Kenya Hospital Imprisons New Moms Who Can’t Pay






The director of the Pumwani Maternity Hospital, located in a hardscrabble neighborhood of downtown Nairobi, freely acknowledges what he’s accused of: detaining mothers who can’t pay their bills. Lazarus Omondi says it’s the only way he can keep his medical center running.


Two mothers who live in a mud-wall and tin-roof slum a short walk from the maternity hospital, which is affiliated with the Nairobi City Council, told The Associated Press that Pumwani wouldn’t let them leave after delivering their babies. The bills the mothers couldn’t afford were $ 60 and $ 160. Guards would beat mothers with sticks who tried to leave without paying, one of the women said.






Now, a New York-based group has filed a lawsuit on the women’s behalf in hopes of forcing Pumwani to stop the practice, a practice Omondi is candid about.


“We hold you and squeeze you until we get what we can get. We must be self-sufficient,” Omondi said in an interview in his hospital office. “The hospital must get money to pay electricity, to pay water. We must pay our doctors and our workers.”


“They stay there until they pay. They must pay,” he said of the 350 mothers who give birth each week on average. “If you don’t pay the hospital will collapse.”


The Center for Reproductive Rights, which filed the suit this month in the High Court of Kenya, says detaining women for not paying is illegal. Pumwani is associated with the Nairobi City Council, one reason it might be able to get away with such practices, and the patients are among Nairobi’s poorest with hardly anyone to stand up for them.


Maimouna Awuor was an impoverished mother of four when she was to give birth to her fifth in October 2010. Like many who live in Nairobi’s slums, Awuor performs odd jobs in the hopes of earning enough money to feed her kids that day. Awuor, who is named in the lawsuit, says she had saved $ 12 and hoped to go to a lower-cost clinic but was turned away and sent to Pumwani. After giving birth, she couldn’t pay the $ 60 bill, and was held with what she believes was about 60 other women and their infants.


“We were sleeping three to a bed, sometimes four,” she said. “They abuse you, they call you names,” she said of the hospital staff.


She said saw some women tried to flee but they were beaten by the guards and turned back. While her husband worked at a faraway refugee camp, Awuor’s 9-year-old daughter took care of her siblings. A friend helped feed them, she said, while the children stayed in the family’s 50-square-foot shack, where rent is $ 18 a month. She says she was released after 20 days after Nairobi’s mayor paid her bill. Politicians in Kenya in general are expected to give out money and get a budget to do so.


A second mother named in the lawsuit, Margaret Anyoso, says she was locked up in Pumwani for six days in 2010 because she could not pay her $ 160 bill. Her pregnancy was complicated by a punctured bladder and heavy bleeding.


“I did not see my child until the sixth day after the surgery. The hospital staff were keeping her away from me and it was only when I caused a scene that they brought her to me,” said Anyoso, a vegetable seller and a single mother with five children who makes $ 5 on a good day.


Anyoso said she didn’t have clothes for her child so she wrapped her in a blood-stained blouse. She was released after relatives paid the bill.


One woman says she was detained for nine months and was released only after going on a hunger strike. The Center for Reproductive Rights says other hospitals also detain non-paying patients.


Judy Okal, the acting Africa director for the Center for Reproductive Rights, said her group filed the lawsuit so all Kenyan women, regardless of socio-economic status, are able to receive health care without fear of imprisonment. The hospital, the attorney general, the City Council of Nairobi and two government ministries are named in the suit.


———


Associated Press reporter Tom Odula contributed to this report.


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Cuba has much to lose as ally Chavez fights cancer






HAVANA (AP) — Cubans who were tuned in to the nightly soap opera on a recent Saturday received a sudden burst of bad news, from the other side of the Caribbean.


State TV cut to the presidential palace in Caracas, Venezuela, where President Hugo Chavez revealed that his cancer had returned. Facing his fourth related surgery in 18 months, he grimly named Vice President Nicolas Maduro as his possible successor.






The news shocked not only Venezuelans but millions of Cubans who have come to depend on Chavez’s largesse for everything from subsidized oil to cheap loans. Venezuela supplies about half of Cuba‘s energy needs, meaning the island’s economy would be in for a huge shock and likely recession if a post-Chavez president forced the island to pay full price for oil.


Despite the drama, the news likely wasn’t a surprise to Cuba’s Communist government, and not only because Chavez has been receiving medical care on the island.


Havana learned important lessons about overdependence when the 1991 collapse of the Soviet Union threw the country into a deep crisis. Trying to avoid the consequences of a similar cut, the Cuban government has been diversifying its portfolio of economic partners in recent years, looking to Asia, Europe and other Latin American nations, and is only about half as dependent on Caracas as it was on the former Soviet Union.


Cuba is also working to stimulate its economy back home by allowing more private-sector activity, giving a leg up to independent and cooperative farming, and decentralizing its sugar industry. A stronger Cuban economy would in theory have more hard currency to pay for energy and other imports.


Also getting off the ground is an experiment with independent nonfarm collectives that should be more efficient than state-run companies. And next year, another pilot program is planned for decentralized state enterprises that will enjoy near-autonomy and be allowed to control most of their income.


“This could have good results,” said a Cuban economist who spoke on condition of anonymity because he wasn’t authorized to talk to the foreign media. Cuba “is also thinking of boosting foreign investment in areas of the national economy, including in restricted areas like the sugar industry.”


