Only 17 snowy miles from the Canadian border, Katie Bushey’s most basic needs are met by traveling health aides who come into her home to change her diapers, track her seizures, spoon-feed her fettucine Alfredo and load her wheelchair into the shower.

But that’s only if someone shows up.

Bushey, 32, who lost her vocal and motor skills shortly after birth, is one of more than 180,000 Medicaid patients in New York who are authorized to receive long-term, in-home care, the most in the state’s history. But there are increasingly too few aides to go around, especially in remote, rural areas.

When there aren’t enough aides for Bushey — over a recent two-day stretch there were workers for only four of the 26 hours of care for which she is authorized — her mother must stay home from her job at an elementary school, forgoing a day’s wages and scraping her savings to pay the bills.

Minimum wage

It’s a national problem advocates say could get worse in New York because of a phased-in, $15-an-hour minimum wage that will be statewide by 2021, pushing notoriously poorly paid health aides into other jobs, in retail or fast food, that don’t involve hours of training and the pressure of keeping someone else alive.

“These should not be low-wage jobs,” said Bruce Darling, executive director at the Center for Disability Rights. “We’re paying someone who gives you a burger the same as the person who operates your relative’s ventilator or feeding tubes.”

There are currently 2.2 million home health aides and personal care aides in the U.S., with another 630,000 needed by 2024 as the Baby Boomer generation ages, according to the nonprofit research and consulting group PHI. New York state employs about 326,000 home health workers but is predicted to need another 125,000 by 2024.

For now, home health aides in New York state earn an average of about $11 an hour, though wages are lower in upstate regions. Advocates say the system needs a complete overhaul that focuses on higher pay, worker retention and finding methods of compensation beyond what is provided through Medicaid.

Democratic Gov. Andrew Cuomo has committed nearly $6 billion in funding for home health care reimbursements in coming years as the agencies transition to the $15 minimum wage.

Statewide initiative

The state’s health department has said it is developing an initiative to attract, recruit and retain home health workers.

New York lawmakers have held hearings on the issue, and both the Senate and Assembly have so far included language in their budgets that would review and restructure how the state transfers Medicaid dollars to the providers, agencies and workers with the aim of providing workers and hours where they are needed most.

Other states are grappling with how to address the dwindling workforce as their minimum wages climb.

In Maine, legislation in 2015 attempted to make personal care worker wages more competitive with specific reimbursements for worker compensation. But a popular initiative will raise the minimum wage to $12 by 2020, minimizing those differences.

In Arizona, minimum wage increases have been accompanied by increased reimbursement rates, and in Washington state, workers negotiated a $15 wage for some home-care workers for when the state minimum increases to $13.50 in 2020.

New York advocates say a higher state minimum wage won’t attract any extra workers in rural regions such as Clinton County, where Bushey lives.

A single agency, North Country Home Services, hires and trains about 300 home health aides and personal care aides for about 1,000 people throughout a mountainous region the size of Connecticut. In any given week, the agency says, it leaves 400 hours of state-authorized care unfilled due to staffing shortages.

Special type of worker

The aides who continue despite the wages are a special breed, said Erica Stranahan, of Plattsburgh, who has worked as a home health aide with North Country for nine years and earns about $12 an hour. Stranahan said several of her co-workers have recently left home care for less-intensive professions that will soon have similar wages.

Stranahan acknowledged she makes it work only by sharing rent and living expenses with her boyfriend. She said she feels a responsibility to those she cares for, and would rather find a second job than quit caring for others.

“I enjoy helping people,” she said. “We’re with them for so many hours. It’s almost like we’re a second family for them,” Stranahan said.

But Rosalie Kline, a personal care aide in Canandaigua for nearly 13 years who also struggles to make ends meet, said that if worse came to worst, she would find another job that paid more.

“I wouldn’t want to. I love my job,” she said. “But I might need to.”
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Eight million metric tons of plastic wind up each year in the oceans, harming marine life and entering the food chain. Mike O’Sullivan reports a new documentary film called “A Plastic Ocean” looks at the problem, and its solutions.
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For some medical students, getting a yes or no Friday was more important than finding the right life partner.

Friday was “Match Day,” the annual day when medical students find out which U.S. medical institution has accepted them for a residency program. It is a competition, of sorts: 32,000 training slots are available for 42,000 applicants, according to this year’s data.

