NREMT-NRP action - NREMT National Registered Paramedic Updated: 2023

The National Nurses United union, which represents 900 registered nurses at Ascension Seton Medical Center Austin, voted May 31 and June 1 to authorize a one-day strike at Ascension Seton Medical Center Austin.

What’s happening?

On June 2, the union announced the strike had passed with 98% support. The move follows contract negotiations that have dragged on since at least November, according to the union. The contract negotiations hinge on pay levels and other measures the union said are needed to fill vacancies and ensure retention.

“This action is disappointing given that both bargaining teams continue to work towards an initial collective bargaining agreement and have multiple sessions scheduled through the end of June,” a representative for Ascension Seton said in a statement.

How we got here

Matthew Clark, a registered nurse in the intensive care unit and a member of the negotiating team, said nurses are "leaving in droves" due to ongoing staffing issues.

Clark said nurses are asking for several changes to increase staff levels and ensure safety for staff and patients, including adding updated staffing minimums to the contract and creating a professional practice committee of nurses who can elevate problems and propose solutions to management.

In his unit, Clark said there are daily requests to pull staffing from other departments to handle incoming patients. He said that the low staffing levels mean nurses often work longer shifts than scheduled and are drained by the work. He also said the frequent turnover means a lack of experienced staff.

Previously, the union has staged a candlelight vigil and picketed in an effort to convince the hospital administration to take them more seriously, Clark said.

Community Impact has reached out to Seton for additional comment and will update this story when it is received.

The context

The nurses' strike would be the largest in Texas history and the first at Ascension Seton Medical Center Austin. The NNU said it would provide at least 10 days' notice to the hospital. The Ascension Seton representative said a plan is in place if that notice is received.

What nurses are saying

“Our patients can’t wait any longer,” said Lindsay Spinney, a registered nurse in the neonatal intensive care unit, in a news release. “Nurses are sending a message to management with this overwhelming strike authorization that we are ready to do what it takes to win a strong contract that protects our patients’ safety.”

“It’s morally distressing to work tirelessly for a nonprofit, Catholic system that consistently puts profits over its own patients and staff. We believe it is our duty to exercise our union power to ensure Ascension invests its deep financial resources back into its staff, patients and the Austin community,” said Clark in the release.

What Ascension Seton is saying

“We continue to bargain in good faith with National Nurses United (NNU) to come to a mutually beneficial agreement on an initial contract that supports all and will further our combined goal of providing safe, compassionate care to those we serve. We respect our associates’ right to organize themselves through union representation and participate in a strike authorization vote,” the statement said.

What happens next

Clark said he hopes that the move will motivate management to take the union more seriously. If not, he said the union is prepared to hold the strike.

© Anna Lefkowitz/The Washington Post

Stephen and Sandra Swanson were eating dinner beside their Christmas tree in 2017 when a Navy official rang the doorbell with alarming news: Hazardous chemicals from firefighting foam, used during training exercises at a nearby military airstrip, had seeped into their well water.

“We were told, ‘Don’t drink the water. ... It’s toxic.’ Then we were handed bottled water from Safeway,” Stephen Swanson, a 78-year-old retired emergency room physician, said in an interview from his home on Whidbey Island, Wash. “It felt like a gut punch.”

Months later, Swanson provided the Washington state legislature with tests showing his blood was filled with high levels of contaminants found in the foam: per-and polyfluoroalkyl substances, commonly called PFAS or “forever chemicals” because they don’t break down in the body or in nature.

His testimony helped convince the Democratic-controlled state legislature in 2018 to become the first in the nation to restrict the use of firefighting foam that contains the chemicals as well as PFAS-laced food packaging, which numerous studies have linked to cancer, infertility and a host of other diseases.

Since then, at least 106 similar laws have been enacted in 24 states, many with GOP-dominated legislatures, to ban or restrict the use of chemicals that are valued for their waterproof, stain-repelling, nonstick and fire-resistant properties and found in a vast array of everyday products including carpeting and rugs, outdoor apparel and stick-proof cookware.

This year alone, 195 new bills were introduced in dozens of state legislatures, seeking to require that an expanding list of products be PFAS-free. Some states have set deadlines that require all or most products made or sold in their states to be PFAS-free, with Minnesota the latest to pass such a measure last month.

