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During nationwide polio campaigns, hundreds of thousands of health workers go door to door, giving children two drops of the polio vaccine. (Getty Images)

The Hidden Costs Of Fighting Polio In Pakistan

Jul 29, 2014 (All Things Considered)

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Security officials attend the funeral of police officials killed by bomb explosions in Jamrud, Pakistan, March 1. The men were escorting a team of polio vaccinators when their vehicles were targeted. Dr. Raza Jamal, of the National Institute of Child Health in Karachi, supports polio eradication. But he says, the vaccinations campaigns have taken away precious health resources.

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Pakistan is currently at the center of the global effort to eradicate polio. Although the country has reported only about a hundred cases this year, that's more cases than in all other nations combined.

Eliminating the paralyzing disease is a major logistical operation in Pakistan. More than 200,000 vaccinators fan out across the country, several times a year, to inoculate millions of children. And the government also deploys tens of thousands of armed security forces to guard the workers.

All this is happening while Pakistan is fighting a vicious insurgency against the Taliban. And that militant group continues to threaten polio vaccinators and parents who immunize their children.

The polio campaign is costing Pakistani lives, national pride and precious health resources. Some health leaders are starting to question whether the focus on polio is worth it.

"All the immunization workers have been redirected into the polio campaign, which has resulted in another disaster: Our routine immunization has gone down to as low as 30 percent or less," says Dr. Raza Jamal, of the National Institute of Child Health in Karachi. "So that has resulted in epidemics of measles, diphtheria, cases of pertussis — which we had stopped seeing for a long time."

Jamal supports the polio eradication effort. But he says, it has become a national obsession. And it has taken a huge toll on Pakistan's already overstretched health system, he adds.

Polio is only one of many challenges facing the poor country. People lack access to jobs, sanitation, decent housing, clean water and electricity. Criminal gangs terrorize the slums of Karachi. Pakistan has a major terrorism problem.

Last month militants in suicide vests fought a five hour gun battle with security forces at the Karachi airport, which left 38 people dead. On the same day, 22 Shiite pilgrims were attacked and killed near the Iranian border.

Amidst all this, Western health officials have pushed polio to the front of the country's national agenda.

Mazhar Nisar coordinates anti-polio campaigns for the Pakistan ministry of health. But even he thinks the constant drum beat on polio can be a problem. "There is a serious fatigue factor in the parents," he says. "There is a serious fatigue factor among the providers."

Coordinating the mass immunization drives, all across the country is a major logistical operation for the health department. And parents have started to question why the government is directing so much attention to this one disease, Nisar says.

"They [parents] said, 'When we go to the hospital, we don't get the medicines. We don't get the proper treatment. My child is dying of diarrhea. My child has measles. And yet every four or six weeks, you come with the polio vaccine,' " he says.

But being one of the last nations on Earth with polio — even if it's just a hundred cases — is an embarrassment for the government.

"There are people at the highest level [of the government] who've told me they start their day with polio, they end their day with polio, as if this is the only priority," says Zulfiqar Bhutta, a professor of pediatrics at the Aga Khan University in Karachi. Bhutta has worked on polio for decades.

Polio eradication is very important, he says. But it's unclear how long Pakistan can stay focused on mass immunization drives. "What we need to go and try to do is something a bit more holistic," he says. "Rather than trying to focus on a single intervention and a single program that bears very little relevance to the lives and livelihoods of people."

Pakistan should work to improve its basic health services, Bhutta says. So kids get immunized for polio along with everything else. Sanitation should be upgraded. Then the polio virus can't contaminate drinking water.

But projects like those take even more time — and more resources — than the current barrage of polio immunization campaigns.

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Smoke and fire rise from the explosion of an Israeli strike over Gaza City on Tuesday (AP)

Israeli Bombing Ruins Gaza's Only Power Plant

by Alan Greenblatt
Jul 29, 2014

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Security officials attend the funeral of police officials killed by bomb explosions in Jamrud, Pakistan, March 1. The men were escorting a team of polio vaccinators when their vehicles were targeted. Dr. Raza Jamal, of the National Institute of Child Health in Karachi, supports polio eradication. But he says, the vaccinations campaigns have taken away precious health resources.

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Israel broadened its assault on Gaza on Tuesday, wrecking the region's only power plant and killing dozens of Palestinians.

Barrages "destroyed Hamas's media offices, the home of a top leader and what Palestinians said was a devastating hit on the only electricity plant," The New York Times reports.

