Students Fill A Gap In Mental Health Care For Immigrants

Access to mental health care can be especially tough for new immigrants.

Access to mental health care can be especially tough for new immigrants. Gary Waters/Ikon Images/Getty Images hide caption

toggle caption Gary Waters/Ikon Images/Getty Images

Patricia Becerril comes to Bethesda Health Center in Charlotte, N.C., every other week. And it’s a slog.

“It takes her two hours to get here,” says University of North Carolina at Charlotte master’s student Katherine Wilkin, translating from the Spanish as Becerril speaks. “She takes two buses, so coming here, she’s definitely devoted to getting this treatment. She comes every time.”

Wilkin is Becerril’s mental health counselor, and Becerril says Wilkin has helped her deal with depression.

“With therapy, she’s gotten able to organize her thoughts and feelings, and she feels better, not frustrated, less stress,” Wilkin says.

Becerril initially came to this free clinic for diabetes treatment. Director Wendy Pascual says primary care is often the starting point for patients here, most of whom are immigrants.

“One thing we have been seeing year after year is that many patients came here with physical problems that really are mental health problems,” Pascual says.

Meanwhile, UNC Charlotte counseling professor Daniel Gutierrez had been looking for a way to get more involved in the community. A mutual friend put him in touch with Pascual, and Gutierrez suggested his master’s and Ph.D. students could offer counseling services.

He and Pascual set up a partnership last year, and now about eight students provide treatment. They’re unpaid — it’s part of their training. Some speak Spanish, some use an interpreter.

Gutierrez says they see a variety of issues.

“The big three we keep finding are depression, high levels of anxiety, and then high levels of trauma,” he says. “At one point, about 85 percent of the folks were experiencing some level of some of that.”

That’s of everyone coming to the clinic for any kind of health care.

The clinic’s focus on the immigrant community means treating many people who are uninsured and often here illegally.

“Latinos, although they’re experiencing a lot of these mental health concerns, they are among the least likely to be able to get services,” Gutierrez says.

Universities in many parts of the country are recognizing that reality. Virginia Commonwealth University, the University of Georgia and the University of Denver all have similar partnerships.

Texas has several, including one between that state’s flagship university and Austin’s Travis County Integral Care.

“The need is enormous,” says Kathleen Casey of the Austin mental health provider.

“We know that there’s great health disparities, lots of stigma overall, and other types of cultural barriers that make it incumbent upon us to do our very best for outreach and engagement to that population,” Casey says.

Latino counselors say the stigma around mental health can be particularly strong in that community. There’s also the language barrier. And the actual border crossing can be traumatic, especially for those who cross illegally.

Shahana Koslofsky, a clinical supervisor at Pacific University in Beaverton, Ore., says some immigrants she treats suffer from PTSD.

“There are stories of sexual assaults and rapes that happen during border crossings,” she says. “And then there’s more cumulative experiences of growing up in poverty or dealing with drug cartels or gangs or some people have difficult experiences in their country of origin.”

Pacific University has around 20 master’s and Ph.D. students providing counseling at any given time. Even with that staffing, she says Latinos face waiting lists for treatment.

Back in Charlotte, people lined up outside Bethesda in the rain recently. It was the one day a week Ana Farrera signs up new patients. “The thing is that rain must have scared them away today,” she says, “because usually we have like, last week we had 10 people, so I had to turn five away.”

Farrera says there have been some mornings where 20 people line up before she opens the door. They’re mostly waiting for primary care, but Farerra says many will get referred to the UNC Charlotte students for counseling.

Clinic leaders say the students are making a big difference at the clinic. Student Katherine Wilkin says it works the other way, too.

“For me it’s been good because that experience hasn’t been just the easiest client I can think of that we read about in textbooks,” Wilkin says. “I feel very comfortable building up from this.”

So do UNC Charlotte professors. The university plans to scale up the partnership with Bethesda.

This story is part of a reporting partnership with NPR, WFAE and Kaiser Health News.

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Denmark's 'Martyr Museum' Places Socrates And Suicide Bombers Side-By-Side

The Martyr Museum in Denmark includes exhibits on recent terrorist attacks. There are large portraits of two brothers who carried out suicide bombing attacks in Brussels in March, Ibrahim and Khalid el-Bakraoui. There are also "reconstructed artifacts" like nails that were used for shrapnel in the attack.

