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What happens when a city’s hospital closes ‘without warning’ during a pandemic

Group of physicians and nurses in Kansas city of Wellington are improvising methods to fight the coming pandemic with little assistance and very little devices

The frontline in the fight versus coronavirus has actually moved a number of hundred backyards down the primary roadway through the Kansas city of Wellington.

Two weeks earlier, as the infection sneaked closer and individuals in other parts of the state began passing away, the owners of the city’s only medical facility believed it a great time to shut down with simply a couple of hours’ notification on the premises the center was losing cash.

“We lost our medical facility quickly and without caution,” stated Dr Lacie Gregory, a household specialist in Wellington. “Even as the doctor here in the area, we did not hear that it was closing up until it was a done offer. We got a text from the director of nursing stating currently there’s no healthcare facility. Actually, actually regrettable timing.”

That has actually left Gregory and a little group of other physicians and nurse professionals at the city’s Family Care Center at the leading edge of getting ready for the coming pandemic with little assistance and very little devices.

The doctors had actually presumed the 63-bed Sumner neighborhood medical facility’s emergency situation department would handle individuals contracting coronavirus while they went on dealing with more regular conditions of cuts, damaged bones and hypertension, which the 2 would stay securely at a range. Now the Family Care Center is the very first line of defence for the city of 8,000 individuals.

The medical professionals improvised, establishing a different drive-thru center at the back of their structure for individuals suffering coughs, fever or revealing other signs of Covid-19. Even discovering the protective devices for the doctors managing those clients is a difficulty.

The county’s emergency situation management workplace in Wellington has actually put in orders for visors, masks and dress however been informed by the state that only part of the demand will be provided. Far absolutely nothing has actually shown up.

u-responsive-ratio”> Dr Dr Lacie Gregory: ‘We got a text from the director of nursing stating currently there’s no healthcare facility.’Photo: Chris McGreal/Dr Lacie Gregory, a household professional in Wellington

The medical professionals at the health centre went looking in other places. At the regional farmers cooperative they discovered masks created to secure employees on the city’s grain elevator from dust. When working with chemicals, at another shop they purchased face guards farmworkers utilize. They are not medical grade however much better than absolutely nothing. The physicians still deal with a lack of gloves and dress.

“It’s been actually aggravating. It’s been what we have actually had the ability to piece together,” stated Gregory. “All of us as doctors are looking into and checking out and depending on associates throughout the nation for details on where they are getting devices and what’s working for them. This is going to overwhelm our system and we will not be prepared to deal with individuals. We will not have the resources to deal with individuals.”

The makeshift center is seeing about 20 individuals a day however even then there is just a lot they can do. The director of the Sumner county health department, Laura Rettig, stated that at any one time it has just a handful of coronavirus test sets for the whole county of 25,000 individuals. They need to be sent out to the state lab and the outcomes take days.

Gregory stated in the lack of a validated medical diagnosis or recognition of something else, such as influenza, all medical professionals can do is inform an individual to self-isolate. “The screening is so minimal which’s been a big disappointment,” she stated.

Gregory stated she understands the infection is coming, if it is not currently in Wellington, however that not everybody in the city is taking it seriously. “Especially for little neighborhoods and little towns, it appears so eliminated. It appears like it’s a New York City issue and it’s a Seattle issue and it’s a Kansas City issue. I believe we have this unsuitable sense of defense due to the fact that we’re rural and we’re separated,” she stated.

But, Gregory kept in mind, there are trainees returning from around the nation and households who have actually been on vacation in locations currently struck by Covid-19. “But I believe it’s improving. Seeing us leaving to the cars and trucks completely masks and dress and protective equipment makes individuals believe if the medical professionals are taking it this seriously, perhaps I need to too. I do not believe we’re taking it seriously enough yet,” she stated.

The county health department is mainly counting on Facebook to get its message out although Rettig stated that has its drawbacks. “Sometimes there are a great deal of rumours on Facebook that are not, um, precise,” she stated. Rettig stated she was stressed that some homeowners continue to think that Covid-19 is no even worse than influenza. “I have actually heard that here in this town. Even if it was the influenza they ought to be taking safety measures, and there is a great deal of influenza around. All I can do is offer education and attempt to describe,” she stated.

Gregory stated the combined messages from the White House have actually not assisted.
“It’s been actually making complex since it simply does not seem like there has actually been a constant message,” she stated.

Some regional authorities in other parts of Kansas have actually not assisted either. Rick Whitson, emergency situation management director and fire chief of a county to the east of Wellington, drew refuse for a Facebook post knocking what he called “worried hysteria” around coronavirus which he stated has actually “been around because the 60s”.

“This is not the bubonic afflict, and we are not digging mass tombs and burning the bodies,” he composed . “Unless there is a significant shift for the worst, (and I question it) when this is past we will assess it and shake our heads, recognizing that it was an unbelievably out of proportion total reaction to the risk.”

The Republican chair of a Kansas county commission north of Wellington withstood procedures to fight coronavirus on the premises there were very few Chinese individuals in his location.

All this likewise comes at an individual expense for Gregory. She has actually needed to separate herself from her hubby and kids despite the fact that they reside in the very same home.

