Tag: General News

You cannot become a war correspondent overnight. That’s a reality I’ve been wrestling with for the past 10 months of bitter fighting in Sudan – a conflict that I am personally caught up in, where I’m no longer just a journalist and impartial witness, but a victim as well.

War correspondents have training and protective gear. They have sympathetic editors and a distance from the story. I don’t have any of those defences. I have, instead, a tormented conscience. Unable anymore to do my job as an independent reporter, it still nags at me constantly.

Since the first shots were fired in April 2023 between the army and rival paramilitary Rapid Support Forces (RSF) battling for power in the capital, Khartoum, all Sudanese have been caught up in the chaos and ruthlessness of this war.

I haven’t taken a single photo nor written a single article – the risks are now too high. Voice a contrary opinion, or make a wrong move in front of these soldiers, and you can wind up with a bullet in your head.

I’ve witnessed our neighbour’s house destroyed by a rocket, their 17-year-old daughter killed. I’ve seen RSF soldiers attacking civilians, shooting and looting at will. And then there are the dead bodies – lying out on the streets for weeks – that nobody has come to claim and bury.

Ordinarily, my instinct would have been to pull out my camera and notebook and document it all. But these are not ordinary times: I haven’t taken a single photo nor written a single article – the risks are now too high. Voice a contrary opinion, or make a wrong move in front of these soldiers, and you can wind up with a bullet in your head.

So instead of work, my priority has become my family: to keep them safe, to provide for them, to get us through this – and it has been psychologically exhausting.

The war on independent journalism

Not only have journalists been robbed of their dignity and security, we have also been stripped of our work. Independent newspapers, websites, TV broadcasting stations, and radio programmes have been shut down. The only working media is controlled by either the army or the RSF, and both sides circulate lists of reporters they accuse of “betraying” the country.

International conventions guaranteeing the safety of journalists do not apply here. In this war, the free press and freedom of expression are also targets. The goal is to suppress the written word, smash the cameras, and block accountability and principle.

As we approach one year since this devastating conflict began, the world knows next-to-nothing about the full extent of the atrocities that are committed daily. Nothing is worse than seeing how truth has been suspended, like a patient sedated indefinitely.

The media blackout is made complete by the number of journalists that have fled Khartoum and other conflict zones. To stay and work is to risk the fate of colleagues that have been beaten, tortured, and imprisoned.

That’s why so many of us have chosen self-exile, joining the more than 1.6 million Sudanese now living abroad. To be honest, If I could get that chance to leave with my family, it’s what I would do as well. 

‘A conflict that’s challenged all taboos’

We are held hostage, surrounded by the stench of death, under the threat of a meaningless demise.

I’ve been living out the war with my family in east Khartoum, where you can’t escape the sound of outgoing artillery and the incoming shells; the buzz of aircraft overhead; the yells of children who now know to run for cover when it all gets too close.

But I can’t write about any of it – I am no longer a voice for my people.

This powerlessness to do my job also means a loss of livelihood. Like other “ex”-journalists trying to make ends meet, I’ve been forced to roam the streets, peddling goods for sale to provide for my family. A well-written story or deeply-researched exposé is not what gets you paid anymore.

As we approach one year since this devastating conflict began, the world knows next-to-nothing about the full extent of the atrocities that are committed daily. Nothing is worse than seeing how truth has been suspended, like a patient sedated indefinitely.

Everybody has become impoverished. Young men, fearing ransom-related kidnapping or arrest, are increasingly choosing to stay indoors. The burden of supporting families therefore falls on women and children, even though – especially in RSF-controlled areas – they risk abduction and sexual violence.

Those civilians that still have formal sector jobs have not been paid in months. People lucky enough to have relatives abroad, who can send money home, have to contend with blackouts and internet outages that delays access to the digital cash when it arrives in their accounts.

Everything is so expensive. People struggle to afford even the staples: lentils, flour, and rice. In some places, like Khartoum’s embattled twin city of Omdurman, it can be too dangerous to go to the market for days on end, deepening everyone’s hunger and desperation.

Healthcare has also collapsed. The closest city with functioning hospitals was Wad Madani, south of Khartoum. But not only is getting there by road dangerous, the RSF is now in control, and no one knows how long those hospitals will stay open.

My inability to cover this conflict has left me silent and tearful. This is not the first civil war Sudan has experienced, but it is the worst. It’s a conflict that has challenged all taboos, where everyone stands to lose – and yet we still have no idea when it may end.

Without that prospect, a stream of existential questions daily fills my thoughts: Will I survive? Will I emerge unscathed? If I am killed, will I be buried, or will my body be left on the streets for the dogs to eat?

This story was published in collaboration with Egab, a news service empowering local journalists across the Middle East and Africa. Edited by Obi Anyadike.

By Ronnie Cohen, KFF Health News

Los Angeles anesthesiologist Marilyn Singleton was outraged about a California requirement that every continuing medical education course include training in implicit bias — the ways in which physicians’ unconscious attitudes might contribute to racial and ethnic disparities in health care.

Singleton, who is Black and has practiced for 50 years, sees calling doctors out for implicit bias as divisive, and argues the state cannot legally require her to teach the idea in her continuing education classes. She has sued the Medical Board of California, asserting a constitutional right not to teach something she doesn’t believe.

The way to address health care disparities is to target low-income people for better access to care, rather than “shaking your finger” at white doctors and crying “racist,” she said. “I find it an insult to my colleagues to imply that they won’t be a good doctor if a racially divergent patient is in front of them.”

