Maryna Lialko had raised the girls alone after their father left the family, their grandmother, Nina Lialko, said.

“She was devoted to these two girls,” she said.

Kateryna was discharged this fall from Ohmadyt hospital, where she received psychiatric and physical therapy, and the girls are now in Kyiv living with their grandmother and aunt.

The aunt, Olha Lialko, said she has seen a shift in their personalities. Kateryna is increasingly turning inward; she speaks very little and struggles to maintain eye contact. Yuliia still can’t fully comprehend the loss.

“Katya is very closed; she keeps it all to herself,” Olha Lialko said. “Yuliia is missing mom a lot. She needs attention, she likes to cuddle.”

The family is trying to help the girls process their loss. And occasionally they see glimpses of the girls they knew before the war.

They dye their hair wild colors and play with makeup. They fight as only sisters can, and cling closely to each other for company.

But no one knows what will come next for them. Their life is on hold. They attend school online and have few friends in the new city. The family is unable to return home to Donetsk but unwilling to commit to staying in Kyiv.

“It will be very difficult for them to live without her,” their grandmother said. “This life has no sense at all.”

Oleksandra Mykolyshyn contributed reporting

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How a Hospital Chain Used a Poor Neighborhood to Turn Huge Profits

RICHMOND, Va. — In late July, Norman Otey was rushed by ambulance to Richmond Community Hospital. The 63-year-old was doubled over in pain and babbling incoherently. Blood tests suggested septic shock, a grave emergency that required the resources and expertise of an intensive care unit.

But Richmond Community, a struggling hospital in a predominantly Black neighborhood, had closed its I.C.U. in 2017.

It took several hours for Mr. Otey to be transported to another hospital, according to his sister, Linda Jones-Smith. He deteriorated on the way there, and later died of sepsis. Two people who cared for Mr. Otey said the delay had most likely contributed to his death.

the hospital’s financial data.

More than half of all hospitals in the United States are set up as nonprofits, a designation that allows them to make money but avoid paying taxes. Although Bon Secours has taken a financial hit this year like many other hospital systems, the chain made nearly $1 billion in profit last year at its 50 hospitals in the United States and Ireland and was sitting on more than $9 billion in cash reserves. It avoids at least $440 million in federal, state and local taxes every year that it would otherwise have to pay, according to an analysis by the Lown Institute, a nonpartisan think tank.

In exchange for the tax breaks, the Internal Revenue Service requires nonprofit hospitals to provide a benefit to their communities. But an investigation by The New York Times found that many of the country’s largest nonprofit hospital systems have drifted far from their charitable roots. The hospitals operate like for-profit companies, fixating on revenue targets and expansions into affluent suburbs.

borrowing tricks from business consultants, have trained staff to squeeze payments from poor patients who should be eligible for free care.

John M. Starcher Jr., made about $6 million in 2020, according to the most recent tax filings.

“Our mission is clear — to extend the compassionate ministry of Jesus by improving the health and well-being of our communities and bring good help to those in need, especially people who are poor, dying and underserved,” the spokeswoman, Maureen Richmond, said. Bon Secours did not comment on Mr. Otey’s case.

In interviews, doctors, nurses and former executives said the hospital had been given short shrift, and pointed to a decade-old development deal with the city of Richmond as another example.

In 2012, the city agreed to lease land to Bon Secours at far below market value on the condition that the chain expand Richmond Community’s facilities. Instead, Bon Secours focused on building a luxury apartment and office complex. The hospital system waited a decade to build the promised medical offices next to Richmond Community, breaking ground only this year.

founded in 1907 by Black doctors who were not allowed to work at the white hospitals across town. In the 1930s, Dr. Jackson’s grandfather, Dr. Isaiah Jackson, mortgaged his house to help pay for an expansion of the hospital. His father, also a doctor, would take his children to the hospital’s fund-raising telethons.

Cassandra Newby-Alexander at Norfolk State University.

got its first supermarket.

according to research done by Virginia Commonwealth University. The public bus route to St. Mary’s, a large Bon Secours facility in the northwest part of the city, takes more than an hour. There is no public transportation from the East End to Memorial Regional, nine miles away.

