The Washington Post National Weekly - June 18, 2017

SUNDAY, JUNE 18, 2017

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TWELVE SECONDS OF GUNFIRE In tiny Townville, S.C., first-graders are haunted by what they survived — and lost — on a school playground PAGE 12

Politics Legislators reassess safety 4

Family Gender affects how dads act 17

5 Myths Famine 23

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THE FIX

3 prongs of the Russia probe BY

C ALLUM B ORCHERS

T

he Washington Post reported Wednesday that special counsel Robert S. Mueller III will interview senior intelligence officials to help determine whether President Trump attempted to obstruct justice. As Mueller widens his inquiry of Russia’s role in the 2016 presidential campaign, it can be difficult to keep track of who is under investigation for what, so I’ve broken down each of the three prongs below.

Russia election meddling and possible collusion with the Trump campaign James B. Comey, who led the law enforcement investigation until he was fired as FBI director May 9, testified before the Senate Intelligence Committee that he has no doubt that Russia attempted to influence the presidential race by hacking the Democratic National Committee and launching cyberattacks on state election systems, among other tactics.

Comey’s testimony was consistent with a joint report issued by the FBI, the CIA and the National Security Agency in January, which concluded: “We assess Russian President Vladimir Putin ordered an influence campaign in 2016 aimed at the U.S. presidential election. Russia’s goals were to undermine public faith in the U.S. democratic process, denigrate Secretary Clinton, and harm her electability and potential presidency. We further assess Putin and the Russian government developed a clear preference for Presidentelect Trump.”

A key question is whether Russia merely preferred Trump or worked with members of his campaign. Comey confirmed in previous testimony March 20 that the FBI was investigating the possibility of collusion between the

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campaign and Russia. Former CIA director John Brennan testified May 23 that his agency alerted the FBI last year to a troubling pattern of contacts between Russian officials and Trump associates. Trump associates reportedly under scrutiny include Paul Manafort, who was Trump’s campaign manager, and former advisers Roger Stone and Carter Page.

ROBERT S. MUELLER III. BRENDAN SMIALOWSKI/AFP/GETTY IMAGES

Possible attempts to obstruct justice Comey testified recently that while he was still head of the FBI, he told Trump on three occasions that the agency was not investigating him, individually. “Officials say that changed shortly after Comey’s firing,” The Post reported Wednesday.

The timing of the FBI’s decision to investigate the president for possible obstruction coincides with Trump’s admission, in a May 11 interview with NBC News, that he was thinking of the Russia investigation when he terminated Comey.

A second potential concern for Mueller relates to actions Trump may have taken to impede a separate FBI investigation of former national security adviser Michael T. Flynn. In his most recent testimony, Comey described a one-on-one conversation in which the president allegedly said, “I hope you can see your way clear to letting this go, to letting Flynn go.”

This publication was prepared by editors at The Washington Post for printing and distribution by our partner publications across the country. All articles and columns have previously appeared in The Post or on washingtonpost.com and have been edited to fit this format. For questions or comments regarding content, please e-mail weekly@washpost.com. If you have a question about printing quality, wish to subscribe, or would like to place a hold on delivery, please contact your local newspaper’s circulation department. © 2017 The Washington Post / Year 3, No. 36

Comey testified that he “understood the president to be requesting that we drop any investigation of Flynn in connection with false statements about his conversations with the Russian ambassador in December.”

The Post reported last month that Trump, in addition to his direct appeal to Comey, asked Daniel Coats, the director of national intelligence, and Adm. Michael S. Rogers, the director of the National Security Agency, to help persuade Comey to let Flynn go.

Possible financial crimes The Post reported last month that “investigators are also looking broadly into possible financial crimes — but the people familiar with the matter, who were not authorized to speak publicly, did not specify who or what was being examined.”

The Post also reported that investigators are scrutinizing the finances of Jared Kushner, Trump’s adviser and son-in-law, and his meetings, including a December sit-down with Sergey Gorkov, the head of Vnesheconombank, which the Obama administration sanctioned after Russia’s annexation of Crimea and its support of separatists in eastern Ukraine.