The Martyr Museum in Denmark includes exhibits on recent terrorist attacks. There are large portraits of two brothers who carried out suicide bombing attacks in Brussels in March, Ibrahim and Khalid el-Bakraoui. There are also “reconstructed artifacts” like nails that were used for shrapnel in the attack. Ida Grarup/Martyr Museum hide caption

toggle caption Ida Grarup/Martyr Museum

Who, exactly, is a martyr? That seemingly simple question is behind a controversial new exhibit by artists in Denmark that’s ignited a fierce debate.

Even before the May 26 opening of the exhibit, called the Martyr Museum, critics claimed it endorsed terrorism and Denmark’s culture minister, Bertel Haarder, described it as “crazy.”

The controversy centers around the depiction of historic figures like Socrates and Joan of Arc near modern-day suicide bombers.

The illuminated cases display reconstructed artifacts like the ones used in suicide attacks in New York on Sept. 11, 2001, in Paris last November and in Brussels in March.

The illuminated cases display reconstructed artifacts like the ones used in suicide attacks in New York on Sept. 11, 2001, in Paris last November and in Brussels in March. Boris Grimb/Martyr Museum hide caption

toggle caption Boris Grimb/Martyr Museum

The exhibit is tucked away in a former slaughterhouse behind Copenhagen’s central train station. Its white-tiled walls are lined with portraits and “reconstructed artifacts” like the vial of poison that Socrates drank after he was sentenced to death and the podium where Dr. Martin Luther King Jr. delivered his “I Have a Dream” speech.

But it’s during the twice-a-day guided tour, led by actor Morten Hee Andersen, that the space comes to life with music and stage lighting.

In one section, visitors are shut in a meat locker as the guide falls to the floor to tell the story of Maximilian Kolbe, a Franciscan friar who voluntarily took the place of Jews the Nazis condemned to starve to death at Auschwitz concentration during World War II.

Further along, the guide assumes a lotus position and, with trembling hands, recounts the 1963 self-immolation of Thich Quang Duc, who took his life to protest the treatment of Buddhists in South Vietnam. Photos of that event shocked the world at a time when the U.S. was becoming involved in the Vietnam War.

And finally, there’s the section most responsible for the headlines: a room where the reconstructed artifacts flashing under strobe lights hit a little closer to home.

The reconstructed artifacts include the heart of Thich Quang Duc, a Buddhist monk in South Vietnam whose self-immolation drew worldwide attention in 1963. Some witnesses claimed the monk's heart refused to burn during his cremation.

The reconstructed artifacts include the heart of Thich Quang Duc, a Buddhist monk in South Vietnam whose self-immolation drew worldwide attention in 1963. Some witnesses claimed the monk’s heart refused to burn during his cremation. Boris Grimb/Martyr Museum hide caption

toggle caption Boris Grimb/Martyr Museum

A melted keyboard from Ground Zero of the Sept. 11 attacks in New York. A portrait of Mohammed Atta, one of the men who carried out that attack.

There are also portraits of the two brothers, Ibrahim el-Bakraoui, who blew himself up in March at the Brussels airport, and Khalid el-Bakraoui, who blew himself up at a subway station an hour later. There is a crumpled coffee cup from the airport, and a display of nails that were used as shrapnel in the attack.

It’s here, among these manufactured artifacts, that the guide recounts the speech on good and evil reportedly delivered by Omar Ismail Mostefai to his hostages in the midst of the attack that left more than 100 dead in Paris last November.

Critics call this provocation for the sake of ticket sales.

The glasses represent members of the Heaven's Gate religious group. In 1997, 39 members of the group committed mass suicide.

The glasses represent members of the Heaven’s Gate religious group. In 1997, 39 members of the group committed mass suicide. Boris Grimb/Martyr Museum hide caption

toggle caption Boris Grimb/Martyr Museum

Not so, says artist Henrik Grimbäck.

“Since 9/11, the word ‘martyr’ has been popping up in our minds more and more. It would have been in many ways strange if we were not discussing our own time when we did this show,” Grimbäck says.

The show does not endorse such actions, but seeks to explore the many definitions of the word “martyr,” says fellow artist Ida Grarup.

“To see the world through these terrorist eyes for a couple of minutes is not the same as sympathizing or understanding them,” Grarup says.

Not everyone agrees.

“I don’t like relativism. I think they are relativists,” says Alex Ahrendtsen, spokesman on culture for the right-wing Danish People’s Party. “If you’re a Westerner, you have to take a stance. You have to say, well, you might say that Islam has martyrs. But we don’t think they’re martyrs – they’re murderers. They’re terrorists.”

The artists have noted that some of their most vocal critics are the same people who staunchly defended the Danish newspapers that published inflammatory cartoons of the Prophet Muhammad a decade ago.