The chemical industry argues that the tide of new legislation is a gross overreaction and that the majority of PFAS chemicals are safe. But the laws have received rare bipartisan support in an era when political divides have deepened in state legislatures, helped by lobbying pushes from broadly popular groups such as firefighters and farmers, and have prompted major companies like McDonald’s, Ikea and Target to set deadlines for eliminating PFAS chemicals in all or most of their products.

“By 2025, these state laws are going to reach a critical mass, and every industry is going to have to face what these other companies have already faced,” said John Gardella, a Boston-based lawyer who represents many of the companies and industries that use the chemicals.

This boom in state-level bans comes as federal regulators have lagged for decades on taking action. While the Agency for Toxic Substances and Disease Registry says the threat of long-term PFAS exposure is not fully known, activists and medical experts point to mounting evidence suggesting the chemicals are linked to liver and immune system damage, as well as other risks. The U.S. Environmental Protection Agency in March proposed for the first time a rule to set legally enforceable limits nationwide on six forever chemicals, although the regulations would cover only water contamination.

After decades of denying that any PFAS chemicals are hazardous, the American Chemistry Council, the industry’s primary trade group, now says at least two of the substances could be problematic at high levels. But the group also argues that the vast majority of the 5,000-plus chemicals in the group are safe and that states are going too far by banning or restricting all of them. The group also says the laws could block production of important products, such as semiconductors and medical devices.

“We have strong concerns with overly broad state legislation that takes a one-size-fits-all approach to the regulation of these chemistries,” said Robert Simon, a vice president with the American Chemistry Council. “Furthermore, a patchwork of conflicting state-based approaches could jeopardize access to important products.”

Simon’s group has asked the federal government to set national standards but has also successfully fought congressional bills to restrict PFAS, including some legislation that died earlier this year, which the group argued went too far by restricting many chemicals the industry says are safe.

State lawmakers who have backed the bills say they’ve fought for broader PFAS bans because new versions of potentially dangerous PFAS chemicals are regularly introduced into the market. Following the industry’s advice would trigger a “whack-a-mole” situation, they say, forcing legislators to pass new laws each time a new PFAS chemical is developed.

The EPA said that its newly proposed ban on two chemicals and restrictions on four others are based on reviews of hundreds of scientific studies showing links to a variety of health problems and are focused on PFAS that can be reliably detected in water and for which there are “proven treatment technologies.” The agency noted that it’s continuing research on other PFAS chemicals and considering further regulations, enforcement actions and technologies that can remove them from the air, land and water.

Until the EPA and other federal agencies do set stricter policies on PFAS use in products and start levying fines to violators, some lawmakers say, state laws are the only recourse.

“What often happens when the federal government fails to act, states step in because we have to protect our citizens,” said Maryland state Del. Sara Love (D-Montgomery), who sponsored a bill signed into law last year that bans forever chemicals in firefighting gear and other products. “We also know that the more states that passed legislation on this, the more it would really push the federal government to do something.”

Forever chemicals were invented in the 1930s and a decade later went to market in nonstick and waterproof coatings in cookware and clothing. By the 1960s, their unique resistance to water, oil and stains prompted a variety of industries to start using the substances, including in firefighting foam and electronics.

The health risks first received widespread notice in 2001, when attorney Robert Bilott sent a 19-page open letter detailing potential hazards and asking the EPA to investigate the disposal of the chemicals by E.I. du Pont de Nemours, commonly referred to as DuPont.

Five months later, Bilott filed a class-action lawsuit against DuPont. A settlement agreement in 2004 awarded affected residents $70 million in damages and created a scientific panel that reviewed existing research and conducted new studies on PFAS exposure, while also testing 69,000 people near a DuPont site in the Mid-Ohio Valley in West Virginia.

The panel released a series of reports in 2011 and 2012 that determined there were probable links from PFAS exposure to kidney and testicular cancer, ulcerative colitis, thyroid disease, pregnancy-induced hypertension and high cholesterol. More than 3,500 of the people tested were later diagnosed with one of the linked diseases.

At the time, DuPont argued the chemical in the study — which it has since phased out — was safe and denied any wrongdoing in the settlement agreement. In response to the panel’s reports, the company in some instances said it did not believe there was a link to health problems and in other instances emphasized reforms it had undertaken, such as the installation of water-filtration systems.

