npr--2020-01-18--Menopause Can Start Younger Than You Think: Here's What You Need To Know

Menopause Can Start Younger Than You Think : Here 's What You Need To Know Sarah Edrie says she was about 33 when she started to occasionally get a sudden , hot , prickly feeling that radiated into her neck and face , leaving her flushed and breathless .
`` Sometimes I would sweat .
And my heart would race , '' she says .
The sensations subsided in a few moments and seemed to meet the criteria for a panic attack .
But Edrie , who has no personal or family history of anxiety , was baffled .
She @ @ @ @ @ @ @ the episodes , along with a few other health concerns she was starting to notice : Her menstrual cycle was becoming irregular , she had trouble falling asleep and staying asleep , and she was getting night sweats .
Their response : a shrug .
It was n't until Edrie went to a fertility clinic at age 39 because she and her partner were having trouble conceiving that she got answers .
`` They were like , 'Oh , those are hot flashes .
It 's because you 're in perimenopause , ' @ @ @ @ @ @ @ n't heard the term `` perimenopause , '' you 're not alone .
Often when women talk about going through menopause , what they 're really talking about is perimenopause , a transitional stage during which the body is preparing to stop ovulating , says Dr. Jennifer Payne , who directs the Women 's Mood Disorders Center at Johns Hopkins University .
`` Technically , menopause is only one day in a woman 's life , which is exactly when she has not had a period for 12 months , '' she says @ @ @ @ @ @ @ time leading up to menopause that causes all the trouble . ''
And it can start earlier than you might think .
Many listeners wrote to us in response to our call-out for individual experiences with menopause to say that they struggled to get medical support for perimenopause in their mid-30s and early 40s .
When Edrie went back to her OB/GYN with the fertility clinic 's conclusion , she says the doctor shrugged again and told her that menopause is a normal part of life .
She was n't satisfied with that @ @ @ @ @ @ @ a normal part of life , but it would be great if we could talk about it and figure out strategies . ''
With that spirit in mind , we reached out to endocrinologists , gynecologists and psychiatrists for advice about navigating this major life transition .
It 's quite possible for women to start to notice things changing in their mid-30s .
Most women arrive at menopause between the ages of 45 and 55 , but perimenopause can start as much as a decade beforehand .
And about 1 % of women @ @ @ @ @ @ @ 40 or younger .
How do you know if you 're starting perimenopause ?
The most telling symptom is changes in your menstrual cycle , says psychiatrist Hadine Joffe , the executive director of the Connors Center for Women 's Health and Gender Biology at the Brigham and Women 's Hospital in Boston .
`` It 's the menstrual cycle pattern that really defines this lead-up to menopause , '' she says .
During perimenopause , periods `` might be shorter , then a long one , or then a skipped one , @ @ @ @ @ @ @ , '' says Joffe .
There 's no blood or hormone test that can `` diagnose '' perimenopause .
Joffe says a hormone test is n't helpful because hormonal cycles become erratic and unpredictable during this stage .
`` There 's not really one point in time when a hormone test is done that can be definitive , '' she says .
Even if you took several tests over time , `` you might get a very different readout . ''
Surprisingly , sometimes doctors are n't prepared to help women recognize the @ @ @ @ @ @ @ was upset at her doctors ' responses — or lack thereof .
`` I felt so disappointed in the medical industry .
How many women has my OB/GYN seen and not recognized the symptoms of perimenopause ? ''
Be prepared for your PMS symptoms to possibly shift , becoming either more or less extreme , says Dr. Cynthia Stuenkel , a founding member of the North American Menopause Society and a professor and endocrinologist at the University of California , San Diego , School of Medicine .
`` Women might not get the @ @ @ @ @ @ @ shifts that they may have noted in the past , '' she says .
Mood problems like depression can spike during perimenopause , especially among women who have previously experienced them .
Many of our listeners wrote in to say that during perimenopause , they felt incredibly irritable and quick to anger in a way that they had never experienced before .
And of course , many — but not all — women experience hot flashes , though they may not recognize them .
`` It 's hard , because no one sits @ @ @ @ @ @ @ 's what a hot flash feels like , ' `` Stuenkel says .
`` I 've seen women who think they 're having panic attacks , or heart palpitations .
That can be frightening . ''
Other common symptoms include more frequent urinary tract infections , difficulty sleeping through the night , vaginal dryness that can make sex painful , night sweats and a decrease in libido .
What treatments are there for symptoms ?
Some symptoms , like heavy or irregular periods , can be managed with an oral contraceptive , which @ @ @ @ @ @ @ own erratic hormonal fluctuations , '' says Stuenkel .
`` This can kind of be a lifesaver , '' she says .
Such medication may help with hot flashes , too .
In some cases , doctors may prescribe menopausal hormone therapy , or very low doses of hormones to supplement estrogen levels .
Stuenkel says it 's not a fit for everyone , but it does n't deserve the bad reputation it has in some circles .
She says there was an `` exodus '' from the use of hormone replacement therapy @ @ @ @ @ @ @ halted a study over safety concerns in 2002 .
But many clinicians now feel much more comfortable using hormone therapy again and usually recommend low doses , selectively , for shorter periods of time .
For people who can not take estrogen therapy , or choose not to , Stuenkel says some drugs in the antidepressant family , such as SSRIs and SNRIs , can help with hot flashes .
Stuenkel says , `` While they 're not perfect , they can take the edge off and help enough so that women can @ @ @ @ @ @ @ '' There are an abundance of nonhormonal , nondrug treatment options for managing symptoms , some of which have significantly more evidence backing them than others .
In 2015 , a North American Menopause Society panel found that cognitive behavioral therapy and hypnosis were significantly effective in treating hot flashes .
The same panel also found that popular herbal remedies ( like black cohosh , dong quai and evening primrose ) are `` unlikely to help , '' although some NPR listeners who wrote in said they got relief from some of those @ @ @ @ @ @ @ , women may want to seek out professional counseling or a psychiatrist .
When do I need to see a doctor ?
You might not need to at all .
Some people sail right through menopause with little trouble .
But if you are experiencing symptoms that are interfering with your life , it 's worth making an appointment .
Some of these symptoms could indicate other problems that need treatment , such as fibroids or even cancer .
For people approaching this stage of life or who are already going through it @ @ @ @ @ @ @ this transition more manageable .
`` Information is key , '' says Joffe .
She suggests that people approaching perimenopause age empower themselves with knowledge .
The Massachusetts General Hospital Blum Center has a curated list of suggested books .
The National Women 's Health Information Center has a section on menopause and perimenopause .
The American College of Obstetricians and Gynecologists also has a perimenopause FAQ .
Joffe encourages people to track symptoms : `` menstrual patterns , hot flash patterns , mood issues , major life triggers . ''
Using a @ @ @ @ @ @ @ symptoms can make it easier to give your doctor details that can be otherwise hard to remember .
`` Knowing that information , somebody can say , 'Well , over the last six months , I only had two periods or I had hot flashes almost every day , ' `` Joffe says , `` or , 'My mood was as bad as it gets for only two days or for a third of the time . '
`` And if you bring a thorough health history to your physician and they still @ @ @ @ @ @ @ specialist .
`` There are OB/GYNs that specialize in perimenopause and menopause , '' Joffe says .
Joffe encourages women to protect themselves from things that might worsen their mood or well-being .
This includes reducing stress when they can and making sure they get enough sleep .
`` Sleep is critical , '' she says .
`` Getting a good night 's sleep , and making sure it 's not broken in the middle of the night . ''
There are lots of online tools and apps to help with sleep , @ @ @ @ @ @ @ like getting enough exercise , eating well and moderating alcohol consumption apply to perimenopause too , says Dr. Steven Goldstein who is the co-author of Could It Be ... Perimenopause ?
and a professor of obstetrics and gynecology at the New York University School of Medicine .
At her doctor 's suggestion , Edrie developed a mindfulness practice .
She says , `` I thought it sounded a little 'woo-woo ' at first , but being able to pay attention to what my body is doing and why helps me separate those symptoms @ @ @ @ @ @ @ my day .
So I 'm not overwhelmed by what my body is putting me through . ''
Most of the women who wrote to NPR about their experiences going through perimenopause said that they felt alone and isolated during this transition .
Having a community to talk to can make it easier to cope with the changes , says Payne , who 's going through perimenopause herself .
She says she has found support from a few close friends from college .
`` To be able to reach out to a group @ @ @ @ @ @ @ and say , 'Did you go through this ?
And , you know , it does provide support .
I think that 's another version of a coping skill , '' she says .
Edrie says she joined a few Facebook groups dedicated to perimenopause and found one in particular where she got tips on coping with one of her most troublesome symptoms : brain fog .
The conversations made her feel understood and validated .
`` I can post about it in this group , and , you know , 10 women @ @ @ @ @ @ @ week , that totally happened to me , ' or like , ' I forgot my kid 's computer on the top of my car and drove away , ' `` she says .
She says that being able to commiserate helps her get through symptoms `` that maybe do n't have a magic pill . ''
Some of her online friendships have even taken shape offline .
Edrie has met up with some of the Facebook group members while touring the country with her band .
Now she 's a big proponent @ @ @ @ @ @ @ `` As we get older , we get more and more quiet about what 's going on with our bodies and ourselves and our lives .
We kind of just , buck up and deal with it . ''
`` And I feel like if we talked more about the things that are happening to our bodies — even if we ca n't actually do anything about some of these things — it would just be better for society in general if we were more vocal about it . ''