“A lot of Danes feel like freedom of speech is a very big thing, and they like to talk about it. But when it’s something that they don’t necessarily agree with, then it’s not freedom of speech, it’s just wrong,” says sociology student Tea Ingemann Olsen, who traveled two hours to see the Martyr Museum.

But in a country with a very strong tradition of free speech, very few critics have actually suggested that the exhibit be shut down.

“It’s an ignorant, stupid exhibition without any deeper knowledge. But they have the right to do it,” says Ahrendtsen, the Danish People’s Party spokesman. “If I don’t like it, I don’t have to go.”

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A Student-Run Farm Cultivates Passion For Sustainable Agriculture

A weekday work session on the Student Organic Farm at Iowa State University has members weeding a perennial bed.

A weekday work session on the Student Organic Farm at Iowa State University has members weeding a perennial bed. Amy Mayer/Harvest Public Media hide caption

toggle caption Amy Mayer/Harvest Public Media

A weathered wooden shed that holds wheelbarrows, hoes and other basic tools is the beacon of the Student Organic Farm, a two-acre swath within the larger horticultural research farm at Iowa State University.

On a warm spring evening, a half-dozen students gather here, put on work gloves and begin pulling up weeds from the perennial beds where chives, strawberries, rhubarb and sage are in various stages of growth.

“I didn’t know how passionate I [would] become for physical work,” says culinary science major Heidi Engelhardt.

So passionate, she’s now the outreach coordinator for the farm. Within her major, she says, “people want to work in kitchens and they want to work in big cities. And that is important, but it’s also important to have that farming aspect. And I think I’m very lucky to have discovered that.”

About 20 years ago, as small-scale farms on the coasts began luring shoppers with fresh produce at farmers markets and through community supported agriculture (CSA), the trend also took root here in the heartland.

The Student Organic Farm sends out boxes full of produce to the local community throughout the growing season. Student members can get a discounted subscription price if they work three hours a week in the field.

Student Organic Farm outreach coordinator Heidi Engelhardt, a culinary science major, says she's developed a passion for the physical work of growing food.

Student Organic Farm outreach coordinator Heidi Engelhardt, a culinary science major, says she’s developed a passion for the physical work of growing food. Amy Mayer/Harvest Public Media hide caption

toggle caption Amy Mayer/Harvest Public Media

On this evening, most of the students working the farm have come from the Iowa State agronomy department.

But the appeal of working here is often independent of academic interests, says agronomy professor Mary Wiedenhoeft, who serves as an academic adviser on the farm.

“It’s hands-on learning,” Wiedenhoeft says. “And so that’s why the student organic farm is really unique.”

When the farm was first set up in the late ’90s, in response to a class about sustainable agriculture, it became one of the area’s first to use the CSA model. As the farm grew, so did academic interest in sustainability. Now the university offers a graduate degree in sustainable agriculture.

At a university where large-scale production of corn and soybeans are the primary interests for many students on campus, it’s especially remarkable that the organic farm is wholly embraced, Wiedenhoeft says.

For some agronomy students who plan to return to a family farm, a vegetable operation could be a new enterprise they bring back, she says.

But on this night, most of the students dumping handfuls of weeds into a wheelbarrow for the compost have not grown up on farms. Riley Madole has the one paid job here, as the summer farm manager. It’s the kind of work he’d like to pursue after he graduates in December.

“Not a lot of people in agronomy are going in my direction,” he says, “whether it be straight organic or just reduced pesticide use.”

But he says the faculty at Iowa State encourage various approaches to farming. “A lot of teachers here are emphasizing that the way we’ve been doing it is not necessarily the right way,” he says. “And we need to be open to change sometimes.”

Fall-planted garlic grows at the Iowa State University Student Organic Farm north of Ames.

Fall-planted garlic grows at the Iowa State University Student Organic Farm north of Ames. Amy Mayer/Harvest Public Media hide caption

toggle caption Amy Mayer/Harvest Public Media

Running this farm, students learn to grow food, manage a business and recruit others to get involved. They donate their surplus produce to area residents in need. And of course, they get to savor the fruits of their labor — literally.

“I went out and harvested some Brussels sprouts and they’re now my favorite vegetable,” says senior Becca Clay, who joined the farm her first semester on campus as an agronomy major.

Culinary science major Engelhardt has learned how to incorporate fresh herbs into her cooking. And for graduate meteorology student Kati Togliatti, the discovery was bright red.

“I really like beets,” she says. “We got them in our box last year. I’ve never had them before because they’re red, and an odd color, but they’re really good.”

This season the students will grow about 40 different fruits, vegetables and herbs. And they’ll help cultivate interest in organic farming among the fresh batch of Iowa State students who sprout up in this fall.


