Walmart Will Implement New Opioid Prescription Limits By End Of Summer

A pharmacist speaks with a customer at Walmart Neighborhood Market in Bentonville, Ark., in 2014. On Monday Walmart introduced a new set of guidelines for dispensing opioid medications.

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Sarah Bentham/AP

Walmart announced Monday it is introducing new restrictions on how it will fill opioid medication prescriptions in all of its in-store and Sam’s Club pharmacies.

It is the company’s latest expansion of its Opioid Stewardship Initiative, intended to stem the spread of opioid addiction, prevent overdoses and curb over-prescribing by doctors. It follows a similar initiative by CVS that went into effect in February.

A March report by the Centers for Disease Control and Prevention found overdoses from opioids soared by nearly 30 percent between 2016 and 2017.

“We are proud to implement these policies and initiatives as we work to create solutions that address this critical issue facing the patients and communities we serve,” Marybeth Hays, executive vice president of Health & Wellness and Consumables said in a statement.

Over the next 60 days, the fourth-largest pharmacy chain will cap acute painkiller supplies to cover a maximum of seven days. It will also limit a day’s total dose to no more than the equivalent of 50 morphine milligrams. And, in states where prescriptions are restricted to fewer than seven days, Walmart will abide by the governing law.

Walmart said the new policies align with the Centers for Disease Control and Prevention recommendations established in 2016. Those rules were meant for doctors prescribing chronic pain medication and encourage primary care physicians to prescribe the “lowest effective dose.”

By the end of Aug. 2018, the company said its pharmacists will begin using NarxCare, a controlled-substance tracking tool with “real-time interstate visibility.”

Pharmacies will also carry naloxone, an opioid overdose antidote that has become instrumental in helping to decrease overdose deaths. The life-saving medicine will be offered over the counter, dispensed upon request, wherever it is legal.

As NPR has reported, “The medicine is now available at retail pharmacies in most states without a prescription.” Retail sales of naloxone, more commonly known by the popular brand name, Narcan, increased by tenfold between 2013 and 2015.

Dr. Steven Stanos, former president of the the American Academy of Pain Medicine told NPR the organization applauds “any action that seeks to limit the over-prescription of opioids.” But, he added, “That needs to be balanced with the very real need of patients.”

“Setting a mandatory limit without giving physicians the ability to explain why a patient might need a longer prescription, interferes with the relationship between that person and their physician, who knows them better than the pharmacist,” Stanos said.

He also explained requiring patients to obtain a new prescription after seven, or sometimes even three days, depending on the state, can become too costly because of mandatory co-pays.

Another of the company’s changes going into effect on Jan. 1, 2020, is a requirement that all controlled-substance prescriptions be submitted electronically. According to Walmart: “E-prescriptions are proven to be less prone to errors, they cannot be altered or copied and are electronically trackable.”

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The Weinstein Co. Gets Court OK To Sell Itself To Lantern Capital Partners

Harvey Weinstein in 2013. His former movie studio got approval from a bankruptcy judge on Tuesday to sell itself.

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The Weinstein Co. has been cleared to sell its assets to Texas-based private equity firm Lantern Capital Partners.

That was the ruling from a federal bankruptcy court judge in Delaware today. The terms of the deal don’t offer a fund for the victims of alleged sexual abuses by the movie studio’s co-founder.

Here’s the backstory: After multiple allegations of sexual abuse against movie mogul Harvey Weinstein were reported last year, The Weinstein Co. board fired him and tried to right the ship. It didn’t help that even before the sex abuse scandal, the company was having trouble getting financing to make deals in the film and TV business.

So the studio tried to sell its assets. Those include a library of movies such as The King’s Speech and Silver Linings Playbook, along with TV shows like Project Runway.

It almost worked. An investor group led by former Obama administration official Maria Contreras-Sweet wanted to rebuild the company with a mostly female board, the employees of The Weinstein Co., and a fund for the alleged victims of Harvey Weinstein. The deal fell apart a few months ago after the buyers found what they called undisclosed liabilities.