One of the country’s top goals has been to make the island’s struggling economy less dependent on a single benefactor.


Under the leadership of Chavez, who regularly calls former Cuban President Fidel Castro his ideological father and has followed parts of the Communist leader’s governance playbook, Venezuela has sent billions of dollars a year to Cuba through trade and petro-aid.


Bilateral trade stood at a little over $ 8 billion last year, much of it in Cuban imports of oil and derivatives. In return, Havana primarily provides Venezuela with technical support from Cuban teachers, scientists and other professionals, plus brigades of health care workers. Analysts say those services are overvalued by outside standards, apparently costing as much as $ 200,000 per year per doctor. Experts peg the total Venezuelan subsidy to Cuba at around $ 2 billion to $ 4 billion a year.


While business with Venezuela makes up 40 percent of all Cuban trade, it’s still a far cry from the days when the Communist Eastern Bloc accounted for an estimated 80 percent.


“A (loss of) $ 2 billion to $ 4 billion would definitely pinch. But it is not the same relative weight as the sudden complete withdrawal of the Soviet subsidies in the early ’90s,” said Richard E. Feinberg, a professor of international political economy at the University of California, San Diego. “Cuba’s not going to go back to the days of bicycles. Could it throw the Cuban economy into recession? Yes.”


That kind of resilience would result largely from Cuba’s successes in courting foreign investors for joint ventures.


Last month, authorities announced a deal with a subsidiary of Brazil’s Odebrecht to manage a sugar refinery, a rare step in an industry that has long been largely off limits to foreign involvement.


China has invested in land-based oil projects, and along with Canada is a key player in Cuba’s important nickel industry. Spain has ventures in tourist hotels and tobacco, while French company Pernod Ricard helps export Cuban liquors. And since 2009, Brazil has been a partner in a massive project to modernize and expand the port at Mariel, west of the capital.


Trade with China alone was $ 1.9 billion and rising in 2010, and Raul Castro paid a visit to Chinese and Vietnamese leaders earlier this year to help cement Asian relationships.


But while Havana says it wants to boost foreign investment, obstacles remain. The approval process for investment projects can be long and cumbersome, and pilferage, disincentives to productivity and government intervention can cut into efficiencies. Foreign companies also pay a sky-high payroll tax.


Feinberg, who wrote a report on foreign investment in Cuba published this month by the U.S. think tank the Brookings Institution, said that while a number of foreign companies are successfully doing business with the island, others have run into problems, sending a chilly message to would-be investors. In particular he noted the recent cases of a government takeover of a food company run by a Chilean businessman accused of corruption, and contentious renegotiations of a contract with Dutch-British personal and home care products giant Unilever amid shifting government demands.


“The Cuban government has to decide that it wants foreign investment unambiguously. I think now there seem to be divisions among the leadership,” Feinberg said. “Some are afraid that foreign investment compromises sovereignty, creates centers of power independent of the leadership or is exploitative.”


He estimated Cuba has left on the table about $ 20 billion in missed investment over the past decade by not following practices typical of other developing nations. Instead, Cuba received $ 3.5 billion in foreign investment in that period.


Experts say a worst-case scenario for Chavez wouldn’t automatically translate into the oil spigot shutting off overnight.


If Chavez’s hand-picked successor, Vice President Maduro, were to take office, he would likely seek to continue the special relationship.


Opposition leader Henrique Capriles has said he wants to end the oil-for-services barter arrangements, but could find that easier said than done should he win. The two countries are intertwined in dozens of joint accords, and poor Venezuelans who benefit from free care by Cuban doctors would be loath to see that disappear.


“You can’t flip the switch on a relationship like this,” said Melissa Lockhart Fortner, a Cuba analyst at the Pacific Council on International Policy, a Los Angeles-based institute that focuses on global affairs. “It would be terrible politics for him. … Switching that off would really endanger his support far too much for that to be really a feasible option.”


For Cuba, Chavez’s latest health scare capped off a year of disappointments in the island’s attempt to wean itself from Venezuelan energy.


Three deep-water exploratory oil wells drilled off the west coast failed to yield a strike, and last month the only oil rig in the world capable of drilling there without violating U.S. sanctions sailed away with no return in sight.


Yet time and again Havana has shown that it’s nothing if not resilient, weathering everything from U.S.-backed invasion and assassination plots in the 1960s to the austere “Special Period” in the early 1990s, when the Soviet collapse sent Cuba’s GDP plummeting 33 percent over four years. When hurricanes damaged the country’s agriculture sector and the global financial crisis squeezed tourism four years ago, Cuba tightened its belt, slashed imports and survived.


“Some people are saying the demise of Chavez is also going to be the demise of Communism in Cuba because the regime’s going to collapse and the people are going to rise up,” Feinberg said. “That’s probably yet another delusion of the anti-Castro exile community.”


Still, many Cubans are nervously tuning into the near-daily updates about Chavez’s health, carried prominently in state media.


“I don’t know what would happen here,” said 52-year-old Havana resident Magaly Ruiz. “We might end up eating grass.”


___


Associated Press writers Andrea Rodriguez and Anne-Marie Garcia in Havana contributed to this report.


___


Peter Orsi on Twitter: www.twitter.com/Peter_Orsi


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Christmas box-office haul paces Hollywood for record year






LOS ANGELES (Reuters) – A strong Christmas-day box office performance by musical “Les Miserables” and western “Django Unchained” put Hollywood on pace to set an all-time box office record with $ 10.8 billion in annual revenue, box-office tracker Hollywood.com said on Wednesday.


