Archive for June, 2008

Struggle for Health: Short Course for Health Activists: Brazil, September 2008

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Our friends at the People’s Health Movement have just announced the next short course for health activists, being offered in Porto Alegre, Brazil, September 7-20, 2008.  This course will be offered in Portuguese, Spanish and English.

The curriculum is an interesting one, and can be viewed at the International People’s Health University (IPHU) website. Of particular interest is the Resource Library at the IPHU website which includes a very rich selection of readings, Powerpoints and other materials (including videos) on the course content.

The curriculum includes:

  • the struggle for health: achievements, strategies and new directions
  • working with communities and with grass roots health organizations
  • comprehensive primary health care: achievements, lessons and new
    directions
  • the political economy of health: globalization, the WTO, the IMF and
    the WB; local issues and global pressures
  • the right to health: principles, achievements and new directions
  • people’s health and the environmental struggle
  • research: part of the problem and part of the solution
  • social determinants of health (poverty, oppression and hierarchy)
  • alienation and exclusion
  • racism and sexism

The 11 day course is presented by the International People’s Health University (IPHU) and the People’s Health Movement (PHM) in association with the School of Public Health of Rio Grande do Sul. The teaching faculty is drawn from Latin America and beyond. Priority is given to students from the Southern Cone. For more information about IPHU and the Porto Alegre Short Course go to www.phmovement.org/iphu. Further inquiries should be directed to the Course Coordinators (porto@phmovement.org).

The short course is offered periodically in various venues and languages. It was, for instance, offered at the US Social Forum in June of 2007.

Matt Anderson

[This entry was updated on 7/13/2008]

Opportunity to do Community Health Research in Cuba: December 2008

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Earlier this week we received the following announcement from MEDICC which we are reproducing with their permission. Opportunities to visit Cuba and do research are very limited:

MEDICC is contacting community health professionals to announce an exciting opportunity for research on Cuba’s primary care health system, December 7 – 14, 2008.

MEDICC (Medical Education Cooperation with Cuba) supports US health professionals undertaking field research in Cuba by providing background materials, guidance on research objectives, and opportunities for publication of research findings. Please see our on-line publications athttp://www.medicc.org.

Over the past several decades, community clinics in the US have mobilized to confront issues of growing disparity and lack of access to health care – all in the face of enormous challenges.

Cuba’s health outcomes often resonate with those in the United States working to find innovative approaches to health problems in medically underserved communities. Despite high levels of poverty, health indicators in Cuba are on par with industrialized countries, including the U.S. Particularly noteworthy are Cuba’s emphasis on community-oriented primary care, the integration of clinical medicine and public health, preventive medicine and effective use of limited resources (see attached article).

The research program in Cuba will be tailored to participants’ interests, and will include meeting with Cuban colleagues and community health leaders, as well as field research on Cuba’s functioning models of primary care, including:

  • Polyclinics (the centerpiece of the community-based system)
  • Family doctor-nurse offices (or consultorios)
  • Community mental health clinics
  • Maternity Homes (for high risk pregnancies)
  • Community organizations such as the sanitary brigades and the Federation of Cuban Women
  • Health programs for the elderly (circulo de abuelos)

Full time health professionals conducting research in Cuba are allowed to do so under the US Treasury’s general license for professional research (see attached). Marazul Charters, an agency licensed to provide travel arrangements to Cuba, organizes the program and books travel. Costs usually range from $2600-$2800 for a week, including airfare from Miami or Cancun. MEDICC serves as an academic consultant for the actual research program and in some cases may be able to provide partial fellowships.

If you are interested in participating in this December 7 – 14 opportunity or would like further information, please let us know by July 2 by writing to admin1@mediccatlatna.org. We will then contact you to discuss your research interests. You can also contact Marazul Charters directly at 1-800 223-5334 ext. 16 for further information on traveling to Cuba on the US Treasury’s general license for professional research. Also, please let us know of any colleagues affiliated with community clinics whom you think might be interested in this opportunity and we will contact them. We look forward to hearing from you.

posted by: Matt Anderson

Using Google Earth as an Innovative Tool for Community Mapping

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We wanted to share an article we just published in Public Health Reports on using Google Earth for community mapping. We have found Google Earth a very useful tool that allows non-experts to make maps illustrating the community context for health problems. This post contains two of the maps created by our residents and medical students.