“It became impossible for me to send people to the advanced heart valve clinic at St. Mary’s,” said Dr. Michael Kelly, a cardiologist who worked at Richmond Community until Bon Secours scaled back the specialty service in 2019. He said he had driven some patients to the clinic in his own car.

Richmond Community has the feel of an urgent-care clinic, with a small waiting room and a tan brick facade. The contrast with Bon Secours’s nearby hospitals is striking.

At the chain’s St. Francis Medical Center, an Italianate-style compound in a suburb 18 miles from Community, golf carts shuttle patients from the lobby entrance, past a marble fountain, to their cars.

after the section of the federal law that authorized it, allows hospitals to buy drugs from manufacturers at a discount — roughly half the average sales price. The hospitals are then allowed to charge patients’ insurers a much higher price for the same drugs.

The theory behind the law was that nonprofit hospitals would invest the savings in their communities. But the 340B program came with few rules. Hospitals did not have to disclose how much money they made from sales of the discounted drugs. And they were not required to use the revenues to help the underserved patients who qualified them for the program in the first place.

In 2019, more than 2,500 nonprofit and government-owned hospitals participated in the program, or more than half of all hospitals in the country, according to the independent Medicare Payment Advisory Commission.

in wealthier neighborhoods, where patients with generous private insurance could receive expensive drugs, but on paper make the clinics extensions of poor hospitals to take advantage of 340B.

to a price list that hospitals are required to publish. That is nearly $22,000 profit on a single vial. Adults need two vials per treatment course.

work has shown that hospitals participating in the 340B program have increasingly opened clinics in wealthier areas since the mid-2000s.

were unveiling a major economic deal that would bring $40 million to Richmond, add 200 jobs and keep the Washington team — now known as the Commanders — in the state for summer training.

The deal had three main parts. Bon Secours would get naming rights and help the team build a training camp and medical offices on a lot next to Richmond’s science museum.

The city would lease Bon Secours a prime piece of real estate that the chain had long coveted for $5,000 a year. The parcel was on the city’s west side, next to St. Mary’s, where Bon Secours wanted to build medical offices and a nursing school.

Finally, the nonprofit’s executives promised city leaders that they would build a 25,000-square-foot medical office building next to Richmond Community Hospital. Bon Secours also said it would hire 75 local workers and build a fitness center.

“It’s going to be a quick timetable, but I think we can accomplish it,” the mayor at the time, Dwight C. Jones, said at the news conference.

Today, physical therapy and doctors’ offices overlook the football field at the training center.

On the west side of Richmond, Bon Secours dropped its plans to build a nursing school. Instead, it worked with a real estate developer to build luxury apartments on the site, and delayed its plans to build medical offices. Residents at The Crest at Westhampton Commons, part of the $73 million project, can swim in a saltwater pool and work out on communal Peloton bicycles. On the ground floor, an upscale Mexican restaurant serves cucumber jalapeño margaritas and a Drybar offers salon blowouts.

have said they plan to house mental health, hospice and other services there.

a cardiologist and an expert on racial disparities in amputation, said many people in poor, nonwhite communities faced similar delays in getting the procedure. “I am not surprised by what’s transpired with this patient at all,” he said.

Because Ms. Scarborough does not drive, her nephew must take time off work every time she visits the vascular surgeon, whose office is 10 miles from her home. Richmond Community would have been a five-minute walk. Bon Secours did not comment on her case.

“They have good doctors over there,” Ms. Scarborough said of the neighborhood hospital. “But there does need to be more facilities and services over there for our community, for us.”

Susan C. Beachy contributed research.

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16 Uvalde 4th Graders Waited An Hour With Wounded Teacher

Minutes before Elsa Avila felt the pain of the bullet piercing her intestine and colon, she was motioning students away from the walls and windows.

Elsa Avila slid to her phone, terrified as she held the bleeding side of her abdomen and tried to stay calm for her students. In a text to her family that she meant to send to fellow Uvalde teachers, she wrote: “I’m shot.”

For the first time in 30 years, Avila will not be going back to school as classes resume Tuesday in the small, southwest Texas city. The start of school will look different for her, as for other survivors of the May 24 shooting at Robb Elementary School in which 21 people died, with an emphasis on healing, both physically and mentally. Some have opted for virtual education, others for private school. Many will return to Uvalde school district campuses, though Robb Elementary itself will never reopen.