Menopause Can Start Younger Than You Think: Here's What You Need To Know
Enlarge this image Katherine Streeter for NPR Katherine Streeter for NPR
Sarah Edrie says she was about 33 when she started to occasionally get a sudden, hot, prickly feeling that radiated into her neck and face, leaving her flushed and breathless. "Sometimes I would sweat. And my heart would race," she says. The sensations subsided in a few moments and seemed to meet the criteria for a panic attack. But Edrie, who has no personal or family history of anxiety, was baffled.
She told her doctor and her gynecologist about the episodes, along with a few other health concerns she was starting to notice: Her menstrual cycle was becoming irregular, she had trouble falling asleep and staying asleep, and she was getting night sweats. Their response: a shrug.
It wasn't until Edrie went to a fertility clinic at age 39 because she and her partner were having trouble conceiving that she got answers. "They were like, 'Oh, those are hot flashes. It's because you're in perimenopause,' " she says.
If you haven't heard the term "perimenopause," you're not alone. Often when women talk about going through menopause, what they're really talking about is perimenopause, a transitional stage during which the body is preparing to stop ovulating, says Dr. Jennifer Payne, who directs the Women's Mood Disorders Center at Johns Hopkins University.
"Technically, menopause is only one day in a woman's life, which is exactly when she has not had a period for 12 months," she says. "It's the period of time leading up to menopause that causes all the trouble."
And it can start earlier than you might think. Many listeners wrote to us in response to our call-out for individual experiences with menopause to say that they struggled to get medical support for perimenopause in their mid-30s and early 40s.
When Edrie went back to her OB/GYN with the fertility clinic's conclusion, she says the doctor shrugged again and told her that menopause is a normal part of life. She wasn't satisfied with that answer. "Yeah, it's a normal part of life, but it would be great if we could talk about it and figure out strategies."
With that spirit in mind, we reached out to endocrinologists, gynecologists and psychiatrists for advice about navigating this major life transition.
How early can perimenopause start?
It's quite possible for women to start to notice things changing in their mid-30s. Most women arrive at menopause between the ages of 45 and 55, but perimenopause can start as much as a decade beforehand. And about 1% of women in the U.S. reach menopause at age 40 or younger.
How do you know if you're starting perimenopause?
The most telling symptom is changes in your menstrual cycle, says psychiatrist Hadine Joffe, the executive director of the Connors Center for Women's Health and Gender Biology at the Brigham and Women's Hospital in Boston.
"It's the menstrual cycle pattern that really defines this lead-up to menopause," she says. During perimenopause, periods "might be shorter, then a long one, or then a skipped one, or then the flow might be different," says Joffe.
There's no blood or hormone test that can "diagnose" perimenopause. Joffe says a hormone test isn't helpful because hormonal cycles become erratic and unpredictable during this stage.
"There's not really one point in time when a hormone test is done that can be definitive," she says. Even if you took several tests over time, "you might get a very different readout."
Surprisingly, sometimes doctors aren't prepared to help women recognize the start of this life phase. Edrie was upset at her doctors' responses — or lack thereof. "I felt so disappointed in the medical industry. How many women has my OB/GYN seen and not recognized the symptoms of perimenopause?"
What symptoms to expect
Be prepared for your PMS symptoms to possibly shift, becoming either more or less extreme, says Dr. Cynthia Stuenkel, a founding member of the North American Menopause Society and a professor and endocrinologist at the University of California, San Diego, School of Medicine. "Women might not get the same kind of breast tenderness or mood shifts that they may have noted in the past," she says.
Mood problems like depression can spike during perimenopause, especially among women who have previously experienced them. Many of our listeners wrote in to say that during perimenopause, they felt incredibly irritable and quick to anger in a way that they had never experienced before.
And of course, many — but not all — women experience hot flashes, though they may not recognize them. "It's hard, because no one sits us down and teaches us, 'Here's what a hot flash feels like,' " Stuenkel says. "I've seen women who think they're having panic attacks, or heart palpitations. That can be frightening."
Other common symptoms include more frequent urinary tract infections, difficulty sleeping through the night, vaginal dryness that can make sex painful, night sweats and a decrease in libido.
What treatments are there for symptoms?
Some symptoms, like heavy or irregular periods, can be managed with an oral contraceptive, which can "shut down the body's own erratic hormonal fluctuations," says Stuenkel.
"This can kind of be a lifesaver," she says. Such medication may help with hot flashes, too.
In some cases, doctors may prescribe menopausal hormone therapy, or very low doses of hormones to supplement estrogen levels. Stuenkel says it's not a fit for everyone, but it doesn't deserve the bad reputation it has in some circles. She says there was an "exodus" from the use of hormone replacement therapy after the Women's Health Initiative trial halted a study over safety concerns in 2002. But many clinicians now feel much more comfortable using hormone therapy again and usually recommend low doses, selectively, for shorter periods of time.
For people who cannot take estrogen therapy, or choose not to, Stuenkel says some drugs in the antidepressant family, such as SSRIs and SNRIs, can help with hot flashes. Stuenkel says, "While they're not perfect, they can take the edge off and help enough so that women can get a better night's sleep."
There are an abundance of nonhormonal, nondrug treatment options for managing symptoms, some of which have significantly more evidence backing them than others. In 2015, a North American Menopause Society panel found that cognitive behavioral therapy and hypnosis were significantly effective in treating hot flashes. The same panel also found that popular herbal remedies (like black cohosh, dong quai and evening primrose) are "unlikely to help," although some NPR listeners who wrote in said they got relief from some of those treatments.
For depressive and anxiety symptoms, women may want to seek out professional counseling or a psychiatrist.
When do I need to see a doctor?
You might not need to at all. Some people sail right through menopause with little trouble. But if you are experiencing symptoms that are interfering with your life, it's worth making an appointment. Some of these symptoms could indicate other problems that need treatment, such as fibroids or even cancer.
Ways to cope with symptoms
For people approaching this stage of life or who are already going through it, here are four steps for making this transition more manageable.
1. Get educated
"Information is key," says Joffe. She suggests that people approaching perimenopause age empower themselves with knowledge.
The Massachusetts General Hospital Blum Center has a curated list of suggested books. The National Women's Health Information Center has a section on menopause and perimenopause. The American College of Obstetricians and Gynecologists also has a perimenopause FAQ.
2. Monitor your health
Joffe encourages people to track symptoms: "menstrual patterns, hot flash patterns, mood issues, major life triggers." Using a paper calendar or an app to monitor symptoms can make it easier to give your doctor details that can be otherwise hard to remember.
"Knowing that information, somebody can say, 'Well, over the last six months, I only had two periods or I had hot flashes almost every day,' " Joffe says, "or, 'My mood was as bad as it gets for only two days or for a third of the time.' "
And if you bring a thorough health history to your physician and they still give you a shrug, consider a specialist. "There are OB/GYNs that specialize in perimenopause and menopause," Joffe says.
3. Practice smart self-care
Joffe encourages women to protect themselves from things that might worsen their mood or well-being. This includes reducing stress when they can and making sure they get enough sleep.
"Sleep is critical," she says. "Getting a good night's sleep, and making sure it's not broken in the middle of the night."
There are lots of online tools and apps to help with sleep, she adds.
And familiar health advice like getting enough exercise, eating well and moderating alcohol consumption apply to perimenopause too, says Dr. Steven Goldstein who is the co-author of Could It Be ... Perimenopause? and a professor of obstetrics and gynecology at the New York University School of Medicine.
At her doctor's suggestion, Edrie developed a mindfulness practice. She says, "I thought it sounded a little 'woo-woo' at first, but being able to pay attention to what my body is doing and why helps me separate those symptoms from what I need to get through my day. So I'm not overwhelmed by what my body is putting me through."
4. Cultivate community
Most of the women who wrote to NPR about their experiences going through perimenopause said that they felt alone and isolated during this transition.
Having a community to talk to can make it easier to cope with the changes, says Payne, who's going through perimenopause herself. She says she has found support from a few close friends from college.
"To be able to reach out to a group of women who are our same age and say, 'Did you go through this? And, you know, it does provide support. I think that's another version of a coping skill," she says.
Edrie says she joined a few Facebook groups dedicated to perimenopause and found one in particular where she got tips on coping with one of her most troublesome symptoms: brain fog. The conversations made her feel understood and validated.
"I can post about it in this group, and, you know, 10 women will be like, 'Oh, last week, that totally happened to me,' or like, 'I forgot my kid's computer on the top of my car and drove away,' " she says.
She says that being able to commiserate helps her get through symptoms "that maybe don't have a magic pill." Some of her online friendships have even taken shape offline. Edrie has met up with some of the Facebook group members while touring the country with her band.
Now she's a big proponent of finding community and speaking out. "As we get older, we get more and more quiet about what's going on with our bodies and ourselves and our lives. We kind of just, buck up and deal with it."
"And I feel like if we talked more about the things that are happening to our bodies — even if we can't actually do anything about some of these things — it would just be better for society in general if we were more vocal about it."


npr--2020-01-18--Meals On Wheels Serves Up Breakfast, Lunch And Community At Local Diner