The bombings came on a day when hope briefly arose about a new cease-fire. Both Israeli and Palestinian officials in the West Bank discussed the possibility.

But Hamas, which runs the Gaza Strip, rejected the idea.

"We don't accept any condition of ceasefire," Hamas military commander Mohammed Deif said on Hamas broadcast outlets. "There is no ceasefire without the stop of the aggression and the end of the siege."

With Tuesday's bombings, which the Guardian described as "the most relentless and widespread" of the three-week-old conflict, the Palestinian death toll has exceeded 1,200.

The shelling of the power plant, which Palestinian officials described as taking a devastating hit, will bring additional hardship. The lack of electricity will make existing problems with water and sewage far worse.

"We need at least one year to repair the power plant, the turbines, the fuel tanks and the control room," Fathi Sheik Khalil of the Gaza energy authority told the Guardian. "Everything was burned."

On All Things Considered, NPR's Emily Harris described how one family in Gaza spent the Muslim holiday of Eid, which marks the end of Ramadan.

Some family members have been killed, others injured and nearly all displaced. "There are 53 people staying in this three-bedroom apartment," Harris reported, "including, the mothers say, at least eight infants."

On the diplomatic front, there was disagreement between the U.S. and Israel about what had been said in private conversations between top officials.

The White House dismissed as "totally false" a report on Israel's Channel 1 that President Obama told Israeli Prime Minister Benjamin Netanyahu during a telephone call Sunday that Israel must immediately end its military offensive in Gaza and was not in a position to choose which countries could mediate a cease-fire.

"We have seen reports of an alleged POTUS-Netanyahu transcript; neither reports nor alleged transcript bear any resemblance to reality," tweeted the National Security Council's press account.

For their part, Netanyahu's aids denied Secretary of State John Kerry's characterization of one of his many conversations with the Israeli prime minister. Kerry suggested Tuesday that Netanyahu had asked him to "try to get a humanitarian cease-fire," but the prime minister's staff said that the cease-fire idea was actually Kerry's.

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The National Labor Relations Board says McDonald's shares responsibility for how workers are treated at its franchised restaurants. (AP)

McDonald's Responsible For Treatment Of Workers, Agency Says

by Alan Greenblatt
Jul 29, 2014

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The Golden Arches logo goes up at a McDonald's restaurant in Robinson Township, Pa., in January Dr. Raza Jamal, of the National Institute of Child Health in Karachi, supports polio eradication. But he says, the vaccinations campaigns have taken away precious health resources.

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McDonald's shares responsibility for how workers are treated at its franchised restaurants, the general counsel's office for the National Labor Relations Board announced Tuesday.

Since November 2012, NLRB has had 181 cases filed involving McDonald's. Many have been dismissed, but the agency said that McDonald's USA LLC will be considered a joint employer in cases that are found to have merit.

Restaurant chains have fought such a designation. McDonald's intends to contest the ruling, which the company warned could have a broad impact beyond the restaurant business.

Its 3,000 franchisees set the terms of employment, such as wages and hours, Heather Smedstad, McDonald's senior vice president for human resources, said in a statement.

"McDonald's also believes that this decision changes the rules for thousands of small businesses, and goes against decades of established law," she said.

Labor advocates say that it's clear who's really the boss, arguing that the company holds enormous sway over the business operations of its franchise owners.

"The reality is that McDonald's requires franchisees to adhere to such regimented rules and regulations that there's no doubt who's really in charge," said Micah Wissinger, a New York attorney who represents McDonald's workers.

Labor organizers have been organizing protests about working conditions at fast-food restaurants and seeking an increase in the minimum wage for employees to $15 an hour.

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People holding Ukrainian and Crimean Tatar flags demonstrate in front of the French-built Vladivostok warship in St. Nazaire, western France, on June 1. The protesters are opposed to the sale of the Vladivostok and Sevastopol warships to Russia. (AFP/Getty Images)

France Presses On With Deal To Sell Two Warships To Russia

Jul 29, 2014 (All Things Considered)

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The Vladivostok leaves the harbor of St. Nazaire, a major shipbuilding center, for a test run in the open sea on March 5. Russian sailors arrive in St. Nazaire aboard the Smolniy on June 30. They are among the 400 Russian sailors who will train on the Vladivostok -- and sail the ship back to Russia.