A residency, three to five years of practical experience and training in a student’s chosen medical specialty, is the next step after medical school, which in the United States generally means four years of postgraduate university studies.

Of those 42,000 applicants vying for residencies, all but about 6,000 are foreign nationals. And that is where their aspirations could collide with President Donald Trump’s latest executive order regulating immigration to the United States.

‘Extensive upheaval’

The National Residency Match Program (NRMP), a nonprofit group that organizes the matches between students and hospitals, said the new immigration order has had a substantial impact on its program. In its current revised form, the order bans citizens from six Muslim-majority countries from traveling to the U.S., at least temporarily.

“The consequences of the [January 27] executive order are far-reaching for match applicants, and the upheaval it is causing is extensive,” NRMP’s chair, Dr. Maria Savoia, and CEO Mona Signer said in a joint statement.

“The affected applicants have worked hard for many years to achieve their goal of becoming physicians,” the two medical-education experts said, “and they should not be denied that opportunity because of a blanket policy that does not consider the individual.”

U.S. courts have issued a restraining order preventing enforcement of the travel ban, pending further legal arguments, but NRMP says it is concerned that some immigrants or foreign medical students with valid visas will nevertheless be delayed or rejected at U.S. borders.

Holidays at home are not care-free

In addition, foreign medical students who travel to their home countries during holidays or breaks in their university studies fear they may not be able to return in time to take up their new residencies in the U.S. Such medical programs typically begin each year on July 1.

“U.S. training programs should be able to select applicants based on their excellent character and qualifications, without regard to nationality. Both applicants and programs benefit from an orderly process for entry into graduate medical education,” said Signer, who is a public health specialist, and Savoia. “The executive order disrupts that process very considerably.”

Hospitals and other medical institutions that offer residencies worry that foreign students they choose for the multiyear training programs will be unable to begin their studies on schedule, Signer said.

Medical residencies are sometimes known as internships, or first-year post-graduate studies, because they occur during a fledgling doctor’s first year of practical training alongside or under direct supervision of a fully qualified physician in one of 21 recognized medical specialties.

Is US becoming less welcoming?

Those who administer medical residency programs do not directly choose the candidates they would like to attract. Instead they rank applicants in order of preference. Under those conditions, Signer said, “It seems likely that residency program directors will be reluctant to rank J-1 visa applicants because they may not be able to enter the country to begin training.”

The U.S. State Department’s J-1 visa program offers foreign nationals an opportunity to come to the United States “to teach, study, conduct research, demonstrate special skills or receive on-the-job training for periods ranging from a few weeks to several years,” according to Cultural Vistas, a nonprofit American group that has been organizing international exchange programs since 1963.

The perception that the United States is becoming less welcoming to foreign nationals in the medical professions appears to be having an effect.

Fewer non-U.S. citizen “international medical school graduates,” or IMGs, submitted program choices for this year: 7,284 in 2017 vs. 7,460 in 2016. However, NRMP said more of these candidates (52.4 percent) were matched with institutions – the highest match rate since 2005.

Foreign physicians benefit all Americans

About 1,800 IMGs already enrolled in accredited residency and fellowship programs in the U.S. are impacted by the travel ban, according to Dr. Thomas J. Nasca, CEO of the Accreditation Council for Graduate Medical Education.

“These physicians are providing much needed medical care to a conservatively estimated 900,000 patients in urban, suburban and rural communities across the country annually. They are a valued and welcomed group of colleagues,” he wrote in a statement.

“Many communities, including rural and low-income areas, often have problems attracting physicians to meet their health care needs. To address these gaps in care, IMGs often fill these openings. These physicians are licensed by the same stringent requirements applied to U.S. medical school graduates,” the chief executive officer of the American Medical Association, Dr. James Madara, wrote last month.

“The medical education community must support all international medical graduates and their families during these difficult times,” NRMP’s statement said.
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Washington’s National Zoo hired its first animal nutritionist 30 years ago. Since then the zoo has been preparing specific, well-balanced meals for each animal, provided by volunteers and food preparation teams. For Yahya Barzinji, Elizabeth Cherneff reports.
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In a medical emergency, an ambulance with a qualified medical team on board can be a lifesaver. But in Nepal, this service is rare if not nonexistent. To help provide the best possible medical emergency services, a team of doctors from Stanford University in California spent 12 weeks training four dozen medical technicians in Kathmandu. VOA’s Faiza Elmasry has more. Faith Lapidus narrates.
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As deaths from painkillers and heroin abuse spiked and street crimes increased, the mayor of Everett took major steps to tackle the opioid epidemic devastating this working-class city north of Seattle.