In March, The Weinstein Co. filed for Chapter 11 bankruptcy and put its assets up for auction. The Texas-based private equity firm Lantern Capital Partners offered $310 million and the company accepted last week.

Problem is, it wasn’t a decision The Weinstein Co. could make on its own. The bankruptcy judge needed to agree. And there were plenty of objections — some from accusers of Harvey Weinstein, angry that Lantern Capital Partners did not provide a fund to compensate them (there is at least one class-action lawsuit against The Weinstein Co. by victims). A bid by Broadway producer and former Wall Street manager Howard Kagan, which includes a victims fund, was submitted but the company opted to stick with Lantern.

Musicians Jay-Z and Eminem also objected to any sale, saying the company still owed them some $800,000 plus rights to projects that were in development.

Now that the sale has been approved, it’s unclear what will happen to these loose threads. The only thing clear is that The Weinstein Company will soon no longer exist.

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Days, Weeks, Years? Scientists Say Hawaii's Erupting Volcano Has No End In Sight

Scientists say the lava from Kilauea’s new eruption may continue to flow for months or even years.

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The eruption at Hawaii’s Kilauea Volcano continues. The lava has now destroyed at least 35 structures and covered the equivalent of more than 75 football fields.

Scientists have been tracking this event since it started last week – but there are still big unanswered questions, the biggest of which is when this will end.

For more than 30 years, the Kilauea volcano on Hawaii’s Big Island has been erupting. Lava levels in the Pu’u ‘O’o crater and the volcano’s summit rose in recent weeks, says Wendy Stovall, a volcanologist with the U.S. Geological Survey. They were “inflating like a balloon, because magma was getting backed up from below,” she says.

Then last week, the magma at Pu’u ‘O’o plummeted. “The whole bottom of the crater floor dropped out and the magma completely drained away from that system,” says Stovall.

Scientists don’t know what started this latest event but there are two possibilities, says Stovall: “Either there’s an increase in magma supply, or something blocked the system, something blocked the pathway out of the system.”

In other words — suddenly more molten rock shot up from deep inside the Earth, or there was a clog. Whatever the cause, the pressurized magma has to go somewhere. It turned away from the crater, heading underground, flowing into spaces between the rocks along what’s known as the volcano’s East Rift Zone.

That set off a series of earthquakes, including a 6.9-magnitude temblor that hit on Friday and could be felt across the island. Stovall said that by tracking the earthquakes and deformations in the ground, they could see the direction the magma was heading.

“Honestly it was pretty frightening to see where the magma was going,” says Stovall. That’s because it was headed towards a lush residential area — Leilani Estates, where more than 1,700 people were ordered to evacuate. Video on social media shows lava gushing out, destroying homes and causing havoc.

Here’s why the lava rips apart the ground, according to Denison University volcanologist Erik Klemetti: “It’s like a leaky pipe or a burst pipe, where the magma is moving down the conduit system and it just reaches a point where the pressure builds enough that you start cracking the surface above.”

There are now at least 12 of these fissures in the ground as of Tuesday in and around Leilani Estates, according to Hawaii’s civil defense.

Scientists are tracking earthquakes and the composition of gas coming out of the cracks in the ground, which hints at whether the eruption will intensify. But what will happen longer term is much more difficult to predict, says Bill Chadwick, a volcanologist at NOAA.

“We can’t really peer through the ground and see it exactly in all its details and intricacies,” Chadwick says. Scientists can’t predict when this eruption will end. “It could last days, weeks, years. All that’s possible. It’s hard to say unfortunately.”

This makes it unique from other natural hazards like hurricanes or tornadoes, where there is a clear end point, Stovall says.

“Volcanoes will build up pressure, and then they’ll release that pressure in eruption, and then they’ll pause,” says Stovall. “And then they’ll build up pressure again and release the pressure in another eruption and then they’ll pause again.”

