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For Some, Wheeling-Ohio County Health Department Needle Exchange Program Is a Lifeline | News, Sports, Jobs

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Photo by Nora Edinger
A long-term user of both street drugs and the needle exchange program operated by the Wheeling-Ohio County Health Department to combat disease spread, Amy Smith (not her real name) said she has been clean since a health crisis last winter.

Editor’s Note: Like all needle exchange programs in West Virginia, a program operated by the Wheeling-Ohio County Health Department is on uncertain ground given a new state law that tightens the operation of and access to such efforts to contain diseases spread by intravenous drug use. Politicians and healthcare providers have had much to say, pro and con. Below is a glimpse into the world of a woman dealing with IV drug addiction and trying to stay alive.

WHEELING — Amy Smith could be any other midlife woman in the city. Shortish red hair, dark-framed glasses, a pink T-shirt whose neckline is accented with a corded necklace, a bit of sunburn on her legs.

But, she isn’t.

Smith (not her real name) is addicted to street drugs. And, until going clean this winter after a health crisis, she was using the Wheeling-Ohio County Health Department’s needle-exchange program.

Her participation was initially about cost, she said. Street drugs are pricey. Needles are, too. Her first packet — which she used to inject methamphetamine 10 to 20 times a week — came from a diabetic acquaintance.

When those ran out, she turned to the needle exchange. “You had to turn in 10 to get 10. If you had eight, you got eight. No extras.”

Engaging in that kind of economy soon also became about keeping an already tough life from getting even tougher, she said. Smith fears needle-borne exposure to HIV. She has already contracted hepatitis C through sharing needles and will begin treatment this summer.

“That scares me. I know someone who had it and didn’t get treated and died,” Smith said during a May interview at Laughlin Memorial Chapel.

She and a small group of other women living on the paper-thin edges of Wheeling society were there for a weekly respite from street life called Blossoms.

Such programs have been a lifeline for Smith, who had a heart attack and pneumonia in early winter and made the decision to go clean.

“I’m alive. I was half dead,” she said of this time of transition.

That difference matters to Smith, 46, even though she danced with death — smoking, snorting or injecting drugs like meth and crack cocaine — on and off for 25 years.

“My daughter is having my first grandbaby — it’s a girl,” said Smith, who has three adult children in her home state of Mississippi. “I’d always told them to wait until I’m at least 50 to make me a grandmother. But, I’ve been asking them about it recently. I said, ‘I’m 50 if you round it off.’”

Smith was planning a bus trip and a month-long stay to see her first grandchild. But, she said she intends to return to Wheeling — even though the apartment she has been staying in for the last three months will no longer be available and she will likely return to the streets.

“I love it here. It’s beautiful. The people are nice. This is home for me,” Smith said of choosing the Mountain State regardless of her precarious residency.

She came here eight years ago to be with a man she met on the internet.

“I was clean when I moved up here, but the guy that I was with was a drug addict. He kept it undercover for a while, but that’s what he was. I started smoking crack again.”

Three or four years ago, she switched to meth. “I smoked it. I snorted it. Then, I started injecting it. I liked the injecting better than I did the smoking and snorting because of the rush.”

That guy is gone from her life, but she remained in Wheeling throughout it all.

“I’ve been in apartments. I’ve been homeless. I’m homeless now, but I’m living with somebody. I still consider myself homeless, but I’m in a home. I’m not sleeping on the streets.”

Street life isn’t easy, she noted, especially for someone battling drug addiction.

“I’ve seen people take needles off the ground outside and use them. I haven’t done that, but I’ve seen it done.” Other times, people share needles. She has done this. Or, they try to clean needles that have already been used.

Knowing that disease-free needles are available was a relief — although she hopes to never need them again.

“It’s like they don’t judge you. They don’t belittle you or anything,” she said of the exchange. “It needs to be there because; people that are using, they’re going to keep on using.”

She doesn’t want to be one of them. One leg jiggles just talking about it. But, she said that “want to” is what it takes.

“I can do it by myself,” she said of her access to drug rehab running out after a single week. “You’ve got to want to get off drugs and I want to get off drugs.

“People don’t understand,” Smith said of succumbing to drugs in the first place and now struggling to get free. “Don’t judge me. God can only judge me. Don’t judge someone, because you’ve never been in their shoes.”