Meals On Wheels Serves Up Breakfast , Lunch And Community At Local Diner Usually Meals on Wheels means home delivery or lunch at a senior center .
For more than 50 years , the federal government has been funding the program to make sure older Americans get the nutrition they need .
Now , a project in Vancouver , Wash. , is trying to use those funds for something new : a retro-hip diner , where seniors can get eggs , coffee , and community .
On the surface , The Diner looks like any other diner .
Servers making @ @ @ @ @ @ @ local business people having meetings , regulars who know the whole menu .
There are the usual diner specialties , with some modern nods — cage-free eggs and local produce — and a retro vibe .
`` They play Frank Sinatra in the mornings , and it makes me so happy , '' says Autumn Zukauskus , who comes for breakfast weekly .
`` Eggs and Frank Sinatra : perfect breakfast . ''
But when a younger patron like Zukauskus reaches for her credit card , seniors like Chris Bingenheimer pull out a @ @ @ @ @ @ @ you can donate , you do .
If you do n't , you do n't , '' Bingenheimer explains .
`` And it 's no big deal to them . ''
That 's because the entire diner is a project of the local organization Meals on Wheels People .
If you look closer , you 'll notice a few differences from other restaurants .
The chairs are on casters , to scoot out easily if they need to make space for a wheelchair .
The coffee cups have large handles , to accommodate @ @ @ @ @ @ @ were designed and selected to minimize noise and maximize comfort .
Suzanne Washington is the CEO of Meals on Wheels People , which serves about 5,000 meals a day .
Most of these are home delivery , and about a third are in senior centers .
But people do n't always want to go to a senior center .
`` We heard lots of folks say it was just too much of a stigma to go , '' Washington says .
Some baby boomers think senior centers are just for their grandparents .
@ @ @ @ @ @ @ ca n't get away for lunch .
So , Washington thought , 'Why not try a restaurant ? '
`` A restaurant that is inter-generational .
It 's good food , '' says Washington .
`` And at the same time , the paying public can help offset the cost of those in our program . ''
There 's a slightly different menu for participating seniors — like an added fruit cup or a glass of milk — to meet nutritional requirements .
And some regular menu items are n't part of the @ @ @ @ @ @ @ make eggs benedict meet regulations , '' Washington says .
`` It just does n't work . ''
But the menu is still delicious , and the diner 's been averaging 140 subsidized meals each month .
They 've signed up an average of 38 new members per month — about three times the number that sign up for Meals on Wheels at their traditional senior centers .
And those who come for the meal donate more for it — the average donation is $ 2.46 , which is four times higher than @ @ @ @ @ @ @ And for an organization that provides 1.2 million senior meals annually , every increase is significant .
New sign-ups also get a visit from a client service coordinator , who does assessments , and checks if seniors need to be connected to additional services — the sort of information that they might have found at a traditional senior center .
The decline in participation at traditional senior centers is n't just a problem in the Pacific Northwest .
`` It is a national trend , where many senior centers are witnessing declining participation @ @ @ @ @ @ @ a provost and professor of social work at Hunter College .
Pardasani says the decline is due to a number of factors : centers that have n't innovated to reflect the diversity of the population , or people who look down on senior centers as something only for `` needy '' people .
And he says the downturn is concerning , because these centers provide far more than just food .
They provide community engagement , and combat isolation , which provides a benefit for mental and emotional health .
`` The core @ @ @ @ @ @ @ , '' says Pardasani .
`` We 're human beings , we 've been socialized to be social animals . ''
And The Diner is a social place .
You can see it in the customers joking with the staff , the people who bring in an older neighbors , the seniors who carpool together for a meal .
Young people like Amber Zukauskus come for that camaraderie just as much as for the little pies .
`` Everyone here is so nice , '' says Zukauskus .
`` And they pay everybody @ @ @ @ @ @ @ your tips just go to donations for Meals on Wheels , which is amazing .
That 's something I want to give money to . ''
The Diner has gone through the usual hiccups of starting a new restaurant — dealing with staffing , figuring out the lunch rush , adjusting portion size so that seniors might have some extra to take home and eat later .
Meals on Wheels People received some grant money to help with start up costs , and they expect to turn a profit in their third year @ @ @ @ @ @ @ seem to be hitting their stride .
It 's a bustling , thriving business .
Chris Bingenheimer learned about The Diner from a friend , and came in to share a meal .
He sometimes goes to a senior center , but was never a fan of the made-in-advance food , or the minimal choices , or of the fact he had to be called up for a meal like at the high school cafeteria .
He said he 'll definitely be back to The Diner .
`` The staff is very friendly @ @ @ @ @ @ @ do n't look down on you because you 're with the Meals on Wheels program .
They treat you kindly .
The service is impeccable . ''
Bingenheimer is a senior using Meals on Wheels .
And at The Diner , he 's also just a guy , sitting with a friend , having a good breakfast .

Meals On Wheels Serves Up Breakfast, Lunch And Community At Local Diner
Enlarge this image toggle caption Tom Cook/Courtesy Meals on Wheels People Tom Cook/Courtesy Meals on Wheels People
Usually Meals on Wheels means home delivery or lunch at a senior center. For more than 50 years, the federal government has been funding the program to make sure older Americans get the nutrition they need. Now, a project in Vancouver, Wash., is trying to use those funds for something new: a retro-hip diner, where seniors can get eggs, coffee, and community.
On the surface, The Diner looks like any other diner. Servers making sure the coffee is topped off, local business people having meetings, regulars who know the whole menu. There are the usual diner specialties, with some modern nods — cage-free eggs and local produce — and a retro vibe.
"They play Frank Sinatra in the mornings, and it makes me so happy," says Autumn Zukauskus, who comes for breakfast weekly. "Eggs and Frank Sinatra: perfect breakfast."
But when a younger patron like Zukauskus reaches for her credit card, seniors like Chris Bingenheimer pull out a little green dining card.
"If you can donate, you do. If you don't, you don't," Bingenheimer explains. "And it's no big deal to them."
That's because the entire diner is a project of the local organization Meals on Wheels People. If you look closer, you'll notice a few differences from other restaurants. The chairs are on casters, to scoot out easily if they need to make space for a wheelchair. The coffee cups have large handles, to accommodate arthritic fingers. The building and finishes were designed and selected to minimize noise and maximize comfort.
Avoiding stigma
Suzanne Washington is the CEO of Meals on Wheels People, which serves about 5,000 meals a day. Most of these are home delivery, and about a third are in senior centers. But people don't always want to go to a senior center.
"We heard lots of folks say it was just too much of a stigma to go," Washington says.
Some baby boomers think senior centers are just for their grandparents. Or they're still working, and can't get away for lunch. So, Washington thought, 'Why not try a restaurant?'
"A restaurant that is inter-generational. It's good food," says Washington. "And at the same time, the paying public can help offset the cost of those in our program."
There's a slightly different menu for participating seniors — like an added fruit cup or a glass of milk — to meet nutritional requirements. And some regular menu items aren't part of the program.
"Because we can never make eggs benedict meet regulations," Washington says. "It just doesn't work."
Enlarge this image toggle caption Meals on Wheels Meals on Wheels
But the menu is still delicious, and the diner's been averaging 140 subsidized meals each month. They've signed up an average of 38 new members per month — about three times the number that sign up for Meals on Wheels at their traditional senior centers. And those who come for the meal donate more for it — the average donation is $2.46, which is four times higher than the donation at a senior center. And for an organization that provides 1.2 million senior meals annually, every increase is significant.
New sign-ups also get a visit from a client service coordinator, who does assessments, and checks if seniors need to be connected to additional services — the sort of information that they might have found at a traditional senior center.
The decline in participation at traditional senior centers isn't just a problem in the Pacific Northwest.
"It is a national trend, where many senior centers are witnessing declining participation rates," explains Manoj Pardasani, a provost and professor of social work at Hunter College.
Providing engagement
Pardasani says the decline is due to a number of factors: centers that haven't innovated to reflect the diversity of the population, or people who look down on senior centers as something only for "needy" people. And he says the downturn is concerning, because these centers provide far more than just food. They provide community engagement, and combat isolation, which provides a benefit for mental and emotional health.
"The core belief behind meals is the socialization aspect," says Pardasani. "We're human beings, we've been socialized to be social animals."
And The Diner is a social place. You can see it in the customers joking with the staff, the people who bring in an older neighbors, the seniors who carpool together for a meal.
Young people like Amber Zukauskus come for that camaraderie just as much as for the little pies.
"Everyone here is so nice," says Zukauskus. "And they pay everybody a living wage, and so all your tips just go to donations for Meals on Wheels, which is amazing. That's something I want to give money to."
The Diner has gone through the usual hiccups of starting a new restaurant — dealing with staffing, figuring out the lunch rush, adjusting portion size so that seniors might have some extra to take home and eat later. Meals on Wheels People received some grant money to help with start up costs, and they expect to turn a profit in their third year. But even early on, they seem to be hitting their stride. It's a bustling, thriving business.
Chris Bingenheimer learned about The Diner from a friend, and came in to share a meal. He sometimes goes to a senior center, but was never a fan of the made-in-advance food, or the minimal choices, or of the fact he had to be called up for a meal like at the high school cafeteria. He said he'll definitely be back to The Diner.
"The staff is very friendly," says Bingenheimer. "They don't look down on you because you're with the Meals on Wheels program. They treat you kindly. The service is impeccable."
Bingenheimer is a senior using Meals on Wheels. And at The Diner, he's also just a guy, sitting with a friend, having a good breakfast.


npr--2020-01-18--Elk Raise Tensions Between Tribes And Farmers In Washington's Skagit Valley