Universal Pictures‘ star-studded “Les Miserables” took in a weekday Christmas record of $ 18.2 million in the United States and Canada when it opened on Tuesday, according to studio estimates of weekday ticket sales.






Quentin Tarantino‘s spaghetti western “Django Unchained,” starring Jamie Foxx and Leonardo DiCaprio, hauled nearly $ 15 million for The Weinstein Co.


Studios “are definitely on the road to a record year with $ 10.8 billion expected (up 6 percent over last year and beating the previous record of $ 10.6 billion in 2009),” Hollywood.com analyst Paul Dergarabedian told Reuters in an email, adding that the number of tickets sold should climb 6 percent from 2011 to 1.36 billion.


Dergarabedian credits a successful marketing year for studios as a chief reason for the projected box-office record, as well as spring and summer smashes “The Hunger Games” and “The Avengers” helping boost revenue.


“It was not just the fact that most of the movies delivered, it was the timing of their release dates and the marketing was obviously effective as well with social media continuing to provide an outlet for the movie-going peer group to talk about their favorite flicks,” Dergarabedian said.


“The Hobbit: An Unexpected Journey,” based on the J.R.R. Tolkein classic fantasy novel, brought in $ 11.4 million on Christmas day after ruling the box office with nearly $ 37 million in sales over the weekend.


Billy Crystal family film “Parental Guidance” debuted in fourth place with about $ 6.4 million in Christmas sales while Tom Cruise’s “Jack Reacher,” which featured author Lee Child’s character in an investigation into a sniper shooting, was fifth with some $ 5.3 million.


“The Hobbit” was distributed by Time Warner Inc’s Warner Bros. Studio. News Corp’s 20th Century Fox released “Parental Guidance” and Paramount Pictures, a unit of Viacom, released “Jack Reacher.” Universal Pictures is owned by Comcast Corp.


(Reporting by Eric Kelsey; Edited by Ronald Grover and Andrew Hay)


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VP says Chavez up, walking; doubts persist






CARACAS, Venezuela (AP) — Vice President Nicolas Maduro surprised Venezuelans with a Christmas Eve announcement that President Hugo Chavez is up and walking two weeks after cancer surgery in Cuba, but the news did little to ease uncertainty surrounding the leader’s condition.


Sounding giddy, Maduro told state television Venezolana de Television that he had spoken by phone with Chavez for 20 minutes Monday night. It was the first time a top Venezuelan government official had confirmed talking personally with Chavez since the Dec. 11 operation, his fourth cancer surgery since 2011.






“He was in a good mood,” Maduro said. “He was walking, he was exercising.”


Chavez supporters reacted with relief, but the statement inspired more questions, given the sparse information the Venezuelan government has provided so far about the president’s cancer. Chavez has kept secret various details about his illness, including the precise location of the tumors and the type of cancer. His long-term prognosis remains a mystery.


Dr. Michael Pishvaian, an oncologist at Georgetown University’s Lombardi Cancer Center in Washington, said it was an encouraging sign that Chavez was walking, and it indicated he would be able to return to Venezuela relatively soon. But he said the long term outlook remained poor.


“It’s definitely good news. It means that he is on the road to recover fully from the surgery,” Pishvaian said in a telephone interview with The Associated Press. “The overall prognosis is still pretty poor. He likely has a terminal diagnosis with his cancer that has come back.”


Pishvaian and other outside doctors have said that given the details Chavez has provided about his cancer, it is most likely a soft-tissue sarcoma.


Chavez first underwent surgery for an unspecified type of pelvic cancer in Cuba in June 2011 and went back this month after tests had found a return of malignant cells in the same area where tumors were previously removed.


Venezuelan officials said that, following the six-hour surgery two weeks ago, Chavez suffered internal bleeding that was stanched and a respiratory infection that was being treated.


Maduro’s announcement came just hours after Information Minister Ernesto Villegas read a statement saying Chavez was showing “a slight improvement with a progressive trend.”


Dr. Carlos Castro, director of the Colombian League against Cancer, an association that promotes cancer prevention, treatment and education, said Maduro’s announcement was too vague to paint a clear picture of Chavez’s condition.


“It’s possible (that he is walking) because everything is possible,” Castro told AP. “They probably had him sit in up in bed and take two steps.”


“It’s unclear what they mean by exercise. Was it four little steps?” he added. “I think he is still in critical condition.”


Maduro’s near-midnight announcement came just as Venezuelan families were gathering for traditional late Christmas Eve dinners and setting off the usual deafening fireworks that accompany the festivities. There was still little outward reaction on a quiet Christmas morning.


Danny Moreno, a software technician watching her 2-year-old son try out his new tricycle, was among the few people at a Caracas plaza who said she had heard Maduro’s announcement. She said she saw a government Twitter message saying an announcement was coming and her mother rushed to turn on the TV.


“We all said, thank God, he’s okay,” she said, smiling.


Dr. Gustavo Medrano, a lung specialist at the Centro Medico hospital in Caracas, said if Chavez is talking, it suggests he is breathing on his own despite the respiratory infection and is not in intensive care. But Medrano said he remained skeptical about Maduro’s comments and could deduce little from them about Chavez’s prognosis for recovery.


