CDC recommends HPV vaccine for boys
Washington, D.C., United States (AHN) – The HPV vaccine should now be given to all males between the ages of 11 and 21, according to new guidelines from the Centers for Disease Control and Prevention.
The CDC’s Advisory Committee on Immunization Practices says that the human papillomavirus vaccine should be routine for all boys ages 11 to 21. It also recommends “catch-up” vaccinations for males ages 13 to 21.
The committee first recommended the vaccine for boys last October, but recommendations were not formalized until they were published this week, the CDC said.
The new recommendations are published in the Feb. 1 issue of the Annals of Internal Medicine, and in the Feb. 3 issue of Morbidity and Mortality Weekly Report.
The move comes after new data compiled over the past two years showed that the vaccine was “very effective” in preventing genital warts in men and women, as well as some cancers.
At least 50 percent of sexually active men and women get infected with HPV at some point, but few develop symptoms or get sick, the CDC reports. Some infections lead to warts, cervical cancer and other cancers, including head and neck. A recent study reveals that 16 million Americans between the ages of 14 and 69 have HPV in their mouth or throat.
The HPV vaccine has been recommended for girls since 2006. However, according to recent estimates, only 49 percent of adolescent girls have gotten at least one of the three recommended HPV shots.
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Snake oil salesmen and dodgy HIV “cures”
Nairobi, Kenya (IRIN) – Uganda’s National Drug Authority recently arrested sales representatives of a company selling a drug that purports to cure HIV; the firm’s owners are not licensed to sell medicine and are being sought by the police.
The drug, known as Virol ZAPPER, was being sold in 37-milliliter liquid doses, each costing about US$210; patients were advised to take 10 drops daily. It was being advertised on local radio and TV stations as a miracle cure for HIV.
The sale of such “cures” is a profitable racket for charlatans willing to take advantage of desperate HIV-positive people; here is a collection of some dodgy treatments that have made the news in Africa over the years:
Tanzania – In 2011, tens of thousands of people from all over East Africa flocked to the tiny village of Loliondo in Tanzania seeking a cure for several diseases, including diabetes, tuberculosis and HIV. Ambilikile Mwasapile, a former Lutheran pastor, was charging 500 Tanzanian shillings – about $0.33 – for a cup for his concoction.
Several sick people died in the queues, which at their peak numbered 15,000 people. Studies are being conducted to determine the properties of Mwasapile’s treatment.
South Africa – A 2008 Cape High Court judgment ruled that clinical trials of multivitamins in the treatment of HIV/AIDS by controversial vitamin salesman Matthias Rath were unlawful, and stopped them. The court also prohibited Rath from publishing any more advertisements claiming that his product, VitaCell, cured AIDS, pending further review by the Medicines Control Council.
Rath, who had been operating in South Africa since about 2004, claimed his multivitamins treated AIDS, heart disease, cancer, diabetes, bird flu and numerous other illnesses. Rath ran numerous advertisements aimed at convincing HIV-positive people to take his high-dose multivitamins rather than ARVs, available free-of-charge through the public health system, which he claimed were “toxic”.
Kenya – In 2008, the government warned HIV-positive people in the country’s eastern Coast Province to reject herbal “cures” peddled by fake herbalists who claimed their concoctions contained unique ingredients that could boost the immune system and even cure HIV.
An estimated 80 percent of Kenyans use traditional healers either exclusively or in conjunction with western medicine; the government is drafting regulations to stop fraudulent herbalists from practicing.
Gambia – In 2007, President Yahya Jammeh was roundly denounced by AIDS activists when he said he had found a cure for HIV/AIDS and began treating citizens. Shortly after his announcement, Jammeh expelled the most senior UN official in the country for questioning his “cure”.
The program is still running, but more Gambians are choosing ARVs over Jammeh’s treatment.
Ethiopia – In 2007, thousands of HIV-positive patients flocked to Entoto, an ancient mountain north of the capital, Addis Ababa, seeking a “holy water” cure for AIDS after local priests said they could cure HIV.
The Archbishop of the Ethiopian Orthodox Church, Abune Paulos, later advised patients to continue with their ARVs even as they sought healing at Entoto.
São Tome and Principe – In 2007, questions were raised about Dorviro-Sida, or “Put AIDS to sleep” in Portuguese, an anti-AIDS herbal remedy produced by Amancio Valentim, president of the Association of Traditional Medicine of São Tome and Principe. Valentim claimed three tablespoons of the brownish syrup, taken every day before meals, could reduce the viral load and make patients feel better; he said four patients who had taken the drug for four years had tested negative for HIV.
