Friday, September 11, 2020

Amid a Global Pandemic, Immigrant Families Face Even Greater Health Care Insecurities

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By Angel Rosario

At EmblemHealth, I lead a dedicated team that’s embedded in our neighborhoods to help families answer questions about health care coverage and services. 

For some, we are the first people that patients have spoken to about whether they qualify for coverage, if they can get the preventative care they need, or how to deal with chronic conditions. We frequently encounter deep-rooted fears and a reluctance from immigrants and their families about how they can access health care.
Their fears are directly linked to the “public charge” rule, which is a new federal regulation that gives federal immigration officials the ability to deny applications for green cards and visas for those new to the country who have used certain government assistance programs. The rule, and confusion surrounding it, have led many to delay obtaining health care or avoiding it altogether; often resulting in people going  to the hospital or worse, watching loved ones die. From a public health and community perspective, we all must ensure this doesn’t happen.

When we talk to people about health insurance, many emotions are exposed, including concerns about qualifying for health coverage. Every day, I watch people walk away from no-cost health insurance because this new rule makes them feel targeted and exposed.

During this uncertain time, where more than 5 million people have confirmed coronavirus cases in the U.S, there’s an especially crucial need to ensure all who need it, have access to health care. Yet, uncertainty runs high for many in migrant communities, unsure  if they can enroll in health insurance and if doing so will designate them as a “public charge”.

Last week, a federal appeals court blocked this proposed rule from being enforced in Connecticut, New York, and Vermont. Unfortunately, the court action has not alleviated anxiety. Individuals  are worried that applying for health care assistance will result in denial of a green card, visa renewal, or US citizenship, or even deportation.

Everyone has a vested interest in this debate; because the more people with coverage helps protect our communities from disease. The facts are New Yorkers can be fully covered. The public charge rule only affected Medicaid, not other coverage, such as the Essential Plan, Child Health Plus, or Qualified Health Plan. Furthermore, even prior to the court action, the federal government exempted pregnant women and children under 21 seeking Medicaid coverage from the public charge rule. Now the court has made it possible for families to seek coverage for others not previously exempted under Medicaid.
This is a confusing time, and we are here to help. If you or someone you know is worried about getting access to health coverage, please call us at 888-432-8026 where you can get answers. Getting coverage helps you protect your family, ultimately making communities safer.

Angel Rosario is the Vice President of Marketplace Sales at EmblemHealth, a New York nonprofit health insurance plan that serves over 3.2 million New Yorkers and nearly half a million patients through AdvantageCare Physicians (ACPNY), where more than 70,000 of its patients are insured through Medicaid.

Children Need to Go Back to School- Parents Say

OpEd: 
In-Person Learning Can’t Be Replaced

In-Person Learning Can’t Be Replaced

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By Monet Elzey and Lude Bonnet, Parents of New York City School Children

It’s been 179 days since New York City schools closed due to the pandemic. Some of those days have felt like weeks, while others have passed with the blink of an eye. But as parents, one thing has remained constant: our devotion to the health and well-being of our children.

The shift to remote learning in March was an incredible feat by teachers, students, and families. Countless hours have been poured into keeping our children on track over the past six months, and the resiliency of our communities has been a beautiful thing to witness. We made it through some of the toughest days in our City’s history, during the height of a crisis no one could have ever prepared for. 

Today, we’ve made it through the worst of that crisis—and we’re uniquely positioned as the only major school district in the country able to safely send our children back to school in the fall. Our children, their education, and their futures can’t afford to wait.

As parents and educators, we know there is no substitute for the experience of being in a classroom. Our children have so much to gain from being in-person with their teachers, peers, and friends during this critical time. One of us has a son whose eyes light up when he talks about going back to his high school to start his junior year. He can’t wait to be back with his friends and a step closer towards graduation. The memories of when he first began his educational journey are still clear as day. It breaks my heart to think about a world in which he spends his last moments as a New York City student in our apartment every day, away from his friends, and separated from the teachers who want him to succeed.

Being in school is an experience that can’t be replaced. And that’s why we are so hopeful we can make blended learning work. It’s a chance to get our children back to their classrooms, where they learn best with one another.