“I’m trying to make sense of everything,” Avila said in an August interview, “but it is never going to make sense.”

A scar down her torso brings her to tears as a permanent reminder of the horror she endured with her 16 students as they waited in their classroom for an hour for help while a gunman slaughtered 19 children and two teachers in two adjoining classrooms nearby.

Minutes before she felt the sharp pain of the bullet piercing her intestine and colon, Avila was motioning students away from the walls and windows and closer to her. A student lined up by the door for recess had just told her something was going on outside: People were running — and screaming. As she slammed the classroom door so the lock would catch, her students took their well-practiced lockdown positions.

Moments later, a gunman stormed into their fourth-grade wing and began spraying bullets before ultimately making his way into rooms 111 and 112.

In room 109, Avila repeatedly texted for help, according to messages reviewed by The Associated Press. First at 11:35 a.m. in the text to her family that she says was meant for the teacher group chat. Then at 11:38 in a message to the school’s vice principal. At 11:45, she responded to a text from the school’s counselor asking if her classroom was on lockdown with: “I’m shot, send help.” And when the principal assured her that help was on the way, she replied simply: “Help.”

“Yes they are coming,” the principal wrote back at 11:48 a.m.

It’s unclear whether her messages were relayed to police. District officials did not respond to requests for comment on actions taken to communicate with law enforcement on May 24, and an attorney for then-Principal Mandy Gutierrez was not available for comment.

According to a legislative committee’s report that described a botched police response, nearly 400 local, state and federal officers stood in the hallway of the fourth-grade wing or outside the building for 77 minutes before some finally entered the adjoining classrooms and killed the gunman. Lawmakers also found a relaxed approach to lockdowns — which happened often — and security concerns, including issues with door locks. State and federal investigations into the shooting are ongoing.

The district is working to complete new security measures, and the school board in August fired the district’s police chief, Pete Arredondo. Residents say it remains unclear how — or even if — trust between the community and officials can be rebuilt, even as some call for more accountability, better police training and stricter gun safety laws.

Avila recalls hearing the ominous bursts of rapid fire, then silence, then the voices of officers in the hallway yelling, “Crossfire!” and later more officers standing nearby.

“But still nobody came to help us,” she said.

As Avila lay motionless, unable to speak loud enough to be heard, some of her students nudged and shook her. She wished for the strength to tell them she was still alive.

A light flashed into their window, but nobody identified themselves. Scared it might be the gunman, the students moved away.

“The little girls closest to me kept patting me and telling me, ‘It’s going to be OK miss. We love you miss,'” Avila said.

Finally, at 12:33 p.m. a window in her classroom broke. Officers arrived to evacuate her students — the last to be let out in the area, according to Avila.

With her remaining strength, Avila pulled herself up and helped usher students onto chairs and tables and through the window. Then, clutching her side, she told an officer she was too weak to jump herself. He came through the window to pull her out.

“I never saw my kids again. I know they climbed out the window and I could just hear them telling them, `Run, run, run!'” Avila said.

She remembers being taken to the airport, where a helicopter flew her to a San Antonio hospital. She was in and out of care until June 18.

Avila later learned that a student in her class was wounded by shrapnel to the nose and mouth but had since been released from medical care. She said other students helped their injured classmates until officers arrived.

“I am very proud of them because they were able to stay calm for a whole hour that we were in there terrified,” Avila said.

As her students prepare to return to school for the first time since that traumatic day, Avila is on the way to recovery, walking up to eight minutes at a time on the treadmill in physical therapy and going to counseling. She looks forward to teaching again someday.

Outside of a shuttered Robb Elementary, a memorial for the people killed overflows at the entrance gate. Teachers from across Texas stopped by this summer to pay their respects and reflect on what they would do in the same situation.

“If I survive, I have to make sure they survive first,” said Olga Oglin, an educator of 23 years from Dallas, her voice breaking.

“Whatever happens to a student at our school, it just happens to one of my kids,” Olgin said, adding that as the person to greet parents, students and staff at the door in the mornings, she likely would be the first person shot.

Ofelia Loyola, who teaches elementary school in San Antonio, visited with her husband, middle school teacher Raul Loyola. She was baffled at the delayed response from law enforcement, as seen on security and police video.