 

Mayor Ray Stephanson stepped up patrols, hired social workers to ride with officers and pushed for more permanent housing for chronically homeless people. The city says it has spent millions combating OxyContin and heroin abuse – and expects the tab to rise.

 

So Everett is suing Purdue Pharma, maker of the opioid pain medication OxyContin, in an unusual case that alleges the drugmaker knowingly allowed pills to be funneled into the black market and the city of about 108,000. Everett alleges the drugmaker did nothing to stop it and must pay for damages caused to the community.

 

Everett’s lawsuit, now in federal court in Seattle, accuses Purdue Pharma of gross negligence and nuisance. The city seeks to hold the company accountable, the lawsuit alleges, for “supplying OxyContin to obviously suspicious pharmacies and physicians and enabling the illegal diversion of OxyContin into the black market” and into Everett, despite a company program to track suspicious flows.

 

“Our community has been significantly damaged, and we need to be made whole,” said Stephanson, who grew up in Everett and is its longest-serving mayor, holding the job since 2003.

 

He said the opioid crisis caused by “Purdue’s drive for profit” has overwhelmed the city’s resources, stretching everyone from first responders to park crews who clean up discarded syringes. The lawsuit doesn’t say how much money the city is seeking, but the mayor says Everett will attempt to quantify its costs in coming months.

 

Connecticut-based Purdue Pharma says the lawsuit paints a flawed and inaccurate picture of the events that led to the crisis in Everett.

 

“We look forward to presenting the facts in court,” the company said in a statement.

 

Purdue said it is “deeply troubled by the abuse and misuse of our medication,” and noted it leads the industry in developing medicines with properties that deter abuse, even though its products account for less than 2 percent of all U.S. opioid prescriptions.

 

In 2007, Purdue Pharma and its executives paid more than $630 million in legal penalties to the federal government for willfully misrepresenting the drug’s addiction risks. The same year, it also settled with Washington and other states that claimed the company aggressively marketed OxyContin to doctors while downplaying the addiction risk. As part of that settlement, it agreed to continue internal controls to identify potential diversion or abuse.

 

While numerous individuals and states have sued Purdue, this case is different because Everett is getting at the results of addiction, said Elizabeth Porter, associate law professor at the University of Washington.

 

She thinks Everett may have a shot at winning, though it will have to overcome some legal burdens, including showing that diverted OxyContin from rogue doctors and pharmacies was a substantial factor in the city’s epidemic.

 

Stephanson said he was “absolutely outraged” after the Los Angeles Times reported last summer it found Purdue had evidence that pointed to illegal trafficking of its pills but in many cases did nothing to notify authorities or stop the flow. That newspaper investigation prompted the city’s lawsuit.

 

In response to the newspaper’s reporting, Purdue said in a statement that in 2007, it provided LA-area law enforcement information that helped lead to the convictions of the criminal prescribers and pharmacists referenced by the Los Angeles Times. The company also pointed to court documents that showed a wholesaler alerted the Drug Enforcement Administration about suspicious activity at a sham clinic noted in the newspaper’s story.

 

Still, Everett contends Purdue created a market for addicts that didn’t exist until the company let its pills flood the streets.

 

The region saw two spikes in overdose deaths: first from OxyContin and other opioid painkillers in 2008 and then, after the drug was reformulated in 2010, a spike from heroin as people switched to a potent but cheaper alternative, officials said.

 

The city contends Purdue’s wrongful conduct fueled a heroin crisis in Everett. Between 2011 and 2013, nearly one in five heroin-related deaths in Washington state occurred in the Everett region.

 

In response to the drug epidemic, Everett last year began sending social workers on routine patrols with police officers. Sgt. Mike Braley says the community outreach and enforcement team strikes a balance between enforcement and connecting people to addiction treatment, mental health and other services.

 

“We understand that we can’t arrest our way out of problems that addiction is causing our city,” Braley said.

 

Sometimes it takes many follow-ups and hours of handholding to get people help. On their first stop one morning, Braley and his team check under a street overpass, a popular hangout for addicts. They find plenty of needles, drug packaging and mounds of garbage but none of the people they had encountered there recently.