Using Google Earth as an Innovative Tool for Community Mapping

SYNOPSIS

Maps are used to track diseases and illustrate the social context of health problems. However, commercial mapping software requires special training. This article illustrates how nonspecialists used Google EarthTM, a free program, to create community maps. The Bronx, New York, is characterized by high levels of obesity and diabetes. Residents and medical students measured the variety and quality of food and exercise sources around a residency training clinic and a student-run free clinic, using Google Earth to create maps with minimal assistance. Locations were identified using street addresses or simply by pointing to them on a map. Maps can be shared via e-mail, viewed online with Google Earth or Google Maps, and the data can be incorporated into other mapping software.

Authors: Theodore B. Lefer, Matthew R. Anderson, Alice Fornari, Anastasia Lambert, Jason Fletcher and Maria Baquero

Source: Public Health Reports, July-August 2008, 123: 474-480, Available at www.publichealthreports.org

Sources of Food and Exercise around the Montefiore Comprehensive Health Care Center; Legend: Red cross = Comprehensive Health Care Center; Grocery cart = Grocery Store (n =10); Fork and Knife = Restaurants (n=16); Red dot = Fast Food outlet (n=32); Yellow dot = Bodegas (small variety stores, n=44); Green tree = Exercise site (n=11). Note the old Yankee stadium on the lower left of the map.


Food stores around ECHO Free Clinic, ranked by variety and quality of produce for sale; Legend: Red Cross = ECHO Free Clinic; Small red icon of shopping cart = “no variety” (n=33) ; Yellow cart = “Poor variety” (n=67); Blue cart = “Limited variety” (n=50); Darker green cart = “Better variety” (n=11); Larger, lighter green cart = “Good variety” (n=15) ; Blue -shaded area = Study area

If you are interested, you can also download the original KMZ file.

posted by: Matt Anderson

Health Funding Opportunities at the Open Society Institute (OSI)

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The Open Society Institute (OSI) is a private foundation established by George Soros and is associated with the Soros Foundations Network. The OSI seeks “to shape public policy to promote democratic governance, human rights, and economic, legal, and social reform. On a local level, OSI implements a range of initiatives to support the rule of law, education, public health, and independent media. At the same time, OSI works to build alliances across borders and continents on issues such as combating corruption and rights abuses.”

OSI has provided funding to health activists in the past through its Fellowship Programs.

One of these programs, Medicine as a Profession, began at OSI and subsequently moved to the Institute on Medicine as a Profession at Columbia University. Medicine as a Profession provided physicians with the opportunity to get fellowship training in advocacy and operated from 1999 to 2007. A list of the 44 funded fellows is on the Columbia website.

OSI also funds particular Initiatives in Health. When we checked their website (in June of 2008) this was the list of current initiatives.

  • Closing the Addiction Treatment Gap
  • Global Drug Policy
  • International Policy Fellowships
  • Open Society Mental Health Initiative
  • OSI-Baltimore
  • Public Health Program

In addition to these initiatives there are standing health-related programs:

Reproductive Health

Project on Death in America

Rx Vote: National Physicians Alliance and Voter Registration

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The National Physicians Alliance has developed a campaign at www.RxVote.org to promote voter registration in health centers and clinics. This is being done in coordination with Rock the Vote.

The campaign’s website provides a fairly complete set of tools for organizing a voter registration drive. Among these are:

The information on felony voting rights comes from the Sentencing Project. According to the project “1.4 million African American men, or 13% of black men, are disenfranchised, a rate seven times the national average.” This is one of the many impacts of mass incarceration on our communities. And yet another reason for us to strengthen the ailing fabric of US democracy.

