Kaiser Health News

Epidemic: Bodies Remember What Was Done to Them

Published

2 years ago

October 10, 2023

Tue, 10 Oct 2023 09:00:00 +0000

Global fears of overpopulation in the ’60s and ’70s helped fuel India’s campaign to slow population growth. Health workers tasked to encourage family planning were dispatched throughout the country and millions of people were sterilized — some voluntarily, some for a monetary reward, and some through force.

This violent and coercive campaign — and the distrust it created — was a backdrop for the smallpox eradication campaign happening simultaneously in India. When smallpox eradication worker Chandrakant Pandav entered a community hoping to persuade people to accept the smallpox vaccine, he said, he was often met with hesitancy and resistance.

“People’s bodies still remember what was done to them,” said medical historian Sanjoy Bhattacharya.

Episode 6 of “Eradicating Smallpox” shares Pandav’s approach to mending damaged relationships.

To gain informed consent, he sat with people, sang folk songs, and patiently answered questions, working both to rebuild broken trust and slow the spread of smallpox.

To conclude the episode, host Céline Gounder speaks with the director of the global health program at the Council on Foreign Relations, Thomas Bollyky. He said public health resources might be better spent looking for ways to encourage cooperation in low-trust communities, rather than investing to rebuild trust.

The Host:

Céline Gounder
Senior fellow & editor-at-large for public health, KFF Health News

@celinegounder

Read Céline’s stories

Céline is senior fellow and editor-at-large for public health with KFF Health News. She is an infectious diseases physician and epidemiologist. She was an assistant commissioner of health in New York City. Between 1998 and 2012, she studied tuberculosis and HIV in South Africa, Lesotho, Malawi, Ethiopia, and Brazil. Gounder also served on the Biden-Harris Transition COVID-19 Advisory Board.

In Conversation With Céline Gounder:

Thomas Bollyky
Director of the global health program at the Council on Foreign Relations

@TomBollyky

Voices From the Episode:

Chandrakant Pandav
Community medicine physician and former World Health Organization smallpox eradication worker in India

@pandavcs1

Gyan Prakash
Professor of history at Princeton University, specializing in the history of modern India

@prakashzone

Sanjoy Bhattacharya
Medical historian and professor of medical and global health histories at the University of Leeds

@joyagnost

Click to open the transcript

Transcript: Bodies Remember What Was Done to Them

Podcast Transcript Epidemic: “Eradicating Smallpox” Season 2, Episode 6: Bodies Remember What Was Done to Them Air date: Oct. 10, 2023

Editor’s note: If you are able, we encourage you to listen to the audio of “Epidemic,” which includes emotion and emphasis not found in the transcript. This transcript, generated using transcription software, has been edited for style and clarity. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

Céline Gounder: In the early 1970s, all around the world, worries about overpopulation were mounting.

Politicians warned about the dangers.

Richard Nixon: Our cities are gonna be choked with people. They’re going to be choked with traffic. They’re gonna be choked with crime. … And they will be impossible places in which to live.

Céline Gounder: And news outlets repeated the claims. A 1970 news analysis from The New York Times described “two avenues” to deal with the problem of overpopulation.

Voice actor reading from NYT article: “… one is persuasion of people to limit family size voluntarily, by contraception, sterilization or abortion. The other is compulsory, through such means as large‐scale injection of at least temporary infertility drugs into food or water.”

Céline Gounder: Popular books like “The Population Bomb” suggested an impending, apocalyptic future. Pulpy paperbacks were passed around — capturing people’s imagination and stoking fears.

Two million copies of “The Population Bomb” were sold. And the author landed on late-night television, his dire predictions becoming entertainment for Americans sitting at home on their couches.

Meanwhile, on the other side of the globe, India — with its growing population — was in the crosshairs of the world’s anxieties.

[Solemn music plays.]

Céline Gounder: In the early ’50s, India had launched a family planning program.

Narrator of Indian Family Planning Film: There are 5 million more mouths to feed every year. … If our population continues to grow unchecked at the present alarming rate, we cannot solve our problems of food and shelter.

Céline Gounder: And that state-sponsored campaign got political and financial backing from international organizations like the World Bank and American foundations like Ford and Rockefeller.

Health workers were dispatched across India to get people to have fewer children.

Sometimes voluntarily.

Sometimes for a monetary reward.

Sometimes using force.

Violence and coercion created distrust.

In this episode, we’ll explore how that distrust affected the public health campaign to stop smallpox.

And ask: What is the path to restoring trust?

I’m Dr. Céline Gounder and this is “Epidemic.”

[“Epidemic” theme music plays.]

Chandrakant Pandav: Ready? Good afternoon. My name is Dr. Chandrakant Pandav. This is a recording in my office at New Delhi.

Céline Gounder: Chandrakant Pandav’s office is decorated with his academic degrees, lantern lights, and floral wallpaper. There are photos of Mahatma Gandhi, Mother Teresa, and various Hindu deities framed in gold.

And on his desk is a small saffron-white-and-green flag.

Chandrakant Pandav: Most important, I have India’s flag always in front of me.

Céline Gounder: And what’s the reason for that?