Elk Raise Tensions Between Tribes And Farmers In Washington 's Skagit Valley Just after sunrise , elk are grazing in a misty field in Washington 's Skagit Valley , an hour and a half north of Seattle .
`` It looks like there are roughly 40 animals there , '' says Scott Schuyler , a member of northwest Washington 's Upper Skagit Tribe .
These elk are at the center of a conflict that 's unfolding between Native Americans and farmers in northwest Washington .
After being nearly wiped out in the late 1800s , the animals are making a @ @ @ @ @ @ @ are thrilled , but the agricultural industry is not .
Schuyler grew up in the suburbs south of Seattle , but , when a court decision reaffirmed his tribe 's right to hunt and fish in the Skagit Valley , his family moved back to their ancestral home .
Schuyler remembers hunting his first elk in 1987 , when he was 24 years old .
`` I was really proud at the time , '' he says .
`` It 's our tradition , when you get your first animal , you give @ @ @ @ @ @ @ your elders .
And so I gave most of the animal away . ''
But , Schuyler says , some of the Skagit Valley 's farmers and ranchers were not happy that tribal members were moving back , claiming their rights .
`` I 've had a lot of firearms pointed in my direction , a lot of lead being shot in my direction , '' he says .
`` I 've been peppered with birdshot . ''
He says he 's had his tires slashed , his fish stolen .
He 's @ @ @ @ @ @ @ Schuyler 's tribe and others are sovereign nations that have treaties with the US government that date back to the mid-1800s .
Those treaties guarantee their right to hunt , fish and gather .
The treaties also grant them a role in fish and wildlife management .
But Schuyler says some residents and some public officials do n't think the tribe should have those rights .
`` And [ so ] it becomes socially acceptable to attack the tribe , tribal members and tribes ' rights , '' he says .
Not far @ @ @ @ @ @ @ pasture in the early morning , Eileen and Randy Good have worked as dairy farmers and cattle ranchers for more than four decades .
The Goods both grew up in Skagit Valley .
Now , Eileen Good says , the elk are `` making it impossible for us to survive as a farmer . ''
She says the elk knock down fences , eat up pastures and destroy crops .
`` I figure we have lost like $ 36,000 a year due to the elk crossing and wrecking the fences all the time @ @ @ @ @ @ @ points to a Skagit County Assessor 's report that says elk are causing $ 1.4 million of damage in the valley every year .
That number relies on farmers self-reporting the damage , but no one doubts the loss is real and widespread .
Bill Schmidt is president of the Skagit Valley Farm Bureau .
He objects to any tribal involvement in elk management .
`` I mean , it 's like one percent or less of our population is controlling the management of the elk , '' he says , `` and @ @ @ @ @ @ @ Historians say Native Americans in the Pacific Northwest have hunted elk for thousands of years .
Still , Schmidt maintains white settlers in the early 1900s said there were n't many Native Americans in Skagit Valley .
And those who were there , he says , `` They were not into deer and elk .
They were basically fishermen . ''
Historians say that claim is incorrect .
But , for Schmidt , this is about something beyond the specifics of deer and elk and fish .
`` They 're claiming all these @ @ @ @ @ @ @ to have extra rights , '' he says .
`` I think they should be more forthright and try and be — to me — more American . ''
The Washington Department of Fish and Wildlife is trying to bridge the divide by keeping elk away from farms , reimbursing farmers for losses and shooting problematic animals .
Wildlife officials will be spending the next three months counting and collaring the Skagit Valley 's elk .
Their goal is to minimize conflict while also growing the herd to a more robust population .
@ @ @ @ @ @ @ difficult because of the pervasive belief that neither elk nor tribes belong in the valley .
`` We made this deal with the United States , '' Schuyler says .
`` It was like , 'OK , well , you 're giving up your land , but , you know what ?
We 'll let you continue fishing and hunting . '
'' `` Those same rights are under attack . ''

Elk Raise Tensions Between Tribes And Farmers In Washington's Skagit Valley
Enlarge this image toggle caption Megan Farmer/KUOW Megan Farmer/KUOW
Just after sunrise, elk are grazing in a misty field in Washington's Skagit Valley, an hour and a half north of Seattle.
"It looks like there are roughly 40 animals there," says Scott Schuyler, a member of northwest Washington's Upper Skagit Tribe.
These elk are at the center of a conflict that's unfolding between Native Americans and farmers in northwest Washington. After being nearly wiped out in the late 1800s, the animals are making a comeback in Skagit Valley. Local tribes are thrilled, but the agricultural industry is not.
Schuyler grew up in the suburbs south of Seattle, but, when a court decision reaffirmed his tribe's right to hunt and fish in the Skagit Valley, his family moved back to their ancestral home.
Schuyler remembers hunting his first elk in 1987, when he was 24 years old.
"I was really proud at the time," he says. "It's our tradition, when you get your first animal, you give to your community; you give to your elders. And so I gave most of the animal away."
But, Schuyler says, some of the Skagit Valley's farmers and ranchers were not happy that tribal members were moving back, claiming their rights.
Enlarge this image toggle caption Megan Farmer/KUOW Megan Farmer/KUOW
"I've had a lot of firearms pointed in my direction, a lot of lead being shot in my direction," he says. "I've been peppered with birdshot."
He says he's had his tires slashed, his fish stolen. He's gotten death threats on social media.
Schuyler's tribe and others are sovereign nations that have treaties with the US government that date back to the mid-1800s. Those treaties guarantee their right to hunt, fish and gather. The treaties also grant them a role in fish and wildlife management.
But Schuyler says some residents and some public officials don't think the tribe should have those rights.
"And [so] it becomes socially acceptable to attack the tribe, tribal members and tribes' rights," he says.
Elk damage farms
Not far from where the elk grazed in a pasture in the early morning, Eileen and Randy Good have worked as dairy farmers and cattle ranchers for more than four decades. The Goods both grew up in Skagit Valley.
Now, Eileen Good says, the elk are "making it impossible for us to survive as a farmer."
She says the elk knock down fences, eat up pastures and destroy crops.
"I figure we have lost like $36,000 a year due to the elk crossing and wrecking the fences all the time," Randy Good says.
He points to a Skagit County Assessor's report that says elk are causing $1.4 million of damage in the valley every year. That number relies on farmers self-reporting the damage, but no one doubts the loss is real and widespread.
Bill Schmidt is president of the Skagit Valley Farm Bureau. He objects to any tribal involvement in elk management.
Enlarge this image toggle caption Megan Farmer/KUOW Megan Farmer/KUOW
"I mean, it's like one percent or less of our population is controlling the management of the elk," he says, "and it doesn't seem right."
Historians say Native Americans in the Pacific Northwest have hunted elk for thousands of years. Still, Schmidt maintains white settlers in the early 1900s said there weren't many Native Americans in Skagit Valley.
And those who were there, he says, "They were not into deer and elk. They were basically fishermen."
Historians say that claim is incorrect.
But, for Schmidt, this is about something beyond the specifics of deer and elk and fish.
"They're claiming all these rights because it's an easy way to have extra rights," he says. "I think they should be more forthright and try and be — to me — more American."
The Washington Department of Fish and Wildlife is trying to bridge the divide by keeping elk away from farms, reimbursing farmers for losses and shooting problematic animals.
Wildlife officials will be spending the next three months counting and collaring the Skagit Valley's elk. Their goal is to minimize conflict while also growing the herd to a more robust population.
Tribal member Scott Schuyler says compromise is difficult because of the pervasive belief that neither elk nor tribes belong in the valley.
"We made this deal with the United States," Schuyler says. "It was like, 'OK, well, you're giving up your land, but, you know what? We'll let you continue fishing and hunting.'"
"Those same rights are under attack."


npr--2020-01-17--3 Years In, 'A Very Stable Genius' Authors Say Trump Decisions Are 'More Chaotic'

3 Years In , ' A Very Stable Genius ' Authors Say Trump Decisions Are 'More Chaotic' After three years of covering the Trump administration , Philip Rucker and Carol Leonnig , longtime and Pulitzer Prize-winning reporters for The Washington Post , were dizzy .
`` It 's been such an exhausting three years , I think , for all of us — for all Americans , '' said Post White House bureau chief , Philip Rucker , in an interview with NPR 's All Things Considered on Friday .
`` The news is sped up so much . ''
@ @ @ @ @ @ @ back from the daily hurricane .
`` We both wanted to just hit the pause button and say : 'How do we make sense of this administration and this unprecedented presidency , for ourselves and for readers ? '
`` said Leonnig , a national investigative reporter for the Post .
They searched for patterns that would help them form a clearer picture of Trump as a person and a president and of this moment in history , ultimately emerging with a new book .
A Very Stable Genius : Donald J. Trump @ @ @ @ @ @ @ three years of Trump 's tenure .
In their own words , Leonnig and Rucker said , `` The result is a deeply reported portrait of a president like no other : a success , a master in some ways , and also a chaotic , undisciplined , impulsive leader . ''
Through an aide , President Trump declined to speak to the journalists for the book , Leonnig said .
Relying on more than 200 unnamed sources — many of whom were at Trump 's side during defining moments of the presidency @ @ @ @ @ @ @ paint Trump as dangerously uninformed as he is self-congratulatory .
One such episode occurs six months into his presidency , during a Pentagon meeting in which , the journalists report , Trump called senior military commanders `` a bunch of dopes and babies . ''
Leonnig and Rucker cite the anecdote as a climactic `` inflection point , '' marking Trump 's determination to drive away those who try to offer him counsel .
`` The guardrails are gone , and increasingly the decisions have become more chaotic , '' Leonnig said .
@ @ @ @ @ @ @ surrounded by are increasingly those who think their mission is to tell him , 'Yes . '
`` On Trump 's 'tirade ' in the Pentagon room meeting Carol Leonnig : In July 2017 , a group of very , very senior Cabinet members and advisers decided : We need to give a tutorial , in effect , to Donald Trump .
They 'd been having a lot of arguments with him , disagreements about where troops and bases were , trade policy , et cetera .
And he was resisting them time @ @ @ @ @ @ @ not go well .
Donald Trump was bellowing and howling and , at one point , so angry and in such a tirade that he was trying to catch his breath to continue howling at this group about how they were losers , they did n't know how to win anymore .
And actually , the last thing that he said was something almost everyone in that room promised they would not talk about publicly , it was such an insult .
And that was : `` I would never go to war @ @ @ @ @ @ @ room , Secretary of State [ Rex ] Tillerson , who 's one of the architects of this meeting , is so upset and he 's watching the military leaders , including the secretary of defense , just bow his head and say nothing .
And he finally stands up and tells the president , `` You 're wrong , Mr. President .
That 's not how it is . ''
Rucker : This became a real inflection point for the presidency , because after this moment , Trump started to shut out @ @ @ @ @ @ @ were trying to steer him in a different course , and started to really try to execute his own wishes , his own orders .
On critics who say a book highlighting Trump 's blunders is snark Rucker : I think the tone of the book is really anything but snarky .
It 's deadly serious .
You know , we 're chronicling what this president has done in office for three years , how he comports himself behind the scenes , how he leads our military , how he leads our domestic @ @ @ @ @ @ @ a bit of a distance .
And what I mean by that is these are not opinions that we 're expressing , we 're unearthing the truth that we discovered in our reporting .
And that leads to some conclusions that might be difficult for some of the president 's supporters to hear .
But they 're real and they 're accurate and they 're serious .
On the book title [ Trump has referred to himself as a `` very stable genius '' ] Leonnig : We did n't want to mock @ @ @ @ @ @ @ use his own words to sort of hold that up as a stress test about this presidency .
We thought that it was important to sort of take that mirror and turn it back to him and find out : What were those folks serving him ?
What did they think about that ?
On whether Trump 's fourth year in office will look different from his first three Rucker : Based on the patterns we 've seen so far in this presidency that we document in the book , I do n't @ @ @ @ @ @ @ .
You know , Donald Trump is not a man who changes easily .
The one thing that might change is the extent to which he feels under siege and he feels needing to punch back and be aggressive on the offensive .
And a reason for that is , he 's facing reelection , which is a huge test and hurdle for him .
When he feels up against a wall and under siege , we 've seen him again and again lash out , do sometimes self-destructive actions .
And there @ @ @ @ @ @ @ that as we get closer to the November election , some of those characteristics will come into the fore .
NPR 's Sam Gringlas and Jolie Myers produced and edited this interview for broadcast .
Emma Bowman adapted it for the Web .