Lear Fellowships for Medical History Students

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As noted in an earlier posting, this year Walter Lear turned 85. He used his birthday party (in part) to fundraise for a medical history fellowship. Here is the description of the fellowship:

“The U.S. Health Left History Center is pleased to announce the availability of the Lear Fellowships to further the investigation of the history of U.S. health activism using the U.S. Health Activism History Collection at the University of Pennsylvania Rare Book and Manuscript Library as well as other relevant resources. Two fellowships of $1000 will be awarded annually. If the fellow is not in commuting distance of Philadelphia the documented costs of travel and two weeks residence will also be defrayed (maximum $2,000).In addition to conducting research, fellows will submit a report of the research completed no later than one year after receipt of the fellowship (this may be posted on the website of the History Center or published in its newsletter).

The U.S. Health Activism History Collection gives priority attention to classism, racism and sexism in the health field and major reform of the health care delivery system including national legislation, as well as to the health and medical aspects of poverty, labor unions, civil and human rights, women’s movements, Left political parties, grass-roots human services, red witch hunts, L/G/B/T issues, and international peace and progressive people’s solidarity campaigns.

Eligibility: Applicants must have been or be enrolled in a college/university degree program.

Time schedule: The deadline for the receipt of applications is July 1. Awards will be announced September 1 and will apply for the subsequent twelve months.

Applications (both PDF and hard copy) must include:

1. a project description of no more than 3 double-spaced pages in 12-point font indicating the purpose and methodology of the research and the historical materials to be consulted; preference will be given to projects that are likely to be useful to current and future U.S. health activists;

2. a curriculum vitae of no more than 2 pages;

3. a proposed budget for travel and residence (two weeks maximum) for applicants not in commuting distance of Philadelphia;

4. the name of one reference who has agreed to send a supporting letter directly to the History Center by July 1.

Submissions may be made either by mail or email to:

The U.S. Health Left History Center
206 N. 35th St.
Philadelphia, PA 19104-2429
Email: wjlear@critpath.org

For more information please contact:
Walter J. Lear, M.D., Director
U.S. Health Left History Center
215-386-5327

Integrating Abortion Services into Primary Care: an Interview with Linda Prine

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Access to abortion services has been an important concern in the US. One way in which access can be expanded is through the integration of abortion services into Primary Care. A 2003 Medscape Interview with RPSM graduate Linda Prine discusses the role of medical abortion in family practice. Dr. Prine currently works with the Reproductive Health Access Project.

The DFSM currently offers a 2 year Fellowship in Family Planning and Reproductive Health. Fellows receive training in clinical research, both qualitative and quantitative, develop clinical and teaching skills, have opportunities to work internationally, and connect to a rapidly expanding network of family planning experts.

A Short Drive with Healthy Skepticism's Dr. Peter Mansfield

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Late on Wednesday afternoon, a picture perfect summer day in New York, I found myself waiting in the baggage claim area of La Guardia airport for Flight 360 from Chicago. I was there to meet Dr. Peter Mansfield of Australia’s Healthy Skeptism and to take him to the Wales Hotel in Manhattan. It would be a brief opportunity to talk to one of the world’s leading critics of pharmaceutical promotion.

Professor Mansfield had told me to look up his picture on Google Images and there was doubt it was him when he walked into the thicket of limousine drivers surrounding the baggage claim area. I soon learned that he was in the 7th week of a 9 week trip around the world that included 23 major metropolitan areas. No wonder he looked a bit tired. He had travelled in Europe (mentioning Switzerland, Italy, Germany, Spain and England), had come back to the US, was now in New York to speak at Mount Sinai Medical School, would then travel to San Francisco, Seattle, Sydney and Hobart before returning home sometime after June 25th. It seemed a Herculean task and he had been doing this for 25 years. [Medicamentos Madrid has a copy of his slide show presentation posted]

On our way to the car, Dr. Mansfield spoke about the Healthy Skepticism website which has links to 14,001 references on pharmaceuticals. The site is very thorough and relatively easy to navigate. Healthy Skepticism also offers a free monthly newsletter and a Fora where members can post messages.