Chandrakant Pandav: Patriotism, mera desh mahaan.

Céline Gounder: Mera desh mahaan — “My great Nation”— he says in Hindi. Chandrakant was so eager to share his pride that at one point he picked up the flag and waved it around a bit.

He could barely contain his love for his country — and its culture.

He even got up out of his chair, turned on a song, and started dancing.

[Video of Chandrakant dancing to upbeat music playing.]

Céline Gounder: A twist of the hand here, a little shimmy there; he did a few hand mudras with a look of delight on his face.

I couldn’t help but smile along with him.

[Dance video continues playing, Céline and Chandrakant laugh.]

Céline Gounder: But even with all that joy, when the music stopped and he shuffled back to his chair, you’re reminded that Chandrakant is in his 70s, with more than 50 years of experience in public health.

[Video of Chandrakant dance video fades out.]

Céline Gounder: He was one of thousands of people asked to take part in the smallpox eradication program in the early and mid-’70s. He didn’t hesitate when he got the call.

Chandrakant Pandav: I said, this is the time to serve my India. Because India has spent so much of money on my education and making me a doctor, so I came from this culture strong, strong ethical background that your life is not for yourself. Money is … doesn’t matter. Serve the society.

Céline Gounder: Chandrakant led a team of smallpox eradication workers. He says nearly every person he talked to about taking the smallpox vaccine seemed to have the same worry, the same questions.

Chandrakant Pandav: “What is this vaccine? What is this you’re doing us? Maybe it’s a population control measure.” So the strongest question they had: “This is the government of India’s new policy for sterilization?”

Céline Gounder: Sterilization. The government’s decades-long family planning campaign was very much top of mind.

Decades later, when Chandrakant thinks about the program — and the unethical tactics India used — the pride melts off his face.

Chandrakant Pandav: It was a very aggressive strategy, unfortunately. I don’t want to go into that period. It was very aggressive.

Céline Gounder: Chandrakant didn’t want to talk about it. But you can’t tell the story of smallpox eradication success without talking about the family planning policies that came first.

Without talking about the state-sponsored coercive tactics that were commonplace and accepted by many.

Without acknowledging the violence of forced sterilizations.

Public health doesn’t happen in a vacuum.

And India’s approach to family planning eroded trust in public health workers for years.

So — in this season all about smallpox — we’re going to spend some time this episode diving into the details of the family planning program.

Gyan Prakash: My name is Gyan Prash and I’m professor of history at Princeton University.

Céline Gounder: Gyan has spent years studying India’s family planning campaign and the various tactics the government used to sterilize millions of people.

The government would pay people to get sterilized, and after natural disasters, like a drought, when many were desperate, any amount of money could be a powerful motivator. Patients might receive fewer than 100 rupees as compensation — which translates to only a few days’ wages, according to a 1986 article published in the journal “Studies in Family Planning.”

Gyan Prakash: It was a very small amount, but it mattered; it mattered to the poor. It was coercive, because it was between going hungry and, and not going hungry.

Céline Gounder: And if you chose not to get sterilized, Gyan says, the government found other ways to twist the screw. Families would receive food rations for up to only three children — any child beyond that would not be allotted food.

Gyan Prakash: Which punishes families which have more than three children.

Céline Gounder: At one point, the government began to prioritize men for sterilization.

Vasectomies were sometimes pushed on men, according to a 1972 report from The Associated Press.

Céline Gounder: Gyan says India’s family planning campaign created an atmosphere of intimidation and harassment that was nearly impossible to escape.

Gyan Prakash: You know, sending district authorities, backed by police, to the countryside and hold sterilization camps. So, I mean, the entire state machinery was mobilized to get people to the sterilization table.

Céline Gounder: Some of the harshest treatment during the sterilization campaign was aimed at Muslims and Indigenous populations like Adivasi tribes living in remote and rural parts of the country. I spoke to Sanjoy Bhattacharya about this.

Sanjoy Bhattacharya: I’m a historian of medicine with a deep interest in health policy, national, international, and global. And I’m the head of the School of History at the University of Leeds, United Kingdom.

Céline Gounder: Sanjoy says marginalized communities were often scapegoated.

Sanjoy Bhattacharya: That global narrative of overpopulation took the shape of, oh, Muslims have more children than Hindus, therefore Muslims are the problem behind Indian overpopulation. So we need to control the Muslim birthrate. What sterilization did was to violently sterilize men from a certain community who were blamed for a population problem that was a general population problem.

Céline Gounder: Sanjoy says many Adivasi and Muslim communities, in particular, lost trust in the government. This distrust lingered and simmered for years.

Imagine for a moment that for decades government trucks have descended on your village unannounced. Tents were set up. Equipment was unloaded. Workers fanned out to talk to village leaders.

This is what it looks like when Indian health workers showed up to sterilize you and your people.

And then, in the early 1970s, more government trucks arrived, maybe with familiar faces at the wheel. Maybe it’s some of the same public health workers.

They unload similar sharp-edged tools and set up their tents, but this time they promise it’s not for sterilization, it’s for a smallpox eradication program. You’d have a hard time trusting them.