As of now, the majority of students will begin the school year in a blended learning model, where they will be learning in-person in their own school buildings part of the week and learning remotely during the remaining days. Our schools play such a critical role in our communities, and hundreds of thousands of New York City parents are ready to safely get their kids back to their classrooms.

Are we nervous? Of course, we’re parents. We lie awake at night thinking about our kids, especially our youngest children. How can we help them understand that they can’t hug their friends? Will they remember to wear their masks all the time? None of it will be easy. Our young ones are dealing with the change, confusion, and even trauma the pandemic has brought into their lives. The social and emotional support of educators, friends, parents, and loved ones is needed more than ever for all developing young minds. We are so grateful for the wrap-around care that is already being planned out in our school communities.

Planning for the school year is never easy, but this fall has required far more preparation than ever. We’ve seen first-hand the work our teachers, principals, and even our Mayor and Chancellor have put in to keep our schools and classrooms safe. A later start to school is allowing educators and families more time to thoroughly prepare for the start of a school year like no other, and mandatory testing will help keep our communities safe and healthy.

We refuse to put our children in harm’s way. One of us has a daughter who was diagnosed with Lupus and making sure she’s healthy has caused many sleepless nights. So, safety is absolutely non-negotiable. Knowing that day-in and day-out, there are teams disinfecting the hallways, spacing out classrooms, ensuring adequate ventilation, and taking every precaution necessary for our children provides a little bit of peace during this turbulent time. Health and safety are leading the way as schools prepare a safe and supportive learning environment for our children, and we know school leaders are doing everything they can to start the school year strong.

As parents, we’re reassured. But above all, we’re hopeful. We believe we can make this work, and that we can give our kids the kind of learning experience they can only get in a classroom. During this unprecedented moment, we want nothing but the best for our children – and we know every New York City parent wants the same for their child. That’s what we owe our young people. Let’s do all we can to make that a successful reality this year.

How EmblemHealth is Supporting the Health of The Bronx


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During these uncertain times, questions about health care can be confusing and overwhelming. Many individuals don’t know where to turn, and what they should ask of their provider or their health insurer. 

For more than 80 years, EmblemHealth has worked to make quality health benefits accessible and affordable to all New Yorkers. Along with our physician partners, AdvantageCare Physicians (ACPNY) and community practice partners like BronxDocs, we offer a wide range of services and resources to our community members, including the following:

Removing Barriers to Care with Neighborhood Care

Navigate the health care system, making the most of your health insurance benefits and having access to local and community resources is important to your health. Through EmblemHealth Neighborhood Care, we provide in-person and virtual customer support to help you gain access to the care and resources available in the community. With numerous health wellness programs, we’re here to help the Bronx community learn and keep healthy behaviors. Our trained professionals offer personalized support in multiple languages, including English and Spanish.

Receiving Local Care from BronxDocs 

Bronx residents deserve access to high-quality, coordinated and culturally competent care. Our community practice partner, BronxDocs is a top-notch medical practice offering care at multiple locations throughout the Bronx community. 

You can schedule an appointment at any location by calling (646) 680-5200. BronxDocs is committed to delivering care that is patient-centered, compassionate, and quality-driven at in-person or virtual appointments. 

BronxDocs can care for your whole family, with a full suite of health care services including: Cardiology, Cardiovascular, Family Medicine, Gastroenterology, Gynecology, Internal Medicine, Laboratory, Ophthalmology, Orthopedics, Pediatrics, Physical Therapy, Podiatry, Pulmonology, Urology, and more. BronxDocs offers a special focus on senior care for Medicare patients. 

You can count on BronxDocs to provide access to the right type of appointment at the right time either in-person, via telephone, or through virtual video appointments and all Medicaid, Commercial and Medicare insurance plans are accepted. BronxDocs offers primary care and pediatric appointments within 24 hours and appointments with specialists are available within one week of your call. Providing high-quality, convenient care is the highest priority during these times, and Bronx residents deserve continued access to high-quality care.

Scheduling Virtual Visits

During these unprecedented times, EmblemHealth is working to ensure members can have access to medical appointments using convenient virtual provider visits. 
Now, you can use your tablet, computer, or phone to schedule appointments for urgent, primary or specialty care. If you are feeling anxious or experiencing grief or depression, you can use these virtual visits to access behavioral health specialists. People in the Bronx wanting to schedule a virtual visit with BronxDocs should call (646) 680-5200. 