AIDS activists were concerned the drug could make HIV-positive people complacent about taking their ARVs, and the health ministry said it did not support Valentim’s treatment.
South Africa – In 2006, a clinic in South Africa’s east coast city of Durban began to sell “ubhejane” – a herbal mixture believed to treat HIV/AIDS.
The controversial traditional medicine received vast media coverage, mainly due to the backing it received from influential political figures such as the former health minister, Dr Manto Tshabalala-Msimang, and provincial health officials. Ubhejane, a dark brown liquid sold in old plastic milk bottles, had not undergone any clinical trials to test its efficacy. All that the tests confirmed was that it was not toxic.
But HIV-positive patients were far more willing to accept the traditional medicine as an effective remedy, flocking to the clinic to buy a full course of the herbal remedy that retailed at R374 ($40).
Uganda – In 2006, the Ugandan government banned the use of a popular anti-AIDS herb remedy known as “Khomeini” , after tests found it provided no cure. Iranian Sheikh Allagholi Elahi claimed the drug – which contained olive oil and honey and cost $1,650 per dose – could cure HIV/AIDS and TB in three weeks.
Studies by experts in Uganda and Kenya found that while patients had gained weight due to the nutritional content of the drug, it was incapable of curing HIV.
kr/kn/mw
– Provided by Integrated Regional Information Networks.
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New guidelines follow recall of faulty HIV test
Nairobi, Kenya (IRIN) – The Kenyan government has changed its HIV testing algorithm following the withdrawal of a widely used brand of HIV test on warnings from the UN World Health Organization (WHO).
In December, WHO removed the Standard Diagnostics Bioline® HIV 1/2 3.0 Rapid HIV Test Kit from its list of approved rapid test kits with immediate effect; the alert was issued after Bioline failed quality assurance tests.
The Kenyan government estimates one million kits were in circulation at the time of the recall, about one-tenth of all the HIV kits available in the country.
“We followed the World Health Organization alert and have in turn ordered all health facilities and voluntary counseling and testing centers to stop using the kit,” said Shahnaz Sharif, Kenya’s director of public health at the Ministry of Public Health and Sanitation.
New guidelines
Bioline, which is manufactured in South Korea, was in use as a confirmatory test, the second conducted during standard HIV testing, which uses three tests – an initial screening test, a confirmatory test and if there is a discrepancy, a third, tie-breaker test.
As a result of the recall, Unigold, the brand used in Kenya as a tie-breaker, now replaces Bioline as the confirmatory test, and the enzyme-linked immunosorbent assay (ELISA) test – which requires a blood sample be sent to a laboratory and takes significantly longer than the rapid tests – becomes the tie-breaker. A brand known as Determine retains its place as the official screening test.
“We have already engaged the services of a supply chain management organization to help with collecting the Bioline kit from facilities countrywide and at the same time, replace it with Unigold; it [the supply chain management firm] has the database of all the health facilities that received the faulty Bioline kit,” said Peter Cherutich, deputy director of the National AIDS and Sexually transmitted infections Control Program.
“Health facilities will commence working with the various partners to help trace people who might have been tested with the faulty kit so that they can come for repeat tests,” said Jackson Kioko, director of public health and sanitation in Kenya’s Nyanza Province, which has the country’s highest HIV prevalence levels –.8 percent compared with a national average of 7.4 percent.
Concern
However, health workers are concerned that the use of the ELISA test will discourage nervous testers. “Except in the cases of infants, HIV tests results have always been instant and that has been the beauty of it; the process of having to wait for your result in case of discrepancies might be very agonizing for many people,” said Julie Nasirembe, a nurse at a health facility in Nairobi.
There is also concern about the impact the recall will have on public confidence in HIV testing, especially as the country pushes for universal access to HIV counseling and testing.
“We don’t know how widely this Bioline kit might have been used but it definitely eroded your confidence, not only in the health facilities but even in yourself, because if you test negative you are not sure if you are accurately negative,” said Dan Mutisya, a resident of Kenya’s capital Nairobi.
ko/kr/mw
– Provided by Integrated Regional Information Networks.