“I’ve not been around my kids. Even though we’re house and we’re in the very same household system, I am a high-risk individual right now since of my contact and so my household is remaining away from me. I’ve started a business in the bedroom-bathroom location, which provides the remainder of the home to live,” she stated. “There might come a time where as health care employees we’re not even going house.”

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Trump to roll back Obama-era clean car rules in huge blow to climate fight

EPA statement will permit cars to produce 1bn more lots of co2, which, critics state, will cause more deadly air contamination

The Trump administration is rolling back the United States federal government’s greatest effort to fight the environment crisis, weakening guidelines which force automobile business to produce more fuel-efficient lorries. Critics state the relocation will cause more lethal air contamination and force Americans to invest more on gas.

The modifications to Obama-era guidelines will permit lorries to produce about a billion more heaps of heat-trapping co2– comparable to approximately a fifth of yearly United States emissions.

The rollback is among lots Trump authorities have actually ushered to conclusion, looking for to boost the nonrenewable fuel source market in the middle of extreme opposition from Democratic-led states and pushback from world leaders.

Experts state the world is away track in handling the environment emergency situation, following a year of record-breaking heat, increasing cravings, displacement and death due to severe temperature levels and weather condition catastrophes.

Donald Trump is anticipated to admire the brand-new guideline as an increase to the United States economy, which has actually been struck by the coronavirus pandemic. His administration states compromising the requirements will make vehicles about $1,000 more affordable, leading Americans to purchase brand-new and more secure designs more often and leading to less crash deaths.

The Environmental Protection Agency (EPA) chief, Andrew Wheeler, stated in a declaration: “Now, more than ever, this nation requires a reasonable nationwide program that strikes the best regulative balance for the environment, the vehicle market, the economy, security, and American households.

” [This guideline] does all of those things by enhancing fuel economy, continuing to minimize air contamination, and making brand-new cars more economical for all Americans.”

Researchers challenge such reasoning .

Miles Keogh, executive director of the National Association of Clean Air Agencies, a company of state and regional air regulators, called the timing of the guideline modification “dreadful”.

He stated: “We understand coronavirus take advantage of individuals with breathing issues, and this unclean air guideline will make more Americans susceptible.”

The Obama administration needed car business to make lorries 4.7% more effective each year. The Trump administration at first wished to freeze any development on fuel effectiveness past 2020. Its last guideline, composed by the EPA and the Department of Transportation, sets an enhancement rate of 1.5% per year– or a market average of 40.4 miles per gallon by 2026.

That’s far less than the 2.4% each year by which the market has stated it will increase requirements with no policy.

The rollback has actually drawn opposition from almost half of states and a considerable part of the automobile market. Twenty-three states and the District of Columbia, representing about half of United States locals, took legal action against over the modifications. They stated compromising the requirements would eliminate about 2,000 more individuals and trigger 50,000 more cases of breathing diseases, while making the environment crisis even worse.

California has actually long set up more rigid vehicle requirements than the federal government, however the Trump administration has actually withdrawed the state’s authority to do so. The state in 2015 struck a handle 4 business– Ford, Honda, Volkswagen and BMW of North America– to surpass what Trump is requesting for and need trucks, vehicles and suvs to get almost 50 miles per gallon typically by 2026.

Environmental supporters and democratic-run states are anticipated to challenge the brand-new policy. They are currently battling the Trump administration over its weakening of lots of other environment and public health defenses.

Ann Carlson, a teacher at the University of California in Los Angeles, stated the legal battle will be “among the hardest combated, in part due to the fact that it’s the most substantial”.

Carlson thinks the rollback is indicated to keep need for gas, which is anticipated to fall as cars end up being more effective and shift to electrical power.

“You can make cars and trucks with absolutely no emissions now, no greenhouse gases that do not operate on petroleum, anymore,” Carlson stated. “So I believe the huge recipients are definitely the oil business.”

The guideline modification comes as lots of neighborhoods around the United States are seeing a decrease in air quality, an outcome of environment modification, wildfires, greater temperature levels, regulative rollbacks and bad enforcement of policies, stated Paul Billings, senior vice-president of advocacy for the American Lung Association.

“This will indicate there will be more contamination connected with oil extraction, transportation, refining– sort of all the method from the well to the pump,” Billings stated. “This will indicate high levels of smog, more coughing, wheezing, shortness of breath, asthma attacks, COPD (persistent obstructive lung illness) worsenings and likewise more particle contamination.”

The impacts will be even worse on neighborhoods near oil processing centers and highways, frequently individuals of color and poorer Americans.

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Bernie Sanders lost his last chance to take Joe Biden down | Nathan Robinson

Sanders assaulted a few of Bidens weak points, however not highly sufficient to make a distinction

A plain contrast was on display screen on Sunday night, and both prospects on the Democratic argument phase understood it. Joe Biden and Bernie Sanders were unified in their criticism of Donald Trump’s action to coronavirus, they clashed consistently on policy concerns, and even their core messages on the infection were really various.