Today, “the company’s use of PFAS is limited,” according to DuPont’s website. “We have systems, processes and protocols in place ensuring that PFAS is used safely, controlled to the highest standards and minimized.”

The EPA also sued DuPont in 2004 for violations of the Toxic Substances Control Act and settled with the company the following year for $16.5 million. Following the release of the panel’s scientific studies, the EPA began testing drinking water at sites across the country, revealing widespread contamination in 27 states that affected 15 million people. The Defense Department followed in 2016, checking water around its military bases and finding it, too, contained PFAS chemicals.

“This information bubbled up to the state legislatures, with state legislators taking notice that their districts were contaminated and grass-roots environmental groups forming to try to address the issue,” said Melanie Benesh, vice president of the Environmental Working Group, which in 2016 first released its map that pinpoints the locations of all the contaminated sites. The map now shows contamination in all 50 states, with about 200 million Americans potentially affected.

The possible health impact of exposure to the chemicals is still a subject of medical study. The EPA recently calculated that restricting six PFAS chemicals in water supplies could have a measurable impact on heart disease alone, preventing 6,000 nonfatal heart attacks, more than 8,800 strokes and 754 deaths. Another peer-reviewed study by Harvard and Chinese-based researchers determined that exposure to one PFAS chemical was associated with 382,000 deaths annually in the United States from 1999 to 2015.

In 2017, bills were introduced in nine state legislatures to ban the chemicals in certain products, with Vermont the first to pass a narrow restriction on one PFAS chemical tied to a single contamination site.

The number of bills quickly rose the following year to 38, with four passing, beginning with Washington state, the first with a broad ban on the entire class of PFAS chemicals in products, beginning with firefighting foam and food packaging.

Similar proposals have increased exponentially ever since, with a record high of 245 bills introduced last year. Two documentaries and the 2019 film “Dark Waters” starring Mark Ruffalo, about Bilott’s fight with DuPont, helped fuel the state legislative movement. (Bilott also wrote about the legal battle in his book “Exposure.”)

In an interview with The Washington Post, Ruffalo credited the film with dispelling myths that poor diets or farming practices had caused the health problems highlighted by Bilott’s suit.

“There is a lot of shame around illness. It showed them it wasn’t them,” Ruffalo said. “It wasn’t their fault. It was done to them, and it was done knowingly.”

Ruffalo said the movie also helped to mobilize victims — along with firefighters and grass-roots environmental groups — to push state lawmakers to take action.

“It’s a case study in the power of film, and it is really what storytelling is all about,” he said. “It is about reaching people where they are. It humanizes us. It humanizes the issue. And it transcends political bounds.”

As the number of state bills have grown, so too has the list of products they are seeking to make PFAS-free, including cookware, surf and ski wax, artificial turf, carpeting, rugs, furniture, outdoor apparel, cosmetics and menstrual products.

Ten states have implemented drinking-water standards with various PFAS limits well below the only existing national standard — a nonenforceable 2016 guideline from the EPA. The agency’s new regulation proposed in March would put legally binding limits of 4 parts per trillion or less on six PFAS chemicals in drinking water, nearly 18 times less than the current guideline. The public comment period for the proposed rule closed May 30, and it could go into effect as soon as December.

“When you had multiple states setting drinking-water standards, that absolutely was part of the pressure that pushed the federal government to finally act,” said Sarah Doll, national director of Safer States, a coalition of environmental health groups focused on toxic chemicals that tracks PFAS legislation.

In other state actions, attorneys general in 17 states have also filed lawsuits to force companies that have produced or used forever chemicals to finance cleanup efforts and to provide medical monitoring to people with high PFAS levels in their bloodstreams.

Companies that make products using PFAS have argued they are not liable, since they didn’t manufacture the substances. And many of the companies that make forever chemicals say their prevalence makes it difficult to pinpoint them as the source of health risks.

Several states have started to move beyond a product-by-product ban of the chemicals to more sweeping laws that set deadlines for removing PFAS from all products, with a few caveats. In 2021, Maine became the first state to do so. The law, which takes effect in 2030, bans any intentionally added PFAS in products. However, if there is not yet a PFAS-free alternative, it allows for exceptions in products deemed to be “essential for health, safety or the functioning of society.”

