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First Ebola Patient Diagnosed in U.S. Dies

Liberian Thomas Eric Duncan, the first person diagnosed with Ebola in the U.S., died in Dallas Wednesday. As Ebola continues to spread in West Africa, where more than 3,400 people have died of the disease, five of the busiest US international airports will begin enhanced screening measures to find travelers infected with Ebola. Forum will discuss how prepared the Bay Area is for a possible Ebola outbreak and what the U.S., and the world, can do to contain the disease.

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PBS NewsHour

Self-quarantined reporter: US must ‘strike balance between caution and panic’ on Ebola


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HARI SREENIVASAN:  For more about West Africa’s fight against Ebola, we are now joined from Washington via Skype by Helene Cooper of The New York Times.  She recently returned from Liberia.

So, I understand you were out and about when you first got home.  In fact, we saw you on “Meet the Press” last Sunday.  And now you’re on some sort of self-imposed quarantine.  Tell us about that?

HELENE COOPER, The New York Times:  It is sort of a modified quarantine as well.

I came back from Liberia on Saturday, and I went on “Meet the Press.”  I am not symptomatic.  I have been taking my temperature and all of that.  But then I started thinking about it when it was time to go back to the office and go into the Pentagon, which is where I actually work often.

And I realized that a lot of people were going to feel weird around me.  So I worked it out with The Times that I would work from home, I wouldn’t go into the Pentagon and into the press bullpen, where — which is a crowded area.

And what I am trying to do is just for the rest of the — until I reach the 21-day point, is to stay away from crowds.  I am not touching anybody, and I am basically behaving the same way I did while I was in Liberia, which is, don’t touch anybody, no hugging, no kissing, none of that, and don’t allow anybody to touch me.

If I do get sick, by some chance, and people are — to do contact tracing, I would like to be, oh, wow she didn’t touch anybody for 21 days, so you are not having to put other people under observation because of me.

HARI SREENIVASAN:  And is this advice that you got from some doctors when you came back, or this what you have got…

HELENE COOPER:  No, this is not advice from — it is much more — I think we are all trying to feel our way around with this and strike a balance between caution and panic.

I am taking my temperature.  I have never been more intimately aware of what my temperature is in my life.  And I tend to stay between 97.6 and 98.4, even though I did once go up to 98.5 and freak out.

I mean, the science says that I am not sick because I didn’t touch anybody when I was in Liberia.  And you don’t get Ebola unless you come into contact with the bodily fluids of a symptomatic Ebola patient.  But, at the same time, I understand that a lot of people feel uncomfortable at the idea of being near anybody who has been in Liberia.

So it’s — in a lot of ways, this is much more psychological.  But I also think there’s some things that we maybe perhaps don’t understand about the disease.  So I am just trying to be as cautious as possible and to sort of treat everybody I come — everybody I see the same way I would treat my 4-year-old nephew, who I am definitely not touching for 21 days.

So my sort of — the way I am looking at it is, if I am not going to touch Cooper (ph) for 21 days, I’m not going to touch anybody for 21 days.


So, paint us a picture of what it was like on the streets of Liberia, a totally different health care infrastructure and the — some of the images that we have seen coming from that country have been so graphic in how people are literally lying on the ground outside of hospitals waiting for care.

HELENE COOPER:  I didn’t see people lying on the ground outside hospitals, because I think that the reporting on that is maybe a couple of weeks old.

What you do see on the street in Liberia right now is people not touching.  You don’t see people holding hands.  You don’t see people hugging and kissing and that sort of thing.  The daily life of the Liberian has — has in many ways almost come to a screeching halt.

The government of Liberia has closed all nonessential services, and schools are not open.  So you have — if you are looking at the ordinary Liberian, who doesn’t have Ebola, they are dealing with, you know, transportation is a lot harder.  They are not going into the office.

And one of the things that really struck me is so many people with school-age children are locking the kids up in the house.  And so you do have a case of — like, for instance, with my sister, who has a 9-year-old daughter, my niece has been locked in the house for two months.

So it is really difficult for — for her and for those sorts of people.  But then you have the other side of the equation.  These are the people who are coming into contact with Ebola.  And there, you see suffering of the magnitude that was very hard for me to sort of get my head around, because the — one of the worst things about this disease is that it makes pariahs out of the people that get it.

