“Alicia Hart has worked as an emergency physician in South Texas for ten years, and has seen a stream of migrant children from Guatemala and Honduras come to the U.S. fleeing gang violence…
But then the Trump Administration began to enforce a “zero tolerance” approach toward migrants arriving at the U.S.-Mexico border, a move that included separating parents from their children…
Last week, on a day when Hart was on duty, the charge nurse called her over to examine a child who needed clearance for psychiatric treatment.
“The boy had been in custody for over a month. One of his guardians told me that he had been ‘acting out’ and threatening to harm himself, by jumping from his bed. This man told me, ‘I’m his clinician,’ but he was definitely not a doctor. I don’t know if he’s a social worker, a medical assistant, a housekeeper. I have no clue…
“This boy seemed devastated—quiet and withdrawn. He barely spoke. I asked if he needed a hug. I kneeled down in front of the recliner, and this kid just threw himself into my arms and didn’t let go. He cried and I cried…
“I referred the boy to an inpatient psychiatric unit for treatment. I worry that he may be treated with psychiatric drugs like antipsychotics, also without the consent of his parents. But I still believe that psychiatric hospitalization is our best option. If we get these kids to the psychiatrists, at least they’re in a protective unit, away from these detention facilities, and they will get some of the counselling they need, because they’ve been through a tremendous trauma.”

to read the full New Yorker article highlight and click on
A Physician in South Texas on an Unnerving Encounter with an Eight-Year-Old Boy in Immigration Detention, by Amanda Schaffer, https://www.newyorker.com/news/as-told-to/a-physician-in-south-texas-on-an-unnerving-encounter-with-an-eight-year-old-boy-in-immigration-detention

…and no new cases of the disease have been confirmed since the last known sufferer died on 9 June, the World Health Organisation said on Wednesday.
The UN health body said it viewed the situation with “cautious optimism”, despite the difficulty of tracking down people who may have been exposed to the deadly virus in remote forests close to the Congo River.
The outbreak has killed 28 people since early April.
“Slightly over a month into the response, further spread of EVD (Ebola virus disease) has largely been contained,” the organisation said in a report.
The outbreak triggered particular concern because it occurred in a remote north-western area that was hard to reach but close to the Congo River, causing fears it could take root in a neighbouring city or spread to the capital Kinshasa, a city of more than 10 million people.
There were also fears that river transport could help the virus spread to the neighbouring Central African Republic and the Republic of Congo.
This outbreak is Congo’s ninth, but the first to be countered with a “ring vaccination” strategy, where all contacts of known patients are vaccinated to try and stop the spread…
“If no new cases are reported, the last contacts of the known confirmed or probable cases will complete follow-up on 27 June 2018.”..
An Ebola outbreak is normally declared over once 42 days have passed since blood samples from the last confirmed case tests negative for the second time.” (A)

(A) WHO: Ebola outbreak in DRC ‘largely contained’, http://ewn.co.za/2018/06/20/who-ebola-outbreak-in-drc-largely-contained

The recent separation of some 2,300 migrant children from their families under the Trump administration’s “zero tolerance” policy on illegal border crossers has thrust this invisible industry into the spotlight in recent weeks, as images of toddlers and teenagers taken from their parents and detained behind locked doors have set off a political firestorm. President Trump’s order on Wednesday calling for migrant families to be detained together likely means millions more in contracts for private shelter operators, construction companies and defense contractors.

A small network of private prison companies already is operating family detention centers in Texas and Pennsylvania, and those facilities are likely to expand under the new presidential directive, should it stand up to legal review, analysts said.

The range of contractors working in the migrant-shelter industry varies widely.

BCFS, a global network of nonprofit groups, has received at least $179 million in federal contracts since 2015 under the government’s so-called unaccompanied alien children program, designed to handle migrant youths who arrive in the country without a parent or other family member. Many of the contractors, some of which are religiously affiliated organizations and emergency-management agencies such as Catholic Charities, see their work as humanitarian aid to some of the most vulnerable children in the world.