Amy Mayer is a reporter based at Iowa Public Radio. This story comes to us from Harvest Public Media, a reporting collaboration focusing on agriculture. A version of this post originally ran on the Harvest website.

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The Best View In Town: A Helicopter Ride Over Los Angeles

Here & Now co-host Jeremy Hobson stands with Rick Dickert, a certified broadcast meteorologist and traffic reporter for Fox 11 Morning News in Los Angeles, in front of a traffic helicopter. (Ethan Lindsey/Here & Now)

Here & Now co-host Jeremy Hobson stands with Rick Dickert, a certified broadcast meteorologist and traffic reporter for Fox 11 Morning News in Los Angeles, in front of a traffic helicopter. (Ethan Lindsey/Here & Now)

Los Angeles is famous for many things, including its traffic and its traffic helicopters. Rick Dickert is one of the traffic and weather reporters who rides high above the city every morning, watching the city’s streets for the morning commute.

During his latest trip to Los Angeles, Here & Now‘s Jeremy Hobson rode along with Dickert and talked about Los Angeles traffic and how the city is changing.

More From Jeremy’s Ride

Got to fly over LA with @RICKatFOX for a @NPR @hereandnow story airing Tuesday! pic.twitter.com/IYPQbWqx2l

— Jeremy Hobson (@jeremyhobson) June 3, 2016

Host Jeremy Hobson’s view of Los Angeles from the Fox 11 Morning News helicopter. (Jeremy Hobson/Here & Now)

Host Jeremy Hobson's view of Los Angeles from the Fox 11 Morning News helicopter. (Jeremy Hobson/Here & Now)

Host Jeremy Hobson’s view of Los Angeles from the Fox 11 Morning News helicopter. (Jeremy Hobson/Here & Now)

Host Jeremy Hobson in the Fox 11 Morning News helicopter. (Jeremy Hobson/Here & Now)

Host Jeremy Hobson in the Fox 11 Morning News helicopter. (Jeremy Hobson/Here & Now)

Host Jeremy Hobson's view of Los Angeles from the Fox 11 Morning News helicopter. (Jeremy Hobson/Here & Now)

Host Jeremy Hobson’s view of a geyser, after a traffic accident with a fire hydrant, in Los Angeles as viewed from the Fox 11 Morning News helicopter. (Jeremy Hobson/Here & Now)

Guest

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Law Professor Says Trump's Comments About Judge Signal Rise Of Authoritarianism

Republican presidential candidate Donald Trump speaks in front of a row of California state and American flags at a campaign rally on June 2, 2016 in San Jose, California. (Elijah Nouvelage/Getty Images)

Republican presidential candidate Donald Trump speaks in front of a row of California state and American flags at a campaign rally on June 2, 2016 in San Jose, California. (Elijah Nouvelage/Getty Images)

A growing number of Republicans are publicly criticizing likely GOP presidential nominee Donald Trump for insisting that federal judge Gonzalo Curiel cannot objectively rule on two lawsuits against Trump University because the judge has Mexican heritage.

Legal expert David Post tells Here & Now‘s Robin Young that the First Amendment protects Trump’s right to say anything he wants about the judge or the court system, but voters must consider what it means for a presidential candidate to attack judicial independence and the rule of law.

Guest

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New Mix: Songs On Letting Go And Believing In Yourself

Clockwise from upper left: River Whyless, Hannah Georgas, Angel Olsen, Ages And Ages

Clockwise from upper left: River Whyless, Hannah Georgas, Angel Olsen, Ages And Ages Courtesy of the artists hide caption

toggle caption Courtesy of the artists

On this week’s All Songs Considered, we play songs about facing fears, being true to yourself and not worrying about what everyone else thinks, plus a new song from Angel Olsen and a conversation with her about her surprising new sound.

Robin Hilton opens with an introspective pop gem from the Portland, Ore. band Ages And Ages inspired by the ephemeral nature of nearly everything. Bob Boilen follows with a sonic adventure from the Asheville, N.C. folk group River Whyless.

Also on the show: Bed., another Portland band, has an ode to being free and escaping the comforts of home; The D.C. band Paperhaus has a fierce new single with some mind-blowing drumming and singer Hannah Georgas takes a simple piano ballad and turns it into a syncopated wonder with pulsing horns.

But first, Bob settles back in after a month on the road while Robin tries to put on a new face with a coffee mug that might just change his whole outlook on life.