They swing by a woody vacant piece of city property to follow up with a homeless man who told social workers he was on a housing list. He previously was reluctant to talk but opens up this time.

 

Social worker Kaitlyn Dowd offers to check on the man’s housing status with a local nonprofit provider and then punches her number into a cellphone he recently got.

 

“You can call me, and I have your number,” she tells him.

 

Social worker Staci McCole said they come across many cases where highly functioning residents were introduced to opiates or heroin.

“So many of these people – somehow it’s taken a hold of them, and their lives now have forever changed,” she said.
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The U.S. Environmental Protection Agency said on Friday it had awarded $100 million to upgrade Flint, Michigan’s drinking water infrastructure to address a crisis that exposed thousands of children to lead poisoning.

The grant to the Michigan Department of Environmental Quality will enable the city to “accelerate and expand” its work to replace lead pipes and make other improvements, according to the EPA. Estimates of the upgrade’s cost range from $200 million to $400 million.

Friday’s announcement made the disbursement official. Last year, Congress passed and former president Barack Obama signed the Water Infrastructure Improvements for the Nation Act to allocate $100 million to aid Flint.

$31.5 million to be paid immediately

The EPA’s state revolving funds, which Congress can allocate to help with cleanup efforts, were one of the few programs that the Trump administration did not slash in its proposed budget for the agency.

“Flint’s water infrastructure as part of our larger goal of improving America’s water infrastructure,” said a statement from agency Administrator Scott Pruitt.

The EPA will make $31.5 million immediately available for lead pipe replacements and upgrades, and Michigan will provide a $20 million required match.

The remaining $68.5 million will come after the city and Michigan complete additional public comment and technical reviews.

“Today we have good news for families in Flint who have already waited far too long for their water system to be fixed,” said a statement from U.S. Senators Debbie Stabenow and Gary Peters, and Congressman Dan Kildee, all Michigan Democrats.

Flint mayor meets Trump

Flint Mayor Karen Weaver, also a Democrat, said the funds would help the city reach its goal of replacing 6,000 pipes this year. She met briefly with President Donald Trump on Wednesday.

In January, 1,700 Flint residents filed a lawsuit in the U.S. District Court in Michigan, saying the EPA failed to warn them of the dangers of the toxic water or take steps to ensure that state and local authorities were addressing the crisis. The plaintiffs seek $722 million in damages.

Midwestern politicians are worried about the elimination in the proposed U.S. budget of funding for an effort to clean up the Great Lakes, from which some states draw their drinking water.

Flint was under the control of a state-appointed emergency manager when it switched its water source to the Flint River from Lake Huron in April 2014. The more corrosive river water caused lead to leach from pipes and into the drinking water.

The city returned to its original water source in October 2015.
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Australian scientists, working with counterparts in Myanmar, are hoping to reduce Myanmar’s high death toll from snake bites in rural communities, especially among vulnerable populations facing inadequate emergency care.

The official toll from snake bites in Myanmar is 600 deaths a year out of some 13,000 cases among a rural population dependent on rice harvesting for a living. But rice paddy fields and rice stacks lure rats and mice, and in turn draw snakes, the most venomous being the Russell’s vipers and cobras.

But the hopes for survival are often challenged by long distances from emergency care, with poor roads and infrastructure between snake bite victims and life-saving medical treatment.

Chen Au Peh, a renal specialist at the Royal Adelaide Hospital in South Australia, said speedy access to emergency medical treatment is crucial.

“So all these factors accumulate to a long delay between bite and administration of an anti-venom. So to help them, we have to help them produce more anti-venom, to get the anti-venom to where it’s required to help them keep the anti-venom in the refrigerator and to help the health professionals,” Peh said.

Lifestock also affected

The project has also involved ensuring higher survival rates of horses used in the production of the anti-venom after being injected with snake venom. High mortality rates were evident among the horses due to anemia, nutritional problems and veterinary practices. Changes in practice included learning the skills developed by Myanmar horse handlers.

“In the last 10 months the average horse mortality is something like six or seven per month – compared to 50 per month – and this is very good news not only for horses but for human patients who may need the anti-venom. The more horses that survive the month, the more vials of anti-venom you can produce,” Peh said.

As a result, production of anti-venom has risen sharply to 100,000 vials from 60,000 vials.

The team’s work, part of a $1.77 million effort begun in 2014 with support from the Australian Department of Foreign Affairs and Trade (DFAT) and working with Myanmar’s Ministries of Industry and Health, is focused on the northern city of Mandalay, a region that faces an estimated 700 to 800 snake bite victims each year.