For Biden, coronavirus is a separated “nationwide emergency situation” that requires to be handled prior to carrying on to concerns like hardship, minimum salaries and the reform of the medical insurance system. For Sanders, these problems are inextricably connected to the coronavirus emergency situation, due to the fact that they worsen the suffering that comes throughout an epidemic. Sanders thinks the spread of the infection is exposing deep systemic issues in the United States: the homelessness crisis , the requirement for single payer free-at-point-of-use health care , the precariousness of work and the absence of paid authorized leave .

Sanders thinks that coronavirus reveals precisely why Medicare for All is so needed: if Americans are needing to stress over whether they have adequate cash to manage treatment, they will not get the care they require, and more individuals will be jeopardized. Biden turned down the argument completely, stating: “You have a single payer system in Italy. It does not work there. It has absolutely nothing to do with Medicare for All. That would not resolve the issue at all.” Now Biden was missing out on the point here: single-payer does not get rid of pandemics or provide the medical system limitless treatment capability, it decreases monetary challenge and ensures individuals aren’t going neglected who might be dealt with, and one may well choose to be in Italy than the U S throughout a massive medical crisis.

But while right on the concern, Sanders did not make an adequately sound case connecting today crisis to more comprehensive systemic issues, often sounding as if he was attempting to insert in progressive politics to an “apolitical” crisis. That’s a pity, since Sanders’ policies are precisely what we require in an immediate minute.

On the whole, Sanders provided the type of efficiency that he required to at this phase, with Biden now the preferred to win the election. He needed to deal Biden a knockout blow– to do unto Biden as Elizabeth Warren did unto Michael Bloomberg. He didn’t. The exchanges in between the 2 were frequently controversial. While Sanders raised some issues about whether Biden might influence young citizens to come to the surveys in November, and had severe words about Biden’s legal record and environment modification strategies, there was no “game-changing” minute that embarrassed or exposed Biden.

Sanders did, nevertheless, land some punches. When Biden declared Sanders was supported by “Super Pacs,” Sanders challenged Biden to “call” them. Biden could not, most likely due to the fact that Sanders isn’t supported by Super Pacs. In the night’s most remarkable exchange, Sanders pursued Biden mercilessly for having long signified his openness to cutting social security advantages. Biden was incredibly elusive, declining to confess something that is really well-documented , and Sanders would not let the concern go, informing audiences to look and go up the video of Biden stating specifically what he declares he never ever stated.

But Biden, it needs to be stated, put in a strong efficiency. In order to come out ahead, he just needed to prevent losing, and he did that. Biden has actually had a variety of humiliating gaffes and faults throughout the project, that have actually even raised concerns about whether he is fit to handle Donald Trump . There was none of that on Sunday night. He was gotten ready for the majority of what came at him. Whatever faults there might have been were small and were shared in equivalent step by both prospects. (Biden inadvertently called coronavirus “Sars” while Sanders called it “Ebola”.)

It didn’t injure that Biden wanted to shamelessly misinform individuals about his own record. This is not an exaggeration: Biden declared to have actually opposed the notorious personal bankruptcy expense he was a passionate fan of and even assisted compose . He likewise wrongly declared to have actually been fooled by George Bush into supporting the Iraq war, and fudged his distinctly combined record on abortion rights. After the argument, Alexandria Ocasio-Cortez was scathing about Biden’s frauds on Twitter, stating “ the reality matters “.

But simply just how much it matters stays to be seen. Biden has long been slippery with the fact , and pretended to have actually long been a progressive when he as soon as extolled being among the most conservative senators . The mediators at this argument didn’t appear to care, and Democratic citizens do not actually appear to either: present surveys reveal Biden with a considerable lead in nearly all of the staying contests. The Biden pitch is that he is the safe option to handle Donald Trump, and all other factors to consider must be reserved in favor of “electability”. Tonight’s dispute enhanced that concept.

Of course, it’s unclear that Biden is the more reliable prospect to handle Trump, and Democrats may be strolling into another catastrophe like 2016 by choosing a weak facility political leader with a long record of oversights Trump can take on. When Biden recommends that Sanders supports authoritarian programs, and when a Biden consultant compares Sanders to the “ sort of protester who frequently appears at project occasions”, it ends up being harder to see how Biden will encourage Sanders fans that he understands with them enough to be worth electing. It is most likely that with tonight’s argument, Sanders lost his swan song to take Biden down. Biden did reveal the lots of vulnerabilities that will undoubtedly end up being Trump-fodder in a basic election. Democrats must bear in mind and be alerted.

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Isolation of older Americans prompts fears amid coronavirus

Older grownups and those supporting them fret preventative measures might even more omit a susceptible neighborhood, intensifying solitude and other social ills

Basilisa Riggio keeps a hectic schedule. 5 days a week, she goes to the Henry Street Settlement Senior Center, situated in the Lower East Sideof New York City. At this center, elderly people such as the 77-year-old Riggio can take part in activities varying from crafts and arts to yoga.

On any offered day, next-door neighbors and pals may overtake each other over a swimming pool match or video game of dominoes, perhaps even drop in the health club. Fridays and wednesdays are karaoke nights. Often, a lots individuals appear to hear her and other individuals sing.

“I like to sing the old tunes, like Only You,” Riggio stated.

Riggio is amongst the around 1 million United States senior individuals who buy from some 10,000 senior centers in this nation. “This is our location to be,” she stated. “It’s our location to mingle. It keeps us from being house.”