Songs Featured On This Episode

Cover for Something To Ruin
01They Want More

4:44
  • <iframe src="https://www.npr.org/player/embed/481100495/481101737" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">

Ages And Ages

  • Song: They Want More
  • from Something To Ruin

We first fell in love with Ages And Ages when the group released the album Divisionary in 2014, which included the beautiful and incredibly inspiring song, “Do The Right Thing.” The Portland, Ore. band is back with this song from its more introspective followup Something To Ruin, due out Aug. 26.

Cover for We All The Light
01All Day All Night

3:33
  • <iframe src="https://www.npr.org/player/embed/481100495/481102054" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">

River Whyless

  • Song: All Day All Night
  • from We All The Light

River Whyless is based out of Asheville, N.C., where the quartet makes largely acoustic folk-based music. On its new album, We All The Light, this talented group of songwriters stretches its style with some surprising new instrumentation.

Cover for My Woman
01Intern

2:47
  • <iframe src="https://www.npr.org/player/embed/481100495/481102160" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">

Angel Olsen

  • Song: Intern
  • from My Woman

Angel Olsen teased this song with a video last week, but we soon learned it’s from her upcoming album, My Woman. “Intern” opens the album and seems to signal a shift from Olsen’s rock roots toward a synth-based, dream pop sound. Listen to the full show with the link above or download the All Songs podcast to hear Angel Olsen tell us why she chose to share this song first from the album.

Cover for Klickitat
01Billy Joel

3:37
  • <iframe src="https://www.npr.org/player/embed/481100495/481102899" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">

Bed.

  • Song: Billy Joel
  • from Klickitat

Bed. is otherwise known as Sierra and Alex Haager, a husband-wife duo from Portland, Ore. They’ve been trickling songs out for the past couple of years but recently released their first official EP, which includes this song, inspired in part by Billy Joel’s “Moving Out (Anthony’s Song).”

Cover for Silent Speaking (Single)
01Silent Speaking

4:38
  • <iframe src="https://www.npr.org/player/embed/481100495/481102993" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">

Paperhaus

  • Song: Silent Speaking
  • from Silent Speaking (Single)

This dizzying new single from the DC-based Paperhaus, led by Alex Tebeleff, is a fierce, propulsive showcase for guest drummer Ian McColm.

Cover for For Evelyn
01Waste

3:30
  • <iframe src="https://www.npr.org/player/embed/481100495/481103165" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">

Hannah Georgas

  • Song: Waste
  • from For Evelyn

Hannah Georgas is a singer from Ontario who originally wrote “Waste” as a reflective piano ballad. But producer Graham Walsh turned it into a frenetic, horn-powered jam. It will appear on her album For Evelyn, out on June 24.

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Scientsts Seek Genetic Clues To Why Asthma Is Deadlier In Blacks

Zunika Crenshaw helps her 3-year-old daughter Jhase Crenshaw Bass with an asthma inhaler.

Zunika Crenshaw helps her 3-year-old daughter Jhase Crenshaw Bass with an asthma inhaler. Lesley McClurg/KQED hide caption

toggle caption Lesley McClurg/KQED

Zunika Crenshaw cringes as a tire swing whips her children around in circles just a little too fast. It’s a sunny afternoon in the park, in Pleasanton, Calif. As her children play, she keeps a close watch on their breathing.

She says asthma is in her genes.

“You have a family, a person who has four kids, and all of them have it, including me,” she says. “And then my mom has it, and my sister’s two kids.”

A little girl, 3-year-old Jhase, runs over to her, wheezing. Crenshaw grabs an inhaler, and her daughter breathes deeply from it.

“Perfect!” says Jhase. She lays her head against her mother’s chest, then runs back to her brothers.

Crenshaw drops the inhaler in a pile of medications in her purse. She points to various pill bottles.

“Zyrtec, and this is ClariSpray. And there’s albuterol and Dulera.”

There are more drugs at home.

Asthma is the leading chronic disease among children, but it hits some populations harder than others.

According to the federal Centers for Disease Control and Prevention, black children are twice as likely to have asthma as white children. And black children are 10 times more likely than white kids to die of complications from asthma.

A team of scientists at the University of California, San Francisco, is on a mission to understand why. The researchers are digging into genetic clues that may have been overlooked until now.

Geneticist Marquitta White just published a study finding that the majority of genetic information scientists have on asthma patients doesn’t apply to African-Americans.

“The majority of genetic studies, not just in asthma but in most diseases, are done in Caucasian- or European-descent populations,” White explains. “The longest studies do not really include very many minority populations, which means that most patients aren’t getting the best care, because we don’t really know what the disease etiology is in their particular population.”

Medications also work differently in different populations, according to Esteban Buchard, a pulmonologist at UCSF. As an example, he points to the small print on the instructions for a common asthma medication called Advair.