Investigators also are examining the dealings of Flynn. A grand jury in Alexandria, Va., has issued subpoenas for records related to Flynn’s businesses and finances. A company owned by a Turkish American businessman who is close to top Turkish officials paid the Flynn Intel Group more than $500,000 for research on Fethullah Gulen, the cleric that the Turkish president claims was responsible for a coup attempt last summer.

In March, Flynn retroactively registered with the Justice Department as a paid foreign agent for Turkish interests. n

© The Washington Post

CONTENTS POLITICS THE NATION THE WORLD COVER STORY TECHNOLOGY BOOKS OPINION FIVE MYTHS

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ON THE COVER Ava Olsen, 7, holding her cat, Autumn, in her room, alternates between bouts of solitude and anger after a shooting at her South Carolina school in the fall. Photography by RICKY CARIOTI, The Washington Post

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POLITICS

After shooting, a push for security

MATT MCCLAIN/THE WASHINGTON POST

After Wednesday’s violence, legislators reassess protection as they engage with public

BY E D O ’ K EEFE, M IKE D E B ONIS AND K ELSEY S NELL

A

violent shootout on a Virginia baseball field that wounded House Majority Whip Steve Scalise and several others exposed simmering concerns among lawmakers that increasingly toxic political rhetoric is putting them at greater risk in Washington and back home.

In the hours after the shooting

in Alexandria, Republicans and Democrats alike struggled to reassess their protection and engagement with the public, outside the protective bubble of the Capitol. Some said they should be allowed to carry firearms at all times — even in Washington, a city with strict gun control laws.

Others pressed top leaders to let them use taxpayer funds to secure their private homes.

The shooting of Scalise (R-La.), a congressional staffer, a lobbyist

and two U.S. Capitol Police officers recalled for many the day roughly 6 1/2 years ago when Rep. Gabrielle Giffords (D-Ariz.) was shot while greeting constituents at an Arizona shopping center.

Her injuries forced her to retire and led to stricter security at public events hosted by lawmakers in their home districts.

Capitol Hill security was dramatically tightened after a gunman stormed the U.S. Capitol in 1998 and shot two Capitol Police

A U.S. Capitol Police officer stands guard outside the Capitol on Thursday. On Wednesday, a gunman opened fire on Republican lawmakers at a park in Alexandria, Va. Among the injured was House Majority Whip Steve Scalise (R-La).

officers. The incident led to the approval of the construction of the Capitol Visitor Center, which also serves as the main entrance for visitors.

In the wake of Wednesday’s shooting, lawmakers are pushing to be allowed to use taxpayer funds to boost security at their personal homes and during events in their districts.

House Speaker Paul D. Ryan (R-Wis.) and House Minority Leader Nancy Pelosi (D-Calif.)

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POLITICS discussed the issue during a recent meeting, according to aides familiar with the talks, and there is now a sense of urgency to make a decision soon.

The proposal came up during an all-members’ briefing just hours after Wednesday’s shooting.

House Majority Leader Kevin McCarthy (R-Calif.) acknowledged that the issue had been raised but said it has not been settled. “That’s an issue we have been looking at,” he told reporters.

Several members said Wednesday that, at the very least, security should be upgraded for any offHill gathering involving more than a few lawmakers.

“There are discussions about perhaps — at least when a large crowd of lawmakers would be gathered, at a practice, at a congressional picnic, those sorts of things — that even if leadership was not there, that there might be some police present,” Pelosi said Thursday.

Rep. Barry Loudermilk (R-Ga.), a member of the GOP baseball team, said Congress should also explore allowing lawmakers to carry weapons to defend themselves.

“If this had happened in Georgia, he wouldn’t have gotten too far,” Loudermilk told reporters once back at the Capitol. “I had a staff member who was in his car maybe 20 yards behind the shooter, who was pinned in his car, who back in Georgia carries a 9-millimeter in his car. . . . He had a clear shot at him. But here, we’re not allowed to carry any weapons here.”