Minnesota Gov. Tim Walz (D) signed a similar bill last month, setting a deadline for some products to be made without the chemicals by 2025, with others facing a 2032 deadline.

In 2019, the Washington legislature ordered the state Department of Ecology to seek PFAS-free alternatives for a variety of products and then set phaseout deadlines. Last year, legislators expanded the scope of the rule and set a 2025 deadline for some products, including apparel and cookware.

“We were able to speed up the timeline for eliminating PFAS, and it was a big fight,” said state Rep. Liz Berry (D). “The chemical companies and their lobbying efforts were very strong.”

Gardella, the Boston-based attorney who represents many of the affected companies, said the new laws will be difficult to follow since many products made in the United States use materials from overseas.

“These components and chemicals don’t always come in containers that say ‘PFAS,’ right?” Gardella said. “When companies ask if they contain PFAS, they’ll get a response that’s very vague, like, ‘This component that we sell has no hazardous substances in it.’ Okay. That’s nice, but who’s determining that?”

Some companies that are going PFAS-free are pledging to play a more active role in keeping the chemicals from their products. McDonald’s said it is now conducting its own “robust testing for chemicals” with the goal of using PFAS-free food packaging by 2025.

Simon, with the American Chemistry Council, said that many modern-day PFAS compounds are safe and made of shorter chemical chains, which allows them to break down more easily than older versions of the man-made chemicals. “Newer PFAS chemistries are eliminated from the body more quickly and do not accumulate in the body like the legacy products,” Simon said.

However, critics point to a 2020 peer-reviewed study by a team of scientists at Auburn University that found the short-chain PFAS compounds are “more widely detected, more persistent and mobile in aquatic systems, and thus may pose more risks on the human and ecosystem health” than their long-chain predecessors. The EPA made similar determinations the following year.

Simon’s group disputes that the studies conclusively prove that modern PFAS are as significant a health threat. Simon also said that many products — crucial to everyday life — cannot be made without the use of PFAS. As state laws become more aggressive, he said, it may lead to a shortage of medical devices and semiconductors key for smartphones and computers.

Benesh, with the Environmental Working Group, said that even though important products cannot yet be made PFAS-free, the industry could be doing more to protect the public.

“They should be capturing PFAS in their production processes, they should be filtering their wastewater, and they should be monitoring the release of PFAS into the air and water so they aren’t making this problem any worse,” she said.

Lawsuits against the makers and users of PFAS chemicals have snowballed since Bilott’s original lawsuit, as have the size of the settlements. Last week, DuPont de Nemours Inc. and other companies announced a $1.185 billion settlement over pollution claims tied to the manufacture of the compounds.

Environmentalists are now pushing states to regulate another source of PFAS contamination — sewage sludge, which is widely used as fertilizer on cropland in all but two states. For decades, municipal sewer districts have partnered with farmers as a cheap and reliable way of disposing of the waste.

Connecticut has long banned use of the bio-waste as fertilizer over a variety of environmental concerns, and in 2021, Maine became the first, and so far the only, state to ban its use specifically due to PFAS contamination.

© Adam Glanzman/Bloomberg Fred Stone, owner of Stoneridge Farm, stands near cattle with high per- and polyfluoroalkyl substances, or PFAS, levels at the his farm in Arundel, Maine, U.S., on Thursday, Aug. 15, 2019. State and federal regulators and researchers have only recently begun to study PFAS presence in agriculture. The Stoneridge Farm is one of only three in the country known to have been shut down by the presence of PFAS. Photographer: Adam Glanzman/Bloomberg

The move came after the state started testing groundwater on farms that were treated with the sludge, which is filled with human and industrial waste. State officials also put out a map of all the sludge-treated sites that contained high levels of PFAS in their groundwater, which included Fred Stone’s dairy farm.

“The map makes the state of Maine look like it has smallpox — it’s that prevalent,” said Stone, who had to close his dairy farm in Maine because of the contamination in his cows’ milk. “If I was operating in most any other state, I’d still be shipping my milk — and that should scare the bejesus out of everyone.”

Alice Crites and Magda Jean-Louis contributed to this report.

An ICB has been threated with legal action over its decision to close a 2,800-patient GP practice in Liverpool.

NHS Cheshire and Merseyside has informed patients at Park View Medical Centre, in Tuebrook, in North-East Liverpool, that their practice will be closing at the end of July.