“It specifically says that if you’re African-American and you take this, you have an eightfold risk of dying,” he says.

Zunika Crenshaw packs her purse full of asthma and allergy medications for her children when the comes to the park near their house in Pleasanton, Calif.

Zunika Crenshaw packs her purse full of asthma and allergy medications for her children when the comes to the park near their house in Pleasanton, Calif. Lesley McClurg/ KQED hide caption

toggle caption Lesley McClurg/ KQED

The UCSF team is analyzing the genes of black, Mexican-American, and Puerto Rican children to better understand drug responses in each population.

“One of our hypotheses is that what’s underlying this huge mortality in African-American children is the fact that the most commonly prescribed drug for asthma is albuterol,” says White. “The problem is that not everyone responds to albuterol the same way. And actually, Puerto Rican and African-American children have the worst drug response. So you’re looking at two populations with the worst drug response with the highest mortality. We have a feeling those things might be related.”

The Right Drugs Matter

Good treatment is key to preventing the kinds of serious asthma attacks that keep kids home sick.

The Crenshaw children are missing fewer school days since they started visiting the Breathmobile, a long motor home converted into an asthma clinic. The clinic is run by a nonprofit called the Prescott-Joseph Center. It travels throughout the East Bay offering free treatment to low-income families.

Inside, a medical assistant tests the lungs of a 5-year-old girl who’s fiddling with her tight braids. The clinician pauses several times so the girl can blow her nose.

A lung test on the Breathmobile finds that 5-year-old Brooklyn Turner's pulmonary function is compromised by her asthma.

A lung test on the Breathmobile finds that 5-year-old Brooklyn Turner’s pulmonary function is compromised by her asthma. Lesley McClurg/KQED hide caption

toggle caption Lesley McClurg/KQED

Pat Granberg, a pediatrician, asks the girl’s mother about their living conditions, their neighborhood and their financial situation, to determine likely triggers for asthma. The disease can be caused by a number of factors, including obesity, air pollution, access to healthcare, molds, mildews, pets, perfumes and smoking. But Granberg begins an assessment by asking whether asthma runs in the family, because there’s usually a genetic link.

One Size Doesn’t Fit All

“On average, 60 percent of what’s going to determine whether or not you have asthma is going to be due to genetic factors,” says White. She says depending on the population, that number could range from 35 to 90 percent.

“I think that what we should be striving for is equal care for everyone,” says White, “and in order to do that you have to know what the disease is doing in everyone. That’s step one.”

Buchard believes a lot of health disparities could be explained if more minorities were included in genetic research. To illustrate his point, he looks back to when researchers studied heart disease only in men.

“Women present differently than men do for heart attacks,” says Buchard. “So a whole generation of physicians were misclassifying and misdiagnosing women simply because women were not involved in the original clinical trials.”

In 1993, Congress passed legislation requiring that publicly funded medical studies include more minorities. But a 2015 review of lung disease studies found only 5 percent of publicly funded research included patients of color.

This story originally appeared on KQED’s blog Future of You.

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Ryan: Trump's Criticism Of Judge 'Textbook Definition Of A Racist Comment'

House Speaker Paul Ryan, R-Wisc., speaks during an appearance in Washington, D.C., on Tuesday.

House Speaker Paul Ryan, R-Wisc., speaks during an appearance in Washington, D.C., on Tuesday. Mark Wilson/Getty Images hide caption

toggle caption Mark Wilson/Getty Images

House Speaker Paul Ryan, the highest ranking Republican in government, disavowed comments by Donald Trump that a judge overseeing a case against the now-defunct Trump University cannot be fair to him because of his Mexican heritage.

“Claiming a person can’t do their job because of their race is sort of like the textbook definition of a racist comment,” Ryan said at an event where he unveiled the GOP agenda to fight poverty in America. “I think that should be absolutely disavowed. It’s absolutely unacceptable.”

Ryan stood by his endorsement of the presumptive GOP presidential nominee, which came last week.

“But do I believe that Hillary Clinton is the answer? No I do not,” Ryan added. “I believe that we have more common ground on the policy issues of the day and we have more likelihood of getting our policies enacted with him than we do with her.”

In interviews over the weekend, Trump doubled down on his claim that U.S. District Judge Gonzalo Curiel, who was born in Indiana, should not preside over the Trump University fraud case because of his Mexican heritage. Trump also said he thought it was “absolutely” possible that a Muslim judge also would treat him unfairly. On Friday, Trump referred to a supporter in the crowd at a rally in Redding, Calif., as “my African American,” sparking criticism.