But several large defense contractors and security firms are also building a presence in the system, including General Dynamics, the global aerospace and defense company, and MVM Inc., which until 2008 contracted with the government to supply guards in Iraq. MVM recently put up job postings seeking “bilingual travel youth care workers” in the McAllen area of South Texas. It described the jobs as providing care to immigrant children “while you are accompanying them on domestic flights and via ground transportation to shelters all over the country.”..
The shelters’ rush to house, and cash in on, the surge of children has made them a new target for Democrats, immigrant advocates and a vocal chorus of local, state and federal officials and community leaders…

Some have raised concerns that the rush to expand will make it difficult to properly manage the housing and care of infants, toddlers and teenagers, all of whom have a host of complex emotional, health and legal issues. In recent years, a number of migrant youth shelters have run into problems unseen by the public: fire-code violations, lawsuits claiming abuse, and complaints from employees alleging wrongful termination and unpaid wages.

To read the full article, The Billion-Dollar Business of Operating Shelters for Migrant Children, by Manny Fernandez and Katie Benner, highlight and click on https://www.nytimes.com/2018/06/21/us/migrant-shelters-border-crossing.html

The president of the American Academy of Pediatrics on Monday said President Trump’s “zero tolerance” policy separating families at the U.S.-Mexico border “amounts to child abuse.”
“I can’t describe to you the room I was in with the toddlers,” Kraft said. “Normally toddlers are rambunctious and running around. We had one child just screaming and crying, and the others were really silent. And this is not normal activity or brain development with these children.”
Kraft stated that Trump’s policy amounts to “government-sanctioned child abuse” when asked by CNN host Kate Bolduan, saying that the U.S. government is taking away the one constant in these children’s lives. “ (A)

“…the Trump administration’s policy (is) to forcibly remove children from parents caught trying to enter the U.S. illegally as they are seeking asylum from violence, presumably to deter people from entering the country illegally.
Their children, including babies and toddlers, are then labeled “unaccompanied alien children” (a phrase never intended to be applied to children who could not yet walk) and placed in the custody of the Office of Refugee Resettlement (ORR)…
Many of these families are fleeing trauma and violence in their home countries, only to be faced with the new trauma we have inflicted through forcible separation. The impact of these traumas on young children and their developing brains is real. Trauma is different from the typical stressors children experience in their normal daily life; those are the healthy stresses from which children learn and grow.
This trauma, the trauma of being forcibly separated from a parent by strangers and then transported to other strangers for prolonged periods of time, is different. This kind of trauma overwhelms the body. It causes feelings of terror and helplessness. Stress hormones flood the body.
Without the nurturance and calming support of a caring adult who is known to the child, these traumas can alter the structure of the developing brain. Long term, we know that this toxic level of stress can affect other organ systems, leading to long term adverse health outcome such as mental illness, substance abuse, cardiovascular disease, and premature death…” (B)

“Pamela Florian is an attorney at the Florence Immigrant and Refugee Rights Project, a nonprofit that provides free legal services to immigrants who have been detained in Arizona
“Our social-services program trains us to understand biological and brain development. We really focus on trauma-informed interviewing, so we don’t traumatize the children any more than they are. We talk about stress reactions, and how to work specifically with different age groups. We also get ethics training for working with kids, and we take into consideration cultural differences. If the child is younger, we see that he or she may speak a different language, and we try to figure out what it is so that we can call an interpreter. There are children who speak indigenous languages, so we can’t assume that everyone speaks Spanish.” (C)

