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India’s Doctors and Medical Workers Face Danger and Trauma

NEW DELHI — The shifts are long, the wards full, the demand so urgent that medical students and interns have been coaxed into filling in. Hundreds of workers have died. Family members at home have fallen ill.

India’s doctors and other medical responders find themselves short-handed and underfunded as they battle the world’s worst coronavirus outbreak. Beyond the physical danger they also face, they have been forced by the devastating size of the outbreak and the government’s mismanagement of the crisis into cruel routines of helplessness, making decisions day after day that could determine whether a patient lives or dies.

As beds fill up, they have to choose who among the throngs outside the hospital gates to allow inside for treatment. As the oxygen runs out, they have to choose who gets precious supplies. The emotional toll is mounting.

to the World Bank, India’s health care spending, public and out of pocket, totals about 3.5 percent of its gross domestic product, less than half of the global average.

They also face intimidation and violence, with videos circulating of angry family members thrashing medical staff in hospital halls covered in blood, or local strongmen bullying and scolding them.

when the hospital ran out of oxygen for 80 minutes early in May. Dr. Himthani had treated Covid patients for 14 months before he and his wife were infected.

As the oxygen ran out, Dr. Shiv Charan Lal Gupta, the director of the hospital and a friend of Dr. Himthani for three decades, ran up and down the hallways sending messages to government officials, media outlets and anybody who might help.

In their masks and gowns, the hospital staff gathered with teary eyes and folded arms at the main gate to pay their final respects as Dr. Himthani’s body was wheeled out. Then they went back to work.

44.5 trained health workers per 10,000.

The distribution is unequally concentrated in urban centers. About 40 percent of health care providers work in rural areas, where more than 70 percent of India’s population lives. Bihar, one of India’s poorest states, has only 0.24 beds per 1,000 people, less than one-tenth of the world average.

“When I close my eyes, I feel someone needs my help,” said Lachhami Kumari, a nurse at a government hospital in the Rohtas district of Bihar, one of India’s poorest states. Her 80-bed facility has been overwhelmed by critical Covid patients. “When I manage to fall asleep, I see people all around, begging for help. That has kept me going.”

At another government hospital in Patna, Bihar’s capital city, Dr. Lokesh Tiwari said almost half of the doctors and paramedic staff have lost family members.

on Twitter. “He asked her vitals, thanked me and hung up.”

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Prince Harry Shares ‘Pain and Suffering’ of Growing Up in Royal Family

“I’m going to be vulnerable,” he said about sharing details on his mental health. “If I get attacked for it, let’s see who’s attacking me.”

In the interview with Ms. Winfrey in March, Meghan also shared her mental health battles, saying that she had struggled with suicidal thoughts when she was part of the royal family. Last year, she shared the trauma of miscarriage in an essay published in The New York Times.

Symptoms of depression and anxiety have been on the rise in many countries since the beginning of the coronavirus crisis, and Harry said that it was important to talk about the feelings caused by the pandemic.

“We’re now in the emotional phase,” Harry said, making reference to a Times article about the feeling of languishing. “You just feel flat. It’s not depressed, it’s definitely not flourishing,” Harry said. “You lack the energy and the will, your motivation, because you sit and wonder, ‘What happens next?’”

Harry said efforts like founding the Invictus Games, a sports event first staged in 2014 that showcases the talents of wounded servicemen and women, had helped him deal with his own mental health problems. “If we’re looking after our body and our body gets injured, what do we do when our mind gets injured?” he said.

About moving to the United States, Harry said “that wasn’t the plan.”

But, he added, “Sometimes you have to make decisions and bring your family first, and put your mental health first.”

And, once again, Harry was asked if he had seen the Netflix series “The Crown.”

“Elements of it,” he said.

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How Child Care Went From ‘Girly’ Economics to Infrastructure

That’s changing. The Biden administration and its allies are pushing the notion that caring for children — and the sick and the elderly — is just as crucial to a functioning economy as any road, electric grid or building. It’s human infrastructure, they argue, echoing a line of thought long articulated by feminist economists (and often ignored).

President Biden included money for home-based care for the elderly and the disabled under the umbrella of infrastructure, as part of a $2 trillion package he proposed in March. The next month, he proposed more funding for paid family leave, universal pre-K and $225 billion for child care.

The ambitious legislation is going to face huge hurdles in Congress, but Dr. Folbre, now 68, is both cautiously optimistic and heartened by the culture shift: “I often say to myself I’m glad I lived this long so I can say maybe I had a point.”

Mariel Mendez and her husband, David, each the first in their immigrant families to earn college degrees and find rewarding careers, assumed they’d rely on high-quality child care to make everything work. She holds a master’s in public health from Columbia University and works at a nonprofit near Kent, Wash., where they live; he has a master’s in education policy and works as a coach for elementary school teachers.

Yet, now they’re debating if one of them should stop working altogether.

Over the past year, the Mendezes have cycled through four different child-care arrangements for Milea, their 2-and-a-half-year-old daughter, starting with an overcrowded center they felt was unsafe, then a back-and-forth with an in-home day care struggling to survive through the pandemic, and a stressful marathon at home managing remote work and never-ending toddler duty.

“We’re starting to think for our mental health and for our relationship as a family, does it make more sense for one of us to step down, shift to part time?” said Ms. Mendez, 28, who is expecting another baby in June. The prospect of an infant, a full-time job and a still uncertain child-care arrangement is overwhelming. “I never thought I’d be here. That we would all be here,” she said.

But in a sense it was inevitable that they would be, since they were headed toward a cliff — with no bridge spanning it.