Sanjoy Bhattacharya: And there are tales of how villages would empty when rumors would spread that these teams were coming ostensibly to vaccinate, but maybe really to sterilize. I mean, people’s bodies still remember what was done to them.

Chandrakant Pandav: They were treated like animals. Coercion, coercion, coercion.

Céline Gounder: That’s community medicine physician and longtime public health leader Chandrakant Pandav again. He says when he arrived in the northern region of the state of Bihar, he knew these communities had every reason to doubt his team.

So first he worked to earn people’s trust.

Chandrakant Pandav: So when you sit with the leader of the village, along with the batch of people there, you talk to them, you explain to them.

Céline Gounder: And Chandrakant says it’s helpful to think of yourself more as a guest than a guest of honor.

Chandrakant Pandav: You don’t sit on a chair. Céline, I didn’t sit on a chair. I sat next to them to make them feel that I’m part of that community.

Céline Gounder: It sounds like convincing the village leader was enough to convince the villagers.

Chandrakant Pandav: It is the first step.

Céline Gounder: Another important step, he says, was to learn the local traditions around smallpox. Locals in Bihar faced the disease for many years, and they’d developed their own ways of dealing with it.

They would tie the leaves of a neem tree outside the homes of infected people.

The neem tree is said to have medicinal properties. Displaying its leaves outside homes where an active infection was present alerted others to stay away — a strategy designed to slow disease spread.

It didn’t stop the virus — it wasn’t effective in the same way as vials of vaccine or the bifurcated needle — but the traditions needed to be honored.

So Chandrakant and the other public health workers adopted some of the local strategies.

Chandrakant Pandav: So it was a very good combination of ancient medicine, ancient practice, with modern approach. Very good combination.

Céline Gounder: Another tradition his team tapped into was folk songs. They frequently used drums, songs, and the public address systems to communicate with people about smallpox.

Music was an especially good match for Chandrakant’s lively personality.

Remember all that joy for India I witnessed in his office in New Delhi — the flag? The dancing? Imagine that harnessed on behalf of his mission to wipe out smallpox.

In fact, he still remembers some of those folk songs nearly half a century later.

Chandrakant Pandav: Because it’s part of me, every atom, every molecule residing [sings folk song in Hindi]. So, it became an important method of communication. I come back again and again, Céline, to the same point: Establish a rapport and instill a sense of faith, anything is possible.

Céline Gounder: Chandrakant was able to pave the way for acceptance of the smallpox vaccine and rebuild trust in public health. But he was one charismatic man. His approach, his compassion were admirable — and it worked, where he was, with the people in front of him.

But the Indian government broke trust with tens of millions of its citizens during the family planning campaign. It makes me wonder about what it might look like to repair trust at that level, across the public health system, across an entire country.

Maybe that would mean an apology. Maybe that would be some kind of reparation to victims for the damage done to their bodies.

My friend and colleague Tom Bollyky says there’s no single silver bullet for rebuilding trust.

Tom Bollyky: That is too big of a mission for public health. We have enough challenges as it is. Instead of planning for how do we rebuild trust, we should be planning for dysfunction.

Céline Gounder: That’s after the break.

[Music fades out.]

Céline Gounder: Distrust and mistrust in the government became something of a defining feature of the response to the covid pandemic here in the United States. And while that might have taken many Americans by surprise, it was totally predictable to Tom Bollyky. He’s the director of the global health program at the Council on Foreign Relations. Bollyky says trust in the U.S. has been deteriorating since Watergate, and that decline accelerated around the 2008 financial crisis. Mistrust here divides along racial lines. It’s lower among African Americans, for example. And most notably, mistrust tends to be partisan. But it didn’t start that way during the covid pandemic.

Tom Bollyky: I think we all forget that there was, for a period of time, a surprising level of political consensus. Almost all states imposed protective policy mandates and most states imposed them at the same time. But as the fall stretched out, you saw some of those mandates and responses become more politicized.

And the moment I regret is, I think there was a moment, when the Biden administration came in and there was an attempt to reset and I … myself and many others really again focused on this message of following the science. But I do feel like perhaps we missed a opportunity to try to pull in some people across partisan lines at that moment.

Céline Gounder: So, as I’m hearing you describe this, restoring trust seems like a really massive undertaking.

I wonder whether you think that’s even the right framework that we should be using to think about this challenge.

Tom Bollyky: Such a great question. No, I think it isn’t. I think if we set an agenda for public health to rebuild the cohesiveness of our societies, to make us have a better relationship with our government, with each other, we will fail.

That is too big of a mission for public health. We have enough challenges as it is. Instead of planning for how do we rebuild trust, we should be planning for dysfunction. That’s really what preparedness is about.

Céline Gounder: So what are some of the ways that public health officials can reach skeptical communities?

Tom Bollyky: Through kinship networks and, uh, local leaders has been important. In some other public health crises, like HIV, people have used soap operas.

Céline Gounder: I remember being in South Africa in the early 2000s. There was a soap opera called “Soul City.” We pulled a clip of it, and there’s this one scene where a husband comes home to find his wife has placed a romantic gift by their bedside. He opens it up and sees condoms.