“A report from the New York Times over the weekend highlighted another layer of the situation: the fact that some immigrant parents are being deported without being able to recover their children first. They try to cross the border, are separated, and then are sent back to their home countries without their children.
The Times highlights the story of Elsa Johana Ortiz Enriquez, a Guatemalan woman who tried to enter the country with her 8-year-old son, Anthony. The 25-year-old Ortiz was sent back to Guatemala, but her son is still in the US. Immigration officials say this isn’t supposed to happen, but apparently, it does. And then parents only have two options, per the Times:
They can have a family member who is living in the United States take sponsorship and custody of the child, or the child can be flown home and delivered into the custody of the authorities in the parent’s home country — and from there to the parent.
Parents are given a hotline to try to find their kids.” (D)

“The Trump administration has created a policy that is abusive to children and intentional in its cruelty. It is using this assault on a defenseless population as leverage against parents seeking to enter the U.S. without documentation. More than 1,500 boys are being held in a detention center in Texas. Other children have been placed into foster care while their parents are incarcerated hundreds of miles away.
Being wrenched from parents is every child’s worst nightmare. In addition to being traumatized by a forced separation, these children are at risk for further abuse and exploitation as the government ward system is imperfect in protecting children. This policy inflicts psychological injury on children, and its malicious intent may lessen the provision of compassionate treatment by those holding these children.
What is even more disturbing to me is that these family separations are occurring in full public view, as if they are done with honor or pride instead of with shame. Such brazen and unflinching cruelty against a highly vulnerable group — immigrant children — suggests that any group could be a target for unjust and cruel treatment by our government.” (E)

(A) American Academy of Pediatrics president: Trump family separation policy is ‘child abuse’, by JUSTIN WISE, http://thehill.com/latino/392790-american-academy-of-pediatrics-president-trumps-family-separation-policy-is-child
(B) Toxic effects of stress on children separated from parents, by DEBORAH GROSS, ELLEN OLSHANSKY AND SARAH OERTHER, http://thehill.com/opinion/immigration/392724-toxic-effects-of-stress-on-children-separated-from-parents
(C) An Immigration Attorney on What It’s Like to Represent Small Children Taken from Their Parents, by Alexandra Schwartz, https://www.newyorker.com/news/as-told-to/an-immigration-attorney-on-what-its-like-to-represent-small-children-taken-from-their-parents
(D) The past 72 hours in outrage over Trump’s immigrant family separation policy, explained, by Emily Stewart, https://www.vox.com/2018/6/18/17475292/family-separation-border-immigration-policy-trump
(E) Separating families at the border isn’t just bad policy — it’s horrible for children’s health, by OSCAR J. BENAVIDEZ, https://www.statnews.com/2018/06/19/separating-families-border-children-health/?utm_source=STAT+Newsletters&utm_campaign=641b1008a8-Daily_Recap&utm_medium=email&utm_term=0_8cab1d7961-641b1008a8-149527969

“Over the last year, as a result of a new policy established by top officials in the Trump administration, U.S. Customs and Border Protection has separated at least hundreds—and possibly thousands—of families at the border with Mexico who are seeking asylum in the United States…
Our field recognizes the importance of avoiding Adverse Childhood Experiences for the healthy growth and development of children. Trauma early in life contributes to a broad range of serious health outcomes, including social impairment, disease and disability, and early death. The harsh treatment of children at the border will affect their health and their lives for many years to come. The trauma to their parents is also devastating, and the lasting consequences to thousands of families will be profound.
These family separations violate the most widely ratified of all human rights conventions, the Convention on the Rights of the Child. Last week, the human rights office of the United Nations objected to forced separations at the U.S. border, stating “the use of immigration detention and family separation as a deterrent runs counter to human rights standards and principles,” and “there is nothing normal about detaining children.” “ (A)

“Studies overwhelmingly demonstrate the irreparable harm caused by breaking up families. Prolonged exposure to highly stressful situations — known as toxic stress — can disrupt a child’s brain architecture and affect his or her short- and long-term health. A parent or a known caregiver’s role is to mitigate these dangers. When robbed of that buffer, children are susceptible to learning deficits and chronic conditions such as depression, post-traumatic stress disorder and even heart disease. The government’s practice of separating children from their parents at the border counteracts every science-based recommendation I have ever made to families who seek to build, and not harm, their children’s intellectual and emotional development.
These parents are given two untenable options. They can return with their children to their home country and the conditions that forced them to flee in the first place. Or they can endure being detained sometimes halfway across the country from their children. Contact is often limited. The separation makes it hard for parents to provide support for the child’s asylum request. In some cases, parents have been deported, leaving a child behind in government custody.” (B)