Stovall adds: “As long as there’s magma supplying the system we’re expecting more of the same to happen.”

May 6 overflight shows lava
from fissure 8 forming an ‘a‘ā flow in Leilani Estates Subdivision, lower East Rift Zone, Kilauea Volcano. https://t.co/UwcSKwXAMgpic.twitter.com/qh5mGsKZ4W

— USGS Volcanoes🌋 (@USGSVolcanoes) May 7, 2018

The uncertainty makes it extremely difficult for the residents of Leilani Estates to know what their future holds, which worries Klemetti.

“When a house today might look like it’s perfectly safe, it might get taken out by a lava flow five years from now if the eruption keeps on going,” he says.

At the same time, it provides what Stovall calls a once-in-a-lifetime research opportunity for scientists. “The things that we will learn in the wake of this eruption will change the way we see volcanoes for the future.”

Scientists are trying to gather as much data as possible, and she says that the information they obtain has the potential change their understanding of how this volcano functions.

And better understanding how it functions, Stovall says, could help keep neighboring communities safe in the future.

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'We Hope It All Works Out': Pompeo Pays Surprise Visit To North Korea For Talks

Secretary of State Mike Pompeo speaks during his swearing-in ceremony earlier this month, as President Trump and Vice President Mike Pence look on.

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President Trump closed the door on U.S. participation in the Iran nuclear deal Tuesday — but during the very same televised announcement, the president opened a window onto talks about another country’s nuclear program: Secretary of State Mike Pompeo is traveling to North Korea to discuss an expected summit between the two countries.

“He will be there very shortly,” Trump told reporters at the White House. “We have our meetings set. The location is picked. The time and date — everything is picked, and we look forward to having a very great success.”

The comments came just moments after he declared that the U.S. will withdraw from the multilateral agreement, signed in 2015, that aimed to restrict Iran’s nuclear ambitions in exchange for sanctions relief. Trump cited the fact that the deal allows Iran to continue work on its ballistic missile program and to continue funding groups the U.S. has deemed terrorists.

North Korea, which already possesses nuclear weapons, has grabbed headlines with frequent missile tests in recent years, even demonstrating a capacity to hit the mainland U.S. The U.S. and its allies, in turn, have responded with escalating sanctions intended to hobble North Korea’s economy.

But typically bellicose Pyongyang has softened its rhetoric since the start of the year, pledging efforts to negotiate a permanent peace treaty with South Korea and denuclearize the entire Korean Peninsula.

Pompeo made a secret visit to Kim last month, before the then-CIA director had been confirmed as secretary of state. At the time, Trump said “a good relationship was formed” between the two men.

In remarks to the media aboard his plane later Tuesday, Pompeo said the visit last month was “a limited diplomatic discussion” — one that he aims to build upon this time around. In particular, he added that the focus will rest both with building a framework for the likely summit between Trump and Kim and with setting expectations for negotiations.

“We are not going to do this in small increments, where the world is essentially coerced into relieving economic pressure. That won’t lead to the outcome that I know Kim Jong Un wants and I know President Trump is demanding,” Pompeo said.

“We’re hoping to set out that set of conditions that will give them this opportunity to have a historic, big change in the security relationship between North Korea and the United States, which will achieve what the President has tweeted about and talked about: complete, verifiable, irreversible denuclearization.”

Pompeo also noted he would speak to his North Korean counterparts about freeing three U.S. detainees being held in the country: “We have been asking for the release of these detainees for – this administration for 17 months,” he said. “We’ll talk about it again today. I think it’d be a great gesture if they would choose to do so.”

Last week Trump hinted at developments related to the three American men, tweeting, “Stay tuned!”

Yet when reporters asked him Tuesday if the three are soon to be freed, Trump made no promises: “We will soon be finding out,” he said. “It would be a great thing if they are.”

“We think relationships are building with North Korea,” Trump added. “We’ll see how it all works out. Maybe it will, maybe it won’t. But it can be a great thing for North Korea, South Korea, Japan and the entire world. We hope it all works out.”