It has now received a letter threatening judicial review proceedings over the decision.

Last year, the ICB ran a procurement process for the practice’s APMS contract, which was due to expire on 31 March, but failed to find a new provider.

Patients have signed a petition to oppose the closure and the practice’s patient participation group has held public meetings to voice their concerns.

A spokesperson for the ICB told Pulse: ‘We were unable to secure a new provider to run Park View Medical Centre, so the decision was made to disperse patients to other local GP practices at the end of the contract term, subject to a short-term extension to enable safe transfer of patients.

‘We have written to all registered patients to inform them that the practice will be closing by the end of July, and that they will be transferred to another nearby practice, as there are 10 practices within a one-mile radius of the Park View site.

‘We have recently received a letter about a proposed claim for a judicial review, which has been responded to and we are awaiting any further responses.’

It is unclear who is threatening legal action and Pulse has asked the ICB for clarification.

In a statement on its website, the practice said: ‘NHS Cheshire and Merseyside is now talking to other local GP practices about arrangements for patients to transfer across to them.

‘There are a range of other GP practices located within a mile of Park View Medical Centre, so we are confident that all patients will still be able to access GP services close to where they live – just as they do now.’

Mersey Care NHS Foundation Trust, which owns the surgery building, is considering selling the property within the next one or two years, which means GP services cannot be contracted to run from the building in the longer term.

Ian Byrne, the Labour MP for Liverpool West Derby, called for the ICB to ‘look at every option available’ to stop the closure.

Mr Byrne said: ‘Park View medical centre is under threat of closure – at a time when GP surgeries are under intense pressure and people are struggling to get appointments, the last thing we need in our community is a GP surgery to close.

‘So I’m calling on the ICB to look at all options that are on the table, and revisit the position that they are now in, which is to close the medical centre.’

Earlier this month, researchers at the University of Manchester found that practice closures are linked with reduced patient satisfaction with services at the surviving practices, which end up having more patients, as well as proportionally less GPs and funding. 

California's reparations task force is recommending as part of its set of proposals to make amends for slavery and anti-Black racism that state lawmakers address what it calls "racially biased" artificial intelligence used in health care.

The task force, created by state legislation signed by Gov. Gavin Newsom in 2020, formally approved last weekend its final recommendations to the California Legislature, which will decide whether to enact the measures and send them to the governor's desk to be signed into law.

The recommendations include several proposals related to health care, including some concerning medical artificial intelligence (AI), which the task force describes as "racially biased" and contributing to alleged systemic racism against Black Californians. 

Specifically, the task force calls for the legislature to fund either state universities or government agencies to study the "potential for harmful biases" in medical AI.

CALIFORNIA REPARATIONS COMMITTEE CALLS FOR MANDATORY 'ANTI-BIAS' TRAINING TO GRADUATE MEDICAL SCHOOL

"The task force recommends that the legislature provide state funding to the California Department of Public Health, a University of California school, a California State University school, or another appropriate entity to study the potential for harmful biases in commercial algorithms and AI-enabled medical devices," the committee writes in the final report outlining its proposals, adding that the study should also recommend how best to regulate medical AI tools in California.

The report additionally suggests the study should probe "'evidence-based research into the use of devices and tools that recommend adjusting patients' treatment or medication based on broad racial categories in the absence of information on genetics or socio-cultural risk factors.'"

The task force quotes from a recent American Civil Liberties Union (ACLU) paper that it cites several times. The paper provides examples of alleged racial bias in medical AI, such as a tool meant to decide how to best distribute the limited resource of extra care to new mothers at risk of postpartum depression that, according to the ACLU, directed care away from Black mothers and favoring White mothers. 

In California, meanwhile, the reparations committee recommends that the legislature require the state's Department of Public Health to issue guidance to hospitals and other medical systems to ensure that AI-enabled medical devices "are not used for clinical applications without FDA approval or clearance, are not used on patient populations they were not intended for, and that cleared tools are not used outside of their intended use cases." That recommendation is also in the ACLU paper.

The task force additionally wants the California Department of Public Health "to make and maintain a public list of software as a medical device (SaMD) products and provide demographic information about the subjects in which the devices were calibrated or trained."