“As public health professionals we know that children living without their parents face immediate and long-term health consequences. Risks include the acute mental trauma of separation, the loss of critical health information that only parents would know about their children’s health status, and in the case of breastfeeding children, the significant loss of maternal child bonding essential for normal development. Parents’ health would also be affected by this unjust separation.
“More alarming is the interruption of these children’s chance at achieving a stable childhood. Decades of public health research have shown that family structure, stability and environment are key social determinants of a child’s and a community’s health.
“Furthermore, this practice places children at heightened risk of experiencing adverse childhood events and trauma, which research has definitively linked to poorer long-term health. Negative outcomes associated with adverse childhood events include some of society’s most intractable health issues: alcoholism, substance misuse, depression, suicide, poor physical health and obesity.
“There is no law requiring the separation of parents and children at the border. This policy violates fundamental human rights. We urge the administration to immediately stop the practice of separating immigrant children and parents and ensure those who have been separated are rapidly reunited, to ensure the health and well-being of these children.”” (C)

“In 1997, the government settled a class-action suit brought by unaccompanied minors against INS. That case, Flores v. Reno, established three mandates for the government’s handling of unaccompanied minors. First, that detention should be as brief as possible, with immediate efforts being taken to find a parent, relative or qualified adult with whom the children could live. Second, that children should be treated with dignity and respect that recognized the vulnerabilities that accompany childhood. And, third, that the detention should be in the least restrictive facility possible — a facility less like a jail than a day care….
Flores “doesn’t come close to saying what the administration says it says,” Motomura said. There have always been some criminal prosecutions for people who are crossing the border illegally, he added. “I just never heard that this resulted in a blanket policy of family separation in this way.”
“The reality is, even though theoretically they have the authority to do that, through the immigration laws, to prosecute the parent, in the past that was truly the exception to the rule,” Young said. “The administration stating that they’re required to do this law flies in the face of a long-standing history of treating families like families and recognizing that the children, whether attached to a family or arriving unaccompanied, have particular vulnerabilities that need to be addressed.”..
Young blamed the administration directly. “They are imploding the system themselves,” she said. “It doesn’t have to happen.” (D)

“The use of criminal charges against parents caught crossing the border triggers a legal situation that necessitates separating children, while the use of civil immigration detention and removal does not require this to occur. When adults are detained and prosecuted in the criminal justice system for immigration offenses, their children cannot, by law, be housed with them in criminal jails, so the family unit is separated. The children are placed with the Department of Health and Human Services in shelters until they can be released to a family member, guardian, or foster family in the United States.
Previous administrations used family detention facilities, allowing the whole family to stay together while awaiting their deportation case in immigration court, or alternatives to detention, which required families to be tracked but released from custody to await their court date. Some children may have been separated from the adults they entered with, in cases where the family relationship could not be established, child trafficking was suspected, or there were not sufficient family detention facilities available. Both the Obama and Trump administrations have tried to establish more capacity to detain families and children, rather than releasing them until their hearing date. However, the zero-tolerance policy is the first time that a policy resulting in separation is being applied across the board.” (E)