But as coronavirus continues to spread out throughout the United States– triggering both basic admonitions about particular cautions and social events to “ greater danger ” individuals such as elders– older grownups and those supporting them fret that preventative measures might even more separate this susceptible neighborhood, worsening solitude and other social ills that strike senior individuals hard.

The Centers for Disease Control recommends that higher-risk individuals “ prevent crowds ” and “ stay at home as much as possible to even more lower your danger of being exposed” throughout a Covid-19 break out.

Riggio stated she questioned: if they close some schools due to the fact that of coronavirus, will senior centers like hers be next?

“We’re worried if that keeps occurring, if they close the center, we’re remaining at house,” she stated. “We’re not working out. We’re not interacting socially. We’re not utilizing our mind.

“The youths, they have households who cope with them, or pals,” she likewise stated. “The senior are mainly living alone– them staying at home, a few of them may get depressed. That’s bad.”

Cheryl Kamen, program director at Henry Street Settlement Senior Center, stated day-to-day visitors decreased 50%, to some 100 individuals, early today.

“Those who do come are really worried, and asking a great deal of concerns,” Kamen stated. “We’re ensuring to have handouts, however likewise to be knowledgable about what’s going on so we can address their concerns.”

Kamen stated that they are increase disinfectant usage on extremely utilized surface areas and motivating elders to expand instead of crowd around one table. They’re offering them a short health screening when they come in– asking how they’re feeling and directing them to a nurse if unhealthy– and offering senior citizens packaged meals to consume at house if they’re unpleasant being at the.

“That is our primary concern today, a lot more than the infection– those who are keeping away,” she stated. “It’s bad for them to be in the house alone, not heading out.

“Particularly for older grownups who’ve had numerous losses– not to be able to hang out with their pals, and in an inviting location, daily, there’s going to be a toll on their psychological health,” she stated.

Staff can sign in with more susceptible members by phone. And if the city were to shut down senior centers, Henry Street staffers would still be available in, and stay in contact with members.

“People need to know that they’re thought about which someone appreciates them,” Kamen stated.

Meals on Wheels America programs throughout the United States, which provide 220m meals to some 2.4 million elders every year, likewise offer essential social interaction to numerous individuals. These programs have strategies to make sure that elders have sufficient food amidst crises. , if social contact had actually to be restricted due to coronavirus– such as changing in person interaction with telephone check-ins– meal receivers may feel separated once again..

“Meals on Wheels volunteers are typically the only individual that a home-bound senior sees in a provided day,” stated Jenny Bertolette Young, Meals on Wheels America’s vice-president of interactions. “That Meals on Wheels volunteer is important, a crucial lifeline– we understand that the effects of social seclusion and isolation are substantial on health.”

“Sometimes, if she didn’t come, I would not have any visitors all the time,” stated 100-year-old Helen Isabell, a recipient of Meals on Wheels of North-west Indiana .

Isabell, who lives alone in Gary, Indiana, stated she would most likely have the ability to get food from next-door neighbors, however has actually grown familiar with day-to-day sees.

“The woman, Margaret, is such a great individual,” she stated. “I’ve gotten rather utilized to her, you understand. When she does not come, I truly miss her.”

Chris Stanley, who lives in The Villages, a vast 55-years-old and up neighborhood in main Florida , stated that she had not seen lots of modifications to life, conserve for scarcities of hand sanitizer and disinfectant wipes.

“We’re going to clean our hands, we’re not going to go stand beside someone who’s sneezing on us, however we’re going to mostly live our lives,” stated Stanley, who is president of The Villages Democratic Club.

Should things alter– such as restrictions on celebration– Stanley assumed that even The Villages’ really senior citizens would be OKAY for a day or more.

“But it’s essential, in a retirement, to have some structure, and we’re extremely social individuals here– a great deal of what we do focuses on being social,” she stated. “Everything has a social part. Somebody losing the structure of their day, and losing their social element, especially the [older] widowers and widows, may not be healthy.

“They truly require that interaction, simply as a matter for psychological health,” she stated of substantially older homeowners.

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One of the last abortions in Louisiana? Diary of a woman from a clinic under threat of closure

This week, the supreme court will hear a case that if upheld could threaten the constitutional right to an abortion in the US

The US supreme court will hear oral arguments this week in a high-stakes case that threatens the constitutional right to an abortion.

The Louisiana law under review, known as June Medical Services v Russo, would require doctors who perform abortions to be able to admit patients at a nearby hospital a law abortion rights groups characterize as a bureaucratic hurdle designed limit abortion access.

The supreme court struck down a nearly identical Texas law in 2016 in Whole Womans Health v Hellerstedt. But since then, Donald Trump has appointed two justices to the court and cemented a solid conservative majority on the bench.

This will be the new courts first major abortion case. If upheld, the law could lead to the closure of Louisianas last three abortion clinics. And in such a ruling, the court could signal its appetite to unwind Roe v Wade, the 1973 landmark decision that guaranteed constitutional abortion rights in America.

Tiffany Pennywell may be one of the last women to have an an elective abortion in Louisiana. This is her story.