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Pharmacies Are Entering the Mental Health Market

CVS, which merged with the insurance provider Aetna three years ago, aims to reduce overall health costs with its mental health pilot program, Dr. Knecht said. Mental health issues that are not addressed become crises, he added, “so our aspiration is to make mental health services accessible and locally available so we can address these issues before they continue to expand and result in substantial morbidity and poor outcomes.”

Removing obstacles to mental health care by making providers more accessible is helpful, said Vaile Wright, senior director of health care innovation at the American Psychological Association, “but they are never the No. 1 barrier to accessing treatment,” she said. “Cost is.”

Psychiatrists are less likely to take insurance than other types of physicians, and many psychologists, social workers and others who offer therapy likewise decline insurance because they say payments by insurers are relatively low and managed care companies sometimes subject them to intrusive audits.

The mental health services provided by the CVS MinuteClinics are covered by many major health insurers and Employee Assistance Program plans, a spokeswoman said.

“Pricing options without insurance range between $129 for an initial assessment to $69 for a 30-minute session, with many options in between,” she added.

At Walmart, the initial therapy session is $60 and the 45-minute follow-up sessions cost $45, according to the company’s website.

If you’re considering using a retail location to receive therapy, be sure to ask the same questions you would of any new therapist, experts advise. Some examples include:

In addition, if you identify as L.G.B.T. or are a member of another minority group — or if you already know that you suffer from a particular condition like anxiety or depression — it’s helpful to know whether the therapist has worked with similar populations in the past and whether they have had cultural competence training, said Alfiee Breland-Noble, a health disparities researcher and founder of the AAKOMA Project, a mental health nonprofit for teenagers and their families.

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Many Families Torn Apart at the Southern Border Face a Long and Uncertain Wait

HUEHUETENANGO, Guatemala — In a small village in the Guatemalan highlands, a father smiled into the tiny screen of a cellphone and held up a soccer jersey for the camera, pointing to the name emblazoned on the back: Adelso.

In Boca Raton, Fla., on the other end of the video chat, his son — Adelso — started to cry.

“I’ll send it to you,” the father, David, said during the call in March. “You need to be strong. We’re going to hug and talk together again. Everything’s going to be fine.”

migrant children who are in the United States but separated from their parents, according to lawyers working on the issue. There are at least another 445 who were taken from parents who have not been located.

The separated families received a jolt of hope in early February when President Biden signed an executive order to reunify the migrant families by bringing the deported parents into the United States.

This week, as migrant apprehensions at the southwest border approach a near 20-year high, the Department of Homeland Security announced that it would bring a handful of separated parents to the U.S. in the coming days. The process of reunifying them all could take months or years, and questions remain about what benefits will be offered to each of those families.

Adelso has lived the last three years with his aunt, Teresa Quiñónez, in Boca Raton, Fla., where she works as a real estate agent. She had come to the United States herself at 17, without her parents.

a 2020 investigation by Physicians for Human Rights, many children separated from a parent at the border exhibited symptoms and behavior consistent with trauma: post-traumatic stress disorder, anxiety disorder and major depressive disorder. In some cases, the trauma stemmed partly from experiences in the child’s home country, but researchers found it was likely linked to the separation itself.

Dr. Falcón-Banchs currently treats eight children between the ages of 6 and 16 who were separated from a parent in 2017 and 2018. Five of those children received a diagnosis of PTSD, anxiety and-or depression. Adelso is faring better and has shown resilience and coping skills, she said.

In one case, a boy from Honduras who is now 13 suffered severe anxiety and PTSD after being separated from his mother for several months and placed in foster care. Being reunited with her didn’t improve his condition right away, Falcón-Banchs said.

“When his mom first took him to school in the U.S., his brain responded in such a way that he began screaming and panicking and wanted to leave,” she said. “When he was separated, he was told that he was ‘lost in the system’ and wouldn’t be able to be reunited with his mom. So he was just crying, perhaps because of that association.”

the Trump administration did not track after separation.

And many families whose whereabouts were known have since moved or changed phone numbers, compounding the challenge of possible reunification.

Further complicating the task is that most migrants come from Central America, and three countries there — Guatemala, Honduras and El Salvador — have experienced lockdowns during the pandemic, as well as widespread internal displacement from two hurricanes, Eta and Iota.

“We must find every last family and will not stop until we do,” said Lee Gelernt, the lead attorney for immigrant rights at the A.C.L.U.

But the process has been “extremely difficult and slow,” he said, adding that “many of the parents can only be found through on-the-ground searches.”

During a visit to a small Guatemalan town, a Times reporter learned of three parents who said they were forcibly separated from their children by U.S. border officials in 2018 and then deported. Two had already made the perilous return trip to the U.S., spending $15,000 on a journey to reunite with their children in Florida.

“They returned for the kids, because they were left alone there,” said Eusevia Quiñónez, whose husband, Juan Bernardo, left with his older brother for Fort Lauderdale, Fla., on Jan. 8. “Thank God, they arrived OK.”

Another father, Melvin Jacinto, was contacted by KIND, a children’s defense group, more than a year ago, but he doubts they will be able to help him. He again wants to try to enter the United States to reunite with his son, Rosendo, in Minneapolis and to find work to support his family. He said talking on the phone with his son, who turned 18 last month and from whom he has been separated for three years, is emotionally difficult for him. He can’t help but cry.

“It’s like I’m traumatized or something,” Mr. Jacinto said. “I’m not good. I don’t sleep, not at all.”

Psychologists working with separated families say that family reunification is just one step in the healing process, and that the parents have as much need for mental health counseling as the children. Many parents blame themselves for the separation, and after reunification the children, too, often blame the parents.

David, who has suffered from stress-induced gastritis and other health complications since the separation, said he had also considered hiring a smuggler to get back to the U.S. to reunite with Adelso.

“I need to see my son,” he said. “And he needs me.”

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