3 Years In, 'A Very Stable Genius' Authors Say Trump Decisions Are 'More Chaotic'
After three years of covering the Trump administration, Philip Rucker and Carol Leonnig, longtime and Pulitzer Prize-winning reporters for The Washington Post, were dizzy.
"It's been such an exhausting three years, I think, for all of us — for all Americans," said Post White House bureau chief, Philip Rucker, in an interview with NPR's All Things Considered on Friday. "The news is sped up so much."
So Rucker and Leonnig decided to step back from the daily hurricane.
A Very Stable Genius Donald J. Trump's Testing of America by Carol Leonnig and Philip Rucker Hardcover, 304 pages | purchase close overlay Buy Featured Book Your purchase helps support NPR programming. How?
"We both wanted to just hit the pause button and say: 'How do we make sense of this administration and this unprecedented presidency, for ourselves and for readers?' " said Leonnig, a national investigative reporter for the Post.
They searched for patterns that would help them form a clearer picture of Trump as a person and a president and of this moment in history, ultimately emerging with a new book. A Very Stable Genius: Donald J. Trump's Testing of America charts the first three years of Trump's tenure.
In their own words, Leonnig and Rucker said, "The result is a deeply reported portrait of a president like no other: a success, a master in some ways, and also a chaotic, undisciplined, impulsive leader."
Through an aide, President Trump declined to speak to the journalists for the book, Leonnig said. Relying on more than 200 unnamed sources — many of whom were at Trump's side during defining moments of the presidency — Rucker and Leonnig build scenes that paint Trump as dangerously uninformed as he is self-congratulatory.
One such episode occurs six months into his presidency, during a Pentagon meeting in which, the journalists report, Trump called senior military commanders "a bunch of dopes and babies." Leonnig and Rucker cite the anecdote as a climactic "inflection point," marking Trump's determination to drive away those who try to offer him counsel.
"The guardrails are gone, and increasingly the decisions have become more chaotic," Leonnig said. "And the people that he's surrounded by are increasingly those who think their mission is to tell him, 'Yes.' "
Interview Highlights
On Trump's 'tirade' in the Pentagon room meeting
Carol Leonnig: In July 2017, a group of very, very senior Cabinet members and advisers decided: We need to give a tutorial, in effect, to Donald Trump. They'd been having a lot of arguments with him, disagreements about where troops and bases were, trade policy, et cetera. And he was resisting them time and time again.
This tutorial did not go well. Donald Trump was bellowing and howling and, at one point, so angry and in such a tirade that he was trying to catch his breath to continue howling at this group about how they were losers, they didn't know how to win anymore. And actually, the last thing that he said was something almost everyone in that room promised they would not talk about publicly, it was such an insult. And that was: "I would never go to war with you people."
In the room, Secretary of State [Rex] Tillerson, who's one of the architects of this meeting, is so upset and he's watching the military leaders, including the secretary of defense, just bow his head and say nothing. And he finally stands up and tells the president, "You're wrong, Mr. President. That's not how it is."
Rucker: This became a real inflection point for the presidency, because after this moment, Trump started to shut out his advisers, the seasoned hands who were trying to steer him in a different course, and started to really try to execute his own wishes, his own orders.
On critics who say a book highlighting Trump's blunders is snark
Rucker: I think the tone of the book is really anything but snarky. It's deadly serious. You know, we're chronicling what this president has done in office for three years, how he comports himself behind the scenes, how he leads our military, how he leads our domestic policies.
We tried to write from a bit of a distance. And what I mean by that is these are not opinions that we're expressing, we're unearthing the truth that we discovered in our reporting. And that leads to some conclusions that might be difficult for some of the president's supporters to hear. But they're real and they're accurate and they're serious.
On the book title [Trump has referred to himself as a "very stable genius"]
Leonnig: We didn't want to mock the president, but we wanted to use his own words to sort of hold that up as a stress test about this presidency.
We thought that it was important to sort of take that mirror and turn it back to him and find out: What were those folks serving him? What did they think about that?
On whether Trump's fourth year in office will look different from his first three
Rucker: Based on the patterns we've seen so far in this presidency that we document in the book, I don't know that it will look that different. You know, Donald Trump is not a man who changes easily.
The one thing that might change is the extent to which he feels under siege and he feels needing to punch back and be aggressive on the offensive. And a reason for that is, he's facing reelection, which is a huge test and hurdle for him.
When he feels up against a wall and under siege, we've seen him again and again lash out, do sometimes self-destructive actions. And there's a possibility, of course, that as we get closer to the November election, some of those characteristics will come into the fore.
NPR's Sam Gringlas and Jolie Myers produced and edited this interview for broadcast. Emma Bowman adapted it for the Web.


npr--2020-01-19--His Dad Died In A Venezuelan Hospital. What He Saw In The Morgue Still Haunts Him