And so, if you get Ebola, people around you are not going to want to touch you.  They are not going to — it has become — you immediately become — you are sick, you are vomiting, you have diarrhea.  And at the same time, you are sort of — you are a menace to anybody else around you.

And that’s one of the things that really struck me about it.  And yet, in the middle of all of that, you still have people trying to take care of these people who are sick, at great peril to themselves.  I mean, people know to put on gloves and masks and that sort of thing, but this is a poor country, where everybody doesn’t have access to that.

So it’s really — it was heartbreaking.  It was one of the hardest reporting experiences I have ever had.

HARI SREENIVASAN:  Is the U.S. intervention — I mean, we had planned on deploying thousand of Marines to the area.  Is that making a difference?

HELENE COOPER:  Not yet, but it is starting to.

What the — I went in.  When I first arrived, I came in with the U.S. military.  And I spent a lot of time with them.  And they are building — working toward building 17 treatment units.  But it definitely seemed like they were in a race against time.  And they are trying to catch up with the disease that is galloping ahead of them.

So the construction has started while I was there on several of these centers.  These military guys are in there.  And they are doing their best.  And they are going as far as — fast as they can, but there is some frustration, because this sort of thing takes time.  It is not as easy or as fast as a lot of people would like.

I think now we are seeing the point now they have stood up one of the hospitals, and they are working on several other that have started.  And I think you are now seeing the point where — that you are starting to see benefit on the ground.

One thing that it really did do, though, is, I think the arrival of the American military gave a lot of Liberians hope, you know, sort of like hope that maybe that other people are coming in to help them.  They are not on their own.  They was a lot of optimism when the American military guys showed up.

HARI SREENIVASAN:  Yes.  At the same time, we have Liberian President Ellen Johnson Sirleaf saying on the BBC “Newshour” — she sort of wrote a letter to the world.

She said — quote — “It is the duty of all of us as global citizens to send a message that we will not leave millions of West Africans to fend for themselves against an enemy that they do not know and against whom they have no defense.”

It is a — it’s just a — it is tragic that we have literally got a president now that is just pleading for help around — for the international community to get in there.

HELENE COOPER:  It really is.

And the whole response has been a lot slower than the disease, and that is the biggest problem.  I mean, I kept asking people, what took so long?  Why did it take them until the end of August and September for us to start, for the international community to get — and, you know, there is not — there is not really a real answer to that.

Everybody thought — it seems as if the CDC, the WHO, all of these different entities thought this was going to go away.  In March, when this first entered Liberia, you know, there was a brief moment, and then things seemed to get under control, and then it showed up again in June.

And so it took a long time.  A couple of people even said, well, it was all this.  A lot of people were on vacation.  It didn’t take — you know, people didn’t realize how big of a deal this was going to be.  And that — that is sort of — that is said, but that’s where we are right now.

HARI SREENIVASAN:  But considering you were on the streets in Liberia, where Ebola is far more rampant, compared to the United States, now that you are back, and the reaction to Ebola that you must have seen on cable news and elsewhere, compare the two for us.

HELENE COOPER:  Wow.  That is a really good question.

I have to say, people are like a lot more calm than they are here.  They seem — there is a resignation in Liberia to this — the fact that they are dealing with this disease.  Liberians seem to know a lot more about how it is spread.

And that is, naturally, because they have been dealing with this since March.  So people in Liberia, the average person on the street, you know, is not touching anybody.  But they also seem to know that you are not going to catch Ebola from somebody touching you.  You are going to catch Ebola from a symptomatic.

And that is a really key word, a symptomatic Ebola patient.  And so that — there’s not — you are not seeing the kind of panic on the streets in Liberia that I see not on the streets necessarily here, because I haven’t really been on that streets that much, but that you see when you turn on cable news and you see — you hear about all these different instances of people keeping their children from school and that sort of thing here.

And I think their tolerance for risk is probably a lot higher than we are here in the — than our tolerance for risk here in the United States.

HARI SREENIVASAN:  All right, Helene Cooper of The New York Times joining us under house quarantine, so to speak, in Washington, D.C., via her phone, thanks so much for joining us.

HELENE COOPER:  Thank you.

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Slipping through the system: Are mentally ill Americans getting adequate health care?


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Editor’s note: An earlier version of this piece appeared on our website in August — this version has been updated to reflect new information.

STEPHEN FEE: Gail Davis is 52 years old and lives on Chicago’s SouthSide. Every day she prepares lunch for her 82 year old mother who suffered a stroke.