Firearms are strictly regulated on the Capitol grounds and in the rest of the District, but gun laws in Virginia — where the shooting took place — are significantly less strict. Firearms can be openly carried without a permit, and the state issues permits to carry concealed weapons. Alexandria allows the ownership and carrying of weapons, but discharging a firearm in the city is illegal.

“Most of us are here in D.C., so how do you have the gun here and just transport it to Virginia?” Loudermilk said when Virginia’s laws were pointed out. “I think we need to look at some kind of reciprocity for members here.”

Loudermilk said perhaps a larger group of lawmakers also should receive security protec-

MATT MCCLAIN/THE WASHINGTON POST

tion, rather than just the top leaders, who have a round-theclock Capitol Police detail.

“We’re not any more special than anybody else, but we are targets,” he said.

Rep. Dave Brat (R-Va.) also said he worries about the protection for members of Congress when they are away from Capitol Hill.

“These town halls, we go out in front of a thousand people screaming and all it takes is one person off the reservation and you’re in trouble,” he said.

At the briefing on Wednesday, several members described threats made against them in recent years, according to people in the room.

Rep. Emanuel Cleaver II (D-Mo.) recounted an attempted firebombing of his Kansas City office in 2014. Rep. Ann Wagner (R-Mo.) tearfully described protesters staging “die-ins” in her driveway and protests outside her church. Rep. Al Green (D-Tex.) talked to his colleagues about the need for unity after others had mentioned death threats against him sparked by his decision to introduce articles of impeachment against President Trump.

Many members insisted they cannot let those kinds of threats deter them from doing their jobs.

“We can’t let the bad guys win.

I’m going to go out and be with my constituents, whether they’re here, in Washington, D.C., visiting me, or whether they’re in the district,” said Rep. Charles J.

“Chuck” Fleischmann (R-Tenn.), a member of the GOP ball team who spent hours recounting the incident to reporters still wearing his practice outfit and clutching his ball cap.

Members of the Capitol Police, uniformed and plain-clothed divisions, are a constant presence on Capitol Hill.

Uniformed officers are usually stationed outside the visitors entrances to congressional office buildings. Inside, at least two officers stand watch at each security checkpoint, reviewing bags, asking to see identification badges and offering directions to lost tourists.

Walking through the office buildings en route to the Capitol, visitors pass several more uniformed officers standing watch as they near the underground subways that carry lawmakers into the Capitol basement. On the second floor of the Capitol outside the House and Senate chambers, officers in business suits and police uniforms stand watch.

Such tight security is not afforded to lawmakers once they leave Washington unless they are members of congressional leadership. Although some members might request police protection at public events, they often travel alone with aides or family members.

Matthew R. Verderosa, chief of the Capitol Police, told the House Appropriations Committee last month that at the request of

Police respond to the shooting Wednesday in Alexandria, Va. In addition to Scalise, a congressional staffer, a lobbyist and two U.S. Capitol Police officers were shot. The gunman was killed.

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House and Senate lawmakers, his agency had interacted 184 times so far this year with local police agencies about providing security at public events. Capitol Police also made unsolicited contact with House and Senate district offices 178 times to check on security for public events they learned about through social media or other public announcements, Verderosa said.

“We’re doing it at a much greater rate,” Verderosa said when compared to previous years.

During the hearing, Rep. Betty McCollum (D-Minn.), reminded her GOP colleagues that threats against lawmakers are common.

“For some of the newer members they might think this is a brand new experience that Capitol Police and our local police are dealing with, but it’s not,” she said. “It’s a lot of the same.”

In the House, Ryan, Pelosi, McCarthy, Scalise and House Minority Whip Steny H. Hoyer (D-Md.) are the only members with roundthe-clock protection. Whenever Ryan flies home to Wisconsin from Reagan National Airport, members of his detail fly with him, and several more officers stand watch at his gate while he waits for the flight.

