember one particular time, I was talking myself out of thinking I had a stomach ache because I was telling my mother and we were going to the doctor and they kept saying that there was nothing anything really wrong with me and it was I was a cheerleader and I had to perform and I was in the mirror in the bathroom talking myself out of having a stomach ache. “You don’t have the stomach ache. There’s nothing wrong with you. Go out there and stop acting like you have a stomach ache because no one was believing me.”
Bruce Kassover: Wow. Even in that process, it sounds like so you were initially sort of misdiagnosed as well.
Melodie Narain-Blackwell: Absolutely.
Bruce Kassover: And what was it like when you finally got a proper diagnosis and you said, “Oh, I could put a label on this. I can understand how it fits into the way my body works or isn’t working.” What was it like when you finally understood what you actually had?
Melodie Narain-Blackwell: So, two emotions. One was extreme gratitude and just happy to know that I didn’t make these things up and that for years, even going through college, how terrible I felt.
Now, one thing I didn’t say was that the bleeding that started at 13; it never went away. It would go away intermittently, but never for the long term. So, it was nice to finally have a reason and answer to what I had been enduring for all these years. The next thing I felt was disappointment because I was closer to my deathbed than I would have liked to have been when I got diagnosed.
By the time I did get diagnosed, I had 8 fistula, I could not eat, I had abscesses from my mouth all the way down to my anus and I was barely able to walk. I had lost mobility and I was trying to gain it back and I was losing my hair, and it was just so many things to name, but I was disappointed in the healthcare system because there’s no way that I should not have been properly diagnosed.
Bruce Kassover: Disappointment, I think, is probably an understatement. And when you did find a physician who actually understood what you were going through, can you talk with us a little bit about what that experience was like – you know, just, just sort of relating to a physician, finding somebody that you could have a meaningful experience with, and going on that treatment journey together?
Melodie Narain-Blackwell: So, what’s interesting is my colorectal surgeon is the one who actually told me that I had Crohn’s disease. I started then seeing a GI after that because my first entry point after being ignored for all these years by primary care and then not being recognized by GIs as having an issue, I went to a colorectal surgeon because I had bled for about four and a half months and it was feeling like Edward Scissorhands had taken a residence in my colon, to be honest, and he recognized it.
When I got to the GI, he actually didn’t. It was a disservice to me because having eight fistula, he started giving me a series of pills instead of recognizing that I had extremely progressive disease, had been delayed for so long. I should have actually gone to an advanced therapeutic and not a set of pills.
Bruce Kassover: Now, were your symptoms sort of typical for somebody who has Crohn’s disease or were you sort of an outlier?
Melodie Narain-Blackwell: No, it’s not typical of a person having a mild to moderate, but definitely moderate to severe. These extra intestinal manifestations, many of which I had, if you don’t know what EIMs or extra intestinal manifestations are, you won’t put it together that the things that are happening.
Like, I had about 64 ounces of fluid build up on my knee. I had pain in my feet and my joints in my feet. And I was told I had gout. So there was quite a few things that were happening to me that were atypical for someone who didn’t know or a physician that wasn’t properly trained in the disease. Once I realized myself through research, not finding one person who actually had all my symptoms, but found my symptoms in different people, each one, I went to a rheumatologist and he told me that I was right.
Steve Gregg: Hey, Mel, your story is heartbreaking and incredibly sad, and you have done so much with your organization focused on trying to help primarily African American women understand the disease and find the care that they need. Do you think your delay in diagnosis was typical of women or more typical of African American women?
Melodie Narain-Blackwell: So the organization, actually, Steve, we support black and brown people. So all of them as best we can. And when it comes to that community space, the delay in diagnosis is pretty typical. It’s unfortunate, but it is typical for a person of color to probably be delayed 10 to 15 years at minimum and then longer than that.
Bruce Kassover: Do you have any particular thoughts on why that is the case?
Melodie Narain-Blackwell: Partially, I would say medical school. This disease has been taught that it only affects, it’s been taught that this disease only affects white people or Jewish people, and that right there disqualifies an entry point for people of color because we’re disadvantaged from the onset.
So when we present these symptoms, knowing that they’re not discussed in our families, we’re not taking through a typical diagnostic journey. When, you know, if you are a caucasian person, a Jewish person, you go into the ER and you show up with these symptoms, they automatically start thinking that you could have inflammatory bowel disease.