President Trump displays a memorandum Tuesday marking his decision to withdraw the U.S. from the 2015 nuclear deal. Moments later, as he left the Diplomatic Room at the White House, he told reporters that Secretary of State Mike Pompeo was on his way to North Korea.

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While Trump was at the White House announcing Pompeo’s visit, Kim was paying a surprise visit of his own to China — his second in just over a month. There, in the port city of Dalian, Kim attended a banquet and took a stroll with Chinese President Xi Jinping while having “an all-around and in-depth exchange of views on China-DPRK relations and major issues of common concern,” according to a statement posted by the Chinese government.

Officials from the two countries focused on deepening their bilateral connections and sorting out the details of dialogue with the U.S.

“China is willing to continue to work with all relevant parties and play an active role in comprehensively advancing the process of peaceful resolution of the peninsula issue through dialogue, and realizing long-term peace and stability in the region,” Xi said in the statement.

On Wednesday, Chinese officials plan to attend still another discussion regarding trade policies with the U.S. and North Korea’s nuclear program — this time in Japan, with Japanese Prime Minister Shinzo Abe and South Korean President Moon Jae-in in Tokyo. Xi’s No. 2, Prime Minister Li Keqiang, is expected to lead the Chinese delegation.

Pompeo’s visit will pertain to the diplomatic maneuverings already underway this week in East Asia. But one of Pompeo’s predecessors, President Clinton’s secretary of state, Madeleine Albright, expressed reservations at the speed with which the Trump administration is moving.

Albright herself visited North Korea in 2000 for a meeting with the current leader’s father, Kim Jong Il, attempting to put an end to the elder Kim’s nuclear aspirations.

“I think diplomatic talks are a good idea. They’re not a gift. They are the way you talk to people that you disagree with,” Albright told NPR’s Rachel Martin last month.

“But it does require preparation,” she added. “And that’s what worries me — is that all of a sudden, if it is a meeting between the two leaders, both of whom have a tendency to kind of say exactly just what the latest thing is on their minds, I do think there needs to be a lot of preparation.”

John Bolton, Trump’s national security adviser, told reporters on a call Tuesday that the administration intends the talks with North Korea to avoid the mistakes they see in the Iran deal, seeking more stringent terms.

“When you’re serious about eliminating the threat of nuclear proliferation, you have to address the aspects that permit the aspiring nuclear state to get there. The Iran deal did not do that,” Bolton said.

“The deal that we hope to reach — and the president’s optimistic we can reach — with North Korea will address all those issues.”

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Administration Rejects Proposal For Lifetime Medicaid Cap

Seema Verma told hospital executives that she wants states to have flexibility in how they administer Medicaid, but there are limits.

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The Trump administration has made clear it would like to remake the American health care system. There’s been the protracted battle over the Affordable Care Act. Now, there are some new moves on the future of Medicaid.

On Monday, the federal government released decisions on requests from two states to change the way they administer the health care program for low-income people.

The first decision came on lifetime caps. Kansas wanted to cut off Medicaid benefits for some people after 36 months.

At a meeting of the American Hospital Association in Washington, D.C., Seema Verma, administrator of the Centers for Medicare and Medicaid Services, made clear that she wants states to have lots of flexibility. But she also drew a line on how far that flexibility can go.

“We’re also determined to make sure that the Medicaid program remains the safety net for those that need it most,” Verma said. “To this end, we have determined we will not approve Kansas’ recent request to place a lifetime limit on Medicaid benefits for some beneficiaries.”

In Kansas, the number of adults eligible for Medicaid is already pretty small, mostly the elderly and the disabled. “Non-disabled adults who don’t have minor children are not eligible for Medicaid at all in Kansas, no matter how low their income is,” says Louise Norris, who writes about health care policy for healthinsurance.org.

The cap would therefore have affected only parents of young kids with extremely low incomes — those who make 38 percent of the federal poverty limit. “So to put that in perspective, if you have a household of three people — like a single parent with two kids — you’re talking $8,000 a year in total income,” Norris said.