NEW AI TOOL HELPS DOCTORS STREAMLINE DOCUMENTATION AND FOCUS ON PATIENTS

A fourth proposal is to allocate positions and funding to the California Department of Justice to pursue claims against AI medical device manufacturers if their products have a "disparate impact" when providers use them according to manufacturers' instructions or if the products "misleadingly promise fairness."

Despite the task force's claims, however, new AI tools have helped medical professionals treat patients in a variety of ways.

One such tool called RestoreU, for example, helps physicians create personalized care plans for patients with Alzheimer’s and other types of dementia. Another tool known as DAX Express streamlines the note-taking process, a benefit that has reportedly helped doctors Excellerate patient outcomes, work more efficiently, and reduce costs.

Beyond AI, the California Reparations Task Force is pushing several controversial health-related proposals, such as mandating "anti-bias training" and an assessment based on that training as graduate requirements for medical school.

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The task force is also pushing a universal, single-payer health care system as a way to achieve health "equity" for Black residents in California.

Kenya's Dadaab refugee camp is facing a serious outbreak of cholera: according to the World Health Organization, as of March 2023, Kenya had recorded more than 7,800 cholera cases and over 127 deaths. The outbreak, which began in October 2022, has seen more than 2,700 occupants of the Dadaab camp contract gastrointestinal illness.

One of the satellite complexes, Dagahaley, has been hardest hit: it accounts for around 1,100 infections alone.

"We have already seen the worst cholera outbreak in five years and the risk of other epidemics breaking out is high," Hassan Maiyaki, the country director for the French medical charity Doctors Without Borders or Medecins Sans Frontieres (MSF), told DW.

"If this occurs, it would outstrip medical capacity in the camps, with potentially catastrophic consequences. Maiyaki warned.

Poor sanitary conditions at the camp

Some factors that have exacerbated the situation include poor sanitary conditions within the camps, influx of refugees, overstretched resources, and dwindling donor funds.

Dr. Kapil Sharma, a medical doctor and the project coordinator for MSF in Dadaab, blamed the seventh-month-long cholera outbreak on the camp's unhygienic conditions.

"One of the main reasons for cholera, as we all know, is poor sanitary situation," Sharma told DW, adding that the camp also lacks access to latrines. "There is rampant open defecation in the camp, and less than 50% of the people have access to the latrines, so these are all compounding factors for this outbreak to increase."

Call to Excellerate camp conditions

The medical practitioners in the area are now advocating for improvements in water, sanitation and hygiene to contain the outbreak.

Kenya's Ministry of Health and other humanitarian agencies have conducted a cholera vaccination campaign since February. They also conducted health promotions, but medical practitioners in the area say it was insufficient.

"More needs to be done in terms of water, sanitation and hygiene for this population," Kapil said, calling on more substantial support from the international community to organizations providing water, hygiene, and sanitation services in the camp.

Influx of refugees from neighboring countries

According to the UN Refugee Agency (UNHCR), Dadaab camp hosts over 43% of Kenya's refugee population.

The humanitarian crisis in neighboring countries has led to a further growth in the number of refugees at the Dadaab camp. In 2022 alone, about 100,000 refugees came into the country, 67,000 of whom found their way to Dadaab.

The new arrivals have put more pressure on the camp's capacity. "The camps are already overstretched, and the humanitarian conditions there are already at its limit," Dr. Nitya Udayraj, MSF's medical coordinator in Kenya, told DW.

Tens of thousands of unregistered refugees 

There are currently more than 124,000 refugees within the Dadaab refugee complex who have yet to be registered.

The drought that has plagued the Horn of Africa region has exacerbated things further, since most of those coming into the camp are either malnourished, tired, or susceptible to the disease. In addition, the worsening drought in Somalia and the crises in the neighboring Sudan, South Sudan, and Ethiopia have all forced more people to seek refuge in Kenya.

Despite having a holding capacity of 35,000 people, the satellite camp of Dagahaley hosts about 140,000 refugees. Meanwhile, more continue to stream in.

Few doctors for thousands of people

The medical doctors are not only providing care to people within the camp, but also to an additional 14,000 people within the host community, who also require their services. This has left the medical facilities overstretched and almost running on empty if help comes in late.

"MSF calls on the international community, donors and aid agencies to respond urgently to the unfolding crisis in Dadaab, taking immediate action to address the alarming sanitary conditions and prevent the further spread of disease," Maiyaki said.