[Music]

“Soul City” clip: Woman: So that we can have safe sex. Man: Safe sex. Woman: I can’t have sex with you while I’m anxious about getting sick. Or, would you prefer I use condoms maybe? Man: We don’t need condoms. Woman: I do.

Tom Bollyky: I was in South Africa and the country was riveted. People really talked about it. It took, it took hold. Uh, they did a nice job of making it interesting, like weaving in the themes you wanted to weave in about people getting tested and talking to their partners and loved ones about their circumstances.

I know, Céline, you were very involved in the Ebola response, in 2013 through 2016. You know, there is high levels of mistrust in government in those post-conflict settings that were most affected in that epidemic.

Céline Gounder: People there don’t trust government, they think that people who serve in government do so to enrich themselves and their family and friends.

When I was in Guinea during the Ebola epidemic, they said Ebola was a hoax, that it was just a way for government officials and international organizations to enrich themselves. And yet, we were able to make some inroads convincing people to comply with Ebola control measures, so hand-washing, testing, safe burials.

Much of that was done through imams and other religious and community leaders.

Tom Bollyky: Those are the types of strategies we should be deploying when the next health crisis emerges, but not simply waiting until that happens. We need to start to build the infrastructure, the relationships. Again, even if it isn’t around fundamentally transforming, you know, communities, relationships with the government, or even how community members feel about, uh, one another, because interpersonal trust, social trust is a big part of this, too.

It’s about building the connections, the networks, about starting to engage individuals in these programs or through those institutions so that when the crisis emerges, you’re not building that from scratch.

Céline Gounder: Well, and to your point, as we prepare for the next pandemic, do you think we’ve learned those lessons about trust or are there things we’re still getting wrong?

Tom Bollyky: I think there is a greater appreciation for trust as an important issue. You hear that messaging. What I worry about is we’re not seeing it reflected yet in where the money is going. Where the money is going by and large is to developing vaccines faster, better vaccines in the future. But if really the lessons we’re drawing from this crisis are that developing a vaccine instead of in 326 days in 250 days … if we really think that would have made a difference in this pandemic, we haven’t been paying attention.

Céline Gounder: Next time on “Epidemic” …

Daniel Tarantola: They did not consider smallpox as the major issues among the many issues they were confronting. … No. 1 priority is food and food and food. And the second priority is food and food and food.

CREDITS

Céline Gounder: “Eradicating Smallpox,” our latest season of “Epidemic,” is a co-production of KFF Health News and Just Human Productions.

Additional support provided by the Sloan Foundation.

This episode was produced by Taylor Cook, Zach Dyer, Bram Sable-Smith, and me.

Saidu Tejan-Thomas Jr. was scriptwriter for the episode.

Swagata Yadavar was our translator and local reporting partner in India.

Our managing editor is Taunya English.

Oona Tempest is our graphics and photo editor.

The show was engineered by Justin Gerrish.

We had extra editing help from Simone Popperl.

Music in this episode is from the Blue Dot Sessions and Soundstripe.

This episode featured clips from National Education & Information Films Limited

We’re powered and distributed by Simplecast.

If you enjoyed the show, please tell a friend. And leave us a review on Apple Podcasts. It helps more people find the show.

Follow KFF Health News on X (formerly known as Twitter), Instagram, and TikTok.

And find me on X @celinegounder. On our socials, there’s more about the ideas we’re exploring on our podcasts.

And subscribe to our newsletters at kffhealthnews.org so you’ll never miss what’s new and important in American health care, health policy, and public health news.

I’m Dr. Céline Gounder. Thanks for listening to “Epidemic.”

[“Epidemic” theme fades out.]

Credits

Taunya English
Managing editor

@TaunyaEnglish

Taunya is senior editor for broadcast innovation with KFF Health News, where she leads enterprise audio projects.

Zach Dyer
Senior producer

@zkdyer

Zach is senior producer for audio with KFF Health News, where he supervises all levels of podcast production.

Taylor Cook
Associate producer

@taylormcook7

Taylor is associate audio producer for Season 2 of Epidemic. She researches, writes, and fact-checks scripts for the podcast.

Oona Tempest
Photo editing, design, logo art

@oonatempest

Oona is a digital producer and illustrator with KFF Health News. She researched, sourced, and curated the images for the season.

Additional Newsroom Support

Lydia Zuraw, digital producer Tarena Lofton, audience engagement producer Hannah Norman, visual producer and visual reporter Simone Popperl, broadcast editor Chaseedaw Giles, social media manager Mary Agnes Carey, partnerships editor Damon Darlin, executive editor Terry Byrne, copy chiefGabe Brison-Trezise, deputy copy chiefChris Lee, senior communications officer

Additional Reporting Support

Swagata Yadavar, translator and local reporting partner in IndiaRedwan Ahmed, translator and local reporting partner in Bangladesh

“Epidemic” is a co-production of KFF Health News and Just Human Productions.

To hear other KFF Health News podcasts, click here. Subscribe to “Epidemic” on Apple Podcasts, Spotify, Google, Pocket Casts, or wherever you listen to podcasts.