Gail is her mom’s primary caregiver — yet Gail herself has struggled for decades with mental illness.

GAIL DAVIS: “I was like that I guess before — when I come into the world I guess. I didn’t match up, and I didn’t um — seem to blend in with society, what society says what the world says this is what you have to be and do.”

STEPHEN FEE: For years, anger, depression, and anxiety all kept Gail from holding a job. And she didn’t have health insurance. That meant that for much of her life, except a few emergency room visits, Gail’s mental conditions went untreated.

MARK ISHAUG: “People with serious mental illnesses generally don’t show up to the doctor’s office. They don’t make medical appointments and psychiatric appointments.”

STEPHEN FEE: That’s Mark Ishaug — he runs Thresholds, Chicago’s largest nonprofit mental health provider. He says Gail’s story isn’t unique among the millions of low-income, uninsured Americans with mental illness.

MARK ISHAUG: “So people with a serious or persistent mental illness in general have been treated very badly by the health care system. Either they haven’t had insurance and so they weren’t able to get care, or they used emergency rooms in hospitals for their care. And it’s really hard to engage people and convince them that they can get help and they can be treated well.”

STEPHEN FEE: In 2010, a family member referred Gail to a mental health clinic in her neighborhood — run and paid for by the city of Chicago. It was the first time in her life she’d seen a therapist.

GAIL DAVIS: “He’s been a good force. He come into my life at the right time because that’s probably what I needed all along.”

STEPHEN FEE: But during the recession, Illinois was under financial strain. From 2009 to 2012, the state cut mental health spending by $187 million dollars — a pattern that was happening nationwide. During the same period, states slashed overall mental health budgets by $1.6 billion dollars.

And that meant mental health clinics like Gail’s were suddenly on the chopping block.

By the end of 2012, Chicago had closed half of its outpatient mental health clinics — including Gail’s.

GAIL DAVIS: “It’s like we was dismissed. And that was the hardest part.”

STEPHEN FEE: But the Chicago clinic closures — along with similar mental health facility closures around the country — weren’t just about budget cuts.

When the Affordable Care Act, or Obamacare, was signed in 2010, it included a provision to expand Medicaid. Twenty-seven states, including Illinois, have opted in to the plan, which means the federal government — rather than states — will pay for treatment of newly qualified low-income people like Gail.

Bechara Choucair has been Chicago’s public health commissioner for five years.

BECHARA CHOUCAIR: “Now all of a sudden they have more options. And if they choose to transition to another provider, we support them through that transition.”

STEPHEN FEE: Just here in Illinois 120 thousand people with persistent mental illnesses are expected to enroll in Medicaid who weren’t eligible before the new rules came into effect. But of course being eligible for insurance doesn’t necessarily mean you’re getting the coverage you need.

STEPHEN FEE: For Gail, signing up for Medicaid complicated her mental health care. After her clinic closed, her therapist began visiting her at home.

But according to her medical records, Gail’s therapist in mid-2013 “was forced to inform [her] that [mental health] services…would likely have to wind down” and that she could only continue services if she dis-enrolled from her Medicaid plan.

A city spokesperson says there was initially uncertainty over whether Medicaid recipients could continue seeing city therapists — but that clinicians were never told services had to cease. Nevertheless, Gail went a year without seeing a mental health professional.

GAIL DAVIS: “If this is something that’s working and this is somebody that I build a bond with, why break that up. You know, because I felt like that was really useless and senseless.”

Mark Heyrman is a law professor at the University of Chicago and advocates for people with mental illness. He says they have a particularly difficult time when they move out of publicly financed facilities and must find new providers on their own using Medicaid.

MARK HEYRMAN: “Losing that human connection and a place that they’ve gone for treatment for quite a few years and being told ‘Now you must go find a new person to be connected to.’ That’s a difficult thing. And people fall through the cracks. They fail to show up.”

STEPHEN FEE: So far, Heyrman says figuring out just how many people like Gail have slipped through the system is nearly impossible.

MARK HEYRMAN: “I think the answer is we don’t know yet. And unfortunately no one has the money or the time or wants to invest their money and time in sort of really figuring out what is happening to everyone who has a serious mental illness.”

HAROLD POLLACK: “It’s gonna be a wild ride I think over the next several years.”

STEPHEN FEE: Harold Pollack is a public health researcher, also at the University of Chicago — he’s an expert on the national health care reform law — and a supporter of it. He says Gail’s difficulties show how important it is to help vulnerable people navigate the system.