His Dad Died In A Venezuelan Hospital .
What He Saw In The Morgue Still Haunts Him Editor 's note : This story contains graphic descriptions of conditions in a hospital morgue .
In the bowels of a Venezuelan hospital , I took my toughest walk ever .
It was just after dawn on October 17 .
The corpse of my 81-year-old father lay on a gurney , covered in thick orange sheets .
He had just died of a heart attack in his hospital room , on the fifth floor .
He was lying in bed next to my @ @ @ @ @ @ @ 20 years .
It was four days after doctors performed a major emergency surgery to repair his large intestine .
My father 's care during his hospitalization was acceptable despite the deterioration in health care services during the current economic crisis .
( The staff was quite good but we had to bring our own water and medications , and there were flies constantly flying around the room . )
After he died , it was another story .
I saw firsthand how drastically the quality of my country 's medical institutions has @ @ @ @ @ @ @ dies in a hospital , the body is moved to the morgue until the family can sign papers to claim the body and take it for burial .
After my father 's death , a male nurse in his early 20s pulled the gurney down a long outdoor corridor at University Hospital of Maracaibo .
I followed along because I wanted to stay with my father 's body until it reached the morgue , at which point I would go to an office to sign the necessary documents .
I was heartbroken , @ @ @ @ @ @ @ father were passing through my mind like a high-speed train : I could see him throwing and catching a baseball with me when I was a kid , and years later , holding my 2-year-old baby girl in his arms .
And then , as we got about 50 feet away from the main entrance of the morgue , a nauseating smell of putrefaction slapped me in the face .
It was the kind of stench that shuffles your stomach and seems to find its way under your skin .
The reek vacuumed @ @ @ @ @ @ @ .
The young nurse froze at the edge of the doorway .
He leaned to the floor and I thought perhaps he had a pain in his knee .
Then I realized he was overcome with a wave of nausea .
Then I , the son of the departed , had to encourage a health worker to go on inside the morgue despite the foul smell .
We went down a narrow indoor hallway leading to the morgue , which consists of five separate rooms .
Every step drew me closer to the @ @ @ @ @ @ @ soon discovered was in one of these rooms .
This particular room was filled with about a dozen rotting bodies on beds , some piled on top of each other .
The nurse with the gurney proceeded to a different , smaller room where my father 's body would stay until I 'd signed the papers .
Then the nurse left .
I was standing in front of a small desk , but as yet there was no staff member there .
The door to the large room with the rotting bodies was @ @ @ @ @ @ @ a quick tour with a tissue covering my mouth and nose .
The scene was creepy , as if extracted from a horror movie .
Two big overhead lamps shone upon two corpses .
I could see their bones .
The little flesh that remained had turned black and rotten .
What was even more horrifying was to see decomposed bits of flesh from their bodies scattered on two thin mats on the floor , surrounded by dozens of dead worms .
I was later told by a hospital representative that cats and @ @ @ @ @ @ @ morgue and feed on the bodies .
The room was unbearably hot .
I found out that the air cooling system that was supposed to keep the morgue at temperatures that would keep the bodies from decomposing had broken .
To document what I was seeing , I quickly took four photos with my phone .
I was worried of what would happen if someone saw me – reporters and news agencies need to ask for permission to take pictures or cover news inside public hospitals in Venezuela .
Five minutes passed before @ @ @ @ @ @ @ He moved my father 's body to another room , next to the bodies of four recently deceased people .
I signed the papers and left , then returned an hour later with two workers from a funeral home to pick up the body .
After a long shower back at home , I joined my family and we went on to bury my father .
But the morgue scene stayed with me .
I could conjure the smell or see the horrific images in my mind anytime .
It distressed me almost @ @ @ @ @ @ @ died , I began making phone calls to learn more about the morgue situation .
While many bodies of the deceased are quickly claimed by relatives , some corpses are abandoned .
Since August , there had been 14 corpses left in this hospital 's morgue because relatives did not claim them , according to a hospital staffer familiar with the forensic procedures in the health center .
This staffer asked for anonymity for fear of being fired for criticizing the hospital , Most of these 14 bodies were homeless people , elderly @ @ @ @ @ @ @ source said .
The two freezer units used for preservation have n't worked for months , and the air conditioning is also broken , the source continued .
So the temperature in the morgue rooms is close to 100 degrees Fahrenheit , the source said .
This situation has been going on for some time .
In October 2018 , the BBC 's Spanish news site reported on the very same Venezuelan morgue I had visited : `` Many lifeless bodies lay over dirty metallic tables .
They should be there for only @ @ @ @ @ @ @ , but most of them spend days there , even months . ''
Photos documented the scene – which was identical to what I saw a full year later .
In a phone interview , Dora Colmenares , secretary of the Organization of the College of Physicians in Zulia state , told me about the animals that infest the morgue : Snakes , cockroaches , worms , mosquitoes , cats and dogs .
`` We 're like a zoo .
The environment is completely polluted , '' she said .
The hospital staff @ @ @ @ @ @ @ but there are too many for them to handle , and often they come in at night .
An NPR request to interview Mervin Urbina , director of the Universitario Hospital , to discuss the situation in the morgue was declined .
No reason was given .
The tragedy in the morgue is only one manifestation of the health care issues in Venezuela , says Colmenares .
The Universitario hospital where my father was treated , she says , ca n't perform X-rays because the equipment is broken and does n't have the @ @ @ @ @ @ @ The Office for the U.N. High Commissioner for Human Rights said last July that the health situation in Venezuela was `` dire , with hospitals lacking staff , supplies , medicines and electricity to keep vital machinery running . ''
She thinks that the landscape of rotten and forgotten bodies is a reflection of how bad the entire system is .
`` In Venezuela , even the human rights of the deceased are violated , '' says Colmenares , who is also a university professor and specialist in general surgery .
Provea , @ @ @ @ @ @ @ human rights , said in July that the number of complaints about the decay of hospital infrastructure and morgues increased from 400 in 2017 to 840 in 2018 .
Few hospital employees want to be inside or near the large morgue room where I stood the day my father died , says Colmenares .
The hospital does not provide gloves or any other equipment for personal protection to the workers of the morgue , I also learned .
That 's definitely a concern , says Melissa Connor , who teaches forensic anthropology at @ @ @ @ @ @ @ of the Forensic Investigation Research Station and studies the decomposition of human remains .
She says that hospital staff who are n't given protective gear could be putting themselves and others at risk .
Most diseases do n't linger on the bodies of the deceased ( although some , including hepatitis B , do ) , but the bigger issue is bacteria .
`` If you do have cuts on your hands , it 's likely you 'll get bacteria into those cuts , '' she notes , explaining that this is especially @ @ @ @ @ @ @ contact with patients with weakened immune systems .
Ivan Lopez , a nurse who works in the hospital , told me that it is common to see medical students , doctors , nurses , maintenance staff or relatives of dead patients head down that corridor where I took my toughest walk – only to turn back when the smell hits them .
Many of them turn around as soon as the smell hits them , Lopez says .
His recollection reminded me of the pale young nurse who pulled my dad 's gurney @ @ @ @ @ @ @ our health , '' Lopez says .
Maybe everyone in Venezuela should be .
And I 'm afraid I will never be able to think of my father , and his wonderful life , without being haunted by that long walk to the morgue .
Gustavo Ocando Alex is a freelance writer in Venezuela who has contributed to BBC World News and the Miami Herald .

His Dad Died In A Venezuelan Hospital. What He Saw In The Morgue Still Haunts Him
Enlarge this image toggle caption Family photo courtesy of Gustavo Ocando Alex Family photo courtesy of Gustavo Ocando Alex
Editor's note: This story contains graphic descriptions of conditions in a hospital morgue.
In the bowels of a Venezuelan hospital, I took my toughest walk ever.
It was just after dawn on Oct. 17. The corpse of my 81-year-old father lay on a gurney, covered in thick orange sheets. He had just died of a heart attack in his hospital room, on the fifth floor. He was lying in bed next to my stepmother, his companion for the last 20 years. It was four days after doctors had performed a major emergency surgery to repair his large intestine.
My father's care during his hospitalization was acceptable despite the deterioration in health care services during the current economic crisis. (The staff was quite good, but we had to bring our own water and medications, and there were flies constantly flying around the room.)
After he died, it was another story. I saw firsthand how drastically the quality of my country's medical institutions has declined.
In Venezuela, when someone dies in a hospital, the body is moved to the morgue until the family can sign papers to claim the body and take it for burial.
After my father's death, a male nurse in his early 20s pulled the gurney down a long outdoor corridor at University Hospital of Maracaibo. I followed along because I wanted to stay with my father's body until it reached the morgue, at which point I would go to an office to sign the necessary documents. I was heartbroken, tearing up uncontrollably.
Memories of my father were passing through my mind like a high-speed train: I could see him throwing and catching a baseball with me when I was a kid and, years later, holding my 2-year-old baby girl in his arms.
And then, as we got about 50 feet away from the main entrance of the morgue, a nauseating smell of putrefaction slapped me in the face. It was the kind of stench that shuffles your stomach and seems to find its way under your skin.
The reek vacuumed up all those recollections in a snap.
The young nurse froze at the edge of the doorway. He leaned to the floor, and I thought perhaps he had a pain in his knee. Then I realized he was overcome with a wave of nausea.
Then I, the son of the departed, had to encourage a health worker to go on inside the morgue despite the foul smell.
We went down a narrow indoor hallway leading to the morgue, which consisted of five separate rooms. Every step drew me closer to the source of the stench, which I soon discovered was in one of these rooms. This particular room was filled with about a dozen rotting bodies on beds, some piled on top of each other.
The nurse with the gurney proceeded to a different, smaller room where my father's body would stay until I'd signed the papers. Then the nurse left. I was standing in front of a small desk, but as yet there was no staff member there. The door to the large room with the rotting bodies was open. I went in and took a quick tour with a tissue covering my mouth and nose. The scene was creepy, as if extracted from a horror movie. Two big overhead lamps shone upon two corpses. I could see their bones. The little flesh that remained had turned black and rotten.
What was even more horrifying was to see decomposed bits of flesh from their bodies scattered on two thin mats on the floor, surrounded by dozens of dead worms.
I was later told by a hospital representative that cats and dogs are able to sneak into the morgue and feed on the bodies.
The room was unbearably hot. I found out that the air-cooling system that was supposed to keep the morgue at temperatures that would keep the bodies from decomposing had broken.
To document what I was seeing, I quickly took four photos with my phone. I was worried of what would happen if someone saw me — reporters and news agencies need to ask for permission to take pictures or cover news inside public hospitals in Venezuela.
Five minutes passed before the staffer on duty showed up. He moved my father's body to another room, next to the bodies of four recently deceased people. I signed the papers and left, then returned an hour later with two workers from a funeral home to pick up the body.
After a long shower back at home, I joined my family, and we went on to bury my father.
But the morgue scene stayed with me. I could conjure the smell or see the horrific images in my mind anytime. It distressed me almost daily.
One week after my father died, I began making phone calls to learn more about the morgue situation.
While many bodies of the deceased are quickly claimed by relatives, some corpses are abandoned. Since August, there had been 14 corpses left in this hospital's morgue because relatives did not claim them, according to a hospital staffer familiar with the forensic procedures in the health center. This staffer asked for anonymity for fear of being fired for criticizing the hospital. Most of these 14 bodies were homeless people, elderly people or patients with no relatives, the source said.
The two freezer units used for preservation haven't worked for months, and the air conditioning is also broken, the source continued. So the temperature in the morgue rooms is close to 100 degrees Fahrenheit, the source said.
This situation has been going on for some time. In October 2018, the BBC's Spanish news site reported on the very same Venezuelan morgue I had visited: "Many lifeless bodies lay over dirty metallic tables. They should be there for only a few hours and always in cold, but most of them spend days there, even months." Photos documented the scene — which was identical to what I saw a full year later.
In a phone interview, Dora Colmenares, secretary of the Organization of the College of Physicians in Zulia state, told me about the animals that infest the morgue: snakes, cockroaches, worms, mosquitoes, cats and dogs.
"We're like a zoo. The environment is completely polluted," she said.
The hospital staff tries to scare the animals away, but there are too many for them to handle and often the animals come in at night.
An NPR request to interview Mervin Urbina, director of the Universitario Hospital, to discuss the situation in the morgue was declined. No reason was given.
The tragedy in the morgue is only one manifestation of the health care issues in Venezuela, says Colmenares. The Universitario hospital where my father was treated, she says, can't perform X-rays because the equipment is broken and it doesn't have the proper supplies to do laboratory tests.
The Office for the U.N. High Commissioner for Human Rights said last July that the health situation in Venezuela was "dire, with hospitals lacking staff, supplies, medicines and electricity to keep vital machinery running."
Colmenares thinks that the landscape of rotten and forgotten bodies is a reflection of how bad the entire system is.
"In Venezuela, even the human rights of the deceased are violated," says Colmenares, who is also a university professor and specialist in general surgery.
Provea, a Venezuelan NGO that promotes and defends human rights, said in July that the number of complaints about the decay of hospital infrastructure and morgues increased from 400 in 2017 to 840 in 2018.
Few hospital employees want to be inside or near the large morgue room where I stood the day my father died, says Colmenares. The hospital does not provide the morgue workers with gloves or any other equipment for personal protection, I also learned.
That's definitely a concern, says Melissa Connor, who teaches forensic anthropology at Colorado Mesa University, is the director of the Forensic Investigation Research Station and studies the decomposition of human remains. She says that hospital staffers who aren't given protective gear could be putting themselves and others at risk. Most diseases don't linger on the bodies of the deceased (although some, including hepatitis B, do), but the bigger issue is bacteria.
"If you do have cuts on your hands, it's likely you'll get bacteria into those cuts," she notes, explaining that this is especially dangerous if the workers then come in contact with patients with weakened immune systems.
Ivan Lopez, a nurse who works in the hospital, told me that it is common to see medical students, doctors, nurses, maintenance staff or relatives of dead patients head down that corridor where I took my toughest walk — only to turn back when the smell hits them.
His recollection reminded me of the pale young nurse who pulled my dad's gurney.
"We're all afraid for our health," Lopez says.
Maybe everyone in Venezuela should be.
And I'm afraid I will never be able to think of my father, and his wonderful life, without being haunted by that long walk to the morgue.
Gustavo Ocando Alex is a freelance writer in Venezuela who has contributed to BBC World News and the Miami Herald.