Bruce Kassover: That’s very, very interesting. Do you have an idea of what the prevalence actually is in minority communities?
Melodie Narain-Blackwell: Unfortunately, it’s really tough to say because we have to think about insurance gaps and access gaps and just education gaps. And so while they may say that the prevalence could be 7 percent or 8 percent, I don’t follow that very closely because a lot of our community members don’t necessarily have typical means of insurance and access.
Bruce Kassover: You know, you’re talking about this with a great degree of knowledge and confidence. I mean, this is not the sort of conversation that you would typically, I think, expect to hear from somebody who’s just dealing with an illness. And you know, Steve also mentioned, you know, about that this has led not only to you dealing with not only addressing your health challenges, but also taking a more proactive role in terms of, you know, trying to be a thought leader and an organizational leader. Can you tell us about how that happened and what you decided to do to go from just being a patient to being more of an advocate?
Melodie Narain-Blackwell: Of course. So in 2018, when I was diagnosed, I actually created my own PSA because I saw how atypical it was for a patient to have all the symptoms that I had, even though I had them. I did my own PSA because it was hard to get to a diagnosis.
And doing that, I said, other people, there are probably others out there that need to know this. So let me just share it. I’m going to put myself on the line because I don’t think it was accidental. And I began to share this PSA that I did and I started getting direct messages on Instagram and Facebook from people telling me that they were the first or the only Black person to be diagnosed with Crohn’s disease.
And it left me baffled because I said, “How could they think that in 2018?” I have an aunt with Crohn’s disease, although extremely different from mine. And I later found out that I have a cousin with Crohn’s disease who actually passed away maybe in 2019, I think. Yeah, 2019. She passed away and I never knew she had Crohn’s disease until after she passed away.
And that’s on my father’s side. So I have presentations of the disease on both sides of my family, which is very interesting. So when I, when I started kind of digging and looking and thinking, I saw so many red flags of disqualification, including nothing that pointed to, very directly, ads or industry information to Black people having Crohn’s disease.
I said, “Okay, that’s one thing.” I also did not find any kind of real research geared towards communities of color. I did not find any advertisements. I didn’t find any support groups. I didn’t find anything that said this community is viable in this disease space. So I decided to build it. And I remember just thinking, what could I do? Like, how do I help? And I heard a classic Kevin Costner Field of Dreams line: “If you build it, they will come.” And I said, build what? I don’t know how to do this. And then, again, biblically, I heard, “Go with the strength that you have.” And I did that. And the doors have opened. I created a Facebook group for Color of Crohn’s and Chronic Illness, and we started as a Facebook group, and I would organically go and find people, and it was tough.
But I let them know that they were valid, that they are seen, they’re heard. We’d love to learn more, and I’d love to be there to support them, whatever that looked like. And from there, as a Facebook group, we became a nonprofit organization in 2020, fully designated then, and we have changed the whole paradigm for this space and these community members that have managed and navigated these diseases by themselves.
We’ve done so much work in just this space. We recognize that from an equitable lens, it’s challenges for all people of color as a whole. We were getting a lot of community members or people asking us questions about other GI spaces. And we found the intersectionality between IBD and we decided that it was time for us to be more inclusive of GI diseases that had an intersectionality with IBD. And as of January 1st, we became Color of Gastrointestinal Illnesses, or COGI.
Bruce Kassover: Unbelievable journey. I love, first of all, just starting the initiative that you took is, is amazing. You know, so many people would just, you know, look at their situation and say, “Wow, that’s awful.” And that’s it. And you know what they would do then is say, “I’m going to focus on my own healing,” because you probably know better than anybody on the planet how much energy that alone takes from you. I mean, where do you find the energy to actually do that while you’re battling a really significant and serious illness?
Melodie Narain-Blackwell: I found it from God. Honestly, this is not my work. This is God’s work. I know that because I never would have done it.
Bruce Kassover: You’ve done amazingly well. I mean, just hearing how you’ve gone from being somebody who’s just suffering with something to help other people get through their own suffering is really amazing. Now, one of the things that we’re going to do, by the way, for anybody who’s listening right now, is that we’re going to put up in the show notes links so that they can find your organization, learn more about you and, and see how they can get involved.