HAROLD POLLACK: “Because it’s not enough to just insure people. You actually have to have systems in place that are effective and economical and credible.”

STEPHEN FEE: Is Medicaid and the private health insurance expansion enough to get people in Chicago who have persistent mental illness the care that they need?

MARK ISHAUG: “Medicaid and private insurance, they’re– that’s just what it is. It’s insurance. It doesn’t mean that it’s care and it doesn’t mean that it’s access to care. But it’s a necessary precondition to what we’re able to do.”

STEPHEN FEE: Not everyone agrees though that Medicaid expansion is the necessary first step. Twenty states have decided not to expand their Medicaid programs mostly out of cost concerns. The federal government has agreed to pay 100 percent of expansion costs, but that figure steadily declines to 90 percent by 2020.

So far, the A-C-A has survived court challenges and repeal efforts – and analyst Harold Pollack says the emerging consensus among states may be more about fixing implementation problems than eliminating the law altogether.

HAROLD POLLACK: “I do think that governors, both Democrats and Republicans are– you know, they do raise a number of very valid points with the Obama Administration that say, ‘You know, health reform has to be tweaked so that it actually works well.’ And as we start to really implement the Affordable Care Act, we will discover various things that have to be fixed along the way.”

STEPHEN FEE: President Obama has said he welcome ideas to modify health care reform as problems arise.

PRESIDENT BARACK OBAMA: “I will always work with anyone who is willing to make this law work even better.”

STEPHEN FEE: Meanwhile, back on the South Side of Chicago, Gail Davis is seeing her city-funded therapist again.

Are you getting the help and the assistance that you need to keep yourself healthy?

GAIL DAVIS: “Not like it should be, you know. But that as I speak will change because I do have an appointment by the way next Friday.”

STEPHEN FEE: Though the city mental health clinics aren’t taking Gail’s Medicaid plan, they are keeping patients like her on board at
least for now.

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Could this Chicago nonprofit be the answer to caring for the mentally ill?

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         2014-08-01 at 12.05.05 PM

Ruthie Anderson spends time with family at her new apartment in Chicago. Credit: NewsHour Weekend

CHICAGO — Just outside Chicago’s city limits in Oak Park, Ill., Ruthie Anderson finally has a place that feels like home.

Her sun-filled, one-bedroom apartment is sparsely furnished — the walls are mostly blank, and there’s just a table and four chairs outside the kitchen and an easy chair in the living room. But it’s a place where the 59-year-old mother of seven can finally spend time with her ten grandchildren.

“I love them to death, they’re just like my world,” Anderson said. “That’s all I live for now is to see them grow up and make sure they’re all right. I don’t want to see them go through the things that I had to go through.”

The apartment is her first permanent home in years. Anderson spent three decades living on the street, struggling with drug addiction and mental illness, including depression. Today, she’s getting treatment and has a place to live — a beneficiary of a year-long mental health pilot program that experts say could serve as a national model for treating people with mental disorders.

According to the 2012 National Survey on Drug Use and Health, nearly 40 percent of adults with severe mental illness, such as schizophrenia or bipolar disorder, received no treatment the year prior. Among adults with any mental illness, the survey said, 60 percent went untreated.

For much of her adult life, Anderson was no different, with the exception of the occasional visits she made to Chicago-area emergency rooms.

She was addicted to heroin and slept in parks and hospital waiting rooms — and at other people’s houses, occasionally in exchange for sex or drugs.

“I was stealing in and out of stores doing everything I could to get high,” Anderson said. “It didn’t make a difference what it was, as long as I got that next fix.”

Ruthie Anderson shares her story of a struggle with mental illness and drug addiction with NewsHour Weekend’s Stephen Fee. Video edited by Mori Rothman. 

​But in 2013, after she was admitted to the hospital for the 19th time in less than a year and a half, an employee of the Chicago-based mental health nonprofit, Thresholds, offered to help her find a place to live and get the care she needed.

“I really didn’t have faith in no one,” Anderson said, “because everyone had lied to me about the things they said they could do for me or help me.”

Anderson said the nonprofit group gave her a place to stay, managed her Social Security disability payments, and gave her access to a mental health provider.

“I thank God that I made it,” she said, “Without Thresholds, I really didn’t think I would’ve made it. I really didn’t.”