npr--2020-01-19--'You Need To Act Now': Meet 4 Girls Working To Save The Warming World

'You Need To Act Now ' : Meet 4 Girls Working To Save The Warming World A teenage girl , Greta Thunberg , has become the world-famous face of the climate strike movement .
But she 's far from alone : Thunberg has helped rally and inspire others — especially girls .
NPR talked to four teenage climate activists , all girls , from the U.S. and Australia , alongside their mothers .
These teenagers are juggling activism with schoolwork and personal time .
And their families are working hard to support them as they grapple with the heavy emotions @ @ @ @ @ @ @ .
In Castlemaine , Australia , Milou Albrecht , 15 , co-founded School Strike for Climate Australia , which organizes student walkouts .
As massive bush fires engulf parts of her home country , Albrecht 's group has been pressuring the German corporation Siemens to withdraw from an Australian coal mining project .
In New York City , Xiye Bastida , 17 , led her school in the city 's first big student climate strike last March , and along with traveling and public speaking , she and some of her classmates have @ @ @ @ @ @ @ .
( `` Gym is on Fridays , so I have a very low grade in gym , '' she notes . )
In Louisiana , 16-year-old Jayden Foytlin was one of 21 young people who sued the federal government for violating their rights to a livable planet .
The young plaintiffs hailed from communities around the country that have been directly affected by global warming — Foytlin , for example , is from south Louisiana , where her home has been flooded in storms .
The lawsuit , Juliana v. United States @ @ @ @ @ @ @ federal appeals court .
But Foytlin says she 's formed lasting friendships with the other plaintiffs .
`` We all share one thing in common — we really care about where we 're from , and how we are going to continue to live [ here ] . ''
In upstate New York , Scout Pronto Breslin , 16 , is focused on wildlife .
She lives in Rhinebeck , and is the founder of a group called Hudson Valley Wild .
`` I volunteer at a wildlife rehab clinic , '' she @ @ @ @ @ @ @ .
`` The birds there often come in with blood poisoning because of illegal toxins from chemical runoff and fertilizer . ''
Pronto Breslin advises other teens to find what really interests them about the climate movement .
She says it could be composting in their schools , gardening , nature : `` Once you find something that you really love , then that will just give you motivation to keep going with it . ''
It 's no coincidence that teenage girls are especially visible right now as climate leaders , says @ @ @ @ @ @ @ is such a great example of the way in which girls and young women are stepping into the heart of this space , and showing us what it looks like to lead with courage and imagination and incredible moral clarity . ''
Wilkinson works with a solutions-focused climate organization called Project Drawdown , and delivered a TED talk on how empowering women and girls can help stop global warming .
`` When we think about the nexus of climate and gender , there are three big points of intersection , '' she tells @ @ @ @ @ @ @ impacts of climate change hit women and girls first and worst , '' particularly in the developing world and in poor communities .
The second , she says , is that `` gender equality is itself a climate solution , '' with women 's education and equity leading to smaller family sizes and , research shows , better land management practices .
And the third is what Wilkinson calls `` transformational leadership that is grounded in intersectional feminism and what we might consider more feminine approaches to leading . ''
Scout Pronto Breslin @ @ @ @ @ @ @ to work on gender equity issues at the United Nations .
She agrees with Wilkinson : `` I think it 's really amazing how many young women are involved in this . ''
On the other hand , she says , `` I do n't believe 'Girls are going to save the world . '
We all need to save the world .
It 's not up to girls .
As much as we admire and love what they 're doing , it also does n't absolve us of responsibility . ''
Raised @ @ @ @ @ @ @ these girls expressed her own , independent commitment to the climate crisis — but it 's impossible to ignore the upbringings that sparked their engagement .
`` My mom and my dad always taught me what it was to take care of the Earth , '' Xiye Bastida says .
Bastida — who has been described as New York City 's Greta Thunberg — is the daughter of Geraldine Patrick Encina , a scholar in residence at the Union Theological Seminary 's Center for Earth Ethics , and an environmental activist since her @ @ @ @ @ @ @ 's father is a member of the indigenous Otomi Toltec nation in Mexico , which advocates for the protection of their local water and land .
Patrick Encina says the family follows indigenous traditions .
`` We will do at least one ceremony , you know , to the waters or to the land frequently , maybe once a week . ''
Milou Albrecht is the daughter of Susan Burke , a psychologist who works in climate adaptation and disaster recovery .
Burke and her husband raised their three children for years in @ @ @ @ @ @ @ .
Albrecht says she grew up going to environmental protests , and that they were `` heaps of fun . ''
Social justice was part of Scout Pronto Breslin 's upbringing , too .
Aside from her mother 's work in areas including sustainable development , her father was an anti-apartheid activist in South Africa , and currently works for the U.N. And Jayden Foytlin 's mother is Cherri Foytlin , a direct action climate activist of Afro-Latina-Indigenous descent who is known for opposing an oil pipeline in south Louisiana .
`` Some @ @ @ @ @ @ @ or ballerina concerts , '' notes Cherri .
`` Well , it 's always been a family function for us to go to marches or meetings or meet with the community and learn how to organize . ''
All of the teenagers , however , made the point that they had friends in the movement whose parents were less aware , less involved or less supportive than their own .
`` I have a few friends whose parents will tell them , 'You can not go to that meeting until you finish your @ @ @ @ @ @ @ to stop skipping school on Fridays , ' `` says Xiye Bastida .
She calls it `` a very fine line because no parent wants their kid to fail school . ''
Young climate change activists need support , they and their parents say , especially emotional support .
`` The toughest moments have been when Xiye just needs a hug , '' says her mother , Patrick Encina .
Climate change is enormous and tragic .
It feels very personal to young people in particular , who are more likely than older @ @ @ @ @ @ @ personally .
That makes it similar to other youth-led movements , such as Black Lives Matter and the March for Our Lives movement against gun violence .
At the same time , eco-anxiety , depression and secondary traumatic stress are normal psychological reactions to learning about the reality of human-caused environmental destruction .
That 's according to psychologist Renee Lertzman , who has been working in this area for decades .
She compares the situation of these teenagers to her own upbringing in the nuclear age .
`` Anyone who 's my age @ @ @ @ @ @ @ up with the threat of nuclear war around you all the time , and how terrifying that is , '' she says .
`` So I have a lot of empathy and compassion for what it 's like to be a young person in the context of an existential threat .
I feel concern , and I feel like we need to be thoughtful about how we navigate this . ''
She says young people need to hear , `` It 's not all on them . ''
On the positive side , @ @ @ @ @ @ @ mother , says getting involved with a cause you care about can be protective for mental health .
`` It 's great to take action on things that are worrying you because action is one of the best antidotes to despair and helplessness and hopelessness . ''
But Burke cautions that this work must be child-led — you ca n't push your children to get involved .
Albrecht says her parents are good at listening and supporting , `` but also kind of stepping back and let me do my thing . ''
@ @ @ @ @ @ @ Breslin , agrees with that approach .
`` We need to not micromanage them .
It 's really hard .
You kind of want to jump in and say , 'Why do n't you try this ? '
`` Many youth and student groups have created guidelines for adult allies on how to be supportive without taking over .
Many activists are also high-achieving students with multiple AP classes and packed schedules .
Bastida says to make room for the school strike planning and the traveling and speaking she 's doing , she @ @ @ @ @ @ @ .
No regrets , she says : `` Model U.N. is so stressful .
I am more nervous about Model U.N. than [ lobbying ] the actual U.N .
Kids are crazy competitive .
I 'm not trying to be part of that . ''
Nevertheless , they all say that they have to — and their parents encourage them to — make room for downtime and hobbies .
Foytlin likes to draw and play with her little brother .
Bastida likes Netflix and taking baths , and she says , `` My @ @ @ @ @ @ @ can not fix the world if you do not fix up your room . '
`` Pronto Breslin likes taking walks in the woods with her golden retriever , Tess ; playing the guitar and listening to Elvis and the Beatles .
And Albrecht likes gardening .
Each of these girls says it 's important to find joy in the moment , and in the friendships they are making as they work for a better future .
`` We advocate [ so much ] for urgency , '' Bastida says .
`` We @ @ @ @ @ @ @ .
You need to do this fast .
But you can not live your life in that way .
And I think that 's the trickiest part — how do you live in a state of urgency without feeling that within you ?
So we have to remain centered not only in our families , but our communities , in organizing .
When we organize , we model the world we want to see . ''