“I have no idea because if it was such a serious, urgent, important operation, and that was 14 days ago, I don’t think he could be walking and exercising after a surgery like that,” Medrano said.


Over the weekend, Chavez’s ally, Bolivian President Evo Morales, made a lightning visit to Cuba that only added to the uncertainty.


Journalists had been summoned to cover his arrival and departure in Havana, but hours later that invitation was canceled. No explanation was given, though it could have been due to confusion over Morales’ itinerary as he apparently arrived later than initially scheduled.


Cuban state media published photos of President Raul Castro receiving Morales at the airport and said he came “to express his support” for Chavez, his close ally, but did not give further details. He left Sunday without making any public comments.


For the second day in a row Tuesday, Morales made no mention of his trip to Cuba during public events in Bolivia.


Yet more questions surround Chavez’s political future, with the surgery coming two months after he won re-election to a six-year term.


If he is unable to continue in office, the Venezuelan Constitution calls for new elections to be held. Chavez has asked his followers to back Maduro, his hand-picked successor, in that event.


Venezuelan officials have said Chavez might not return in time for his Jan. 10 inauguration.


Opposition leaders have argued that the constitution does not allow the president’s swearing-in to be postponed, and say new elections should be called if Chavez is unable to take the oath on time.


But government officials have said the constitution lets the Supreme Court administer the oath of office at any time if the National Assembly is unable to do it Jan. 10 as scheduled.


___


Associated Press writers Peter Orsi in Havana, Vivian Sequera in Caracas, Camilo Hernandez in Bogota, Colombia, and Paola Flores in La Paz, Bolivia, contributed to this report.


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Ticket rush: Film fans hand Hollywood record cash






LOS ANGELES (AP) — The big deal for Hollywood is not the record $ 10.8 billion that studios took in domestically in 2012. It’s the fact that the number of tickets sold went up for the first time in three years.


Thanks to inflation, revenue generally rises in Hollywood as admission prices climb each year. The real story is told in tickets, whose sales have been on a general decline for a decade, bottoming out in 2011 at 1.29 billion, their lowest level since 1995.






The industry rebounded this year, with ticket sales projected to rise 5.6 percent to 1.36 billion by Dec. 31, according to box-office tracker Hollywood.com. That’s still well below the modern peak of 1.6 billion tickets sold in 2002, but in an age of cozy home theater setups and endless entertainment gadgets, studio executives consider it a triumph that they were able to put more butts in cinema seats this year than last.


“It is a victory, ultimately,” said Don Harris, head of distribution at Paramount Pictures. “If we deliver the product as an industry that people want, they will want to get out there. Even though you can sit at home and watch something on your large screen in high-def, people want to get out.”


Domestic revenue should finish up nearly 6 percent from 2011′s $ 10.2 billion and top Hollywood‘s previous high of $ 10.6 billion set in 2009.


The year was led by a pair of superhero sagas, Disney’s “The Avengers” with $ 623 million domestically and $ 1.5 billion worldwide and the Warner Bros. Batman finale “The Dark Knight Rises” with $ 448 million domestically and $ 1.1 billion worldwide. Sony’s James Bond adventure “Skyfall” is closing in on the $ 1 billion mark globally, and the list of action and family-film blockbusters includes “The Hunger Games,” ”The Twilight Saga: Breaking Dawn — Part Two,” ”Ice Age: Continental Drift,” ”Madagascar 3: Europe’s Most Wanted,” ”The Amazing Spider-Man” and “Brave.”


Before television, movies were the biggest thing going, with ticket sales estimated as high as 4 billion a year domestically in the 1930s and ’40s.


Movie-going eroded steadily through the 1970s as people stayed home with their small screens. The rise of videotape in the 1980s further cut into business, followed by DVDs in the ’90s and big, cheap flat-screen TVs in recent years. Today’s video games, mobile phones and other portable devices also offer easy options to tramping out to a movie theater.


It’s all been a continual drain on cinema business, and cynics repeatedly predict the eventual demise of movie theaters. Yet Hollywood fights back with new technology of its own, from digital 3-D to booming surround-sound to the clarity of images projected at high-frame rates, which is being tested now with “The Lord of the Rings” prelude “The Hobbit: An Unexpected Journey,” shown in select theaters at 48 frames a second, double the standard speed.


For all of the annoyances of theaters — parking, pricy concessions, sitting next to strangers texting on their iPhones — cinemas still offer the biggest and best way to see a movie.


“Every home has a kitchen, but you can’t get into a good restaurant on Saturday night,” said Dan Fellman, head of distribution for Warner Bros. “People want to escape. That’s the nature of society. The adult population just is not going to sit home seven days a week, even though they have technology in their home that’s certainly an improvement over what it was 10 years ago. People want to get out of the house, and no matter what they throw in the face of theatrical exhibition, it continues to perform at a strong level.”


Even real-life violence at the movie theater didn’t turn audiences away. Some moviegoers thought twice about heading to the cinema after a gunman killed 12 people and injured 58 at a screening of “The Dark Knight Rises” in Colorado last summer, but if there was any lull in attendance, it was slight and temporary. Ticket sales went on a tear for most of the fall.


While domestic revenues inch upward most years largely because of inflation, the real growth areas have been overseas, where more and more fans are eager for the next Hollywood blockbuster.


Rentrak, which compiles international box office data, expects 2012′s foreign gross to be about $ 23 billion, 3 percent higher than in 2011. No data was yet available on the number of tickets sold overseas this past year.