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COVID-19 and beyond: Health minister Horowitz’s top five challenges

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Israel’s new health minister is inheriting a sick country that needs a lot of healing, despite the low number of daily COVID-19 cases.

MK Nitzan Horowitz (Meretz) will be sworn in as health minister if the government passes a confidence vote in the Knesset on Sunday. He is not a medical professional, but he has spent the last two decades engaged in social justice efforts, from fighting for foreign workers to serving as a board member of the Association for Civil Rights in Israel.

Horowitz is inheriting a ministry that suffered through a nearly year-and-a-half battle against a global pandemic that was intensely politicized by Prime Minister Benjamin Netanyahu.

He is also taking over against the backdrop of a number of fraud schemes that center around his ministry.

Last week it was reported that two top advisers of former health minister MK Ya’acov Litzman are being probed for conspiring to influence government policy in health sector issues such as food in exchange for bribes. 

Litzman is also under investigation himself for two offenses during his tenure: one that involved his meeting with Jerusalem’s district psychiatrist to pressure him into issuing a false assessment for accused sex offender Malka Leifer and the other for trying to influence inspectors to reopen a restaurant that failed a health inspection.

Horowitz’s job will be to maintain the low number of daily COVID cases while moving beyond the pandemic to other issues plaguing Israel’s healthcare system, and to gain back the trust of the Israeli public in the system.

“The things that he will need to deal with will require out-of-the-box thinking and major reforms,” Prof. Dan Ben-David, president and founder of the Shoresh Institution for Socioeconomic Research, told The Jerusalem Post. “I hope that he has the requisite sense of humility required to know that he should surround himself with some of the top people in the field.”

These should be the next health minister’s top five priorities:

1 – Mental Health

Mental illness – mainly but not only depression – is among the fastest growing health challenges for the State of Israel.

A recent survey published by Tel Aviv University researchers found that the level of personal resilience experienced by Israelis hit a two-year low during the recent Gaza escalation.

The researchers measured resilience on a scale of one (lowest) to five (strongest). In 2018, Israelis’ level of resilience was 4.68. At the height of the pandemic in October 2020, it fell to 4.28. In January 2021, during the third wave, it dropped to 3.48. And during the recent Gaza operation it plummeted to 2.47.

The data is “very concerning” and even “dangerous,” the study’s lead researcher Dr. Bruria Adini told the Post.

Israel still lacks services for and understanding of mental health issues, said Prof. Hagai Levine, former chairman of the Association of Public Health Physicians.

“We treated the COVID-19 pandemic well with the vaccines, but now we have some seriously traumatized people,” Levine told the Post.

He said there has been an increase in people coming to their family physicians for other causes that are rooted in stress and depression.

“There is a connection between mental and physical health,” he said. 

Coalition agreements have indicated that the new government plans to add psychological services for the public – an important first step if it is implemented.

At the same time, the government should specifically focus on the mental health needs of healthcare workers after coronavirus, the Meron tragedy and the latest war – all of which struck within less than two years.  

“Healthcare workers need to be mentally well to care for the population,” Levine said.

2 – COVID-19 Surveillance

While Israel was among the first countries to come out of the coronavirus crisis, vaccinating close to 5.5 million Israelis and thereby opening up its economy, health experts understand that the pandemic is not over yet.

With hundreds of thousands of new daily coronavirus cases worldwide, Israel is still vulnerable to vaccine-resistant COVID variants that could enter the country through Ben-Gurion Airport.

In general, the Health Ministry has maintained a tight and effective closure on the border since the third wave. Any unvaccinated Israelis or Israelis returning from countries with high infection must quarantine on arrival for a minimum of 10 days. And all passengers are required to take a PCR-grade coronavirus test before boarding and upon arrival.

Minimal group of vaccinated tourists have been entering Israel since last month. An announcement by the Tourism and Interior ministries last week indicated that individual vaccinated tourists will be able to enter beginning as early as July 1. It will be the new health minister’s job to test and confirm that these travelers are COVID-free during their time in Israel. 

Earlier this month, a group of 16 olim (new immigrants) from India who maintained they tested negative for COVID in their hometown were found to have had the virus on arrival. Surveillance caught the infected immigrants and they were put into state-run COVID hotels until they recovered. Strict screening protocols must be maintained.

At the same time, health officials must keep tabs on what is happening inside the country. Israel must find a way to maintain a minimum number of daily tests to catch outbreaks before they start.