So that’s going to be there. But even now, while we’re talking, can you tell us how somebody can go out and make use of or benefit from the support that you provide?
Melodie Narain-Blackwell: Sure, they can find us on the world wide web at www.colorofgi.org. We have a Facebook group, Color of Gastrointestinal Illnesses. We also have Instagram, Color of GI. Twitter, we’re X now, right, t’s not Twitter anymore, it’s X, @Color of GI. And if someone needs direct support, you can email us at info@colorofgi.org.
Bruce Kassover: That’s excellent. Now, I do also think that it’s very interesting that you have broadened your scope so that, you know, it’s not just Crohn’s. It’s not, no longer Crohn’s and chronic illness, but it’s specifically gastrointestinal illnesses. What is the sort of range of conditions that you try and address?
Melodie Narain-Blackwell: So now as COGI, we will be moving forward in the following disease spaces… So we will definitely have IBD as our largest disease space. And then we’re going into colorectal cancer and IBS, obesity and nutrition and mental health.
Bruce Kassover: I really love that because I think that adding obesity is really an important thing because a lot of people don’t think of it as an illness as much as it is, you know, some people see it as a moral failing or as some sort of weakness or something else.
So medicalizing that is certainly going to be something that I think is going to be helpful for a lot of people. And even more importantly, mental health, that’s, that’s really great because we know from everybody we talk with that the mental challenges associated with a lot of these conditions, the gastrointestinal conditions, but also you know, anything related to incontinence, is really taxing. People, feel shame, there’s a stigma, they really struggle and suffer with a lot of issues related to their own self image. So I love hearing that. I mean, did you find that as you were going through your journey that you had to deal with some of those own challenges yourself or…
Melodie Narain-Blackwell: I did.
Bruce Kassover: You did, yeah.
Melodie Narain-Blackwell: I did. I was, after I had my daughter, my medication no longer worked. It was failing me and I had to go on to long term use of prednisone. And once I did that, I gained about 60 pounds and I’m naturally around 135 to 145, and I was 203. So I had to figure out, once I got off of prednisone, how to manage my weight.
Well, what a lot of people don’t know is that you can have IBD and be obese. And I was technically classified as obese, although I was losing weight and I was trying to manage what I was dealing with life. I started looking into just what I could do. And the first thing I did is what I believe naturally everyone does, is they start working out.
I already had a really healthy diet. But I started working out. I was walking between 5 to 8 miles a day, and I was working out at least five days a week, and I was gaining about a quarter of a pound a week, so it didn’t make any sense to me, and I took matters into my own hands. I tracked everything for 3 months.
I shared it with my GI for IBD, and she recommended that I see a GI who focuses on weight loss and nutrition. Once I did that, I learned that my metabolism was running and operating at a pace for a woman that was 60 years old, not at the pace of a woman that was 41.
Bruce Kassover: So what did you do to address your metabolism?
Melodie Narain-Blackwell: I actually ended up taking a medication that was really slow to boost your metabolism. And it was really slow and it worked for me, the pace I wanted it to go, because I didn’t want to lose weight quickly. I wanted to lose weight the way that I would naturally lose it if I was working out and eating well.
So it worked for me really well and I got well. And at that moment, I feel like God allows me to endure quite a few things so that I can understand and relate. And I’m not speaking from a space of a person who’s never had the lived experience. So, at going through that, going through it mentally, it was challenging for me because you can get depressed when you’re doing everything in your power, everything possible, and nothing is moving, especially when people are trying to move that needle back on that scale.
Once I experienced that, I said, “Wow, okay, this is something I have to share. I have to put it on display the same way I put my Crohn’s on display.” And I did. I started sharing my workout videos. I started talking about it, and I recognized that it was a huge unmet need in that space for our community, and that’s why we’re moving forward in.
Steve Gregg: Now, NAFC did a bowel health survey with people that have everything from fecal incontinence to IBD and IBS about a year ago. I think we finished it up early, sort of mid last year. And one of the things that struck us was, was two things. One is, you’ve addressed exactly what everybody wanted. So we asked patients about their interaction with their doctors, and they all said that they left feeling improperly cared for because none of them had been given anything. Not a printout, not a website, nothing. And 92 percent of them said that, the other thing that they all said was, “We want is more information and support from a nutritional standpoint and from a mental health standpoint.” So, it’s good to see that our research supports where you’re already ahead of us in doing sort of that.