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Some hospitals turn to post-discharge clinics to help hold down readmissions
United States (KaiserHealth) – For patients, the transition from hospital to home is a critical time. Discharged with follow-up instructions and often a fistful of medications, many need medical guidance. But too often a smooth handoff to a primary-care physician doesn’t happen, and small recovery glitches become larger ones. The result: In short order the patient is often back in the hospital.
According to a study released this month by the Center for Studying Health System Change, a Washington-based research group, a third of adult patients discharged from a hospital don’t see a physician within 30 days — and experts say this is a key reason so many of them are readmitted.
Some hospitals are trying a new strategy to interrupt this predictable and pricey pattern: post-discharge clinics. These hospitals are identifying patients who are more likely to have trouble after discharge, either because of their medical conditions or because they lack health insurance or a primary-care provider, and funneling them to the clinic where they receive one-on-one assistance.
Deloris Eason, 64, was discharged from Boston’s Beth Israel Deaconess Medical Center earlier in December, after having been treated for severe stomach cramps, diarrhea and vomiting. Clinicians weren’t sure whether she had had a bad case of food poisoning or colitis, an inflammation of the colon. Because her primary-care physician couldn’t see her until mid-January, hospital staff referred her to the post-discharge clinic.
By the time she came in four days after leaving the hospital, Eason was feeling better but was concerned because she hadn’t had a bowel movement since returning home. The practitioner at the clinic told her to give it another day and then take a laxative. If that didn’t work, she was instructed to come back.
“I had a chance to ask questions I didn’t get to ask at the hospital,” Eason says, “key questions that came up after I got home.”
The doctor also checked that she was following the diet she had been given and was taking her antibiotics, and made follow-up appointments for her with a gastroenterologist and her primary-care provider.
The clinic helps streamline the process of getting patients in to see their primary-care physicians, says its medical director, Lauren Doctoroff.
A typical patient visits Beth Israel’s post-discharge clinic, located near the hospital, just once or twice. But treatment may last longer at post-discharge clinics affiliated with safety-net hospitals that serve large numbers of low-income, uninsured and other vulnerable patients.
One such hospital is Tallahassee Memorial HealthCare’s Transition Center. Clinicians say they see most patients for up to two months and will extend that time frame if necessary.
“We’re a bridge until we are guaranteed they are in . . . primary care,” says Dean Watson, Tallahassee Memorial’s chief medical officer.
The center targets patients at high risk for readmission, including the uninsured, those who don’t have a primary-care physician or who can’t get an appointment with their doctor within a week of discharge, and patients who have been admitted at least three times in the past year.
Patients who are referred to the center work with clinicians to develop a plan for their ongoing care and receive referrals to rehab or other medical services. The center’s staff finds a primary-care provider for them if they need one and connect them with social services for such needs as transportation, food and home care.
Since the center opened in February, more than 600 patients have visited it, says Watson, and emergency room visits and hospital readmissions have decreased by 61 percent for these high-risk patients.
Hospital officials and policy experts agree that the impetus for the post-discharge clinics comes in part from new penalties for certain hospital readmissions that will take effect starting in 2012. Under the 2010 federal health-care overhaul, hospitals that have higher than expected 30-day readmission rates for three conditions – pneumonia, heart failure and heart attack — may face Medicare payment penalties.
But some analysts question whether the clinics are an efficient solution.
“Creating a whole separate post-discharge follow-up clinic when you’ve got an outpatient network in existence could be duplicative,” says Ann O’Malley, a senior researcher at the Center for Studying Health System Change, the Washington-based research group that did the study that was released this month. “What we need is better support of the primary-care infrastructure in the community.”
Even with that, some patients are likely to fall through the cracks. Barnes-Jewish Hospital, a safety-net hospital in St. Louis, opened a post-discharge clinic about three months ago. Medicare-eligible patients with chronic obstructive pulmonary disease, pneumonia, heart attack and heart failure are referred to the Stay Healthy Clinic for follow-up care.
But there’s a hitch. Even though the hospital schedules the initial post-discharge appointments and offers to arrange a ride for patients to the clinic, about half of them don’t show up.
“We’re trying to understand it,” says John Lynch, the hospital’s chief medical officer. It’s unclear, he says, whether patients don’t understand the importance of the appointments, for example, or feel better and don’t think they need to come in. With roughly a third of high-risk Medicare patients being readmitted within a week of discharge, it is critical to look for answers. “We’ll continue to try to tweak it,” he says.