Protecting City of New York Employees

EmblemHealth has been serving New York families for over eight decades. We’ve supported our members through the Great Depression, and in the aftermath of 9/11. Today, with the health and economic challenges facing our country and our city, we remain dedicated to ensuring City of New York employees have access to safe, quality care. After all, City of New York employees are the heart and soul of New York. 

For those workers, many of whom have been on the frontlines of the COVID-19 crisis since the beginning, our commitment to limiting exposure to COVID-19 while still caring for this critical workforce and their families remains a top priority. To that end, we are pleased to provide prescription drug delivery services, among other options.

In addition, City of New York employees have access to EmblemHealth’s City of New York HMO Preferred Plan, which combines a personalized health care experience with affordable coverage for city workers. These benefits include concierge health coaching service offered at no additional cost to our City of New York HMO Preferred Plan members, through our dedicated “Gold Line.” 

For more information on how EmblemHealth is supporting the Bronx, visit emblemhealth.com/bronx.

Thursday, September 10, 2020

How to Help Kids Cope with Unusual School Year


How to Help Kids Cope with Unusual School Year
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With all the changing plans and confusion during this back-to-school season, it is unsurprising that many students will be feeling more intense back-to-school jitters. In fact, with all the turbulence and disruption of the last school year, many more children could be feeling anxious about how this school year will go. And parents and caregivers are in the same boat. 

Dr. Zubair Khan, child psychiatrist at the Montefiore School Health Program, advises that families need to have open and honest conversations ahead of the start of school, and continue these conversations often throughout the year. 
How to Help Kids Cope with Unusual School Year


“The first thing to do, which is very important, is to acknowledge that it’s going to be an unusual year,” says Dr. Khan.

According to health professionals, the COVID-19 pandemic has taken a toll on the mental health of many children, with heightened feelings of loneliness, isolation, anxiety and depression. Everyone wants children to have the best school experience and get a quality education, while being able to cope with the challenges that will likely continue throughout the year. Dr. Khan offers these simple tips for families to keep in mind during these uncertain times:

*Be honest: 

Help kids understand what they are walking into, and reinforce that the new environment is intended to keep everyone safe and healthy.

*Explain that things may change – and that’s ok. Explain that everyone will need to be flexible and accepting.

*Maintain a schedule at home – Children thrive on a routine: make sure they are getting enough sleep, eating a healthy diet and getting physical activity every day.

*Manage expectations – Recognize that both children and adults may feel worried and stressed, but model positivity and reassure yourself and children that it will be ok.

*Practice and teach mindfulness techniques to help everyone cope with moments of stress or anxiety. Deep breathing exercises are easy and effective for children of all ages, as well as adults.

*If caregivers are concerned about their child’s changing behavior, consult with your pediatrician for further guidance.

Undoubtedly, the school year ahead will present challenges as children try to adjust and many families learn how to navigate teaching and working from home. 

Dr. Khan reminds families to have an open mind, share feelings with each other, and trust that the guidance from teachers and schools is intended to protect children’s safety and ensure they continue to learn and develop academically. 

Navigating Suicide Prevention in a Global Pandemic: Home Health Care Insight


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By Deirdré DeLeo, MA, LCSW, Visiting Nurse Service of New York, Community Mental Health Services 


If any of these sound relative to your own experience, you are not alone. According to a recent study conducted by the U.S. Centers for Disease Control and Prevention, 40 percent of U.S. adults reported dealing with mental health issues or substance abuse in late June, 11 percent of which seriously considered suicide. Additionally, essential workers, unpaid adult caregivers, those who are racial/ethnic minorities and younger adults ages 18-24 reported disproportionately more severe mental health struggles, substance abuse and suicidal ideation. 

It is important to note that while this time of crisis has exacerbated increased symptoms of mental illness, suicide was a public health concern even before the pandemic and continues to be so. 

In my role as Associate Director for Community Mental Health Programs and Clinical Operations at the Visiting Nurse Service of New York, my colleagues and I are trained to observe and skillfully respond to people of all ages who may be struggling with mental health issues.