The global economic crisis has also played a part in the worsening of the situation at the camp. As a result, many aid organizations have delayed remitting funds.

"What is important is the allocation of appropriate resources for organizations responsible to provide these services as fast as possible," Kapil said.

Kenya plans new refugee camp

The Kenyan government has announced plans to reopen a fourth camp, Ifo 2, to accommodate new arrivals and alleviate the strain on resources in the existing camps.

"MSF calls on the government of Kenya and the UNHCR to find durable solutions for the refugees confined within the camps at Dadaab," Maiyaki said.

Even as MSF calls on the government to fulfill the promise urgently, other interventions like water distribution and sanitary facilities supply to the refugees have been in top gear to prevent the further spread of the disease.

"We are providing 50,000 liters of water to the outskirts population of 9,000 people," Kapil said, stressing that the organization had facilitated the construction of 150 latrines for the population. It has also provided them with plastic sheeting and maps.

The MSF health practitioner said he remains optimistic that the situation can improve. "I feel really very sad when I see this number which has really increased over the last few months," Kapil said, calling on all stakeholders to collaborate and provide essential human services "to prevent people from contracting these disease which should not happen actually."

Edited by: Chrispin Mwakideu

Two top congressional progressives are joining forces with leading health care activists to pressure Washington officials to help ease the burden of patients’ medical debt and predatory practices.

The upcoming “Freedom From Medical Debt” initiative, led by Our Revolution, Rep. Ro Khanna (D-Calif.) and Sen. Bernie Sanders (I-Vt.) and first reported by The Hill, is intended to push Democrats from the White House to Congress to address what liberals see as one of the most pressing national problems: the cost of care. 

“Health care is the third rail in American politics,” said Joseph Geevarghese, who leads Our Revolution, a coalition of grassroots members spearheading the debt-relief campaign. 

“The truth is, even after the expansion of the ACA, efforts to expand Medicaid through the states, we’re still seeing a significant amount of patients, even patients with health insurance, struggling under the burden of medical debt,” Geevarghese said. 

Close ideological allies and personal friends, Khanna and Sanders are authoring forthcoming legislation in the House and Senate this month, while activists are preparing to push President Biden to use executive action to help stop price gouging for vulnerable patients, end a variety of predatory debt collection tactics, and ensure that people seeking medical assistance have financial aid and free or reduced price care available.    

The progressive lawmakers are making their case as Biden kicks off his 2024 reelection campaign and after he recently signed a bill announcing the end of the national emergency for the COVID-19 pandemic, leaving many in a financially vulnerable spot around treatment.

Expanding access to health care and patient protections continues to poll as a reliable and popular position nationally, encouraging Democrats — from former presidents Clinton and Obama to Sanders himself — to lean heavily into the issue during election time.

Our Revolution and Khanna are holding a virtual forum Monday evening alongside advocates from the National Consumer Law Center and Tzedek DC and patients whose lives have been significantly impacted by medical debt and related systematic burdens. 

The event is expected to draw testimonies from patients who have suffered long-term harm as a result of the industry’s most pernicious practices, including racking up life-altering debt from cancer diagnoses to strokes and traumatic brain injuries.

“In 2010, I was hit by a car on my bike. I barely survived, had a brain injury, my hand amputated and reattached — costing nearly $1 million,” said Kristin Noreen, a patient from Washington. “Even with insurance, some of that went on credit cards. Now, instead of paying it down, I’m incurring more costs for pain treatments that aren’t covered,” she said. “It’s a vicious cycle.” 

Elizabeth McLaughlin, a resident from Indiana, said she was debt-free until one experience at the emergency room left her reeling.

“I had no debt until I went to the ER for an injury in 2015 and got hit by a $20,000 bill,” McLaughlin said ahead of the meeting. “Even with insurance and working all my life, I still got saddled with debt.”

Khanna, who is leading the effort in the House, has become a prominent voice within the Congressional Progressive Caucus with an elevated national presence, often tying together a range of policy concentrations with their real-world financial impact for middle- and working-class Americans. 

His former role as Sanders’s campaign co-chair in 2020 allowed him to work alongside the Vermont senator on his signature issue, where he attracted massive crowds for his commitment to Medicare for All and railing against what many on the left say are the medical industry’s most damaging anti-patient practices. 