The Australian team, which includes Afzal Mahmood, a senior lecturer in public health at the University of Adelaide and Julian White, a world renowned toxicologist from the Women’s and Children’s Hospital in Adelaide, is working with specialists in Myanmar and local partners on guidelines, protocols and standard operating procedures for the health sector.

Real numbers higher

Mahmood said a recent survey indicated the rate of snake bites was considerably higher than official figures.

“It is not a new phenomenon, it happens because many people do not reach the health system where recording takes place. Some people get treated by the traditional healers; some may die without actually reaching the health system and some may suffer and get healed,” Mahmood told VOA.

But he said the program has succeeded in boosting the skills among the local medical and non-medical community.

“We have produced revised guidelines for the doctors [and] some diagnostic tests, and the training of some 200 health care providers,” he said.

The work has reached about 150 villages with local community meetings targeting around 7,000 people to promote awareness of snake bite treatments.

The goal, the scientists said, is to shorten the time to treatment by providing solar powered refrigerators near to local communities with supplies of anti-venom.

Mahmood says the challenges go beyond the initial treatment.

“Psychological issues post-bite [affect] not only the person but the family themselves suffer. It’s a very life-changing experience,” he said.

Victims of snake bites are among Myanmar’s poorest. They often face long periods of hospitalization, leaving families facing high medical bills, often equivalent to several months of real earnings as they struggle to meet hospital and transport expenses, even those receiving subsidies.

To ensure the project is sustainable, its goal is to provide a model that can be applied elsewhere in Myanmar.
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The human nose, in all its glorious forms, is one of our most distinctive characteristics, whether big, little, broad, narrow or somewhere in between.

Scientists are now sniffing out some of the factors that drove the evolution of the human proboscis.

Researchers said on Thursday a study using three-dimensional images of hundreds of people of East Asian, South Asian, West African and Northern European ancestry indicated local climate, specifically temperature and humidity, played a key role in determining the nose’s shape.

Wider noses were more common in people from warm and humid climates, they found. Narrower noses were more common in those from cold and dry climates.

The nose’s primary functions are breathing and smelling. It has mucous and blood capillaries inside that help warm and humidify inhaled air before it reaches more sensitive parts of the respiratory tract.

Having narrower nasal airways might help increase contact between inhaled air and tissues inside the nose carrying moisture and heat, said Penn State University geneticist Arslan Zaidi, lead author of the study published in the journal PLOS Genetics.

“This might have offered an advantage in colder climates. In warmer climates, the flip side was probably true,” Zaidi said.

Our species appeared in Africa about 200,000 years ago and later migrated to other parts of the world. The researchers said people with narrower nostrils may have done better and produced more offspring than those with wider nostrils in colder, drier locales, driving a gradual decline in nose width.

The finding generally supports what’s called Thomson’s rule, formulated by British anatomist and anthropologist Arthur Thomson (1858-1935), that people from cold, dry climates tend to have longer and thinner noses than people from warm, humid climates.

Zaidi said most previous evidence regarding Thomson’s rule came from skull measurements, while this study expanded on that by analyzing external nose shape.

The researchers studied nose width, nostril width, nose height, length of the nose ridge, nose tip protrusion, external surface area and total nostril area.

“What we have tested is a very simple hypothesis about the nose, which likely had a very complex evolutionary history. There’s a lot we don’t know,” Zaidi said, citing the need to probe genes underlying nose shape.

“One can imagine how cultural differences in attractiveness could have led to some of the differences in nose shape between populations. For example, were wider noses considered more attractive in some populations relative to others?”
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Brazil’s Health Ministry says 424 people have been infected with yellow fever in the largest outbreak the country has seen in years. Of those, 137 have died.

 

An update published Thursday said that more than 900 other cases are under investigation. During the current outbreak in the Southern Hemisphere’s summer rainy season, the vast majority of the confirmed cases have been in the southeastern state of Minas Gerais.

 

Much of Brazil is considered at risk for yellow fever, and people in those areas are supposed to be vaccinated. But this outbreak struck some areas not previously considered at risk, and Brazil is rushing vaccines to those areas.

 

Yellow fever is a mosquito-borne disease that cause causes fever, body aches, vomiting and can cause jaundice, from which it gets its name.
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