——————————
Title: Epidemic: Bodies Remember What Was Done to Them
Sourced From: kffhealthnews.org/news/podcast/epidemic-season-2-episode-6-bodies-remember/
Published Date: Tue, 10 Oct 2023 09:00:00 +0000

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Kaiser Health News

Dual Threats From Trump and GOP Imperil Nursing Homes and Their Foreign-Born Workers

Published

5 days ago

June 26, 2025

Staff Editor

kffhealthnews.org – Jordan Rau, KFF Health News – 2025-06-26 04:00:00

Jordan Rau, KFF Health News

June 26, 2025

In a top-rated nursing home in Alexandria, Virginia, the Rev. Donald Goodness is cared for by nurses and aides from various parts of Africa. One of them, Jackline Conteh, a naturalized citizen and nurse assistant from Sierra Leone, bathes and helps dress him most days and vigilantly intercepts any meal headed his way that contains gluten, as Goodness has celiac disease.

“We are full of people who come from other countries,” Goodness, 92, said about Goodwin House Alexandria’s staff. Without them, the retired Episcopal priest said, “I would be, and my building would be, desolate.”

The long-term health care industry is facing a double whammy from President Donald Trump’s crackdown on immigrants and the GOP’s proposals to reduce Medicaid spending. The industry is highly dependent on foreign workers: More than 800,000 immigrants and naturalized citizens comprise 28% of direct care employees at home care agencies, nursing homes, assisted living facilities, and other long-term care companies.

But in January, the Trump administration rescinded former President Joe Biden’s 2021 policy that protected health care facilities from Immigration and Customs Enforcement raids. The administration’s broad immigration crackdown threatens to drastically reduce the number of current and future workers for the industry. “People may be here on a green card, and they are afraid ICE is going to show up,” said Katie Smith Sloan, president of LeadingAge, an association of nonprofits that care for older adults.

Existing staffing shortages and quality-of-care problems would be compounded by other policies pushed by Trump and the Republican-led Congress, according to nursing home officials, resident advocates, and academic experts. Federal spending cuts under negotiation may strip nursing homes of some of their largest revenue sources by limiting ways states leverage Medicaid money and making it harder for new nursing home residents to retroactively qualify for Medicaid. Care for 6 in 10 residents is paid for by Medicaid, the state-federal health program for poor or disabled Americans.

“We are facing the collision of two policies here that could further erode staffing in nursing homes and present health outcome challenges,” said Eric Roberts, an associate professor of internal medicine at the University of Pennsylvania.

The industry hasn’t recovered from covid-19, which killed more than 200,000 long-term care facility residents and workers and led to massive staff attrition and turnover. Nursing homes have struggled to replace licensed nurses, who can find better-paying jobs at hospitals and doctors’ offices, as well as nursing assistants, who can earn more working at big-box stores or fast-food joints. Quality issues that preceded the pandemic have expanded: The percentage of nursing homes that federal health inspectors cited for putting residents in jeopardy of immediate harm or death has risen alarmingly from 17% in 2015 to 28% in 2024.

In addition to seeking to reduce Medicaid spending, congressional Republicans have proposed shelving the biggest nursing home reform in decades: a Biden-era rule mandating minimum staffing levels that would require most of the nation’s nearly 15,000 nursing homes to hire more workers.

The long-term care industry expects demand for direct care workers to burgeon with an influx of aging baby boomers needing professional care. The Census Bureau has projected the number of people 65 and older would grow from 63 million this year to 82 million in 2050.

In an email, Vianca Rodriguez Feliciano, a spokesperson for the Department of Health and Human Services, said the agency “is committed to supporting a strong, stable long-term care workforce” and “continues to work with states and providers to ensure quality care for older adults and individuals with disabilities.” In a separate email, Tricia McLaughlin, a Department of Homeland Security spokesperson, said foreigners wanting to work as caregivers “need to do that by coming here the legal way” but did not address the effect on the long-term care workforce of deportations of classes of authorized immigrants.

Goodwin Living, a faith-based nonprofit, runs three retirement communities in northern Virginia for people who live independently, need a little assistance each day, have memory issues, or require the availability of around-the-clock nurses. It also operates a retirement community in Washington, D.C. Medicare rates Goodwin House Alexandria as one of the best-staffed nursing homes in the country. Forty percent of the organization’s 1,450 employees are foreign-born and are either seeking citizenship or are already naturalized, according to Lindsay Hutter, a Goodwin spokesperson.

“As an employer, we see they stay on with us, they have longer tenure, they are more committed to the organization,” said Rob Liebreich, Goodwin’s president and CEO.

Jackline Conteh spent much of her youth shuttling between Sierra Leone, Liberia, and Ghana to avoid wars and tribal conflicts. Her mother was killed by a stray bullet in her home country of Liberia, Conteh said. “She was sitting outside,” Conteh, 56, recalled in an interview.

Conteh was working as a nurse in a hospital in Sierra Leone in 2009 when she learned of a lottery for visas to come to the United States. She won, though she couldn’t afford to bring her husband and two children along at the time. After she got a nursing assistant certification, Goodwin hired her in 2012.