The litigation is part of a national crusade by right-leaning advocacy and legal groups against diversity, equity, and inclusion, or DEI, initiatives in health care. The pushback is inspired in part by last year’s U.S. Supreme Court ruling barring affirmative action in higher education.

The California lawsuit does not dispute the state’s authority to require implicit bias training. It questions only whether the state can require all teachers to discuss implicit bias in their continuing medical education courses. The suit’s outcome, however, could influence obligatory implicit bias training for all licensed professionals.

Leading the charge is the Pacific Legal Foundation, a Sacramento-based organization that describes itself as a “national public interest law firm that defends Americans from government overreach and abuse.” Its clients include the activist group Do No Harm, founded in 2022 to fight affirmative action in medicine. The two groups have also joined forces to sue the Louisiana medical board and the Tennessee podiatry board for reserving board seats exclusively for racial minorities.

In their complaint against the California medical board, Singleton and Do No Harm, along with Los Angeles ophthalmologist Azadeh Khatibi, argue that the implicit bias training requirement violates the First Amendment rights of doctors who teach continuing medical education courses by requiring them to discuss how unconscious bias based on race, ethnicity, gender identity, sexual orientation, age, socioeconomic status, or disability can alter treatment.

“It’s the government saying doctors must say things, and that’s not what our free nation stands for,” said Khatibi, who immigrated to the U.S. from Iran as a child. Unlike Singleton, Khatibi does believe implicit bias can unintentionally result in substandard care. But, she said, “on principle, I don’t believe in the government compelling speech.”

The lawsuit challenges the evidence of implicit bias in health care, saying there is no proof that efforts to reduce bias are effective. Interventions have thus far not demonstrated lasting effects, studies have found.

In December, U.S. District Judge Dale S. Fischer dismissed the suit but allowed the Pacific Legal Foundation to file an amended complaint. A hearing is scheduled for March 11 in federal court in Los Angeles.

In enacting the training requirement, the California legislature found that physicians’ biased attitudes unconsciously contribute to health care disparities. It also found that racial and ethnic disparities in health care outcomes are “remarkably consistent” across a range of illnesses and persist even after adjusting for socioeconomic differences, whether patients are insured, and other factors influencing care.

Black women are three to four times as likely as white women to die of pregnancy-related causes, are often prescribed less pain medication than white patients with the same complaints, and are referred less frequently for advanced cardiovascular procedures,the legislature found.

It also noted that women treated by female doctors were more likely to survive heart attacks than those treated by men. This month, the California legislature’s Black Caucus unveiled legislation requiring implicit bias training for all maternal care providers in the state.

Khama Ennis, who teaches an implicit-bias class for Massachusetts doctors, sees only the best intentions in her fellow physicians. “But we’re also human,” she said in an interview. “And to not acknowledge that we are just as susceptible to bias as anybody else in any other field is unfair to patients.”

Ennis offered an example of her own bias in a training session. Preparing to treat a patient in a hospital emergency room, she noticed a Confederate flag tattoo on his forearm.

“As a Black woman, I had to have a quick chat with myself,” she said. “I needed to ensure that I provided the same standard of care for him that I would for anyone else.”

Ennis’ class meets the requirements of a Massachusetts law that physicians earn two hours of instruction in implicit bias to obtain or renew their licenses, as of 2022.

That same year, California began requiring that all accredited continuing medical education courses involving direct patient care include discussion of implicit bias. The state mandates 50 hours of continuing education every two years for doctors to maintain their licenses. Private institutions offer courses on an array of topics, and physicians generally teach them.

Teachers may tell students they do not believe implicit bias drives health care disparities, Fischer wrote in her December ruling. But the state, which licenses doctors, has the right to decide what must be included in the classes, the judge wrote.

Professionals who elect to teach courses “must communicate the information that the legislature requires medical practitioners to have,” the judge wrote. “When they do so, they do not speak for themselves, but for the state.”

Whether they speak for themselves or for the state is a pivotal question. While the First Amendment protects private citizens’ right to free speech, that protection does not extend to government speech. The content of public school curricula, for example, is the speech of state government, not the speech of teachers, parents, or students, courts have said. In 1988, the U.S. Supreme Court ruled that the First Amendment did not apply to student journalists when a principal censored articles they wrote as part of a school curriculum.

The Pacific Legal Foundation’s amended complaint aims to convince the judge that its clients teach as private citizens with First Amendment rights. If the judge again rules otherwise, lead attorney Caleb Trotter told California Healthline, he plans to appeal the decision to the U.S. Court of Appeals for the 9th Circuit, and, if necessary, the Supreme Court.

“This is not government speech at all,” he said. “It’s private speech, and the First Amendment should apply.”

“Plaintiffs are plainly wrong,” lawyers for Rob Bonta, the state attorney general, responded in court papers. “There can be no dispute that the State shapes or controls the content of continuing medical education courses.”

The medical board declined to comment on the pending litigation.

From 2019 through July 2022, in addition to California and Massachusetts, four statesenacted legislation requiring health care providers to be trained in implicit bias.

A landmark 2003 Institute of Medicine report, “Unequal Treatment,” found that limited access to care and other socioeconomic differences explain only part of racial and ethnic disparities in treatment outcomes. The expert panel concluded that clinicians’ prejudices could also contribute.

In the two decades since the report’s release, studies have documented that bias does influence clinical care and contribute to racial disparities, a 2022 report said.

But implicit-bias training might have no impact and might even worsen discriminatory care, the report found.

“There’s not really evidence that it works,” Khatibi said. “To me, addressing health care disparities is really important because lives are at stake. The question is, How do you want to achieve these ends?”