“They are all kids. It doesn’t matter how old they are, you protect them,” she said.

Last week, Avila and several of her students met for the end-of-year party they were unable to have in May. They played in the pool at a country club and she gave them each a bracelet with a little cross to remind them that “God was with us that day and they are not alone,” she said.

“We always talked about being kind, being respectful, taking care of each other — and they were able to do that on that day,” Avila said.

“They took care of each other. They took care of me.”

Additional reporting by The Associated Press.

Source: newsy.com

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The Woman Behind Iconic Beyoncé Looks and ‘Black Owned Everything’

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The costume designer and wardrobe stylist Zerina Akers does not want people to think that her life is picture-perfect, even if she spends her time making sure that her clients are.

“I want to dispel the thought that it is glamorous,” she said of her days, which often include piecing together ensembles for her celebrity clientele, overseeing fittings and tending to her e-tail site. “Yeah, you’re dealing with beautiful things, but you also have to deal with all the luggage, getting all the looks right and running around. It’s a lot of hard work and heavy lifting.”

And, lately, she has been doing all of that on a wounded ankle. She’s mainly worn comfort shoes during the pandemic, but a pair of post-quarantine wedge heels led to her recent mishap. (“Who did I think I was?!” she said, while describing the stumble during a phone interview.)

Ms. Akers, 35, is the go-to stylist for Beyoncé Knowles-Carter — the iconic oversized black hat that the singer modeled in the 2016 “Formation” music video was her handiwork. She also compiled the wardrobe for Ms. Knowles-Carter’s opulent 2020 visual album, “Black Is King,” pulling designs from both established European fashion houses and independent designers from across the African diaspora.

Black Owned Everything, an e-commerce hub featuring a curated selection of apparel, accessories, beauty and décor products.

“Last summer, there was a huge surge in support of Black brands,” she said, describing widespread calls for inclusivity and representation that swelled after the protests against racism and police brutality. That led some people to ask a new question: How long would this last?

“Would it be something that’s going to stick around and really create change, or was it just a trend?” Ms. Akers said. “I felt it was important to not wait around and gauge the reaction of the fashion industry. We were able to create something that we own, and we’re going to keep it going,” she said of the website, which features about three dozen brands.

Ms. Akers, a Maryland native who is based in Van Nuys, Calif., has also been designing clothing recently, a throwback to her teenage years spent creating garments for school fashion shows. Some of her work — a color-blocked dress, a chain-trim bodysuit, a trench jumpsuit — is featured in a capsule collection of separates for Bar III, the private label from Macy’s.

We spoke with her in early May, as she mulled over ideas for revamping the Black Owned Everything site and sorted through wardrobe items intended for the Colombian reggaeton artist Karol G and Chloe Bailey of the R&B duo Chloe x Halle.

Interviews are conducted by email, text and phone, then condensed and edited.

Brandice Daniel, the founder and chief executive of Harlem’s Fashion Row, as part of their annual Designer Retreat. We’re on with the accessories designer Brandon Blackwood, talking about our career paths and giving advice to young people on how to make it in fashion. I talk about the importance of being in good financial standing and doing what you love without prioritizing being “internet famous.”

3:30 p.m. My assistant, Christian Barberena, arrives at my house and we chill in the backyard, going over our next two weeks of work and divvying up tasks. Usually, my team handles internet shopping and sourcing items in stores. Then, I’ll primarily handle things that are being custom-made by designers.

5:45 p.m. I realize I’m about 15 minutes late for a Netflix virtual screening event for “Halston,” and Chris and I tune in to watch. It’s a must-see. Based on what I’ve read about him, it was well-cast — and it’s visually quite stunning.

8 a.m. I awake with a bit of anxiety, because I’ve been trying to figure out how to seamlessly do some construction on the Black Owned Everything site without alarming our followers. I want it to have much more storytelling, engage more Black photographers and graphic designers, and make it more than just a generic e-commerce space. I also have to find an entry-level social media manager to help make the Instagram account more robust while the site is down.

The Rooftop by JG with Liza Vassell, the founder of Brooklyn PR. We’re both late but make it just in time to not lose our table. It’s our first time connecting outside of work and we spent an hour and a half stuffing our faces, discussing our experiences being Black women making our own way, and investing in and supporting each other.