Monday, 23 December

Pennywell stood in the restroom of a Target retail store, staring at a pregnancy test, waiting. She was already a week late. It was 9am on a mild morning in Shreveport, Louisiana, two days before Christmas. Shed stopped in on her way to work.

It didnt take long for the line to show up it wasnt even faint.

Target in Shreveport, Louisiana. Photograph: Annie Flanagan/The Guardian

I guess I gotta roll with the punches with this one, she remembers thinking. She bought prenatal vitamins and went to her retail job at a jewellers.

Pennywell was already a mother of three; two boys and a girl, aged 11, seven and five years old. Each had been complicated pregnancies, requiring caesarean sections that left a build-up of scar tissue. After the second, the scar had trouble healing. The doctor advised her that her third child should probably be her last.

Shed wanted a hysterectomy but the hospital, a Catholic institution in this conservative state in the deep south, wouldnt perform one. The intrauterine device, or IUD, shed had implanted instead caused her so much pain it had to be removed.


Her last option had been to take the birth control pill, but it caused her cramps and dizziness. So, she and her partner had simply tried to be cautious. It had worked until now.

Tuesday, 24 December

Pennywell and her partner were in the bedroom wrapping presents on Christmas Eve. They stayed up all night talking.

Pennywell had told her partner, the father of her two youngest children, about the pregnancy the day she found out, and he was upset. Theyd been doing well as a couple, becoming more financially stable. But, he had said: Its your body and your decision.

Pennywell believes it is a womans choice whether to carry a pregnancy, but a part of her still clung to the teaching of the conservative Christianity she was raised in, in the Church of Christ. Shed left to find her own spiritual path in her early twenties, but it remained in the back of her mind: abortion is taking away a life.

Still, Pennywell was afraid for her health, and frightened that the birth could even kill her. She worried that her kids could lose their mum.

There was a lot of crying on my part because I was torn, she said. Its not something I ever really saw myself doing or being able to do.

After hours of talking, she recalls having a moment of stillness, and felt it just made the most sense.

Tiffany Pennywell writes a poem in her bedroom in Shreveport. There was a lot of crying on my part because I was torn, she said about her decision to have an abortion. Photograph: Annie Flanagan/The Guardian

I had been in denial, kind of sweeping it under the rug that if we just go ahead and go through with the pregnancy, things would be okay, wed go day by day, she says. But in the back of my mind, I knew I was scared. And I had to face that. The guilt was keeping me from facing that fear and I had to push that aside.

It felt as if a weight lifted off her shoulders. She knew she was doing the right thing.

By that morning, hours before they had to get the kids up for presents, they came to a decision. Pennywell would have an abortion.

Wednesday, 25 December

She told her mom on Christmas Day, after the presents. Pennywell didnt want her imagining a grandchild that would not come. She explained the medical reasons.

Are you sure? her mom asked.

For my safety, its something I need to do, Pennywell told her.

Her mother was sad, torn between her beliefs about abortion she remained in the Church of Christ and her daughters safety. Eventually shed support her daughters decision. She didnt want to face the chance of losing her only child.

Friday, 27 December

Pennywell had her first appointment that Friday morning at Hope Medical Group for Women, the only abortion clinic in north Louisiana and one that serves women from across neighboring states. She was born and raised in this town, and she knew about Hope knew who to call, where to go. She was surprised, relieved, that there werent any protesters outside that day.

The clinic hardly looked like a lightning rod of controversy: a low, windowless brick building with a parking lot and small sign. Traffic whizzed by on a busy two-lane road. She pulled the first door open and waited to be buzzed through the second. No phones or bags were allowed inside; Do not feed (or speak to) the protesters one sign read.

Hope Medical Group for Women in Shreveport, Louisiana, the only abortion clinic in north Louisiana, serves women from across neighboring states. Photograph: Annie Flanagan/The Guardian

She entered a small waiting room and checked-in at the reception counter. Daytime soap operas and game shows played on two TVs. A large carafe of coffee sat on a table.

This room is packed most days. Pennywell filled out pages of paperwork and read some brochures one on feelings after an abortion, like anxiety or fear; one about the pain that can be involved in the procedure, which later shed wish shed picked up.

She browsed the magazines and books. The time seemed to pass without notice. She was nervous.

There are just three abortion clinics left in Louisiana, which together provide between 8,000 and 10,000 abortions annually.

In 2014, the state passed a law requiring abortion doctors to have admitting privileges at nearby hospitals, essentially the ability to admit patients in the event of an emergency. Only one doctor in Louisiana has such privileges the others have been denied.

If the law being debated in the supreme court is upheld, the clinics in Baton Rouge and New Orleans would close immediately, and Hope would likely follow. That lone doctor with admitting privileges works at Hope, but the clinic would have a hard time staying open without its second physician.

Hope Medical Group is one of three abortion clinics left in Louisiana, which together provide between 8,000 and 10,000 abortions annually. Photograph: Annie Flanagan/The Guardian

When the supreme court hears Louisianas case on 4 March, Hope will be the lead plaintiff. Its not a stretch to say that what happens to this clinic could shape the future of abortion access across the country.

Louisiana has already passed some of Americas harshest abortion restrictions, and by far the most of any state since abortion was declared a constitutional right by the US supreme court in 1973. A recent poll found that almost a quarter of the states population believe abortion should be entirely illegal.