Conteh said taking care of elders is embedded in the culture of African families. When she was 9, she helped feed and dress her grandmother, a job that rotated among her and her sisters. She washed her father when he was dying of prostate cancer. Her husband joined her in the United States in 2017; she cares for him because he has heart failure.

“Nearly every one of us from Africa, we know how to care for older adults,” she said.

Her daughter is now in the United States, while her son is still in Africa. Conteh said she sends money to him, her mother-in-law, and one of her sisters.

In the nursing home where Goodness and 89 other residents live, Conteh helps with daily tasks like dressing and eating, checks residents’ skin for signs of swelling or sores, and tries to help them avoid falling or getting disoriented. Of 102 employees in the building, broken up into eight residential wings called “small houses” and a wing for memory care, at least 72 were born abroad, Hutter said.

Donald Goodness grew up in Rochester, New York, and spent 25 years as rector of The Church of the Ascension in New York City, retiring in 1997. He and his late wife moved to Alexandria to be closer to their daughter, and in 2011 they moved into independent living at the Goodwin House. In 2023 he moved into one of the skilled nursing small houses, where Conteh started caring for him.

“I have a bad leg and I can’t stand on it very much, or I’d fall over,” he said. “She’s in there at 7:30 in the morning, and she helps me bathe.” Goodness said Conteh is exacting about cleanliness and will tell the housekeepers if his room is not kept properly.

Conteh said Goodness was withdrawn when he first arrived. “He don’t want to come out, he want to eat in his room,” she said. “He don’t want to be with the other people in the dining room, so I start making friends with him.”

She showed him a photo of Sierra Leone on her phone and told him of the weather there. He told her about his work at the church and how his wife did laundry for the choir. The breakthrough, she said, came one day when he agreed to lunch with her in the dining room. Long out of his shell, Goodness now sits on the community’s resident council and enjoys distributing the mail to other residents on his floor.

“The people that work in my building become so important to us,” Goodness said.

While Trump’s 2024 election campaign focused on foreigners here without authorization, his administration has broadened to target those legally here, including refugees who fled countries beset by wars or natural disasters. This month, the Department of Homeland Security revoked the work permits for migrants and refugees from Cuba, Haiti, Nicaragua, and Venezuela who arrived under a Biden-era program.

“I’ve just spent my morning firing good, honest people because the federal government told us that we had to,” Rachel Blumberg, president of the Toby & Leon Cooperman Sinai Residences of Boca Raton, a Florida retirement community, said in a video posted on LinkedIn. “I am so sick of people saying that we are deporting people because they are criminals. Let me tell you, they are not all criminals.”

At Goodwin House, Conteh is fearful for her fellow immigrants. Foreign workers at Goodwin rarely talk about their backgrounds. “They’re scared,” she said. “Nobody trusts anybody.” Her neighbors in her apartment complex fled the U.S. in December and returned to Sierra Leone after Trump won the election, leaving their children with relatives.

“If all these people leave the United States, they go back to Africa or to their various countries, what will become of our residents?” Conteh asked. “What will become of our old people that we’re taking care of?”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This article first appeared on KFF Health News and is republished here under a Creative Commons license.

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Note: The following A.I. based commentary is not part of the original article, reproduced above, but is offered in the hopes that it will promote greater media literacy and critical thinking, by making any potential bias more visible to the reader –Staff Editor.

Political Bias Rating: Center-Left

This content primarily highlights concerns about the impact of restrictive immigration policies and Medicaid spending cuts proposed by the Trump administration and Republican lawmakers on the long-term care industry. It emphasizes the importance of immigrant workers in healthcare, the challenges that staffing shortages pose to patient care, and the potential negative effects of GOP policy proposals. The tone is critical of these policies while sympathetic toward immigrant workers and advocates for maintaining or increasing government support for healthcare funding. The framing aligns with a center-left perspective, focusing on social welfare, immigrant rights, and concern about the consequences of conservative economic and immigration policies without descending into partisan rhetoric.

Kaiser Health News

California’s Much-Touted IVF Law May Be Delayed Until 2026, Leaving Many in the Lurch

Published

6 days ago

June 25, 2025

Staff Editor

kffhealthnews.org – Sarah Kwon – 2025-06-25 04:00:00

Sarah Kwon

June 25, 2025

California lawmakers are poised to delay the state’s much-ballyhooed new law mandating in vitro fertilization insurance coverage for millions, set to take effect July 1. Gov. Gavin Newsom has asked lawmakers to push the implementation date to January 2026, leaving patients, insurers, and employers in limbo.

The law, SB 729, requires state-regulated health plans offered by large employers to cover infertility diagnosis and treatment, including IVF. Nine million people will qualify for coverage under the law. Advocates have praised the law as “a major win for Californians,” especially in making same-sex couples and aspiring single parents eligible, though cost concerns limited the mandate’s breadth.

People who had been planning fertility care based on the original timeline are now “left in a holding pattern facing more uncertainty, financial strain, and emotional distress,” Alise Powell, a director at Resolve: The National Infertility Association, said in a statement.

During IVF, a patient’s eggs are retrieved, combined with sperm in a lab, and then transferred to a person’s uterus. A single cycle can total around $25,000, out of reach for many. The California law requires insurers to cover up to three egg retrievals and an unlimited number of embryo transfers.