Melodie Narain-Blackwell: Steve, I love that. Thank you so much for sharing that. But can you actually get me a copy of that?
Steve Gregg: We can, we can work that out. The other question, Mel, is internally, we talk a little bit about bowel health versus bladder health. And what strikes us painfully is how early these conditions of IBS occur in a child’s life, and one of the things that we heard a lot about in your recent conference was is it occurs in your early part of life.
It can be very serious as a young woman is going into college. And so the stressors, the lifestyle changes, the being away from home, questions of intimacy, it’s really confusing and really painful. How do they manage that? And what can we do to help support them with these terrible conditions during a time of real change in their life?
Melodie Narain-Blackwell: So, Steve, I love that you asked me that because a lot of my challenges really got exacerbated when I was in college. I didn’t know that I had the disease, but I was really, really sick and I would just be in the bathroom and my roommate, I had a roommate then and I, we had our own bathroom and it’s unfortunate, but she would have to leave the room and go use the bathroom down the hall bathroom or on another floor because I was occupying the bathroom a lot.
One thing that I would say is that we need to put more information in the health centers about these diseases because they have such complicated symptoms that could look like numerous other diseases, even, you know, I hate to say this, but some of them like STDs. And college students are navigating quite a bit, so they can really get confused, not knowing or being uncertain, especially if they haven’t been diagnosed or they haven’t had such an atypical symptom.
So we have to get education and resources on the campuses. That’s the best way to do this, one of the things that COGI does to support this effort is we go to HBCUs. We go through our program called Community Conversations and we educate the students. We bring a physician, we bring a mental health expert, we bring a community health provider as well, and we talk about these issues and the diseases and clinical research.
We’re having these conversations so that students are given the tools to navigate to support their peers, their roommates, their friends, and even their family members, because if those seeds have never been planted, what will they do when something like this presents itself?
Bruce Kassover: That is really remarkable, and I can imagine that that’s got to be very rewarding getting a chance to go talk to people right when they might be sort of experiencing conditions early on and at their most vulnerable and seeing seeing how you can make it make a real difference for them.
Melodie Narain-Blackwell: Bruce, it’s the best experience ever. And we always leave from each campus completely filled. Our hearts are filled. The students want to engage. They want to connect. They want to know more. We’ve met several students that have come up to us saying that they didn’t know anybody else with Crohn’s disease, but they have it, or they have a family member with the disease and they had no idea that this is why their family member might retreat or disconnect or… and they want to do more to check on them and can they join our ambassador program. So it leaves us feeling really rich every time we leave. And honestly, I would welcome you all to attend one time. And if that’s something that you’d like to do, we can make that happen, but it’s, it’s one of the most rewarding programs that we deliver at COGI.
Bruce Kassover: That is very cool. Now we’ve been talking a lot about how you’ve been helping other people manage and overcome their own conditions. Can you tell us a little bit about how you finally got to the place where you are today in terms of your treatment path?
What ultimate treatments did you find made a difference for you or that you’re continuing to follow that are making a difference for you? You know, how, how did you get to the point where you’re comfortable today?
Melodie Narain-Blackwell: I do a combination of things. I do see a holistic practitioner as well as my traditional provider, my gastroenterologist, who is an IBD-ologist.
I’ve actually been on 16 medications, from pills to injections to suppositories – or rectal inserts – and it’s been a lot. I finally got on an advanced therapy in… I was prescribed in December of 2023, so it’s been a little over a year now, a year and a couple weeks, and that medication actually changed my life. Before that, I was just working very sick. I was not well.
Bruce Kassover: That is fantastic that you found something that works for you. Now, what do you have to say to people who are, who have not yet reached that stage, who are still struggling to find things, working with their physicians to come up with some sort of a treatment plan that actually does make a difference for them?
Melodie Narain-Blackwell: One thing I would say is that you deserve to be well. And I would encourage people to connect with community as well as their providers and not just feel like they have to listen to one set of advice, get another opinion. And get into community, because sometimes, unfortunately, especially with complicated illnesses like inflammatory bowel disease, if you’re not seeing an IBD-ologist, an IBD specialist, and one that is well-seasoned, they may not know how to treat your particular case.