The rejection of lifetime caps in Kansas sends a signal to the handful of other states — Maine, Arizona, Utah and Wisconsin — that have similar proposals pending.

Later in the day, there was another decision on Medicaid, when New Hampshire became the fourth state to have its request approved to add work requirements.

Joan Alker of the Georgetown University Center for Children and Families said the timing of the decisions on Kansas and New Hampshire was probably planned. “The fact that they rushed them out together suggests that they wanted to quickly get back to their message that states know best,” she said.

What wasn’t determined Tuesday was the outcome of Kansas’ proposal to add its own work requirements. All of the states that have received approval so far — Indiana, Kentucky, Arkansas and now New Hampshire — expanded eligibility for Medicaid under the Affordable Care Act.

If Kansas’ request is approved, it would be a first for a nonexpansion state. And Alker says many adults in Kansas would lose their Medicaid coverage. “You have a parent who, if they met the work requirement their income would be too high and they’d lose Medicaid, and if they don’t meet the work requirement they’d get kicked off,” Alker says. She calls it a Catch-22.

Other states that didn’t expand Medicaid and also want a work requirement — like Mississippi and Alabama — are closely watching what happens with Kansas’ proposal.

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She Strips, She Swears, She Goes To Jail … For The Good Of Her Country

Stella Nyanzi arrives at the High Court in Kampala, Uganda, in April 2017. She had been jailed for “cyber-harassment” of the president.

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Editor’s note: This post contains some strong language.

Stella Nyanzi walks into court with a broad smile. She is familiar with this place, so she is the first in the door and casually takes a seat on a wooden bench right in front of the judge.

It was almost a year ago that Nyanzi was released from prison. She served a month in May 2017 for insulting Ugandan President Yoweri Museveni, calling him “a pair of buttocks” and talking about the size of the first lady’s vagina. She stumbled out of a pickup truck too weak to walk. She was held up by two female police officers, a bandage on her left wrist, grimacing in pain.

Nyanzi, 43, is a university researcher, a feminist and a writer of erotic nonfiction who has emerged as one of Museveni’s most serious — and profane — adversaries. But at the time, she looked wounded and dejected, as if that stint in prison had drained all the indignation and resistance she came to represent in Uganda.

At court this March, she looks at ease again. The government, which has charged her with insulting the president, argues that she is crazy and should submit to a medical evaluation. What is unspoken is that the government wants her committed. It wants her gone because she has emerged as a serious threat to a three-decade-old regime.

Nyanzi just sits there, smiling. She takes notes, seemingly oblivious to the fact that this place is crawling with intelligence agents. Almost every single guest or journalist is sitting right next to one, taking notes on their notes.

The judge hears a few arguments and says that before he rules, he is going to wait for a constitutional court to decide whether submitting Nyanzi to a mental evaluation violates her constitutional rights. He dismisses the court, and a horde of media surround Nyanzi.

She flips from English to Luganda. It’s the lyrical language of her tribe, and when Nyanzi uses it, she tends to stretch vulgarities like taffy. The journalists erupt in laughter, asking her to repeat herself. She says she is a woman at her wit’s end. Both her parents are dead; she lost her job; she’s dead broke.

“What else will they do? Kill me?” she says. “If they kill me, it defeats their purpose. I am liberated. I rest in some earth, and I go home victorious.”

Comments — and no comments

On the streets of Kampala, you very quickly understand that talking politics requires lots of diplomacy.

A group of motorcycle taxi drivers on street corner refuse to talk about Nyanzi. They laugh and say they cannot allow their names to be used for fear of retribution. One of them leans back on his motorcycle with a broad grin on his face.

“You know, she said something about the big man being a pair of buttocks,” he says, not once mentioning Museveni by name. “What I will say is that an ass does exist in this country.”