Please send comments or ideas for future topics for the Insuring Your Health column to questions@kaiserhealthnews.org.
– Provided by Kaiser Health News.
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CDC: U.S. teens not eating enough fruits, vegetables
Atlanta, GA, United States (AHN) – U.S. teens are not eating enough fruits and vegetables, according to a new study by the U.S. Centers for Disease Control and Prevention.
The findings, based on data complied from nearly 10,800 students in grades nine through 12 who took part in the National Youth Physical Activity and Nutrition Study 2010, found median consumption was 1.2 times per day for both fruits and vegetables.
Median fruit consumption was much higher among males than females, and much higher among grade nine students than among students in grades 10 and 12.
A little more than 28.5 percent, or one in four, of the high school students ate fruit less than once a day, and 33.2 percent ate vegetables less than once a day.
Only 16.8 percent of students ate fruit at least four times a day, and only 11.2 percent ate vegetables at least four times a day.
Vegetable consumption was lowest among Hispanic and black students, the study found.
Researchers said the findings show that most high school students do not meet the daily fruit and vegetable recommendations, and more needs to be done to see the recommendations are met.
The researchers wrote in the Nov. 25 issue of the CDC’s Morbidity and Mortality Weekly Report, “The infrequent fruit and vegetable consumption by high school student highlights the need for effective strategies to increase consumption.”
Steps have already been taken at schools throughout the country to remove sugary snacks, sodas, high fat, high salt and low nutrient dense foods. New programs such as farm-to-school initiatives, school gardens and salad bars aim to improve access to both fruits and vegetables.
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Psychiatric drug use soars during past decade
Atlanta, GA, United States (AHN) – Over the past decade, the medicating of Americans for mental illness has continued to grow.
From 2001 to 2010, overall use of psychiatric drug use among adults rose 22 percent. One on five adults now takes at least one psychotic drug such as anti-depressants, antipsychotics and anti-anxiety medications.
The new figures, released Wednesday, are based on prescription drug pharmacy claims of 2 million insured American adults and children reported by Medco Health Solutions Inc., a pharmacy benefit manager.
In 2010, Americans spent $16.1 billion on antipsychotics to treat depression, bipolar disorders and schizophrenia; $11.6 billion on antidepressants; and $7.2 billion on treatment for ADHD, according to IMS Health, which tracks prescription drug sales.
While the use of most psychotic drugs grew strongly, declines were seen in antidepressant use in children and anti-anxiety drug use in the elderly.
A pronounced increase in medication to treat ADHD among young and middle ages adults was seen, particularly in women.
Use in the over-65 population also spiked by about 30 percent for men and women over the last decade.
Reasons for the rise could include people who were diagnosed and treated as children for ADHD continue to suffer symptoms, adults who were never before treated but suspect they have symptoms sought help, and increased awareness.
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More American patients seek treatment abroad to escape high medical costs
Washington, D.C., United States (AHN) – The number of Americans heading abroad for medical care rose sharply last year amid high health care costs and a poor economy in the United States, according to medical tourism industry figures.
Some of their preferred locations for life-saving surgeries and other procedures are India and Mexico, the health information company Health Digital Systems reported.
Surgeries like hip replacements, dental implants and heart bypasses can cost half as much in Southeast Asia and Latin America compared with the United States.
Among the six million Americans who traveled abroad for medical care last year, 45 percent traveled to Asia, 26 percent to Latin America and 2 percent to the Middle East, according to industry statistics.
Health care officials in the countries treating foreigners are upbeat about their patients. Medical tourism, primarily from the United States and Europe, represents a nearly $100 billion a year industry.
Mexico’s Health Ministry recently produced a report saying “the globalization of health services can offer excellent medical care at lower costs than developed countries.”
The health ministry has developed a strategic plan to encourage medical tourism by continuing “the effort to improve the perception of public safety and promote [Mexico's] image as a global capital of culture and entertainment.”
Any success by Mexico’s health providers in reaching American patients is most obvious in border cities like Monterrey, Tijuana and Chihuahua, according to the Health Digital Systems. Pharmacies, hospitals and medical specialty practices have sprung up to take care of them.
However, patients also assume risks by trusting their health care to foreign medical standards.
Only 2 percent of Mexico’s hospitals have earned “Joint International Commission” certification.
The certification means a hospital and its staff have met international standards that would allow them to be reimbursed by foreign medical insurance companies.