But its not alone in its antipathy to abortion rights. More than half of US states are deemed hostile to abortion, according to the reproductive rights research group the Guttmacher Institute. Many of those states would be likely to pass a similar law if Louisianas were upheld, leading to more clinic closures.

States could also amp up the passage of other restrictive laws, buoyed by the hope that they, too, would be upheld by the court. The decision could also signal this courts willingness sooner or later to overturn Roe v Wade.

Notes of support at the Hope Medical Group. Photograph: Annie Flanagan/The Guardian

Pennywell had hurried to get her own abortion out of fear that the laws could soon change. How long are these places still going to be here? shed wondered. If I wait too much longer, am I going to find out, oh, you should have been here a week earlier before you know this law passed or this happened?

If the clinics close, a lot of women will be disadvantaged, she thought. Some will have to go out of state, if they can afford it.

It causes more hurdles, she said. Youre already going through so much emotionally, mentally and spiritually that its too hard to have to go that one more step or 10 more steps.

At the clinic, Pennywell first had to undergo an ultrasound, as mandated by the state. Staff told her she was five-and-a-half weeks pregnant, and that made everything more real.

Pennywell didnt look at the ultrasound image for fear of becoming too attached. She still felt on edge. She knew the pregnancy could harm her, but a part of her still wanted this baby.

She spoke to a counselor, as all patients at the clinic do, about the reasons for needing the abortion. The counselor listened. Pennywell felt she understood. They talked about birth control and decided she should have a medication abortion, rather than the surgical procedure. She talked with a physician, too, who agreed.

She made the abortion appointment and left women in Louisiana must wait a state-mandated 24 hours before undergoing abortions, another anti-abortion law in force. The laws were the reason Pennywell couldnt simply go to her obstetrician for an abortion, and the reason the state dropped from 11 clinics in 2001 to its current three.

Saturday, 4 January

Pennywell had originally made the appointment for 2 January, but she couldnt get her shift covered at work, so she pushed it to Saturday, 4 January.

That morning, her partner met her in the clinic parking lot and gave her a hug. He said that it would be OK, and to call him as soon as it was over, she recalls.

The clinics waiting rooms were packed Saturday is its busiest day of the week and there was more paperwork to fill out. Federal law bans abortion coverage under government healthcare in the US, and Louisiana bars most insurance from covering it. Pennywell qualified for financial assistance offered through the clinic, putting the cost at about $400. She put it on her credit card.

Tiffany Pennywell: Youre already going through so much emotionally, mentally and spiritually that its too hard to have to go that one more step or 10 more steps. Photograph: Annie Flanagan/The Guardian

On her first visit, she had spotted a copy of Michelle Obamas Becoming, and she grabbed it and read while she waited.

The Center for Reproductive Rights, a legal group fighting for Hope at the supreme court, has described the looming supreme court case as a direct attack on court precedent. A nearly identical law in Texas shut half of that states 40 clinics, before it was struck down by the supreme court in 2016.

The facts, the law and the constitution have not changed in the intervening years, the centers president, Nancy Northup, has noted. But what has changed is the make-up of the court. Trump has placed two new conservative justices on the court, both considered hostile to abortion rights.

Kathaleen Pittman, the clinics administrator, has worked at Hope since 1992. Shes been distressed at the wealth of misinformation and the high number of phone calls lately from potential patients asking if abortion is even legal in Louisiana, questions fueled by the states six-week heartbeat abortion ban passed last year. The law has not taken effect and is also being challenged in separate legal proceedings.

Kathaleen Pittman, director of Hope Medical Group for Women: I think women all over the state should be very afraid at this point in time. Photograph: Annie Flanagan/The Guardian

The staff here are used to lawsuits the clinic has been the plaintiff in cases over anti-abortion laws since 1992 but this will be its first appearance the supreme court. I think this time feels different for all of us, said Merritt Rebouche, 27, the clinics director of patient advocacy.

Surely the credibility of the supreme court means something to somebody, Pittman said. But she was frightened. I think women all over the state should be very afraid at this point in time.

Even so, most of the clinics patients have not heard about the supreme court case before they enter its doors, her staff said. Rebouche and others try their best to educate women, but a legal battle in Washington DC can feel far removed from the immediacy of a personal crisis. Many women tell staff that they never thought theyd need an abortion, and swear theyll never be back.

The staff called Pennywell to a back room. She undressed from the waist down for a vaginal ultrasound even that was painful, due to her scar tissue.

She took the first set of pills. Staff had told her the abortion medication can make people nauseous, and theyd given her a prescription for nausea medication as well as one for the second abortion pills. They warned her to avoid two pharmacies in the area that dont like giving out abortion medication.

She left the clinic, and her partner took her home.

Sunday, 5 January

She took the second pills 24 hours later, and the pregnancy passed that day. It felt like severe cramping, like the first time she had contractions. She didnt know it was going to be that painful. She called the clinic, just to be sure, and they told her that each persons pain is different.

She wore pads for the next couple of days, a long period of bleeding, sometimes so heavy that she went to her doctor and discovered shed become anemic.

The pain would be worse in the morning. I had a hard time getting out the door, getting the kids to school, she said.