Normally, providers like Thresholds bill Medicaid for each service provided — the fee-for-service model that typifies insurance providers in the US. In this case, though, Thresholds was given a list of 50 high-risk, high-cost mental health patients receiving Medicaid.

Under the year-long pilot program, a managed care Medicaid organization called IlliniCare gave Thresholds a flat fee for keeping Anderson healthy and out of the hospital — and Thresholds could spend the money any way they saw fit.

“I think everyone across the spectrum and everyone within the medical community, the social service and policy community understands we have to move out of this fee-for-service mindset,” said Harold Pollack, a professor at the University of Chicago and an expert on health care policy. “We don’t quite know how to do it yet, and we’re working on it.”

Over the past 15 years, states have experimented with managed care organizations that contract with state Medicaid programs and avoid the fee-for-service model. The state of Illinois passed a law requiring 50 percent of its Medicaid recipients to move to managed care entities by next year, but managed care entities are still restricted to the types of services they can provide.

As Anderson’s case shows, supportive housing and other services are often a necessary part of treatment for people with serious mental illnesses — but those services are seldom financed by Medicaid or private insurance plans. And with 1.2 million mentally ill Americans expected to join Medicaid under the Affordable Care Act, advocates say supportive services have to be part of the treatment mix.

“One of the ironies in our health care system is that we provide tremendous resources, all things considered, to deal with the things that we consider to be medical problems,” Pollack said. “If someone needs psychiatric care, we will provide that. And then that same person needs a place to live. And suddenly we’re in a much more underfunded and challenged set of systems.”

Illinois is looking to change that. This summer, the state applied for a Medicaid waiver, asking the federal government for permission to use Medicaid dollars to pay for services like housing.

“If you can spend money on social services and keep people out of hospitals, obviously that’s a win-win situation,” said University of Chicago lawyer and mental health policy expert Mark Heyrman. “The federal government spends less money. The state government spends less money. And the person with the serious mental illness is getting services in the community that keep him or her from getting really sick and ending up in the hospital.”

Anderson says she still has her daily struggles. She goes to a methadone clinic six days a week to treat her drug addiction.

“It takes faith,” she said. “It might look gloomy, but sooner or later you will run across somebody that will pick you up and help you.”

The post Could this Chicago nonprofit be the answer to caring for the mentally ill? appeared first on PBS NewsHour.

Obama pushes back against calls for West Africa travel ban

         Director Tom Frieden listens via videoconference as U.S. President Barack Obama holds a meeting with cabinet agencies coordinating
         the government's Ebola response, in the Cabinet Room of the White House on Oct. 15. Photo by Kevin Lamarque/Reuters

CDC Director Tom Frieden listens via videoconference as U.S. President Barack Obama holds a meeting with cabinet agencies coordinating the government’s Ebola response at the White House on Oct. 15. President Obama pushed back against calls for a West Africa travel ban in his weekly address on Saturday. Photo by Kevin Lamarque/Reuters

WASHINGTON — President Barack Obama urged Americans on Saturday not to succumb to hysteria about Ebola, even as he warned that addressing the deadly virus would require citizens, government leaders and the media to all pitch in.

In his weekly radio and Internet address, Obama also pushed back against calls for the U.S. to institute a travel ban. Lawmakers have called it a common-sense step to prevent more people with Ebola from entering the U.S., but Obama said such a ban would only hamper aid efforts and screening measures.

“Trying to seal off an entire region of the world – if that were even possible – could actually make the situation worse,” Obama said.

Growing U.S. concern about Ebola and the three cases diagnosed so far in Dallas prompted Obama on Friday to tap a former top White House adviser to be his point person on Ebola. Striking a careful balance, Obama said there’s no “outbreak” or “epidemic” of Ebola in the U.S., but said even one case is too many.

“This is a serious disease, but we can’t give in to hysteria or fear-because that only makes it harder to get people the accurate information they need,” Obama said. “We have to be guided by the science.”

As Obama sought to reassure anxious Americans, U.S. officials were still working to contain the fallout from the Ebola cases identified in the U.S. so far, rushing to cut off potential routes of infection for those who may have come into contact with individuals who contracted Ebola. Obama said he was “absolutely confident” the U.S. could prevent a serious outbreak at home – if it continues to elevate facts over fear.

“Fighting this disease will take time,” Obama said. “Before this is over, we may see more isolated cases here in America. But we know how to wage this fight.”

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