6:30 p.m. Today was one of those weird days — productive, yet somehow I was left feeling like I didn’t quite do enough. I start checking out mentally by watching trash TV.

8:30 a.m. My makeup artist, Leah Darcy Pike, arrives to help me get ready for a portrait for this column. I decided to throw on an aqua blue look from my Macy’s collection.

1:17 p.m. I call my product development consultant and deliver the good news that I love our new Black Owned Everything candle sample. It’s kind of woody and sort of like patchouli, with these other weird notes. We also discuss possible product ideas we could launch for Juneteenth, like a summer travel kit.

2:05 p.m. I open my garage in an attempt to organize it, then close it back. It’s filled with jewelry, clothes from past photo shoots, my personal wardrobe overflow, B.O.E. stuff … it’s gotten a little crazy.

3 p.m. It’s Chris’s birthday, so I run out and grab a cake from Sweet Lady Jane and we indulge for just a moment.

4:15 p.m. I go to a mall in Sherman Oaks to pick up monochromatic sneakers for my weekend shoot with Karol G. I love color-blocking, particularly red shoes and red bags.

Sally Hemings. I’m currently obsessed with the narratives of slaves. The varied experiences never cease to amaze me. I keep them etched in my brain as a reminder of how resilient we really are as a people.

8:33 a.m. I’m cracking open the week’s packages one by one. There are 20 to 30 — a combination of gifts, things from Black-owned businesses that they want us to review, and some celeb stuff. For the most part, I try to have some stuff go to my office, but since we’re blurring lines with the pandemic, I’ve just been having it come straight to one place.

10:45 a.m. Head out to meet Chris so we can set up a rack for Karol G before heading into a fitting. The first thing I usually try to do with fittings is see what makes the client’s face light up, then I’ll start with those things that they’re most excited about. Typically, the trickiest part is the alterations because you want to make sure they hold up and last, but not damage the garment. On this day, everything went smoothly.

5:33 p.m. After grabbing a bowl of fried tofu with veggies and grits at Souley Vegan, I head to my office to work on a new project with Chris. We’re trying to start a virtual reality character for the site. She’ll be dressed in the Black-owned brands and you can follow her day-to-day.

8 p.m. We realize we should probably stop working and head home to pack for a shoot in San Francisco. When I fly, I have to have my travel blanket (right now, it’s Burberry), my memory foam neck pillow and a sleep mask — I can never stay awake on a plane, even if it’s just an hourlong flight.

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Meet Virtual Reality, Your New Physical Therapist

The company has all of its programs registered with the F.D.A., said Eran Orr, founder and chief executive.

Not all the programs offered for V.R. rehab are games; some clinics allow a patient to virtually practice real-life skills they may have trouble doing, such as grocery shopping or dishwashing.

To really push the use of virtual reality for physical and occupational therapy, “we’ll need to build a body of evidence that shows it’s effective, how we pay for it and how we can develop it in a way that’s easy to use,” said Matthew Stoudt, chief executive and a founder of Applied VR, which supplies therapeutic virtual reality. “We have to be able to demonstrate that we can bring down the cost of care, not just add to the cost paradigm.”

While research specifically on V.R. use in physical and occupational therapy is in the early stages, an analysis of 27 studies, conducted by Matt C. Howard, an assistant professor of marketing and quantitative methods at the University of South Alabama, found that V.R. therapy is, in general, more effective than traditional programs.

“Does it mean V.R. is better for everything? Of course not,” he said in an interview. “And there’s a lot we still don’t know about V.R. rehab.”

Much of the research uses small samples with varying degrees of rigor, and more needs to be studied about how a patient’s activity in the virtual world translates into improved performance in the physical world, said Danielle Levac, an assistant professor in the department of physical therapy, movement and rehabilitation sciences at Northeastern University. Professor Levac researches the rational for using virtual reality systems in pediatric rehabilitation; many of the children she works with have cerebral palsy.

“We have to consider the downside of a lack of one-on-one contact with therapists,” she said. “I view V.R. as a tool that has a lot of potential, but we should keep in mind it should fit in — and not replace — an overall program of care.”

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