International business generally used to account for less than half of a studio film’s overall receipts. Films now often do two or even three times as much business overseas as they do domestically. Some movies that were duds with U.S. audiences, such as “Battleship” and “John Carter,” can wind up being $ 200 million hits with overseas crowds.


Whether finishing a good year or a bad one, Hollywood executives always look ahead to better days, insisting that the next crop of blockbusters will be bigger than ever. The same goes this time as studio bosses hype their 2013 lineup, which includes the latest “Iron Man,” ”Star Trek,” ”Hunger Games” and “Thor” installments, the Superman tale “Man of Steel” and the second chapter in “The Hobbit” trilogy.


Twelve months from now, they hope to be talking about another revenue record topping this year’s $ 10.8 billion.


“I’ve been saying we’re going to hit that $ 11 billion level for about three years now,” said Paul Dergarabedian, a box-office analyst for Hollywood.com. “Next year I think is the year we actually do it.”


___


Online:


http://www.hollywood.com


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Study finds spiritual care still rare at end of life






NEW YORK (Reuters Health) – Physicians and nurses at four Boston medical centers cited a lack of training to explain why they rarely provide spiritual care for terminally ill cancer patients – although most considered it an important part of treatment at the end of life.


“I was quite surprised that it was really just lack of training that dominated the reasons why,” senior author Dr. Tracy Balboni, a radiation oncologist at the Dana-Farber Cancer Institute in Boston, told Reuters Health.






Current U.S. palliative care guidelines encourage medical practitioners to pay close attention to religious and spiritual needs that may arise during a patient’s end-of-life care.


However, the 204 physicians who participated in the study reported providing spiritual care to just 24 percent of their patients. Among 118 nurses, the figure was 31 percent.


The 69 patients with advanced cancers who took the survey reported even lower rates, saying 14 percent of nurses and six percent of physicians had provided them some sort of spiritual care.


Past research has shown that spiritual care for seriously ill patients improves their quality of life, increases their overall satisfaction with hospital care and decreases aggressive medical treatment, which may in turn result in lower overall health spending.


“There was a time when nurses and physicians may have said, ‘That’s not my job,’ but I think the tides are changing,” said palliative care researcher Betty Ferrell of City of Hope, a cancer research and treatment hospital in Duarte, California.


“I think we are realizing we can no longer ignore this aspect of care,” said Ferrell, a professor of nursing who was not involved in the new study.


Yet the reasons why spiritual care is rarely incorporated into patient treatment and dialogue have been poorly understood.


To gain more insight, Balboni and her colleagues designed a survey – the first of its kind, to their knowledge – to compare attitudes toward spiritual care across randomly chosen patients, nurses and doctors in oncology departments at four hospitals.


The questions were geared toward identifying barriers preventing healthcare professionals from delivering spiritual care, beginning with whether anyone felt it was inappropriate for them to be doing so.


The participants’ answers indicated that, on the contrary, a majority of providers and patients supported the appropriateness of eight specific examples of spiritual care, such as a doctor or nurse praying with a patient at his or her request or referring the patient to a hospital chaplain.


Next, the researchers asked participants to rate previous spiritual care experiences. Again, most ranked these as having a positive impact on care. A fourth possibility offered to nurses and doctors was lack of time.


“Indeed we found that on average 73 percent reported time to be a significant barrier to spiritual care provision to patients,” Balboni told Reuters Health in an email.


But those who noted insufficient time as a problem provided spiritual care just as often as those who reported having enough time. That suggested time was not an issue after all, she added.


In fact, a lack of training stood out as the biggest barrier to providing spiritual care in this small study.


Only 13 percent of doctors and nurses reported having ever received spiritual care training.


But those who had training were seven to 11 times more likely to provide spiritual care to their patients than those who hadn’t been trained.


A lack of “models” for training healthcare professionals to tend to patients’ spiritual needs seems to be the underlying problem, Balboni told Reuters Health.


“There are some basic models, but a rigorously developed spiritual care training model has not been established,” she said.


Ferrell, who leads End-of-Life Nursing Education Consortium workshops, said such small-scale organized training opportunities are drops in the bucket of a huge unmet training need.


“We can’t practice what we don’t know,” she said. “Physicians and nurses have never been taught to access and respond to spiritual need.”


In addition to training, the field of spiritual care needs a clear definition, said Dr. Christina Puchalski, director of the George Washington Institute for Spirituality and Health in Washington, D.C.


“There is quite a bit of controversy about asking only about religion,” Puchalski said. “But previous studies have shown that it’s not a patient’s particular religious denomination that matters, but what gives meaning and purpose in peoples’ lives -things such as family, arts, work, nature, yoga and other values.”


Puchalski, who invented a basic spiritual assessment questionnaire that is in wide use, added that the study could have benefitted by asking patients if nurses and doctors acted compassionately toward them, which is another example of spiritual care.


In a country full of diverse cultures, spiritual care may be intimidating to medical workers, but training can help with that, Ferrell said.


“For example, if we have a patient who says, ‘I’m very devout in my faith and I never make decisions without consulting my rabbi,’ then we immediately take that into account – perhaps by giving the patient extra time between procedures,” she noted.


“Patients are telling us spiritual care has to be done with greater intention,” Ferrell said.