Here in Uganda, people like Nyanzi are rare. Museveni came into power in 1986 after leading a coup that overthrew the government of Milton Obote. Since then, he has made sure that any serious dissent is shut down. Street protests are often met with deadly force, members of the opposition face arrest and detention, and in 2013, Parliament passed a law that essentially bans gatherings of more than three people.

Ugandans, therefore, are careful with what they say.

Haja Njolchra says that in Uganda, you never know who is a spy and can turn you in for speaking ill of the president. That is why she supports Nyanzi “100 percent,” because Nyanzi says what she is too afraid to.

Yes, as a Muslim woman, she would prefer that Nyanzi used less colorful language. But she also understands why she does it.

“She speaks strongly because of the problems people are facing,” she says. “Because she’s in the same Uganda we are in right now.”

After a long period of civil war, Uganda is relatively peaceful, a fact the government likes to point out often. But Uganda is still one of the most corrupt countries in the world. It’s poor, yet millions of dollars are lost to graft. In the past few years, millions have been stolen from health and education programs and few — especially not the political elite — have ever been held accountable.

Down the street, Bryan Mtumbe is shopping at a mobile phone store. He says Nyanzi has changed Uganda. Every Ugandan knows, for example, that you can criticize the president, but the first lady — who crowned herself the mother of the nation and whom everyone is forced to call Mama Janet Museveni — is out of bounds.

Nyanzi, though, went right after her.

“I think when she dared her, people came to believe that, ‘OK, even the mighty can be taken on,’ ” he says.

What Nyanzi has done for Ugandans, he says, is give them hope that the powerless can take on the powerful.

An “awakening”

Just a few years ago, Nyanzi was a little-known anthropologist studying sexual behavior in society at Makerere University in Kampala. She was controversial only because she wrote openly, and with explicit detail, about her sex life and her fantasies.

But in 2014, her life changed. Her dad was doctor, but he died because the hospitals near his house didn’t have the right medicine. And then in 2015, her mother died because an ambulance didn’t have fuel to take her to the hospital.

If this could happen to her, a privileged Ugandan, she thought, what happens to the poor?

“So suddenly, the issues of those poor women, those poor Ugandans became my issues, and sometimes, it takes that sort of awakening,” she says.

Nyanzi took to Facebook, where she wrote critically of the government, accusing Museveni of “murdering” her parents. At the same time, her relationship with her university deteriorated. Her department head wanted her to teach instead of conduct research, but she refused because she was a research fellow. The university suspended her and asked Nyanzi to vacate the premises, but she chained herself to her office.

On live television, she smeared red paint across walls at the university. She cried, she screamed, and as a final act of protest in a very conservative country, she stripped naked.

For Nyanzi, who has a doctorate and loved her academic job, losing it felt as if she had lost everything.

And then last year, the first lady backed off from a campaign promise to provide free sanitary pads to schoolgirls, and Nyanzi was enraged once more.

This time, her target was Janet Museveni, who had campaigned on the program and had become the minister of education and sports.

In a Facebook post, Nyanzi wrote that she refused to call the first lady “Mama Janet.”

“What sort of mother allows her daughters to keep away from school because they are too poor to afford padding materials that would adequately protect them from the shame and ridicule that comes by staining their uniforms with menstrual blood?” she wrote. “What malice plays in the heart of a woman who sleeps with a man who finds money for millions of bullets, billions of bribes, and uncountable ballots to stuff into boxes but she cannot ask him to prioritize sanitary pads for poor schoolgirls? She is no Mama! She is just Janet!”

At the same, time Nyanzi started collecting pads and money on GoFundMe. But it all ended the day she planned her most daring feat. For five years, the first lady had served as a member of Parliament representing a county in southwestern Uganda. Nyanzi was arrested the day she was going to deliver free pads to the first lady’s former constituents.

“Look what did I do? I wasn’t shaming the girls. I wasn’t putting women’s menstruation out there just for the sake of getting sanitary pads. I was saying, ‘Screw you, Museveni,’ ” she says.