As we drove out of the airport he told me he has been working on a reform proposal to address the problems of misleading drug advertising. Among the elements of this proposal were to 1. Increase regulation of drug promotion; 2. Improve medical decision making; 3. Redesign the incentives for doctors; and 4. Redesign the incentives for drug companies. He spoke of the need for doctors to be educated about their own biases. “Doctor’s don’t like to think that they are subject to bias,” he told me. And he then made a point of his own interest in hearing criticisms of their proposals; “that’s the only way they will get better.”

How did he propose to bring about these reforms? He leaned over conspiratorially and said: “With laughter! You can get people to see things with laughter that you cannot do in other ways.” Then, more seriously, he compared political processes to earthquakes. For a long time steam builds up until finally something dramatic happens and there is a break. This is the time when you need to present the politicians with a well-worked out plan. How could one build up such steam? Who were the natural constituencies of the reform plan? “Well, anyone who thinks that now – or in the future – they might get sick. [A smile] And all the employees of the pharmaceutical industry, except a very small group at the top, will want to see that they are doing the right thing. Reform is in their interest.”

I had wanted to ask if he really felt that misleading promotion was the main problem with the pharmaceutical industry, but by this time the New York City traffic had taken us near Mount Sinai Medical School and the Wales Hotel. He had to be up the next morning for an 8AM lecture and so it seemed time to end. As we parted he told me that his home town of Wilunga, where he worked as a GP, had only three thousand inhabitants “and would fit easily into one of these large buildings here.” Unloading his luggage we shared a bit about our families. Doctor Mansfield and his wife had three daughters: twins aged 18 and a 16 year old. “When I was in Sweden,” he told me, “and I told them I had 3 daughters in 18 months they asked, With how many women?” We laughed and said good-bye, exchanging cards and ideas. I mused on the idea of travelling for 9 weeks to 23 cities, entrusting yourself to complete strangers (as I was to him), getting to know them briefly and then moving on. This is political organizing or – as Dr. Mansfield might put it – building up steam.

Former WHO Director Halfdan Mahler on Alma Ata, May 2008

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Halfdan Mahler was the Director-General of the World Health Organization from 1973-1988. During this period WHO co-sponsored the 1978 Alma Ata conference where the bold goal of “Health for All by the Year 2000” was proclaimed. How sad that some 30 years later this expansive vision of health founded on primary care and social change has been replaced by the miserly and narrow-minded “Millennium Development Goals.” Dr. Mahler addressed the Sixty-first World Health Assembly on May 20th, 2008 reminding us once again of what World Health once meant.

We reproduce his speech below.

A bit of background: The Alma Ata Declaration is not long and is well worth reading; it can be found on the WHO website. Readers interested in learning more about Alma Ata may wish to consult a 2007 article by Fran Baum published in Social Medicine. For a discussion about the assault on Alma Ata see From Alma Ata to the Global Fund:The History of International Health Policy by Italian Global Watch. The most prominent organization of activists working today to realize the goals of Alma Ata are the People’s Health Movement.

Address to the 61st World Health Assembly
Dr. Halfdan Mahler
Former Director-General of WHO

Distinguished audience,

My remarks will focus on “Why Alma-Ata in 1978 and Whither the Health for All Vision and Primary Health Care Strategy”.

Milan Kundera wrote in one of his books: “The struggle against human oppression is the struggle between memory and forgetfulness.” So allow me to remind all of us today, of the transcendental beauty and significance of the definition of health in WHO’s Constitution: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

This definition is immediately followed by: “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” Most importantly, the very first constitutional function of WHO reads: “To act as the directing and coordinating authority on international health work.” Please do note that the Constitution says “the” and not “a” directing and coordinating authority.

So please, allow this old man in front of you to insist that unless we all become partisans in renewed local and global battles for social and economic equity in the spirit of distributive justice, we shall indeed betray the future of our children and grandchildren.