India’s medical tourism industry is losing patients to competing hospitals in Singapore, Thailand and Malaysia amid concerns about poor sanitation.
Indian hospitals have been struggling with a “superbug” that is resistant to disinfectant.
As a result, some patients are reporting they become sick when they enter Indian hospitals for other treatments.
Nevertheless, the discount price of foreign medical treatment is creating a backlog of patients for hospitals with good reputations.
Mediescape, an Indian medical tourism company, reports that India’s hospitals offering medical services to patients from the United States and Europe say their booked up to December.
Between 15 percent and 20 percent of India’s hospital income now comes from medical tourism, according to industry data.
There were 800,000 foreign patients in India last year. They are expected to generate a $3 billion a year industry for India by 2015, up by more than a third from 2010.
Behind the figures on rising medical tourism is the desperation of patients who cannot afford health care in the United States, where about 40 percent of the population lacks adequate medical insurance, according to U.S. government statistics.
Some Americans are even treating themselves for serious ailments, not always with successful outcomes, according to a recent survey by TMD Limited, a medical tourism company.
“Today we are seeing many breast cancer patients that self-treated for years,” said Antonio Jimenez, a doctor raised in New Jersey who now runs the Hope4Cancer Institute in Mexico’s Baja California. “Unfortunately, cancer treatment is not a do-it-yourself project.”
Many of the women search for treatments on the Internet.
“We see more and more women who have spent thousands of dollars on supplements and wonder cures they used at home,” Jimenez said. “When those treatments fail, they look for a clinic that can help.”
The American Cancer Society reports that 230,480 American women will be diagnosed with breast cancer this year. Of those, 39,520 will die.
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Arroyo goes abroad for medical care as corruption charges loom
Manila, Metro Manila, Philippines (AHN) – Former Philippine President Gloria Macapagal-Arroyo plans to seek medical treatment abroad for a pinched neck nerve. She has undergone three surgeries to correct the ailment, but still needs further medical attention.
However, she and husband Miguel Arroyo are on the immigration watch list because of numerous corruption and plunder cases filed against the couple.
House Speaker Feliciano Belmonte Jr. said he is willing to grant the former president, now a congresswoman, travel authority to pursue medical treatment in Germany. Belmonte had previously issued an authority to Arroyo, but it had lapsed.
Justice Secretary Leila de Lima, who placed Arroyo – her former boss – on the immigration watch list, said she is willing to allow the former president to travel abroad for humanitarian reasons.
Despite Arroyo’s medical crisis, de Lima’s current boss, President Benigno Aquino, said Wednesday that he is intent on filing cases in November against his predecessor.
Arroyo’s husband is also facing graft charges over the sale of secondhand helicopters to the Philippine National Police in 2009 that were allegedly passed off as new aircraft. The former First Gentleman criticized Aquino for being obsessed with putting the Arroyos behind bars despite the absence of evidence against them.
Miguel Arroyo said the government should focus on helping Filipinos affected by recent calamities instead of spending its energy persecuting him and his wife. His statement is a veiled criticism of Aquino not going to the flood-stricken areas but instead being abroad when two typhoons devastated the country.
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Trump Casino offers plastic surgery jackpot
Atlantic City, NJ, United States (AHN) – The Trump Taj Mahal Casino Resort is offering a prize guaranteed to change the life, or at least the looks, of one lucky winner.
The jackpot of the Trump Taj Mahal Nip and Tuck Sweepstakes is $25,000 towards an array of plastic surgery procedures including Botox injections, implants and liposuction.
Players can roll the dice and pull the slots for the top prize through Oct. 29 at the Atlantic City casino.
The sweepstakes is open to Trump One Card holders who earn a certain number of points and then must be present and playing at the time of the drawing for a chance to win. Casino representatives said they wanted to change the face of a typical casino promotion and with the new sweepstakes they are doing just that.
Plastic surgery specialists say the cost of breast augmentation can run between $5,000 and $8,000. Botox infections cost a couple hundred dollars and liposuction can run upwards of $10,000. The $25,000 grand prize appears enough to cover a complete overhaul.
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Oakland clinic provides medical care to ex-offenders
Oakland, CA, United States (KaiserHealth) – Most former inmates leave California prisons with no consistent place to get medical care. Instead, they rely on a scattershot of county-funded clinics or end up at county emergency rooms. But in California, that’s beginning to change.