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France plans to go ahead with the sale of two warships to the Kremlin, even as the European Union and U.S. strengthen sanctions on Russia amid continued fighting in Ukraine and the aftermath of the downed Malaysian airliner.

People in St. Nazaire, the port town where the boats are being built, agree: The contract with Moscow should be fulfilled, they say. Despite mounting international pressure, cancellation of the deal, they say, would be a bad move for business.

There's not much love for Russian President Vladimir Putin in France. But in St. Nazaire, the contract is more about preserving a way of life than anything else.

Shipbuilding has been a mainstay of the local economy since the 19th century. Today, the town — located where the Loire River empties into the Atlantic Ocean — is one of the world's top builders of massive cruise ships and ferries. To keep that place, people say, contracts must be respected.

That includes 72-year-old retired Russian teacher Francois Chabeau. He says he avoids meeting Russians these days because they all love Putin, who Chabeau says is "dreadful."

"I think we must deliver the ships because we have a contract with the Russians," Chabeau says. "If we don't deliver the ships there will [not be new] contracts for ships."

And that, he says, trumps what's happening in Ukraine.

"Yes, on one side it's terrible what happens," he says. "But on the other side, we have a contract."

Other townspeople, like tobacco shop owner Christian Saunier, 60, say the ships are not the cause of the conflict between Russia and Ukraine, and canceling them won't resolve the crisis. He also points out that France is the world's third-largest arms seller, and if it cancels the ships it should also cancel all the missiles and planes it sells abroad.

The Russian ships are providing five years of employment for about 2,500 people in St. Nazaire.

The town appears to be thriving. On a recent day, hundreds of people shop at a market overflowing with fresh produce, and freshly caught fish.

Marc Menager, 65, has worked at the St. Nazaire shipyard for 37 years.

While the ship workers are prouder of the ocean liners they build, like the Queen Mary 2, Menager says, the warship contract came at a time when orders were down.

He says the two warships will not be outfitted with weaponry or communications systems. Critics say they will be able to carry hundreds of troops and helicopters.

Some 400 Russian soldiers sailed into St. Nazaire last month. They came to train on one of the newly built warships, the Vladivostok — and then sail it home in a few months. A second ship, the Sevastopol, which is still under construction, is set to be delivered to Russia in 2015.

Down by the water, there's a ceremony going on in the shipyard, next to the Vladivostok. A group of Russian sailors in uniform is singing military songs.

Bernard Grua, an activist who is protesting this ship deal, is one of the local people watching through the fence.

"These people, they represent Putin's regime. And sure, it's not only frustrating, but excuse me, it's disgusting," he says. "This collaboration is a shame for France."

Grua says the next generation will have to live with the consequences.

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Anti-abortion protester Mary McLaurin calls out to a patient at the Jackson Women's Health Organization in 2013. (AP)

Court Rejects Law Threatening Mississippi's Last Abortion Clinic

by Alan Greenblatt
Jul 29, 2014

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The Vladivostok leaves the harbor of St. Nazaire, a major shipbuilding center, for a test run in the open sea on March 5. Russian sailors arrive in St. Nazaire aboard the Smolniy on June 30. They are among the 400 Russian sailors who will train on the Vladivostok -- and sail the ship back to Russia.

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A federal appeals court has rejected a Mississippi law that would have forced the state's only abortion clinic to close.

In a 2-1 decision, a panel of the 5th U.S. Circuit Court of Appeals on Tuesday turned aside arguments that women seeking to have an abortion could have the procedure done in a neighboring state.

Closing the clinic in Jackson would place an "undue burden" on women, the court found.

"Pre-viability, a woman has the constitutional right to end her pregnancy by abortion," Judge E. Grady Jolly wrote for the majority. "Mississippi may not shift its obligation to respect the established constitutional rights of its citizens to another state."

The Mississippi law, enacted in 2012, requires abortion providers to have on staff doctors with admitting privileges at neighboring hospitals. Physicians at the Jackson clinic applied for privileges at area hospitals, but were unable to obtain them.

Other states have passed similar requirements, which has led to the closure of numerous clinics in states such as Texas and Ohio.

In March, a 5th Circuit panel upheld the Texas law, finding that it did not endanger women's health. The number of abortion clinics operating in Texas has dropped by half over the past year.

With today's ruling, the judges signaled that while closing many clinics is OK, a law that forces the closure of a state's very last clinic is not.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

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