Trump now shows no signs of backing off. A senior campaign source confirms to NPR that Trump urged surrogates on a conference call on Monday to keep responding to questions about the controversy, reversing a memo that a campaign staffer had sent to many of them earlier directing those speaking for the campaign to avoid discussing the lawsuit.

The purpose of Trump’s call was to give surrogates the “confidence to keep standing up,” according to the campaign source, who added that Trump believes “if we don’t respond we can’t win.”

Among those on the 50-minute call were former Arizona Gov. Jan Brewer, Florida Attorney General Pam Bondi, former Massachusetts Sen. Scott Brown and Trump backer Jeffrey Lord, who frequently speaks in support of the candidate on CNN.

Trump also urged his supporters to go after reporters they feel are unfair.

Ryan’s comments on Tuesday were part of a growing chorus of Republican leaders – including many who’ve endorsed Trump – in admonishing his racially-charged remarks about Curiel.

GOP Sen. Bob Corker of Tennessee urged Trump to change course multiple times in an interview on MSNBC’s Morning Joe on Tuesday. “He has, no doubt, missed an incredible opportunity. He still has time to pivot,” Corker said. “Time is running short, but he has time to do that.”

Florida Sen. Marco Rubio is among several former rivals who pledged months ago to support the party’s nominee. Rubio told a local news station in Florida that he saw that promise as a “binding agreement,” but said he couldn’t defend Trump’s remarks about Judge Curiel.

“I think it’s wrong. He needs to stop saying it,” Rubio said. “I don’t think it reflects well on the Republican Party. I don’t think it reflects well on us as a nation. There shouldn’t be any sort of ethnicity or religious or racial test for what kinds of judges should hear what kinds of cases. If you take that argument and you expand, it you can make that argument about anybody in some circumstance or another. It’s wrong and I hope he stops.”

Sen. Lindsey Graham of South Carolina told the New York Times that Trump’s comments represent an “off-ramp” for leery Trump supporters and compared his rhetoric to that of Sen. Joe McCarthy. “There’ll come a time when the love of country will trump hatred of Hillary,” Graham added.

Texas Sen. Ted Cruz told NBC that it’s “obviously inappropriate to attack a judge’s race or ethnicity.” On Twitter, Ohio Gov. John Kasich called Trump’s comments “wrong” and said he should “apologize” to Curiel.

On Sunday, Senate Majority Leader Mitch McConnell declined to say whether or not the comments were racist in an appearance on NBC’s Meet The Press, but said he “couldn’t disagree more.”

Former House Speaker Newt Gingrich – a Trump supporter and another potential VP pick – had harsh words for real estate developer in an interview with Chris Wallace of Fox News.

“This is one of the worst mistakes Trump has made. I think it’s inexcusable,” Gingrich said. “This judge was born in Indiana. He is an American — period. When you come to America, you get to become an American. And Trump, who has grandparents who came to the U.S., should understand this as much as anybody.”

No surprise, critiques are also coming from Republicans who’ve so far held off on endorsing the presumptive nominee or, like Sen. Ben Sasse of Nebraska, vowed never to do so. Sasse tweeted this critique: “Public Service Announcement: Saying someone can’t do a specific job because of his or her race is the literal definition of ‘racism.'”

Sen. Susan Collins of Maine has not yet publicly endorsed Trump. She released a statement calling his remarks about Curiel, “absolutely unacceptable,” and saying they show a “lack of respect for the judicial system and the principle of separation of powers.”

Many in the GOP establishment talked of Trump becoming more presidential as he turned away from the primary, but the past week has made that look less likely. Trump is taking comfort in polls showing him in a close race with Hillary Clinton, and unless that changes he may not change course any time soon.

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The Long Road Back From Boko Haram

Amina Ali Nkeki, 19, was one of the Nigerian school girls kidnapped by Boko Haram in 2014. She was found last month wandering in the Sambisa Forest, a Boko Haram stronghold, with her 4-month-old baby.

Amina Ali Nkeki, 19, was one of the Nigerian school girls kidnapped by Boko Haram in 2014. She was found last month wandering in the Sambisa Forest, a Boko Haram stronghold, with her 4-month-old baby. Henry Chukwuedo/Anadolu Agency/Getty Images hide caption

toggle caption Henry Chukwuedo/Anadolu Agency/Getty Images

One of the 219 Chibok schoolgirls abducted two years ago by Boko Haram militants returned home last month. Nigerian president Muhammadu Buhari welcomed her in a televised meeting, promising to support her as she remakes her life, helping her return to school and receive needed social support services. Reintegration is the goal for 19-year-old Amina Ali Nkeki and the four-month-old baby she had while in captivity.