In the Senate, Majority Leader Mitch McConnell (R-Ky.), Minority Leader Charles E. Schumer (D-N.Y.), and their deputies, John Cornyn (R-Tex.) and Richard J. Durbin (D-Ill.), all have constant police protection from businesssuit-wearing officers. They are ferried to and from the Capitol each day in a pair of black SUVs and have protection with them wherever they travel.

Sen. Orrin G. Hatch (R-Utah), the longest-serving member of the Republican conference, is the Senate pro tempore, a constitutional officer in the presidential line of succession. He also travels with a large protective detail in the hallways and to and from his office in the Russell Senate Office Building.

Hatch boarded an elevator after a Wednesday afternoon vote with three members of his security detail and an aide. Asked whether more of his colleagues should receive security protection like him, he quipped, “I think all of you deserve protection, too,” before adding later: “I think we have to protect everybody.” © The Washington Post

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POLITICS ANALYSIS

In GOP, it’s senator vs. senator As they debate health care, lawmakers angle to get the best deal for their states

BY

P AUL K ANE

H

ere’s one easy-to-grasp way to understand the continued gridlock among Senate Republicans on how to change the healthcare industry: Each senator is trying to get the best deal for his or her state.

It’s a somewhat obvious observation, because that’s what happens in most congressional debates. But the last six weeks of Senate consideration of the Republican effort to overturn the Affordable Care Act has been somewhat lost in the weeds of Medicare regulations, the size and scope of tax credits and proposals to phase out benefits over a couple of years or much longer.

That makes this process look a lot like what happens when, say, a big infrastructure bill is making its way through the Capitol, as lawmakers fight over regional funding formulas to try to maximize the benefits to their states.

“It all comes down to making sure you get what’s best for your own state,” said Sen. John Barrasso (R-Wyo.), a key member of the GOP group overseeing the negotiations.

The most critical divide sits between Republicans from states that accepted the federal funding to expand Medicaid coverage to millions more Americans, and those from states that declined that expansion.

Many of the Republicans from non-Medicaid-expansion states are more conservative, and those from states that accepted the extra federal funding tend to be more moderate. But it’s not a purely ideological breakdown.

Take Sen. Lindsey O. Graham (R-S.C.), who started in Congress more than 22 years ago as a rabblerousing conservative but has evolved into a leading dealmaker with Democrats. Yet on the Medicaid expansion issue, he’s with the hard-liners.

Graham has long supported allowing flexibility for states — for instance, allowing them to decline Medicaid expansion — so now he opposes fellow Republicans who

SAUL LOEB/AGENCE FRANCE-PRESSE VIA GETTY IMAGES

“It all comes down to making sure you get what’s best for your own state,” Sen. John Barrasso (R-Wyo.) says of the health-care talks.

want to revise the ACA but only with a generous exit ramp, in the form of a slow-moving phaseout, for their states and the Medicaid expansion dollars they receive.

Republicans like Graham take a purely parochial view: that a more costly phaseout of Medicaid expansion is a federal giveaway to states that made a bad decision to begin with when the ACA was first enacted.

Sen. Shelley Moore Capito (R-W.Va.) takes an equal and opposite parochial view. With 10 percent of her entire state’s population benefiting from the new Medicaid coverage, she is defending the interests of those constituents.

As Barrasso put it, it’s all about what is in the best interest of each senator’s home state.

All of this is making the final weeks of negotiation a bit more difficult because neither side in this standoff is giving a full signal of their bottom line — what they’re willing to live with. Doing so gives away a leverage point, potentially leading to a little bit worse of a deal and thus endangering the entire negotiations.

The existing law expands eligibility for Medicaid coverage beyond its core target group of poor Americans to include anyone making up to 133 percent of the federal poverty level. It gives states 100 percent of the funding, with plans to ratchet down to 90 per-

cent eventually. For many Republicans, the benefit presented a stark choice: say yes to a good deal that dramatically expands health coverage to the working poor, or say no to a federal entitlement that meddles in a state-run program.