September is National Suicide Prevention Awareness Month and a time–perhaps more fitting than ever–to discuss how those struggling with mental illness and their loved ones can navigate a public health crisis during a public health crisis.

Look for Signs
Use the increased time you are spending with roommates or family to be one step ahead when it comes to recognizing signs and symptoms someone you love might be contemplating suicide. Phrases like, “I can’t do this anymore,” “I just want to give up,” or “I’ll never be good enough,” may disguise suicidal desires and can be a transparent but overlooked sign that someone might be thinking about suicide. 

Other signs and symptoms to take note of include: increased use of drugs or alcohol, a change in sleeping habits (either can’t sleep or sleeping more), introduction of new habits, reckless behavior, or the giving away of prized possessions. While we have all endured a social disconnect in some variety during the pandemic, uncharacteristic withdrawal from social interaction can also be a sign that someone is severely depressed or struggling with suicidal thoughts. 

Stay Connected…
Humans are social creatures, but once social distancing regulations were put into place many of our daily face-to-face interactions stopped. That may be taking a bigger toll after more than six months of what feels to many like a “lockdown.” It’s natural to feel alone during this time or believe your relationships with friends or family are drifting apart, both of which can produce depressive patterns. 

Now is the time to let technology help you stay connected with loved ones, whether through a simple text message, a humorous meme, social media post or through more personal avenues such as a voice or video call. While there may not be game-changing updates to share, a quick touch-base can mean a lot in these challenging times. Don’t be afraid to ask someone you care about if they are struggling. And don’t be afraid to listen to what they say if they open up. It is important too not to minimize what someone says with comments like, “don’t say that.” Just listen and let them express how they feel.

…But Know When to Disconnect!

Anyone listening to the news these days might find themselves feeling overwhelmed, endangered or hopeless, wishing there was a way to “make things better.” We live in a time (and city) where things are so fast paced. There’s a wealth of information is at our fingertips, but as efficient and helpful as this might be, it is also important to know when information overload becomes too much to handle. Try setting aside time once or twice a day to get news updates. “TMI” can add to stress in our already stressful lives.

Air it Out!
Quarantined conditions have given people limited options when it comes to enjoying activities beyond the square footage of their homes. Spending too much time in one indoor space can increase feelings of agitation, anxiety or confinement. Additionally, many people who cohabitate are spending extended time together in tight spaces, which has the potential to create conflict fueled by general stress. Remember that we all need alone time, even if we’re isolated from the rest of the world! Getting outside, even just sit on your stoop or a park bench for a few minutes, can be a much-needed change of scenery and a simple way to break out of repetitive routines.

Find Hope in Each Day
It’s standard to feel hopeless during a pandemic, but hopelessness can often trigger suicidal ideation. Take some time each day to practice self-care and do something enjoyable, whether it’s watching a TV show, working on a craft, trying a new recipe, taking a hot shower with your favorite scents or reading a book. Make sure you are also eating and drinking water properly and keeping physical active–even if that means dancing to a favorite song or walking laps around your room! 

Many of us have also had radical changes in how our time is structured, so keeping a schedule can be a great way to not only have your priorities in order, but also ensure that you pencil in self-care activities and always have something to look forward to! Thinking about the future–or even the next month–can be intimidating and even feel impossible at times, but conquering life one day at a time will always provide you with a daily gift: You’ve won another battle–and you are a winner.

If you or someone you care about seems seriously anxious or depressed, it’s time to get help. Remember to Ask, Listen and Get Help by calling NYC WELL at 1-888-692-9355.

To learn more about the VNSNY Bronx Mobile Crisis Team and other community mental health services visit VNSNY.org. 

Deirdré DeLeo, is the Associate Director of Programs and Clinical Operations with the Visiting Nurse Service of New York and its Community Mental Health Services division. For more information please visit www.VNSNY.org or call (800) 675-0391.  

Tuesday, September 8, 2020

Taking the Right Steps: Tips for Preventing Falls at Home

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By Abigail Fortune, PT, DPT, Visiting Nurse Service of New York

One out of four Americans age 65 and older experience a fall each year, and one out of five falls will cause serious injury, according to the U.S Centers for Disease Control and Prevention. 