My memory tells me that the World Health Assembly had this in mind when, in 1977, it decided that the main social target for governments and WHO in the coming decades should be the attainment of what is known as “Health for All”.

And, the Health Assembly described that as a level of health that will permit all the people of the world to lead socially and economically productive lives. The Health Assembly did not consider health as an end in itself, but rather as a means to an end.

That is, I believe as it should be.

When people are mere pawns in an economic and profit growth game, that game is mostly lost for the underprivileged.

Let me postulate that if we could imagine a tabula rasa in health without having to deal with the constraints – tyranny if you wish – of the existing medical consumer industry, we would hardly go about dealing with health as we do now in the beginning of the 21st century.

To make real progress we must, therefore, stop seeing the world through our medically tainted glasses. Discoveries on the multifactoral causation of disease, have for a long time, called attention to the association between health problems of great importance to man and social, economic and other environmental factors. Yet, considering the tremendous political, social, technical and economic implications of such a multidimensional awareness of health problems I still find most of today’s so-called health professions very conventional, indeed.

It is, therefore, high time that we realize, in concept and in practice, that a knowledge of a strategy of initiating social change is as potent a tool in promoting health, as knowledge of medical technology.

Primary health care is indeed conditioned by its holistic framework and as such, may use different expressions. For example, in some countries health management has to be considered along with such things as producing more or better food, improving irrigation, marketing products, etc. It is not that people consider health services as unimportant, but there are things like getting food, or a piece of land, or house or an accessible source of water which are more of a life and death nature and must, in the wisdom of the people, come first to make other things meaningful. We have rarely considered these needs as falling within our expressed policies for health development and therefore, we risk being restricted, unilateral and ineffective in our action.

Again, I am afraid that conventional or medical wisdom has done very little to provide scientific and political credibility to the alleged importance of individual, family and community participation in health promotion.

These concerns, to which I have just alluded prompted an organizational study on “Methods of promoting the development of basic health services” by WHO’s Executive Board in 1973 in which it is bluntly stated that:

“There appears to be widespread dissatisfaction of population about their health services for varying reasons. Such dissatisfaction occurs in the developed as well as in the Third World. The causes can be summarized as a failure to meet the expectations of the populations; an inability of the health services to deliver a level of national coverage adequate to meet the stated demands and the changing needs of different societies; a wide gap (which is not closing) in health status between countries, and between different groups within countries; rapidly rising costs without a visible and meaningful improvement in service; and a feeling of helplessness on the part of the consumer who feels (rightly or wrongly) that the health services and the personnel within them are progressing along an uncontrollable path of their own which may be satisfying to the health professionals but which is not what is most wanted by the consumer”.

It was this organizational study by WHO’s Executive Board that led to the decision by WHO in co-sponsorship with UNICEF to convene “The International Conference on Primary Health Care” in the city of Alma-Ata in 1978.

Let me then repeat with awe and admiration, the consensus concept of primary health care as contained in the Declaration of Alma-Ata 1978:

“Primary Health Care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. It forms an integral part, both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community.

“It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.”

Let me also quote from the Declaration of Alma-Ata, that primary health care includes at least: education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs. In my opinion, an admirable summation of key priorities.

Are you ready to address yourselves seriously to the existing gap between the health “haves” and the health “have-nots” and to adopt concrete measures to reduce it?

Are you ready to ensure the proper planning and implementation of primary health care in coordinated efforts with other relevant sectors, in order to promote health as an indispensable contribution to the improvement of the quality of life of every individual, family and community as part of overall socio-economic development?

Are you ready to make preferential allocations of health resources to the social periphery as an absolute priority?

Are you ready to mobilize and enlighten individuals, families and communities in order to ensure their full identification with primary health care, their participation in its planning and management and their contribution to its application?

Are you ready to introduce the reforms required to ensure the availability of relevant human resources and technology, sufficient to cover the whole country with primary health care within the next two decades at a cost you can afford?