But how will that be achieved?

The experiences of those who were formerly held captive by Boko Haram suggest the range of challenges ahead, as well as what might help — and what will not.

Although the particulars of each story differ, Amina Ali Nkeki and the other former captives can all be said to be “triple victims,” says Rachel Harvey, UNICEF’S chief, child protection in Nigeria. First, they were abducted, “taken from their homes and often taken far away.” Second, during their captivity, “the vast majority were subjected to rape.” And then, when they escape or are rescued, their families “are not always willing to take them back.”

Amina Ali Nkeki’s mother did welcome her back and accompanied her to the meeting with President Buhari. (Her father had died while she was in captivity.) But in many cases, families and villagers alike are wary. They worry that the girls have been radicalized by their captors, says Mia Bloom, professor of communication at Georgia State University and an expert in terrorism and its impact on women and children. That fear is not abstract: In 2015, Boko Haram used 21 girls under the age of 18 as suicide bombers.

Then there is the severe ostracism faced by those who are pregnant or return with children. In Nigeria’s deeply religious society, sex outside of marriage is considered “an “abomination,” says Mausi Segun, Nigeria researcher for Human Rights Watch.

And the stigma applies to those who were abducted and their entire families. Community members often shame them with verbal abuse, insult their babies as “devils” and pressure their families to abandon them or else face isolation and disgrace. Harvey tells of one instance where a girl who returned from Boko Haram captivity with a child born out of sexual violence was accepted by her mother — but rejected by her father and brothers. As a result, the mother and father separated.

Such a “welcome” back is why those who have not become pregnant or had a child may prefer to remain silent about any sexual violations, says Segun. One woman who had been married prior to her abduction told Segun that she feared that revealing her experience of sexual abuse might lead to community pressure for her husband to leave his “tainted” wife even if he wished to stay with her.

That is why families with the resources try to move or send these girls to a new place where they can start over, says Mausi, who in the past three years has interviewed approximately 100 girls and women who had been abducted by Boko Haram and then escaped or were found or rescued and returned home. She has spoken to girls who were sent away to escape the notoriety and stigma they faced in their villages, whether to a big city such as Lagos or churches or other organizations that will take them in.

Regardless of where these girls find themselves, the traumas they have suffered are “acute” and the “scars are raw,” says Harvey. Indeed, initial reports of Amina Ali Nkeki described her as looking thin and weak, and limping as she walked.

It is not just the former captives who have suffered. So have their families and communities over the course of the years of conflict with Boko Haram. In many cases, UNICEF’s Harvey points out, “These families have been ripped apart, experienced violence themselves, are living away from their own homes [in displaced persons camps], and undergone their own acute trauma.” As a result, these families may not have the resources to provide for a returning family member who may bring an infant with her.

Programs are being put in place to help the returning girls and their families, says Harvey, who has even heard some success stories. One woman who has been abducted was initially rejected by her husband upon her return. But after talking to program counselors, he came to see she had been victimized. When he voiced fears that she had contracted HIV while with Boko Haram, she was tested. After she was found to be free of the virus, they reunited and are now expecting a baby.

What has proven most helpful is placing the returnees in peer groups with other former abductees who have experienced similar traumas. Instead of feeling isolated and alone, Harvey says, these women are able to connect with others and through such discussions and interactions begin to see a pathway to the future.

UNICEF (in conjunction with International Alert, and local partners FOMWAN and HERWA, as well as the Borno State Ministry of Women Affairs and Social Development) is implementing programs in six internally displaced persons camps and four host communities in Maiduguri, capital of Borno State in Nigeria.

At the same time, the communities themselves need to be involved. Identifying and gaining the support of influential religious and other leaders who hold sway is essential. Rather than outsiders telling the people what they “should” do or believe, these internal leaders can hold forums and discussions that allow people to air their worries. “They can say, ‘they were victims, these are our daughters, our wives,'” says Harvey.

Radio campaigns have also begun to spread the message of reintegration. Discussion and call-in programs often will feature a psychologist, lawyer or perhaps a victim to discuss the various issues and the necessity for support and understanding.

At this time, Amina Ali Nkeki’s current location has not been disclosed, but President Buhari has announced she will receive support from the Murtala Muhammed Foundation, which operates a counseling center in Kano.

But the biggest mistake would be to assume that there is a short-term fix for anyone else who has felt the impact of Boko Haram, including the children born as a result of sexual violence. “The whole community has suffered,” Harvey emphasizes. “All the victims of the conflict must be recognized and attended to.”

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