It is also important to note that 60 percent of falls that require hospitalization occur at home. That’s an important point to remember this September as National Falls Prevention Awareness Month comes in the wake of the COVID-19 pandemic here in New York City. 

As a licensed physical therapist with the Visiting Nurse Service of New York, my colleagues and I work to keep our patients safe from falls in their homes. We educate them and their family caregivers so they are aware of risk factors and consequences of serious falls, and we work to help them build strength and regain balance that can decline with age or after hospitalization. Sometimes people believe that falls are an inevitable or natural part of aging—I can assure you, that does not have to be true. 

As a matter of fact, falls can be significantly reduced–even prevented–by implementing some practical lifestyle adjustments.  

In honor of Falls Prevention Awareness Week from September 21-25, I am sharing some tips for caretakers and homebound seniors to prevent falls in or around the home.

Clear Your Path

Cluttered homes can be severe safety hazards and increase chances of tripping or falling. Evaluate each room in the home and consider rearranging furniture or putting certain items into storage in order to create as open of a space as possible. Take note of any objects that can increase risk of tripping such as shoes, books, laundry baskets, pet toys or anything that can roll. Electrical wires should also be moved out of walkways or taped down. Do not hide any wires under rugs, as this can be a fire hazard!

Slippery When Wet

Be aware of any liquid spills, including water transfers from sinks, showers, swimming pools, rain–even condensation from air conditioners–that can increase chances of slipping. Bathrooms are high-risk areas for falling, so make sure to have anti-slip bathmats in your shower or bathtub. Railings or grab bars in the bathroom are also helpful to have in order to improve steadiness, catch any slips before they become falls or help get you back on your feet after a fall. Rugs should also be laid out in the bathroom, especially outside of the shower, to avoid any wet and slippery floors. 

Keep Light on Your Feet

Make sure to keep your home well lit, especially as autumn approaches and the sun begins to set earlier in the day. Take advantage of daylight, open your window blinds and “let the sunshine in,” but as also make sure to keep entryways and staircases well lit. Plug-in nightlights are helpful to have along stairways and in shadowed corners as well as right below light switches that might not be easy to see on the wall. Keep tableside lamps in frequently used locations such as the bedside and living room.

Find your ‘Sole’mate

Putting the correct shoes on your feet can help you stay on your feet! Ill-fitting shoes can increase instability or chances of falling. Make sure to wear proper footwear with anti-slip properties, closed backs and rubber soles. Also, in perhaps one of the first falls prevention lessons we are taught, always make sure your shoelaces are tied!

Let’s Get Physical!

Increased time spent at home due to social distancing is likely to reduce body movement, so it is vital to maintain strength and agility through regular activity. Healthy seniors and people of all ages should participate in an exercise program at least twice a week at home, with doctor’s approval. Your doctor may even recommend you work with a physical therapist if you’re living with a condition that can interfere with your movement or coordination. Simple stretches or yoga poses can also be effective in staying active and improving balance. Pairing up with a friend can make exercise fun and safe as well.

Getting in Gear

Canes, walkers, or other assistive devices can make a world of difference in terms of stability. Walking equipment should always be within arm’s reach (or on each level of the home if there are multiple stories). Equipment should also be maintained regularly, and rubber tips on canes and walkers should be kept intact. Worn-out tips are unreliable and can increase chances of falling, so be sure to visit your local drugstore or local surgical supply store to purchase new rubber tips if needed. 

Glasses with a proper prescription are also essential, especially as one gets older. According to the National Council on Aging, as one ages, less light reaches the retina which can make contrasting edges, obstacles, potential safety hazards and obstacles more difficult to see. Poor depth perception can also lead to problems navigating uneven or slippery surfaces. Seniors should visit a doctor for a vision assessment every year and pursue treatments that will correct any problems that arise. 

Know the Health Risks

Seniors and caretakers should be well-informed on certain health conditions that increase the risk of falls. For example, diabetes can cause joint pain, foot sensitivity, dizziness and vision problems. COPD, CHF, low blood pressure and other circulatory diseases can also cause dizziness and affect balance. Balance and mobility may be impacted by bone and joint conditions, such as osteoporosis and arthritis, and eye diseases such as glaucoma and cataracts interfere with vision. 