As the progressive lawmakers prepare to work through the legislative process on Capitol Hill — and face the political difficulties of the GOP-controlled House — activists are amassing support from dozens of states and key congressional districts that they hope will catch the attention of the White House. 

Their goal is to pressure the Biden administration to explore what’s possible through executive action. They also plan to target the Department of Health and Human Services and the Centers for Medicare & Medicaid Services for their support to, as Geevarghese puts it, “get beyond the band-aid” of debt forgiveness and to tackle the broader problem. 

“Medical debt is the number one reason for personal bankruptcies in the United States,” Geevarghese said. “We can stop that and the president has the power.”

A new paper published in The Lancet Psychiatry has called for radical action on a global scale to put an end to the growing mortality rates of people with mental illness and mental distress.

The paper, written by 40 global experts—including the University of Glasgow's Prof Rory O'Connor, Chair in Health Psychology—followed an extensive road mapping process of evidence reviews and consultation with mental health researchers, clinicians, policy experts and people with lived and living experience of mental illnesses and suicide.

The group mapped the range of factors which increase the risk of early mortality for people who are suffering from mental health conditions. These include adversities such as traumatic life events, unemployment, stigma and marginalization, lack of meaningful societal relationships, and poor access to health care, education, housing, and income security.

Although these factors are widely acknowledged, more research is urgently needed into the ways we can reduce these risks and deliver changes to both medical and wider government policies, to Excellerate the life expectancy for people diagnosed with mental health conditions or in mental distress.

The paper, produced by MQ Mental Health Research, sets out ambitious goals for implementing concrete solutions, and calls on government policymakers to coordinate their response to the mental health challenges we face nationally and globally. The paper also challenges the private sector such as social media companies and employers to make changes now to save lives in the future.

The 18 recommendations outlined in the paper include delivering integrated health care, community-based interventions, restriction of access to lethal means of suicide, reduction of inequalities as well as increased investment in mental health services and research.

The paper's lead authors are Professor Rory O'Connor, Director of the Suicidal Behavior Research Laboratory at Glasgow University and Professor Carol Worthman from the Anthropology Department at Emory University in the U.S.

Professor O'Connor, from the University of Glasgow's School of Health and Wellbeing, said, "Globally, too many people die prematurely from suicide and the physical health problems associated with mental illness and mental distress. These devastating losses are preventable.

"For this first time, we have brought together a multidisciplinary global team of academic, policy, clinical, and lived and living experience experts with the specific aim of understanding the driving forces behind these deaths together with what needs to be done to tackle this public health crisis.

"The time to act is now, to rebuild health-care systems, to prioritize mental health funding, and address the effects of stigma, discrimination, marginalization, gender violence, and victimization."

The paper offers a practical roadmap for implementing the solutions, but the authors are eager to make it clear that any solutions must be co-designed by people with lived and living experience of mental illnesses, in order to be successful. The paper's authorship itself integrated many people with first hand and family experience of mental illness.

Mental health campaigner and contributor to the paper, James Downs, said, "From the very start, Gone Too Soon has prioritized the knowledge and expertise that comes from having lived and living experiences of mental illness.

"As someone with longstanding serious mental illness, comorbidity, and suicidality, it has been meaningful to have an active role in this ambitious research alongside world-leading experts. By integrating experts by experience on an equal footing, we have aimed to create a fuller, more representative knowledge of the problems that underpin why people like me are likely to live shorter and more difficult lives as a result of mental illness. I hope the solutions we have proposed are more impactful as a result of lived experience being included in the project, and that we have set an example for how to co-produce knowledge and co-design more effective solutions together."

The authors recognize that this is an ambitious paper, and the solutions must be implemented across all levels of society, including at a global political level.

Professor Carol Worthman said, "The Gone Too Soon road mapping process revealed cross-cutting factors behind mortality from both suicide and mental health comorbidities.

"We also discovered that many of these factors operate across the social-ecological spectrum, from individuals through families, communities, and society.

"These insights open possibilities for common solutions that reduce premature mortality from both suicide and comorbidities and suggest opportunities to leverage ramifying effects via strategic interventions.

"That our global team combined diverse expertise and living and lived experience was crucial for identifying common cross-cutting factors and recognizing the local forms they take, thus advancing inclusive efforts to promote human welfare."