The whole time Im thinking there is no one who just casually goes through this, this decision to have this pain, she said. Theres nothing casual about getting an abortion.

Tiffany Pennywell: Women have a mind, a conscience, and they know whats right for their bodies. And no one should be telling them what to do with it. Photograph: Annie Flanagan/The Guardian

Monday, 30 January

A few weeks later, she returned to the clinic for a check-up the first time shed seen protesters outside: two women in their sixties passed out anti-abortion pamphlets.

The appointment went well. Pennywell took a pregnancy test, and the line was very faint. Staff gave her another one to take a few days later, but she was positive it was just left-over hormones.

She felt at peace.

The last month had been a mourning phase with a gamut of emotions: sadness, anger, depression. The pregnancy was something that could have grown up to be a person and sibling, and she allowed herself to grieve that.

Some people see things as black and white, but abortion is not, she said.

And the people and politicians trying to close down these clinics?

I think its selfish of them, she said. Thats a lot of pain I would have gone through. They arent paying for the doctor bills, they arent going to be paying for anything that happens afterwards. Theyre not going to be there for my family if something happens to me.

Abortion is a common experience about one in four US women will have one but most patients dont talk about them publicly. Pennywell had wanted to tell her story so that she could be there for other women. She wanted her daughter to grow up with the chance to make the same choice for herself.

I just hope that at some point politicians will realize that womens bodies are not something to politicize, that theyre human, she said.

They have a soul. Women have a mind, a conscience, and they know whats right for their bodies. And no one should be telling them what to do with it.

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Bernie Sanders surges in Democratic field after shrugging off health scare

The Vermont senator raised more than any Democrat in the last quarter topping a spectacular bounceback from a cardiovascular disease

S hortly after Bernie Sanders revealed early this month that his project raised a showstopping $34.5 m– the greatest amount of any 2020 Democrat throughout any single quarter up until now in this main– #PresidentSanders was trending on Twitter.

It was a remarkable turnaround of fortunes for a governmental prospect who, 3 months previously, remained in a Las Vegas health center recuperating from a cardiovascular disease. At the time, Sanders was under enormous political pressure, eclipsed by fellow progressive Elizabeth Warren and suspended by numerous in the celebration and by the president.

The episode may have hindered Sanders’ 2nd mission for the White House had it not been for his army of devoted advocates, whose abiding faith turned the Vermont senator into a powerful competitor for the Democratic election.

With less than 4 weeks till ballot starts and the next dispute looming on Tuesday, Sanders is rising in Iowa and New Hampshire as his project promotes brand-new indications of development in his assistance, especially amongst youths of color.

Even Larry David, the comic who impersonates Sanders with striking similarity on Saturday Night Live, has actually been amazed by his doppelganger’s strength.

“I believed when he had the cardiovascular disease that was going to be it– I would not need to fly in from Los Angeles,” David informed late night host Stephen Colbert. “But, you understand, he’s unbreakable. Absolutely nothing stops this male.”

Perhaps, however Sanders would not be where he remains in the last weeks prior to the Iowa caucuses without the steady assistance of a dedicated neighborhood that he has actually cultivated considering that running for president in 2016. “Not me. United States,”– Sanders’ project motto– completely records how the 78-year-old senator concerned sit atop the most recent Des Moines Register and CNN survey of Iowa caucus-goers in a main contest that has actually up until now been formed by prospects who are more youthful, more varied and more recent to nationwide politics.

'Nothing television doppelganger, larry david.” src=”″/> ‘Nothing stops this guy.’Bernie Sanders satisfies his TELEVISION doppelganger, Larry David. Photo: NBC/NBCU Photo Bank through Getty Images

In the days and weeks after Sanders’hospitalization, a profusion of issue and well wants developed into a record wave of project contributions that culminated in a”Bernie is back” rally in Queens including Alexandria Ocasio-Cortez, the New York congresswoman who traces her political increase to Sanders’2016 project. There, she officially backed him in front of more than 20,000 ardent advocates.

“The cardiovascular disease remained in some methods the very best thing that took place to his project,”stated Ana Maria Archila, the co-executive director of the Center for Popular Democracy, a union of progressive groups that backed Sanders in December.

She stated it ended up being a clarifying minute for his advocates, with Ocasio-Cortez’s recommendation working as an actual rallying cry.

“Bernie has actually developed a motion that makes individuals think a various sort of politics is possible,”she stated.”So when he returned, everybody desired him to feel the love.”

In studies, Sanders advocates are considerably more faithful to him than those backing any other 2020 Democrat. They are most likely to state they will certainly elect him which they are “passionate” about his candidateship.

Their unshakeable assistance implies that unlike a number of his competitors Sanders might have the resources to remain in the race for months after the early-voting contests. Lots of Democrats worry he will not leave the race even if he does not have the delegates to win the election, dragging out the main contest, compromising the ultimate candidate and perhaps even establishing a significant face-off at the celebration’s convention in Milwaukee.

Sanders has actually stated he would support the candidate.

Sanders ‘motion– paired with a huge fundraising operation– sustained him through a possibly devastating duration of his project and raised him greater still.