Medications that depress the central nervous system increase the risk of falling, as do certain medications, such as pain relievers, heart medications, antidepressants, seizure medications, over-the-counter sleep aids, allergy medications and some cold and cough remedies. Optimal awareness and regular check-ins with your physician can help manage symptoms, address side effects and reduce risk.

Stay Connected

While many homebound seniors have assistance at home, their loved ones may not be able to visit them frequently. Mobile devices are extremely helpful to have on hand, whether for simple text messaging, voice or video calls, or even for use of your phone’s built-in flashlight to see more clearly in the dark. Be sure to have caretakers on speed dial in case of a severe fall or other health-related emergency, or identify a neighbor who can be trusted in case of immediate need. If your loved one is at risk of damaging falls or health conditions, regular check-ins can be very useful, especially in a time of such isolation, and may even help save a life! Home care providers like VNSNY can also provide information about setting up a subscription with services like Life Alert for elderly loved ones who live alone.

Abigail Fortune is a physical therapist and rehabilitation instructor with the Visiting Nurse Service of New York. For more information please visit www.VNSNY.org, or call 1-800-675-0391.
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Tuesday, September 1, 2020

CORONAVIRUS HEALTH DELAY IS DANGEROUS- DOCS SAY

Come to the ER If You Need Care 
Come to the ER If You Need Care
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By Dr. Anthony Ruvo, Emergency Medicine, 
Montefiore Westchester Square


What worries me is that the COVID-19 pandemic is moving other medical emergencies to the back burner, putting the lives of our community at risk.
In the Bronx, our patients have been plagued with having some of the highest rates of premature death in New York due to heart disease. Separately, research from our neurology colleagues found that many of our disadvantaged patients are coming the hospital long after stroke symptoms, even though the goal for stroke care is arriving less than an hour after symptoms appear.

At Montefiore Westchester Square, we have been proud to offer our community top notch service and record-setting timeliness for seeing doctors. Since the beginning of COVID-19, we ramped up efforts to disinfect our waiting room, and socially distance patients so they would feel as comfortable as can be – despite these efforts, we have seen a 40 percent drop in visits to our free-standing emergency department. What keeps me up at night is that the most striking decreases in visits are for deadly conditions like heart attack and stroke. 

This drop is not because these serious medical issues have gone away, but because people do not feel safe coming to the ER in the wake of COVID. In reality, it is much more dangerous to try to handle medical emergencies at home or postpone care.

In January of this year, we saw an average of 150 patients a day, a historic high for Montefiore Westchester Square, the first freestanding emergency department in New York. Now we see an average of 65-70 patients daily. Kids and older adults are not coming in at the rates they once did, leaving these vulnerable populations without the frequent evaluations and monitoring they need. 

As a doctor, the safety of my patient is always priority number one – and while the emergency department is far from the first place people want to go, I fear that people are delaying the lifesaving care they need.

My goal in writing this piece is to reassure our community that coming to Montefiore Westchester Square is not just safe, but speedy. Every person who walks through our doors can expect to have an emergency medicine doctor at their bedside in less than 20 minutes. On average, their stay will be less than two hours, better than any neighboring location.
We take pride in keeping our waiting areas as efficient as possible, so people have their own private space while they are being evaluated and cared for – regardless of the day of the week or time of night.

From daily temperature checks of our staff and screening patients prior to entering the emergency department to designated areas separated by illness type, we ensure an environment that provides maximum comfort and safety. Patients can expect to be greeted upon arrival by a courteous and professional staff that are not just providers, but members of the community we serve.

Our job is to get people and their families back home and to their normal lives as quickly and safely as possible. At Montefiore Westchester Square, we have proven this year after year: Our focus is not just your illness today, but your life for many years to come. 

We are open 24/7 at 2475 St Raymond Ave in the Bronx, and are equipped with X-ray, ultrasound and CT scanners staffed by our team of Emergency Medicine doctors. Please do not hesitate to come by if you need emergency medical care.  While change is always hard, and these days can be scary – the most dangerous thing we can do is delay care when it is needed the most.

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