Not everyone’s coverage would be affected by the delay. Even if the law took effect July 1, it wouldn’t require IVF coverage to start until the month an employer’s contract renews with its insurer. Rachel Arrezola, a spokesperson for the California Department of Managed Health Care, said most of the employers subject to the law renew their contracts in January, so their employees would not be affected by a delay.

She declined to provide data on the percentage of eligible contracts that renew in July or later, which would mean those enrollees wouldn’t get IVF coverage until at least a full year from now, in July 2026 or later.

The proposed new implementation date comes amid heightened national attention on fertility coverage. California is now one of 15 states with an IVF mandate, and in February, President Donald Trump signed an executive order seeking policy recommendations to expand IVF access.

It’s the second time Newsom has asked lawmakers to delay the law. When the Democratic governor signed the bill in September, he asked the legislature to consider delaying implementation by six months. The reason, Newsom said then, was to allow time to reconcile differences between the bill and a broader effort by state regulators to include IVF and other fertility services as an essential health benefit, which would require the marketplace and other individual and small-group plans to provide the coverage.

Newsom spokesperson Elana Ross said the state needs more time to provide guidance to insurers on specific services not addressed in the law to ensure adequate and uniform coverage. Arrezola said embryo storage and donor eggs and sperm were examples of services requiring more guidance.

State Sen. Caroline Menjivar, a Democrat who authored the original IVF mandate, acknowledged a delay could frustrate people yearning to expand their families, but requested patience “a little longer so we can roll this out right.”

Sean Tipton, a lobbyist for the American Society for Reproductive Medicine, contended that the few remaining questions on the mandate did not warrant a long delay.

Lawmakers appear poised to advance the delay to a vote by both houses of the legislature, likely before the end of June. If a delay is approved and signed by the governor, the law would immediately be paused. If this does not happen before July 1, Arrezola said, the Department of Managed Health Care would enforce the mandate as it exists. All plans were required to submit compliance filings to the agency by March. Arrezola was unable to explain what would happen to IVF patients whose coverage had already begun if the delay passes after July 1.

The California Association of Health Plans, which opposed the mandate, declined to comment on where implementation efforts stand, although the group agrees that insurers need more guidance, spokesperson Mary Ellen Grant said.

Kaiser Permanente, the state’s largest insurer, has already sent employers information they can provide to their employees about the new benefit, company spokesperson Kathleen Chambers said. She added that eligible members whose plans renew on or after July 1 would have IVF coverage if implementation of the law is not delayed.

Employers and some fertility care providers appear to be grappling over the uncertainty of the law’s start date. Amy Donovan, a lawyer at insurance brokerage and consulting firm Keenan & Associates, said the firm has fielded many questions from employers about the possibility of delay. Reproductive Science Center and Shady Grove Fertility, major clinics serving different areas of California, posted on their websites that the IVF mandate had been delayed until January 2026, which is not yet the case. They did not respond to requests for comment.

Some infertility patients confused over whether and when they will be covered have run out of patience. Ana Rios and her wife, who live in the Central Valley, had been trying to have a baby for six years, dipping into savings for each failed treatment. Although she was “freaking thrilled” to learn about the new law last fall, Rios could not get clarity from her employer or health plan on whether she was eligible for the coverage and when it would go into effect, she said. The couple decided to go to Mexico to pursue cheaper treatment options.

“You think you finally have a helping hand,” Rios said of learning about the law and then, later, the requested delay. “You reach out, and they take it back.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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The post California’s Much-Touted IVF Law May Be Delayed Until 2026, Leaving Many in the Lurch appeared first on kffhealthnews.org

Political Bias Rating: Center-Left

This content is presented in a factual, balanced manner typical of center-left public policy reporting. It focuses on a progressive healthcare issue (mandated IVF insurance coverage) favorably highlighting benefits for diverse family structures and individuals, including same-sex couples and single parents, which often aligns with center-left values. At the same time, it includes perspectives from government officials, industry representatives, opponents, and patients, offering a nuanced view without overt ideological framing or partisan rhetoric. The emphasis on healthcare access, social equity, and patient impact situates the coverage within a center-left orientation.

Kaiser Health News

Push To Move OB-GYN Exam Out of Texas Is Piece of AGs’ Broader Reproductive Rights Campaign

Published

7 days ago

June 24, 2025

Staff Editor

kffhealthnews.org – Annie Sciacca – 2025-06-24 04:00:00

Annie Sciacca

June 24, 2025

Democratic state attorneys general led by those from California, New York, and Massachusetts are pressuring medical professional groups to defend reproductive rights, including medication abortion, emergency abortions, and travel between states for health care in response to recent increases in the number of abortion bans.

The American Medical Association adopted a formal position June 9 recommending that medical certification exams be moved out of states with restrictive abortion policies or made virtual, after 20 attorneys general petitioned to protect physicians who fear legal repercussions because of their work. The petition focused on the American Board of Obstetrics and Gynecology’s certification exams in Dallas, and the subsequent AMA recommendation was hailed as a win for Democrats trying to regain ground after the fall of Roe v. Wade.