Ben-David suggested that serological testing could be offered to patients undergoing routine bloodwork, for example. Or PCR testing could become part of one’s annual checkup.

3 – Healthcare Workers

The Israeli healthcare system entered the COVID-19 crisis in a starved condition, forcing Israel to enter three lockdowns for fear that the hospitals would collapse under the strain of so many seriously sick individuals.

That is because the country does not have enough doctors, nurses, technicians or even aides.

Israel has one of the worst nurse-to-population ratios, with five nurses per 1,000 people – a figure that is significantly lower than the Organization for Economic Cooperation and Development (OECD) average of 8.8 – and the number of nursing school graduates is also low, meaning there is little expectation for growth.

When it comes to physicians, Israel has only slightly less doctors per capita than the average OECD country. However, that is primarily because of the huge influx of new MDs in the 1990s from the former Soviet Union – and these doctors are aging.

While doctors over the age of 75 make up only 1% of the entire workforce in OECD countries, in Israel they make up more than 10%, Ben-David explained. And, like nursing students, Israel is at the bottom of the OECD in terms of the number of new medical school graduates.

During the coronavirus crisis, Health Minister Yuli Edelstein added around 2,000 new positions, but the financing was done via extra-budgetary payments earmarked for the virus and the positions were meant to expire on June 30.

A decision was made to extend the positions until a new government was formed and the next budget was prepared, making it the responsibility of the new health minister to fight for those roles.

Furthermore, Israel’s hospital residents work untenable 26-hour shifts – a situation that hospital heads say has to change.

4 – Infrastructure

The issue of infrastructure is vital, as the number of hospital beds per capita has been plummeting for decades, leaving Israel with the highest hospital congestion rate in the developing world. This leads to a deficient level of care, despite the high professionalism of the staff.  

“We have this dichotomy: Very good physicians and nursing staff that qualitatively speaking are the best in the world, working in a system that in some cases is not part of the developed world,” Ben-David said.

And people being treated in hospital corridors leads to unnecessary infections.

Israel went into this pandemic with the highest number by far of people dying from infectious disease per capita in the developed world – 73% more than No. 2, Greece.

A March 2020 state comptroller report highlighted Israel’s lack of a detailed program to close identified gaps in the healthcare system – including intensive care beds and equipment.

As a new state budget is set to be approved for the first time since March 2018, it is essential that the health minister works closely with the finance minister to obtain the needed money.

At the same time, Horowitz should strive to run his ministry more efficiently by providing hospitals and health funds with a greater sense of control and accountability, implementing new modes of measurement and evaluations for success.  

“The health system often takes a Band-Aid approach or is extinguishing fires all the time,” Levine said. “The system needs more long-term planning and execution.”

5 – An Aging Population

While Israel is young compared to OECD countries, its people are rapidly aging – and the Health Ministry has not prepared for this new reality.

The number of elderly in Israel is expected to reach 1.66 million by 2035, according to projections by the Central Bureau of Statistics – an increase of 77% between 2015 and 2035, which is “going to be a huge drain on the health system,” Ben-David said.

Health officials need to shift their focus to finding better solutions for elder care, both in nursing homes and through in-home care. This could include telemedicine and digital monitoring programs that could save money and keep the elderly safe.

“Health is one of the most important aspects that determines quality of life,” Ben-David said. “The COVID-19 pandemic showed the deficiencies of our country’s health system. No one can claim it isn’t broken – it is.”

The question now is whether Horowitz will take the steps needed to fix it.

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New Montana laws enshrine health care alternatives, for better or worse | Health

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When Paul Rana’s primary care physician left the VA clinic in Kalispell to open her own practice, he followed her. But instead of picking up a new health insurance policy, Rana and his partner agreed to pay a monthly fee that came with the promise of better access.

Their provider, Dr. Lexi Tabor-Manaker, opened Glacier Direct Primary Care clinic in 2018. The model known as DPC, which can also stand for direct patient care, furnishes basic health care to patients for a set fee, often billed monthly like a subscription. The arrangement offers patients unlimited access to their doctors and allows them to communicate by phone or email. But the costs are all out-of-pocket.

“We have been pleased to be able to communicate with her instantly without going through an administrative gauntlet,” as he might with the Department of Veterans Affairs, Rana said.