The state negotiated with the Obama administration to gain early access to funds available under the federal health law. Starting last month, counties began enrolling all low-income residents — including ex-offenders — into a version of Medi-Cal.
Ex-convict Darren Thurmond wears a prison-issued grey sweat suit, stretched tightly over his large belly and carries a crumbled brown paper bag, as he climbs out of the prison van stopping just outside the metal gates of San Quentin.
Waiting for him is Don Williams – a counselor from a local health clinic who’s here to give Thurmond a ride to Oakland.
“I’m not sure how many times I can do this, man,” Thurmond says to Williams.
Thurmond has been in and out of prison in the last twenty years for cocaine and methamphetamine possession. Now at age 45, all the drug use and hard living has damaged his heart.
Like many ex-convicts, he says hasn’t had health insurance since he was a kid, and his heart problems were first diagnosed and brought under control in prison. But each time Thurmond gets out, he’s left with a 4-week supply of medication and no insurance. Now that’s changing.
With the early expansion of health coverage this summer, former inmates will be covered for preventive care, prescription drugs, specialty visits and mental health and substance abuse. One place where Thurmond will now get care is at the non-profit Healthy Oakland, his first stop after his release from prison.
This is one of the few clinics in the state that offers medical care to ex-convicts who have typically been excluded from public insurance programs like Medi-Cal.
Thurmond sits down for a full medical checkup with George Pearson, the clinic’s physician assistant. They discuss his heart problems, his weight and the painful arthritis that’s overtaking Thurmond’s hips.
Pearson says a 45-year old ex-convict will often have the ailments of someone 10 years older. They have higher rates of almost all chronic conditions, like high blood pressure, diabetes and asthma. To be sure, these ailments stem from living a hard life, but it’s also because they have common medical problems that go untreated.
“So the hypertension becomes heart failure. The diabetes becomes diabetic neuropathy, which can lead to amputation, even blindness,” Pearson says.
Researchers say that when these pervasive problems are left untreated, they can lead right back to prison or jail, and that giving ex-offenders health insurance and assigning them a regular doctor brings some order to their chaotic lives.
“Their whole life is transitional. And it lacks stability. You need a facility that’s going to be the home of their records, [that's] going to know them as a person,” Pearson says. Having a regular health care provider can prevent ex-offenders from over utilizing the ER.
Expansion of Care in Some Counties
Some county health departments are using the new federal money to re-structure their safety nets to provide a fuller array of services. For example, Alex Briscoe of the Alameda County public health department says he’s adding mental health specialists to primary care clinics.
“Historically, services for this population are fragmented and tend to be episodic. And what we’re trying to do is prepare for health reform by assigning all consumers in our system, all clients in our system, to a medical home.”
Those preparations are especially important as California begins to comply with a court order to reduce its state prison population. To relieve overcrowding, tens of thousands of lawbreakers are expected to be put on probation in their home towns instead of going to state facilities. That means even more ex-offenders signing up for the expanded health coverage.
However, health researchers say the new enrollees will likely only add to a maxed out Medi-Cal system. Wait times for specialists have long plagued Medi-Cal across California, largely due to the state’s low reimbursement rate.
Still, providing coverage is important for public health, experts say. Emily Wang of the Yale School of Medicine says many former inmates return home with communicable diseases.
“Treating substance abuse, HIV, hepatitis C will reduce the disease rates in our communities,” she says.
But Wang and others say health insurance though is no magical cure for a group of people with more pressing, every day needs.
After Darren Thurmond finished his doctor’s visit at Healthy Oakland, this reporter drove him to a pharmacy to pick up his many prescriptions. By bus, this trip would’ve taken an hour, plus a painful walk with his arthritic hips.
Afterward, we headed to a Mexican restaurant in downtown Oakland for lunch. Thurmond says he had fantasized in prison about authentic enchiladas.
He’s thankful that he now has a regular doctor, he says. But he’s homeless. Living in his van, he’s unsure how he’ll get to his appointments to get his blood work checked or his prescriptions refilled.
“Being homeless, often I have the time to do it, but I don’t have the gas to get there,” Thurmond says.
For now, Thurmond is thinking pragmatically. On his first day out of San Quentin the basics are his main concerns: finding a job, getting money for food and gas, and a place to shower. “I’m pretty resourceful,” he says with no hint of pity. “I know a few places where I can shower.”
Alex Liu contributed to this story.
– Provided by Kaiser Health News.
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