And if it’s not come across their plates, or they’re not connected to other IBD specialists, it limits your real access to their performance and your performance. So I would ask questions and I would see if they can get a second opinion from their peers, because they may be connected. I always love when doctors tell me, “You know, I’m not familiar with this, but I’m going to talk to a few of my colleagues,” because that shows me that they’re collaborating in making group decisions and it allows me to make an informed decision and not just feel like I’m, the dice are just rolling with me.
Bruce Kassover: It makes a lot of sense what you just said. And it seems like it feels like it’s sort of common sense in some ways, you know, you should find support and you should, you know, seek the support of the community and all those sorts of things.
But I guess it is something that really does need to be stressed. Too many people isolate themselves when they, when they’re dealing with these conditions, don’t they?
Melodie Narain-Blackwell: They absolutely do. And common sense isn’t so common. So we have to think about it, especially as we’re growing up. You know, I am in my forties, but I still remember hearing things like, “What happens in my house stays in my house.” “We don’t talk under our clothes.” Like, these are all things that are told to people that they’re still dealing with. There’s also lots of stigma. There’s lots of anxiety. There’s embarrassment. There’s shame. So people don’t want to go share their personal business when they’re managing those challenges mentally.
Also, COGI just came about four years ago, so there wasn’t a group of resources or resources specifically tailored to black and brown communities until we came. So if you go looking for something and you can’t find it, you’re also inclined to give up.
Bruce Kassover: That brings up a question I wanted to ask you about your organization. You’re relatively young as far as groups like this go and I imagine you’re really sort of in that particularly exciting period where you’re really starting to get people aware of you and had reached a lot of new people that you can help. Where do you see yourselves going over the next few years and for the longer term?
Melodie Narain-Blackwell: I actually see us going international. We’ve gotten a lot of engagement internationally in Africa in Europe, and I see us moving there, too, to support our communities of color internationally.
Bruce Kassover: That’s very cool. That’s exciting. I love that idea. So Melodie, as you know, the name of the podcast is “Life Without Leaks.” And one of the things we normally like to do is ask all of our guests if they could share one bit of advice, a tip, a strategy so that they can live a life without having to deal with the symptoms of whatever condition they’re suffering from. So I’m wondering if maybe you could share with our listeners today what your best piece of advice might be to live a fuller, more rewarding life for somebody who’s struggling with Crohn’s disease.
Melodie Narain-Blackwell: Absolutely, Bruce. I would say that, I would tell anyone, what, to do what I did. You know, I would say be relentless in the pursuit of your wellness. And it may not be the same today or next month or next year, but be relentless in that pursuit. If you’re finding that you’re having a hard time focusing and mentally it’s feeling like it’s weighing you down, get to a community support group and get to a mental health care provider because you deserve that.
If you’re feeling like things are weighing you down and you’re feeling embarrassed about some of the symptoms because you can’t leave the house or you’re feeling afraid to do that, share with the people who love you so that they can take you where you need to go and support you and be there with you to be a community with you.
I personally wore Depends and from time to time I still do wear them when I need mental and physical security because I was not going to allow Crohn’s to restrict me to my house. So be relentless in the pursuit of your wellness. You deserve it. And even though we make adjustments and accommodations for something that we live with, it doesn’t mean that we stop living.
Bruce Kassover: That is really motivating and I appreciate it. So thank you for sharing that. It really meshes very, very well with what a lot of the things that we say at the National Association for Continence. You know, there are a couple of phrases that we’d like to use also.
You know, one is that “There’s no shame in being human,” and that directly relates to exactly what you’re talking about. The other thing we’ve been talking a lot about recently is how, you know, some of the conditions that we’re trying to address may not be life threatening, but they are life limiting, and we like to say that, you know, our goal is, “We may not save lives, but we save life.” And that sounds like it’s exactly what you’re doing for the people who are turning to you, as well. So we really appreciate it, and I know that they appreciate it also. So thank you so much.
Melodie Narain-Blackwell: Thank you. And thank you so much for having me today.
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Music:
Rainbows Kevin MacLeod (incompetech.com)
Licensed under Creative Commons: By Attribution 3.0 License
http://creativecommons.org/licenses/by/3.0/