Direct primary care practices have been emerging around the country, but they are often criticized for not offering the patient safeguards of traditional insurance. State legislators this year, however, sought to preserve the approach and passed two new laws that prohibit direct primary care practices or health care sharing ministries — religious or ethical groups whose members pool money to cover medical costs — from being regulated as insurance.

Such arrangements, according to supporters, afford greater flexibility and lower costs for health care compared with traditional health insurance. Without these laws, “a future commissioner of insurance may deem them to be insurance and require them to come under the health insurance regulatory scheme, thus destroying their value and defining characteristics,” said Sen. Tom McGillvray (R-Billings), sponsor of the bill on health care sharing ministries.

Lack of regulation comes with risks. Patients in direct primary care and health care sharing ministries mostly miss out on consumer protections mandated by the Affordable Care Act, such as coverage of preexisting conditions and prohibitions against charging more based on gender.

In Montana, a pastor filed a lawsuit in 2007 after Medi-Share refused to pay for expenses for a member’s heart condition. A state judge ruled the group was selling insurance without registering in the state, effectively banning health care sharing ministries. That changed in 2017 when Matthew Rosendale, then insurance commissioner, declared the programs weren’t health insurance and could operate in the state.

McGillvray’s bill cements Rosendale’s ruling into state law.

Eight direct primary care facilities operate in Montana with out-of-pocket fees that typically range from $70 to $120 per month for an adult, according to DPC Frontier.

Supporters of direct primary care said the model lets doctors spend more time with patients. Physicians told lawmakers that when working with traditional insurance plans they might spend a significant chunk of their days on administrative tasks instead of patient care, according to Sen. Cary Smith (R-Billings), sponsor of the direct primary care bill.

That bill allows for any form of health care practice — therapists, dentists, physical therapists, etc. — to operate under the direct primary care model.

Direct primary care agreements don’t cover hospital visits, prescription drugs, surgery or specialized care, such as cancer treatment. Providers and supporters recommend people sign up for health insurance to cover those costs.

Another criticism, one leveled by traditional health insurers, is that the monthly fee often doesn’t save people money. Patients would have to go to the doctor several times a year to make the direct primary care monthly payments worthwhile, and people usually don’t make that many visits, said Richard Miltenberger, CEO of Mountain Health Co-Op, a nonprofit health insurance cooperative that sells health insurance in Montana, Idaho and Wyoming.

“So, it’s actually often, for many consumers, more cost-effective to just pay for the service [that isn’t covered by insurance] when you utilize it, as you utilize it, as opposed to paying a monthly membership fee,” Miltenberger said.

Rana, a retired Army veteran who lives in Woods Bay, doesn’t fully depend on direct primary care for his health care. He still uses the VA clinic for regular checkups. He also has Medicare and Tricare — a health program for military members and their families — for larger procedures he gets outside of the VA, such as when he had knee surgery in 2020.

But his first stop when he noticed something wrong with his knee was with Tabor-Manaker, who saw him quickly and referred him to a specialist. That makes the expense worth it, he said.

“I knew going in that this was all out-of-pocket for me, and I accepted that because the quality of service is far greater in its value to me than the hundred bucks a month,” Rana said.

To see what else is happening in Gallatin County subscribe to the online paper.

KHN{span} (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at {/span}KFF{span} (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.{/span}

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Vaccine clinic at East Bluff Heartland Health Services gives an incentive to get vaccinated

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PEORIA, Ill. (WMBD) — The East Bluff Heartland Health Services administered vaccines and addressed vaccine hesitancy at their first vaccine clinic on Saturday, June 12.

Partnering with Blue Cross Blue Shield, leaders at the event provided vaccines, medical information, and food boxes from Peoria Area Foodbank and Midwest Foodbank.

Michelle Sanders, Director of Development and Marketing at Heartland Health Services, said the event is one way to educate people about COVID-19 vaccines and the virus in their community.

“We had a lot of people say you’re just trying to bribe us to get this shot,” Sanders said. “No, we just want to educate you, make you aware of what services are available, and let you know that Heartland is here.”

As an incentive to get vaccinated, every person who received a shot was entered to win a grill, grill set, and a free lunch.

Sanders said Heartland Health Services organization has vaccinated more than 1,000 people across Peoria since April.

She said they are ready to hold more events based on community needs.

To learn more about Heartland Health and vaccinations, visit their website.

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