'You Need To Act Now': Meet 4 Girls Working To Save The Warming World
Enlarge this image LA Johnson/NPR LA Johnson/NPR
A teenage girl, Greta Thunberg, has become the world-famous face of the climate strike movement. But she's far from alone: Thunberg has helped rally and inspire others — especially girls.
NPR talked to four teenage climate activists, all girls, from the U.S. and Australia, alongside their mothers. These teenagers are juggling activism with schoolwork and personal time. And their families are working hard to support them as they grapple with the heavy emotions that come with fighting for the future.
In Castlemaine, Australia, Milou Albrecht, 15, co-founded School Strike for Climate Australia, which organizes student walkouts. As massive bush fires engulf parts of her home country, Albrecht's group has been pressuring the German corporation Siemens to withdraw from an Australian coal mining project.
In New York City, Xiye Bastida, 17, led her school in the city's first big student climate strike last March, and along with traveling and public speaking, she and some of her classmates have continued to strike on Fridays ever since. ("Gym is on Fridays, so I have a very low grade in gym," she notes.)
In Louisiana, 16-year-old Jayden Foytlin was one of 21 young people who sued the federal government for violating their rights to a livable planet. The young plaintiffs hailed from communities around the country that have been directly affected by global warming — Foytlin, for example, is from south Louisiana, where her home has been flooded in storms.
The lawsuit, Juliana v. United States, was recently thrown out by a federal appeals court. But Foytlin says she's formed lasting friendships with the other plaintiffs. "We all share one thing in common — we really care about where we're from, and how we are going to continue to live [here]."
In upstate New York, Scout Pronto Breslin, 16, is focused on wildlife. She lives in Rhinebeck, and is the founder of a group called Hudson Valley Wild. "I volunteer at a wildlife rehab clinic," she says, explaining what motivated her activism."The birds there often come in with blood poisoning because of illegal toxins from chemical runoff and fertilizer."
Pronto Breslin advises other teens to find what really interests them about the climate movement. She says it could be composting in their schools, gardening, nature: "Once you find something that you really love, then that will just give you motivation to keep going with it."
Girls to the front
It's no coincidence that teenage girls are especially visible right now as climate leaders, says Katharine Wilkinson.
LA Johnson/NPR
"The youth movement is such a great example of the way in which girls and young women are stepping into the heart of this space, and showing us what it looks like to lead with courage and imagination and incredible moral clarity."
Wilkinson works with a solutions-focused climate organization called Project Drawdown, and delivered a TED talk on how empowering women and girls can help stop global warming.
"When we think about the nexus of climate and gender, there are three big points of intersection," she tells NPR.
"One is that the impacts of climate change hit women and girls first and worst," particularly in the developing world and in poor communities.
The second, she says, is that "gender equality is itself a climate solution," with women's education and equity leading to smaller family sizes and, research shows, better land management practices.
And the third is what Wilkinson calls "transformational leadership that is grounded in intersectional feminism and what we might consider more feminine approaches to leading."
We all need to save the world. It's not up to girls. As much as we admire and love what they're doing. It also doesn't absolve us of responsibility.
Scout Pronto Breslin's mother, Jennifer Breslin, used to work on gender equity issues at the United Nations. She agrees with Wilkinson: "I think it's really amazing how many young women are involved in this."
On the other hand, she says, "I don't believe 'Girls are going to save the world.' We all need to save the world. It's not up to girls. As much as we admire and love what they're doing, it also doesn't absolve us of responsibility."
Raised to care for the Earth
Each of these girls expressed her own, independent commitment to the climate crisis — but it's impossible to ignore the upbringings that sparked their engagement.
LA Johnson/NPR
"My mom and my dad always taught me what it was to take care of the Earth," Xiye Bastida says.
Bastida — who has been described as New York City's Greta Thunberg — is the daughter of Geraldine Patrick Encina, a scholar in residence at the Union Theological Seminary's Center for Earth Ethics, and an environmental activist since her own teenage years in Chile. Bastida's father is a member of the indigenous Otomi Toltec nation in Mexico, which advocates for the protection of their local water and land.
Patrick Encina says the family follows indigenous traditions. "We will do at least one ceremony, you know, to the waters or to the land frequently, maybe once a week."
Milou Albrecht is the daughter of Susan Burke, a psychologist who works in climate adaptation and disaster recovery. Burke and her husband raised their three children for years in an eco-friendly, rural, intentional community. Albrecht says she grew up going to environmental protests, and that they were "heaps of fun."
Social justice was part of Scout Pronto Breslin's upbringing, too. Aside from her mother's work in areas including sustainable development, her father was an anti-apartheid activist in South Africa, and currently works for the U.N.
And Jayden Foytlin's mother is Cherri Foytlin, a direct action climate activist of Afro-Latina-Indigenous descent who is known for opposing an oil pipeline in south Louisiana.
"Some families, they go to baseball games or ballerina concerts," notes Cherri. "Well, it's always been a family function for us to go to marches or meetings or meet with the community and learn how to organize."
It's always been a family function for us to go to marches or meetings or meet with the community and learn how to organize.
All of the teenagers, however, made the point that they had friends in the movement whose parents were less aware, less involved or less supportive than their own.
"I have a few friends whose parents will tell them, 'You can not go to that meeting until you finish your homework,' or, 'You have to stop skipping school on Fridays,' " says Xiye Bastida. She calls it "a very fine line because no parent wants their kid to fail school."
Supporting, but also stepping back
LA Johnson/NPR
Young climate change activists need support, they and their parents say, especially emotional support. "The toughest moments have been when Xiye just needs a hug," says her mother, Patrick Encina.
Climate change is enormous and tragic. It feels very personal to young people in particular, who are more likely than older generations to say that it impacts them personally. That makes it similar to other youth-led movements, such as Black Lives Matter and the March for Our Lives movement against gun violence.
The toughest moments have been when Xiye just needs a hug.
At the same time, eco-anxiety, depression and secondary traumatic stress are normal psychological reactions to learning about the reality of human-caused environmental destruction. That's according to psychologist Renee Lertzman, who has been working in this area for decades. She compares the situation of these teenagers to her own upbringing in the nuclear age.
"Anyone who's my age knows what it's like to grow up with the threat of nuclear war around you all the time, and how terrifying that is," she says. "So I have a lot of empathy and compassion for what it's like to be a young person in the context of an existential threat. I feel concern, and I feel like we need to be thoughtful about how we navigate this."
She says young people need to hear, "It's not all on them."
On the positive side, Susan Burke, Milou Albrecht's psychologist mother, says getting involved with a cause you care about can be protective for mental health. "It's great to take action on things that are worrying you because action is one of the best antidotes to despair and helplessness and hopelessness."
But Burke cautions that this work must be child-led — you can't push your children to get involved.
It's great to take action on things that are worrying you because action is one of the best antidotes to despair and helplessness and hopelessness.
Albrecht says her parents are good at listening and supporting, "but also kind of stepping back and let me do my thing."
Scout Pronto Breslin's mom, Jennifer Breslin, agrees with that approach. "We need to not micromanage them. It's really hard. You kind of want to jump in and say, 'Why don't you try this?' "
Many youth and student groups have created guidelines for adult allies on how to be supportive without taking over.
Balancing school, life and activism
LA Johnson/NPR
Many activists are also high-achieving students with multiple AP classes and packed schedules. Bastida says to make room for the school strike planning and the traveling and speaking she's doing, she's dropped gymnastics and Model United Nations. No regrets, she says: "Model U.N. is so stressful. I am more nervous about Model U.N. than [lobbying] the actual U.N. Kids are crazy competitive. I'm not trying to be part of that."
Nevertheless, they all say that they have to — and their parents encourage them to — make room for downtime and hobbies.
Foytlin likes to draw and play with her little brother. Bastida likes Netflix and taking baths, and she says, "My dad tells me every day, 'You cannot fix the world if you do not fix up your room.' "
Pronto Breslin likes taking walks in the woods with her golden retriever, Tess; playing the guitar and listening to Elvis and the Beatles. And Albrecht likes gardening.
Each of these girls says it's important to find joy in the moment, and in the friendships they are making as they work for a better future.
"We advocate [so much] for urgency," Bastida says. "We are saying you need to act now. You need to do this fast. But you cannot live your life in that way. And I think that's the trickiest part — how do you live in a state of urgency without feeling that within you? So we have to remain centered not only in our families, but our communities, in organizing. When we organize, we model the world we want to see."