SOURCE: http://bit.ly/Zm7Fey Journal of Clinical Oncology, online December 17, 2012


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As winter storm bears down on Midwest, death toll climbs




MOBILE, Ala. (AP) -- A powerful storm system that erupted Christmas Day with Gulf Coast tornadoes and snow in the nation's midsection headed for the Northeast on Wednesday, spreading blizzard conditions that slowed holiday travel.


The death toll rose to six with car accidents on snow and sleet-slickened highways in Arkansas and Oklahoma.


Post-Christmas travelers braced for flight delays and a raft of weather warnings for drivers, a day after rare winter twisters damaged buildings in Louisiana, Mississippi and Alabama.


Snow blew across southern Illinois and southern Indiana early Wednesday as the storm tracked up the Ohio River valley toward the Eastern seaboard and New England.


There were whiteout conditions in parts of southwestern Indiana, where 6 inches or more of snow had fallen by midmorning around Evansville. State police reported dozens of vehicles stuck after not being able to get up a hill on a central Indiana highway, while some roads around Evansville were impassable with wind gusts around 30 mph.


A blizzard warning was in effect for much of the state's southern two-thirds and more than a dozen counties issued travel watches asking residents to make only essential driving trips.


Indianapolis had 7 inches on the ground by 10 a.m. after receiving as much as 3 inches of snow in a single hour, said John Kwiatkowski, a meteorologist with the National Weather Service in Indianapolis. He said the storm's winds were just high enough to classify the storm as a blizzard, making it one of the strongest snowstorms in years to strike central and southern Indiana.


"The way I've been describing it is as a low-end blizzard, but that's sort of like saying a small Tyrannosaurus rex. Just to become a blizzard is quite an accomplishment. And it's sure a heck of a lot more than we've seen," he said.


In Arkansas, the storm left more than 189,000 customers without electricity Wednesday, utility Entergy Arkansas said.


Severe thunderstorms were forecast for the Carolinas while a line of blizzard and winter storm warnings stretched from Arkansas up the Ohio River to New York and on to Maine.


State police reported scores of accidents on snow-covered highways in central and western Maryland, where forecasters predicted up to 5 inches of snow in most counties west of the Baltimore-Washington area, followed by freezing rain.


Thirty-four tornadoes were reported in Texas, Louisiana, Mississippi and Alabama during the outbreak Tuesday, the National Weather Service said.


Rick Cauley's family was hosting relatives for Christmas when tornado sirens went off in Mobile. Not taking any chances, he and his wife, Ashley, hustled everyone down the block to take shelter at the athletic field house at Mobile's Murphy High School in Mobile.


It turns out, that wasn't the place to head.


"As luck would have it, that's where the tornado hit," Cauley said. "The pressure dropped and the ears started popping and it got crazy for a second." They were all fine, though the school was damaged, as were a church and several homes, but officials say no one was seriously injured.


Camera footage captured the approach of the large funnel cloud.


Mobile was the biggest city hit by numerous twisters. Along with brutal, straight-line winds, the storms knocked down countless trees, blew the roofs off homes and left many Christmas celebrations in the dark. Torrential rains drenched the region and several places saw flash flooding.


More than 900 flights around the U.S. were canceled as of Wednesday midday, according to the flight tracker FlightAware.com. The cancelations were mostly spread around airports that had been or soon would be in the path of the storm.


Holiday travelers in the nation's much colder midsection battled treacherous driving conditions from freezing rain and blizzard conditions from the same fast-moving storms. In Arkansas, highway department officials said the state was fortunate the snowstorm hit on Christmas Day when many travelers were already at their destinations.


Two passengers in a car on a sleet-slickened Arkansas highway died Wednesday when the vehicle crossed the center line and struck an SUV head-on. In Oklahoma, the Highway Patrol said a 76-year-old Wisconsin woman died Tuesday when the car she was riding in was hit head-on by a pickup truck on Interstate 44.


The Oklahoma Highway Patrol had earlier reported that a 28-year-old woman was killed in another crash Tuesday on a snowy highway. The storm's winds were blamed Tuesday for toppling a tree onto a pickup truck in Texas, killing the driver, and another tree onto a house in Louisiana, killing a man there.


Trees fell on homes and across roadways in several communities in southern Mississippi and Louisiana. Mississippi Gov. Phil Bryant declared a state of emergency, saying eight counties reported damages and some injuries.


It included McNeill, where a likely tornado damaged a dozen homes and sent eight people to the hospital, none with life-threatening injuries, said Pearl River County emergency management agency director Danny Manley.


The snowstorm that caused numerous accidents pushed out of Oklahoma late Tuesday, carrying with it blizzard warnings for parts of northeast Arkansas, where 10 inches of snow was forecast. Freezing rain clung to trees and utility lines in Arkansas and winds gusts up to 30 mph whipped them around, causing about 71,000 customers to lose electricity for a time.


Christmas lights also were knocked out with more than 100,000 customers without power for at least a time in Texas, Arkansas, Oklahoma, Mississippi, Louisiana and Alabama.


Blizzard conditions were possible for parts of Illinois, Indiana and Kentucky up to Cleveland with predictions of several inches to a foot of snow. By the end of the week, that snow was expected to move into the Northeast with again up to a foot predicted


Jason Gerth said the Mobile tornado passed by in a few moments and from his porch, he saw about a half-dozen green flashes in the distance as transformers blew. His home was spared.