Are you ready to introduce, if necessary, radical changes in the existing health delivery system so that it properly supports primary health care as the overriding health priority?

Are you ready to fight the political and technical battles required to overcome any social and economic obstacles and professional resistance to the universal introduction of primary health care?

Are you ready to make unequivocal commitments to adopt primary health care and to mobilize international solidarity to attain the objective of health for all by the year 2000?

Alma-Ata was, in my biased opinion, one of the rare occasions where a sublime consensus between the haves and the have-nots in local and global health emerged in the spirit of a famous definition of consensus: “I am not trying to convince my adversaries that they are wrong, quite to the contrary, I am trying to unite with them, but at a higher level of insight.”

The Alma-Ata primary health care consensus also reflects a famous truism: “The Health Universe is only complete for those who see it in a complete light, it remains fragmented for those who see it in fragmented light!”

In conclusion, my personal view is that the Alma-Ata primary health care consensus has had major inspirational and operational impacts in many countries having a critical mass of political and professional leadership combined with adequate human and financial resources to test its adaptability and applicability within the local realities through a heavy dose of systems and operations research.

Mind you, it is much easier to be rational, audacious and innovative when your are rich! But, please, let us not forget that the inspirational energies and the evidence base came from the developing countries themselves, be they governmental or non-governmental sources.

For a majority of these countries, financial support from so-called donors was essential to carry out a broad array of studies, in appropriate technology, human resources development, infrastructure development, social participation, financing etc. in order to integrate the Alma-Ata vision into heavily constrained local contexts.

Most donors, after an initial outburst of enthusiasm quickly lost interest or distorted the very essence of the Alma-Ata Health for All Vision and Primary Health Care Strategy under the ominous name of selective primary health care which broadly reflected the biases of national and international donors and not the needs and demands of developing countries.

But in spite of these brutal impediments many developing countries have shown, before and after the Alma-Ata happening, courageous adhesion to its health message of equity in local and global health. Civil society movements have also been prime shakers and movers in these admirable efforts.

And so, being an inveterate optimist I do believe that the struggle between memory and forgetfulness can be won in favour of the Alma-Ata Health for All Vision and its related Primary Health Care Strategy. Let us not forget that visionaries have been the realists in human progression.

And so, distinguished audience, let us use the complete light generated by WHO’s Constitution and the Alma-Ata Health for All Vision and Primary Health Care Strategy to guide us along the bumpy, local and global health development road.

Thank you.

Health Activism in the UK

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A very partial listing…

Medact: formed from the Medical Campaign Against Nuclear Weapons and the Medical Association for the Prevention of War, Medact “speaks out for countless people across the globe whose health, wellbeing and access to proper health care are severely compromised by the effects of war, poverty and environmental damage.” We are particularly grateful to Medact for their consistent attention to the health effects of the war against Iraq. Their work, however, involves a broad set of social issues including development, environment and refugees.

Socialist Health Association: The SHA is affiliated with the British Labour Party and works for a health care system that reduces inequalities and is founded on socialist principles.

Medical Foundation for the Care of Victims of Torture: “Founded in 1985, the Medical Foundation for the Care of Victims of Torture provides care and rehabilitation to survivors of torture and other forms of organized violence.”

Medical Justice “Medical Justice facilitates the provision of independent medical advice and independent legal advice and representation to asylum seekers detained in immigration removal centres. We also seek to negotiate changes to policy and practice within detention centres and publish our findings on the treatment of detainees.”

Action on Smoking and Health: The UK site for this international organization of anti-tobacco activists. The US site is at this link.

Politics of Health Group (UK) POHG’s slogan is: “Healthcare as if people mattered.” (What a radical idea!) PoHG “campaigns for the social, economic and environmental conditions that support health for all people, and against the market-oriented political and economic decisions that are currently being taken in the UK and across the world, and the inequalities, discrimination and poor health they create.” They have a number of thoughtful publications, accessible at this link.

Please attach a comment or send us an email if there are other groups we should include.




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