“It seems incremental, but there are so many things that go into expanding and maintaining access to care,” said Arneta Rogers, executive director of the Center on Reproductive Rights and Justice at the University of California-Berkeley’s law school. “We see AGs banding together, governors banding together, as advocates work on the ground. That feels somewhat more hopeful — that people are thinking about a coordinated strategy.”

Since the Supreme Court eliminated the constitutional right to an abortion in 2022, 16 states, including Texas, have implemented laws banning abortion almost entirely, and many of them impose criminal penalties on providers as well as options to sue doctors. More than 25 states restrict access to gender-affirming care for trans people, and six of them make it a felony to provide such care to youth.

That’s raised concern among some physicians who fear being charged if they go to those states, even if their home state offers protection to provide reproductive and gender-affirming health care.

Pointing to the recent fining and indictment of a physician in New York who allegedly provided abortion pills to a woman in Texas and a teen in Louisiana, a coalition of physicians wrote in a letter to the American Board of Obstetrics and Gynecology that “the limits of shield laws are tenuous” and that “Texas laws can affect physicians practicing outside of the state as well.”

The campaign was launched by several Democratic attorneys general, including Rob Bonta of California, Andrea Joy Campbell of Massachusetts, and Letitia James of New York, who each have established a reproductive rights unit as a bulwark for their state following the Dobbs decision.

“Reproductive health care and gender-affirming care providers should not have to risk their safety or freedom just to advance in their medical careers,” James said in a statement. “Forcing providers to travel to states that have declared war on reproductive freedom and LGBTQ+ rights is as unnecessary as it is dangerous.”

In their petition, the attorneys general included a letter from Joseph Ottolenghi, medical director at Choices Women’s Medical Center in New York City, who was denied his request to take the test remotely or outside of Texas. To be certified by the American Board of Obstetrics and Gynecology, physicians need to take the in-person exam at its testing facility in Dallas. The board completed construction of its new testing facility last year.

“As a New York practitioner, I have made every effort not to violate any other state’s laws, but the outer contours of these draconian laws have not been tested or clarified by the courts,” Ottolenghi wrote.

Rachel Rebouché, the dean of Temple University’s law school and a reproductive law scholar, said “putting the heft” of the attorneys general behind this effort helps build awareness and a “public reckoning” on behalf of providers. Separately, some doctors have urged medical conferences to boycott states with abortion bans.

Anti-abortion groups, however, see the campaign as forcing providers to conform to abortion-rights views. Donna Harrison, an OB-GYN and the director of research at the American Association of Pro-Life Obstetricians and Gynecologists, described the petition as an “attack not only on pro-life states but also on life-affirming medical professionals.”

Harrison said the “OB-GYN community consists of physicians with values that are as diverse as our nation’s state abortion laws,” and that this diversity “fosters a medical environment of debate and rigorous thought leading to advancements that ultimately serve our patients.”

The AMA’s new policy urges specialty medical boards to host exams in states without restrictive abortion laws, offer the tests remotely, or provide exemptions for physicians. However, the decision to implement any changes to the administration of these exams is up to those boards. There is no deadline for a decision to be made.

The OB-GYN board did not respond to requests for comment, but after the public petition from the attorneys general criticizing it for refusing exam accommodations, the board said that in-person exams conducted at its national center in Dallas “provide the most equitable, fair, secure, and standardized assessment.”

The OB-GYN board emphasized that Texas’ laws apply to doctors licensed in Texas and to medical care within Texas, specifically. And it noted that its exam dates are kept under wraps, and that there have been “no incidents of harm to candidates or examiners across thousands of in-person examinations.”

Democratic state prosecutors, however, warned in their petition that the “web of confusing and punitive state-based restrictions creates a legal minefield for medical providers.” Texas is among the states that have banned doctors from providing gender-affirming care to transgender youth, and it has reportedly made efforts to get records from medical facilities and professionals in other states who may have provided that type of care to Texans.

The Texas attorney general’s office did not respond to requests for comment.

States such as California and New York have laws to block doctors from being extradited under other states’ laws and to prevent sharing evidence against them. But instances that require leveraging these laws could still mean lengthy legal proceedings.

“We live in a moment where we’ve seen actions by executive bodies that don’t necessarily square with what we thought the rules provided,” Rebouché said.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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This article first appeared on KFF Health News and is republished here under a Creative Commons license.

The post Push To Move OB-GYN Exam Out of Texas Is Piece of AGs’ Broader Reproductive Rights Campaign appeared first on kffhealthnews.org

Political Bias Rating: Center-Left

The article presents a viewpoint largely aligned with progressive and Democratic positions on reproductive rights and gender-affirming care. It highlights efforts led by Democratic attorneys general and the American Medical Association to protect abortion access and transgender healthcare amid restrictive state laws, portraying these actions positively. While it includes perspectives from anti-abortion advocates, their views are presented briefly and framed as opposition to the broader pro-choice initiatives. The overall tone and framing emphasize support for reproductive freedom and healthcare protections, reflecting a center-left leaning stance typical of mainstream health policy reporting sympathetic to Democratic policy goals.