"It missed us by 100 feet and we have no damage," Gerth said.


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Ouch, Charlie! YouTube Sensation Kids Talk Christmas Toys






The infamous “Charlie Bit My Finger” video has surpassed half a billion views on YouTube — not bad for a 56-second clip of a one-year-old kid biting his older brother’s finger.


Charlie and Harry, now six and eight, returned to the web earlier this year with a new series through Viral Studios. The mini-episodes focus on the boys and their younger brother, Jasper, as they talk about toys, viral videos and — of course — biting things.






[More from Mashable: 8 Festive Christmas Tumblrs, Presented by Santa Dogs]


Mashable sat down for a Skype interview with the three boys last week. Unfortunately, the Internet connection wasn’t the greatest — Harry twice referred to me as a “man made out of boxes” because of the spotty video quality — but they were still able to talk about what toys they were most excited about this holiday season. Check ‘em out below:


[More from Mashable: Now and Then: 10 Awesome Past and Present Pics]


Charlie’s Pick: Playmobil Large Pirate Ship


Price: $ 95.50


Image courtesy of Playmobil


Harry’s Pick: Thomas & Friends Take-n-Play The Great Quarry Climb


Price: $ 19.99


Image courtesy of Fisher-Price


Jasper’s Pick: Turbo Snake Remote Control


Price: £38.45 (only available in the U.K.)


Image courtesy of Amazon


You can catch all the episodes on the “Charlie Bit Me!” series on their YouTube page. Which toys or gadgets did you score this year? Tell us below.


BONUS: 10 Gifts for People You Hate


1. 50 Used Toilet Paper Rolls


Price: $ 19.99 Mother Earth appreciates a little holiday upcycling. Your mother-in-law, on the other hand, may not. Cheaper DIY alternative: Your own toilet paper rolls.


Click here to view this gallery.


Image courtesy of Viral Studios


This story originally published on Mashable here.


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As winter storm bears down on Midwest, death toll climbs




MOBILE, Ala. (AP) -- A powerful storm system that erupted Christmas Day with Gulf Coast tornadoes and snow in the nation's midsection headed for the Northeast on Wednesday, spreading blizzard conditions that slowed holiday travel.


The death toll rose to six with car accidents on snow and sleet-slickened highways in Arkansas and Oklahoma.


Post-Christmas travelers braced for flight delays and a raft of weather warnings for drivers, a day after rare winter twisters damaged buildings in Louisiana, Mississippi and Alabama.


Snow blew across southern Illinois and southern Indiana early Wednesday as the storm tracked up the Ohio River valley toward the Eastern seaboard and New England.


There were whiteout conditions in parts of southwestern Indiana, where 6 inches or more of snow had fallen by midmorning around Evansville. State police reported dozens of vehicles stuck after not being able to get up a hill on a central Indiana highway, while some roads around Evansville were impassable with wind gusts around 30 mph.


A blizzard warning was in effect for much of the state's southern two-thirds and more than a dozen counties issued travel watches asking residents to make only essential driving trips.


Indianapolis had 7 inches on the ground by 10 a.m. after receiving as much as 3 inches of snow in a single hour, said John Kwiatkowski, a meteorologist with the National Weather Service in Indianapolis. He said the storm's winds were just high enough to classify the storm as a blizzard, making it one of the strongest snowstorms in years to strike central and southern Indiana.


"The way I've been describing it is as a low-end blizzard, but that's sort of like saying a small Tyrannosaurus rex. Just to become a blizzard is quite an accomplishment. And it's sure a heck of a lot more than we've seen," he said.


In Arkansas, the storm left more than 189,000 customers without electricity Wednesday, utility Entergy Arkansas said.


Severe thunderstorms were forecast for the Carolinas while a line of blizzard and winter storm warnings stretched from Arkansas up the Ohio River to New York and on to Maine.


State police reported scores of accidents on snow-covered highways in central and western Maryland, where forecasters predicted up to 5 inches of snow in most counties west of the Baltimore-Washington area, followed by freezing rain.


Thirty-four tornadoes were reported in Texas, Louisiana, Mississippi and Alabama during the outbreak Tuesday, the National Weather Service said.


Rick Cauley's family was hosting relatives for Christmas when tornado sirens went off in Mobile. Not taking any chances, he and his wife, Ashley, hustled everyone down the block to take shelter at the athletic field house at Mobile's Murphy High School in Mobile.


It turns out, that wasn't the place to head.


"As luck would have it, that's where the tornado hit," Cauley said. "The pressure dropped and the ears started popping and it got crazy for a second." They were all fine, though the school was damaged, as were a church and several homes, but officials say no one was seriously injured.


Camera footage captured the approach of the large funnel cloud.


Mobile was the biggest city hit by numerous twisters. Along with brutal, straight-line winds, the storms knocked down countless trees, blew the roofs off homes and left many Christmas celebrations in the dark. Torrential rains drenched the region and several places saw flash flooding.


More than 900 flights around the U.S. were canceled as of Wednesday midday, according to the flight tracker FlightAware.com. The cancelations were mostly spread around airports that had been or soon would be in the path of the storm.


Holiday travelers in the nation's much colder midsection battled treacherous driving conditions from freezing rain and blizzard conditions from the same fast-moving storms. In Arkansas, highway department officials said the state was fortunate the snowstorm hit on Christmas Day when many travelers were already at their destinations.