More than any other Democratic project, his advocates are extremely arranged online . They share stories, ballot and memes throughout numerous pro-Sanders Facebook groups. And this cycle, his project introduced its own mobile app, Bern, and its own e-mail newsletter, Bern Notice, that keeps his fans engaged and approximately date with news from the path.

“These tools are not as reliable for persuasion, “stated Michael Slaby, the Obama project’s primary innovation officer in 2008 and primary combination and development officer in 2012.”If you’re an uncertain citizen you’re most likely not tuning in to see Sanders’ Twitch channel. In terms of his capability to stand up to obstacles, it is truly important to have that long lasting tough assistance.”


Now a pushed Sanders is honing his case for the presidency, tapping his deep funds to introduce a massive marketing campaign in Iowa. He’s likewise ended up being significantly vital of his closest competitor, Joe Biden, the putative Democratic frontrunner who has actually shown resistant at the top of the splintered field in spite of self-inflicted gaffes and continual attacks.

In interviews and on the path, Sanders has actually stressed his longstanding hostility to war in reaction to the escalation of stress with Iran. It’s part of a widerstrategy to weaken the core reasoning for Biden’s candidateship: that he’s the most electable. In specific, the senator has actually strongly slammed Biden for his 2003 vote to license the intrusion of Iraq and his previous assistance for foreign trade offers.

Biden has actually primarily rejected Sanders ‘broadsides, though that might alter in the next argument on 14 January, the last prior to the caucuses.

He has likewise silently began to target Warren, a fellow liberal and a good friend whom he had actually declined to engage openly.

Bernie Bernie Sanders fans voice their support at a rally in Los Angeles last month. Photo: Robyn Beck/AFP through Getty Images

A script gotten by Politico advised Sanders’ volunteers to inform citizens fluctuating in between the 2 liberals that Warren’s appeal was restricted to the upscale and extremely informed which she was “bringing no brand-new bases into the Democratic Party”– a criticism suggested to raise doubts about her electability.

Her project reacted in a fundraising letter on Sunday: “This kind of attack isn’t about disagreeing on concerns– it’s about dismissing the effectiveness of our grassroots motion.”

Sanders’ prospective for triumph, on the other hand, has actually stirred panic amongst establishment-minded Democrats. They see a prospect who went into the race with all the benefits of a frontrunner– near-universal name acknowledgment, a prodigious fundraising operation and a message that still draws big, passionate crowds– and yet has actually dealt with little analysis and fairly couple of attacks from his competitors.

In current weeks, numerous moderate Democrats have actually prompted Sanders’ competitors to challenge his case for electability.

In 2018, progressive prospects mainly stopped working to show they might develop winning unions in swing districts and states. Much of the moderate House prospects who swept the Democrats to power by winning in Republican-held districts deal with hard re-elections and think a Sanders election might threaten their bulk, consisting of a group of prominent freshmen who just recently backed Biden.

A memo flowed by the centrist Third Way alerts that choosing Sanders would lead to “electoral carnage” on a scale not seen because 1984, when President Ronald Reagan beat Walter Mondale by the best electoral college margin in governmental history. Mondale brought only his house state of Minnesota and the District of Columbia.

Sanders’ group balks at such analysis, which they thinks disregards more current history. Hillary Clinton’s loss to Trump in 2016, they state, was the expense of playing it safe.

A current Fox News survey found Sanders beating Trump by almost the very same margin as Biden in Wisconsin, maybe the most vital 2020 battlefield.

To win, Sanders’ project states he needs to broaden the electorate by ending up a union of individuals who vote rarely or have never ever voted previously, consisting of young, working-class and minority citizens. Sanders’ project understands it should do much better, especially amongst black citizens, an important Democratic constituency that chooses Biden by large margins .

u-responsive-ratio”> Bernie at berg intermediate school on saturday in newton, iowa.” src =””/> Bernie Sanders shows up for a project stop at Berg intermediate school on Saturday in Newton, Iowa. Picture: Scott Olson/Getty Images

But his group argues that they are making development. New ballot has him running close behind Biden in Nevada, the very first state with a big Hispanic electorate to enact the main. And he is leading the field in California, a state with a big Hispanic electorate that is likewise the biggest reward of the Democratic nominating contests.

And last quarter his project stated it included 300,000 brand-new donors and significant another turning point: it got more than 5 million contributions, setting a brand-new record for governmental prospects at this phase in the cycle.

In the last weeks prior to the Iowa caucuses, Biden has actually begun to combine assistance from facility Democrats while Warren has actually begun pitching herself as the prospect finest placed to unify a divided celebration.

Unlike his competitors, Sanders should get rid of deep suspicion from Democrats who still harbor appointments about his dedication to the celebration after years of upseting for modification from the exterior. Numerous Democrats who supported Clinton in 2016 still feel bitter Sanders for dragging out the main race and, in their view, refraining from doing enough to assist combine the celebration when the bitter contest was over.

“Sanders has actually revealed that he can fire up his base, “stated Sean McElwee, the executive director of the liberal ballot company Data For Progress .”What he requires to reveal now is that he can encourage individuals to choose him who today are supporting Warren or Biden. He still requires to show to Democrats that he can represent them and the celebration in a basic election. That’s the huge turn that he requires to make.”

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