(A) Separating Families at U.S. Borders is a Public Health Issue, by Ellen J. MacKenzie et al, https://www.jhsph.edu/about/dean-mackenzie/news/separating-families-at-us-borders-is-a-public-health-issue.html
(B) Separating parents from their kids at the border contradicts everything we know about children’s welfare, by Colleen Kraft, www.latimes.com/opinion/op-ed/la-oe-kraft-border-separation-suit-20180503-story.html
(C) Separating parents and children at US border is inhumane and sets the stage for a public health crisis, https://www.apha.org/news-and-media/news-releases/apha-news-releases/2018/parent-child-separation
(D) Why the Trump administration bears the blame for separating children from their families at the border, by Philip Bump, https://www.washingtonpost.com/news/politics/wp/2018/06/15/why-the-trump-administration-bears-the-blame-for-separating-children-from-their-families-at-the-border/?noredirect=on&utm_term=.1144174165f2
(E) Why Are families Being Separated at the Border? An Explainer, by Tim O’Shea, Theresa Cardinal Brown, https://bipartisanpolicy.org/blog/why-are-families-being-separated-at-the-border-an-explainer/

“A statement late Friday said the confirmed cases are in Mbandaka city, where a single case was confirmed earlier in the week.
There are now 17 confirmed Ebola cases in this outbreak, including one death, plus 21 probable cases and five suspected ones.
Three new cases of the often lethal Ebola virus have been confirmed in a city of more than 1 million people, Congo’s health minister announced, as the spread of the hemorrhagic fever in an urban area raised alarm.
The statement late Friday said the confirmed cases are in Mbandaka city, where a single case was confirmed earlier in the week.
There are now 17 confirmed Ebola cases in this outbreak, including one death, plus 21 probable cases and five suspected ones. It was not immediately clear what link the new cases might have to others…
Health officials are trying to track down more than 500 people who have been in contact with those feared infected, a task that became more urgent with the spread to Mbandaka, which lies on the Congo River, a busy traffic corridor, and is an hour’s flight from the capital.” (A)

“The next global plague is coming…
The big picture: The total number of outbreaks every 10 years “has more than tripled since the 1980s,” Yong says. Bill Gates told Yong that if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days.
“Boy, do we not have our act together.” — Bill Gates…
Preparing and confronting a pandemic relies on multiple moving parts, from the doctors to the nurses, appropriate hospital isolation for infected patients, vaccine delivery, Congress appropriation, and more. The director of the National Institute of Allergy and Infectious Diseases, Anthony Fauci, told Yong: “It’s like a chain—one weak link and the whole thing falls apart. You need no weak links.”” (B)

Although Chattanooga’s health care systems have never treated anyone for Ebola virus, Africa’s latest outbreak is a reminder that in today’s world, emerging infectious diseases are only a plane ride away.
In the event that a rare, deadly pathogen should strike the region, there’s a network of behind-the-scenes health care professionals — hospital workers, emergency medical services providers, health department staff — trained and prepared to handle the situation. They also know that there’s risk involved…
Following the 2014 Ebola outbreak in West Africa, the United States government sought to beef up the nation’s ability to respond and treat patients infected with Ebola and other emerging infectious diseases in the event they traveled into the country.
Every hospital in Tennessee became a “front-line” facility, and six hospitals around the state — one of which is Erlanger’s main campus — were chosen as assessment facilities, meaning the hospital would provide the first 96 hours of supportive care to patients with suspicious symptoms and diagnose the illness through screening and lab tests. If test results are positive, EMS would transport the patient to a treatment facility in Atlanta.”
Dr. Jay Sizemore, an infectious diseases specialist and medical consultant for the team, said the first step is to know current pathogen activity around the world and where and when the patient traveled. (C)

(A) Congo says 3 new Ebola cases confirmed in large city, https://www.cnbc.com/2018/05/19/congo-says-3-new-ebola-cases-confirmed-in-large-city.html
(B) What we’re reading: U.S. is unprepared for a global plague, by Haley Britzky, https://www.axios.com/america-unprepared-global-plague-pandemic-cfd85278-eea5-49e2-a6f1-58e76ee34171.html
(C) Should Ebola or another infectious disease strike Chattanooga, a team of health care professionals is ready, http://www.timesfreepress.com/news/local/story/2018/jun/17/should-ebolor-another-infectious-disease-stri/473216/