Two passengers in a car on a sleet-slickened Arkansas highway died Wednesday when the vehicle crossed the center line and struck an SUV head-on. In Oklahoma, the Highway Patrol said a 76-year-old Wisconsin woman died Tuesday when the car she was riding in was hit head-on by a pickup truck on Interstate 44.


The Oklahoma Highway Patrol had earlier reported that a 28-year-old woman was killed in another crash Tuesday on a snowy highway. The storm's winds were blamed Tuesday for toppling a tree onto a pickup truck in Texas, killing the driver, and another tree onto a house in Louisiana, killing a man there.


Trees fell on homes and across roadways in several communities in southern Mississippi and Louisiana. Mississippi Gov. Phil Bryant declared a state of emergency, saying eight counties reported damages and some injuries.


It included McNeill, where a likely tornado damaged a dozen homes and sent eight people to the hospital, none with life-threatening injuries, said Pearl River County emergency management agency director Danny Manley.


The snowstorm that caused numerous accidents pushed out of Oklahoma late Tuesday, carrying with it blizzard warnings for parts of northeast Arkansas, where 10 inches of snow was forecast. Freezing rain clung to trees and utility lines in Arkansas and winds gusts up to 30 mph whipped them around, causing about 71,000 customers to lose electricity for a time.


Christmas lights also were knocked out with more than 100,000 customers without power for at least a time in Texas, Arkansas, Oklahoma, Mississippi, Louisiana and Alabama.


Blizzard conditions were possible for parts of Illinois, Indiana and Kentucky up to Cleveland with predictions of several inches to a foot of snow. By the end of the week, that snow was expected to move into the Northeast with again up to a foot predicted


Jason Gerth said the Mobile tornado passed by in a few moments and from his porch, he saw about a half-dozen green flashes in the distance as transformers blew. His home was spared.


"It missed us by 100 feet and we have no damage," Gerth said.


Read More..

Obama, Congress set for late push on “fiscal cliff”






WASHINGTON/HONOLULU (Reuters) – President Barack Obama is due back in Washington early Thursday for a final effort to negotiate a deal with Congress to avert or at least postpone the “fiscal cliff” of tax increases and government spending cuts set to begin next week.


No specific bill dealing with the cliff was on the schedule of either the U.S. Senate or House of Representatives, which are expected to return on Thursday after the holiday break. In Congress, the corridors were almost empty and the doors to members’ rooms were locked.






Investors are closely watching the talks, concerned that going over the cliff could throw the economy into recession. U.S. stocks slipped on Wednesday after retailers reported disappointing holiday sales as shoppers tightened belts possibly due to fiscal cliff worries.


Aides and members of Congress have said that a modest, last-minute measure to avoid the spending cuts and most of the tax hikes could pass the Democratic-controlled Senate if Republicans agree not use a procedural roadblock known as a filibuster, a commitment that Senate Republican leader Mitch McConnell has so far not made.


The legislative focus continues to shift from deficit reduction to averting the immediate shock of the December 31 cliff dive.


“This is the ‘Break Glass’ scenario that we have long believed would rise in probability the closer we go to December 31, which essentially calls for extending all the rates for those individuals making under $ 200K and households under $ 250K and does not address the debt ceiling or the deficit,” analyst Chris Krueger of Guggenheim Securities wrote in a research note.


But to win approval in the Republican-controlled House of any bill that raises taxes on anyone, a rare bipartisan vote would be required. All 191 Democrats would have to team with up with at least 26 Republicans to get a majority if the bill included tax hikes on the wealthiest Americans, as Obama is demanding.


Some of those votes could conceivably come from among the 34 Republican members who are either retiring or were defeated in the November elections and no longer have to worry about the political fallout.


JANUARY SCRAMBLE?


In the alternative, Congress could let income taxes go up on everyone as now scheduled and then during the first week of January, scramble and get a quick deal to cut them back except for the highest brackets, along with a measure putting off the $ 109 billion in automatic spending cuts that most lawmakers want to avoid.


Once the clock ticks past midnight on December 31, no member of Congress would have to vote for a tax increase on anyone – taxes would have risen automatically – and the only votes would be to decrease tax rates for most Americans back to their 2012 levels.


Americans’ optimism that Obama and congressional leaders will reach a budget agreement before January 1 has waned in recent days, according to a Gallup poll released on Wednesday. Fifty percent believe a deal will be reached – a drop of 7 percentage points from the previous week – and 48 percent are doubtful. The poll was taken just after talks ran into trouble last week.


Obama and congressional lawmakers left Washington on Friday for the Christmas holiday with negotiations to avert the fiscal cliff in limbo.


The president will cut short his vacation in Hawaii and leave for Washington later on Wednesday, arriving in the capital early on Thursday.


Obama is expected to turn to a trusted Democratic ally, Senate Majority Leader Harry Reid, to help craft a quick deal.


White House aides began discussing details of the year-end budget measure with Senate Democratic counterparts early this week.


Starbucks Chief Executive Howard Schultz is urging workers in the company’s roughly 120 Washington-area coffee shops to write “come together” on customers’ cups on Thursday and Friday to send a message to sharply divided politicians.


“We’re paying attention, we’re greatly disappointed in what’s going on and we deserve better,” Schultz told Reuters.


(Additional reporting by Thomas Ferraro and Richard Cowan in Washington and Lisa Baertlein in Los Angeles; Editing by Eric Beech)


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