She pauses for a long time and then a smile emerges from her face.

“I think it was fun. It was so fun,” she concludes with a cackle.

Suddenly in that spring of 2017, Nyanzi had become a household name to an entire nation, and she had found her political voice.

Behind the barbs

As political analyst Bernard Sabiti sees it, Nyanzi is coming to the fore of Ugandan politics at a strange time. One of the leading opposition members of parliament is a reggae singer, who calls himself the “ghetto president.” Young men are bringing bloodied pigs to Parliament as a symbol of the country’s shameless corruption.

Sabiti thinks this is because the government has dramatically curtailed the freedom to dissent.

“So you find that in that context, then people reach a point where they use desperate means to express their feelings,” he says.

He says Nyanzi fits right into that category. Because there are no legitimate ways to be heard in Uganda, Sabiti says, Nyanzi has resorted to vicious barbs.

“You know to be that no-holds-barred, in a way, alienates certain allies who would have supported your cause,” he says.

In some ways, Sabiti believes that by being so caustic, Nyanzi has fallen into the government’s trap. Their main argument against Nyanzi is that she’s crazy, and her behavior does little to dispel that narrative.

That was evident in an interview that Janet Museveni gave to Ugandan broadcaster NTV last year. She didn’t address the substance of Nyanzi’s critiques, instead she spoke patronizingly of her.

“I just wanted to tell people that I honestly forgive that lady,” Museveni said, “because I can’t understand how an educationalist could use that language to say anything about anybody.”

Not invincible

That one-month stint in jail did shake Nyanzi. She says she is not afraid, but when asked where to hold an interview, she said it had to be somewhere safe, where she wasn’t in danger of being poisoned.

When we finally sit, she looks around, behind her shoulders; she jumps from subject to subject.

Most of the time, she is full of bravado. She says that sometimes, she feels like a bystander watching Stella Nyanzi unfurl an outrageous situation. When she disrobed, she found herself holding on to the burglar bars at the university and declaring herself a nalongo owenene — the mother of twins with the big vagina.

It’s a vulgarity that few in Uganda would dare say in public. But Nyanzi used it once on a live TV appearance and the host went pale, shocked by her audacity.

At another point, conjuring tribal mythology, she also said that Janet Museveni had no power over her, because, as the mother of twins, she had endured a pain Museveni would never know. Her vagina was bigger and more powerful than Museveni’s, Nyanzi said. She also denigrated the first lady using sexual, misogynist imagery that made Nyanzi unpopular with her feminist colleagues.

After jail, she says she thought about reforming, especially because a raid on her home scared her three children. While she was in jail, they stayed with family, and on at least one occasion, Nyanzi says, her sister stopped talking to her because of all her antics.

Nyanzi is also cognizant of what happens to opposition figures in this part of the world. In the 1990s in Kenya, the Nobel laureate Wangari Maathai, who also undressed once in protest, was beaten for trying to plant trees. The government belittled her, the authoritarian president, Daniel Arap Moi, called her a “mad woman.”

More recently, in Rwanda, Diane Rwigara, a young, rich woman, dared to challenge President Paul Kagame. She tried to run for president and call out corruption and repression in Rwanda, but a few months later, she was jailed along with her sister and mother.

This reporter told Nyanzi that when he spoke to Rwigara a few months before her arrest, he got the feeling that she felt invincible.

“Invincibility is the wrong word for me,” Nyanzi says. “Mine is just a refusal to keep quiet.”

Every time she thinks about quitting, she says she notices that nothing has changed in Uganda. So she thinks about her mom and dad and all the other Ugandans suffering through a corrupt regime and her blood boils.

“For me, I don’t have guns,” she says. “I don’t have money. I don’t have clout. I have Facebook and I have language, and I think we can be polite and continue to suffer or we can step out and be rude and get some…”

She stops — to think, to measure her words and perhaps to rein in some expectations — and continues, “Maybe they won’t give us the sanitary pads or the public health services, but they will know that we know.”

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