The Republicans who saw Medicaid expansion as a noxious federal giveaway won the day in the ACA revision that emerged from the House this year. That bill would begin eliminating Medicaid expansion in two years — eventually cutting Medicaid funding by roughly $880 billion over 10 years.

That detail of the Republicanwritten American Health Care Act is a big reason the Congressional Budget Office estimated that the bill would cause 23 million fewer Americans to have health insurance over 10 years. That number has stunned Republicans, including Capito and Sen. Rob Portman (R-Ohio), another senator who hails from a state that took the Medicaid funding.

Some of these Republicans have been advocating for a seven-year phaseout of the Medicaid expansion. Also, Capito and Portman have advocated guaranteed funding streams to help battle the opioid epidemic that has particularly ravaged their states.

Republicans from non-Medicaid states view that long of a phaseout to be overly generous

and the sort of timeline that will simply allow a new Congress in the next decade to try to prevent it from happening altogether.

All told there are 20 Republicans from states that accepted some version of the additional Medicaid funds, but they aren’t themselves a unified bloc. Some conservatives, including Sens.

Tom Cotton (R-Ark.) and Patrick J. Toomey (R-Pa.), are searching for a middle-ground solution that meets their own ideological principles without too much pain for their constituents.

With just two votes to spare, Senate Majority Leader Mitch McConnell (R-Ky.) has to walk a tightrope in crafting a final deal on this, which Republicans hope could happen before the end of July.

There are other issues gripping these negotiations — how to determine the size of tax credits to help people buy private insurance, what type of coverage mandates from the ACA would apply under the new law, whether to eliminate federal funds for Planned Parenthood.

But nothing is quite as fundamental as the fight over the Medicaid money.

Barrasso, whose state declined the expansion, believes his governor and state legislature did a reasonable thing in declining the expanded federal funds.

Their fear was that if Washington lost its ability to meet the funding levels, states would be forced to pick up the tab, bankrupting them in the process. Those states think they made the right call and shouldn’t have to pick up the tab for states like Ohio and West Virginia.

But the senators also don’t want to leave millions of people with no insurance.

For now, not enough Republicans have indicated that they’re willing to find a middle ground.

Deep down, they have a bottom line, even if they’re not yet sharing it.

“I believe that each member knows,” Barrasso said. “And everyone doesn’t want exactly the same thing.” n © The Washington Post

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POLITICS COMMENTARY

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The attitudes that helped Trump win BY

D AN B ALZ

T

he story of President Trump’s victory over Hillary Clinton has been analyzed and reanalyzed, told and retold since November. Is there more to add? The short answer, based on four reports released Tuesday, is yes, and what the reports say is provocative.

The reports debunk some of the assertions of why Trump won — his criticism of free-trade agreements apparently was not as big a factor as some have suggested — while focusing on the specific role that race, religion, immigration and national identity played in the outcome and particularly how those issues may have influenced voters who switched to Trump after supporting President Barack Obama in 2012.

One of the reports notes that while those factors played a more significant role in 2016 than in 2012, in large part because Trump highlighted them, the ground was already shifting on those issues before Trump. If these issues continue to remain prominent in the national debate, they could further alter the alignment of American politics.

The reports are the first produced by the Democracy Fund Voter Study Group, which comprises 20 analysts from think tanks or other institutions across the ideological spectrum. Driving forces in assembling the project were Joe Goldman of the Democracy Fund and Henry Olsen of the Ethics and Public Policy Center.

The findings are based on online surveys, including one after the election with a sample of 8,000 people who had participated in other such surveys in 2011, 2012 and mid-2016. The surveys were conducted by the firm YouGov. The authors of the reports approach the implications of what happened in 2016 from slightly different angles, examining the appeal of candidate Trump, the multifaceted coalition that came to support him, political divisions that continue between and within the parties, and how certain issues came to prominence in 2016.

John Sides, a political scientist at George Washington University and editor in chief of the Monkey Cage blog hosted by The Washington Post, directly confronts the role of race, religion and immigration and concludes that “attitudes about immigration, feelings toward black people and feelings toward Muslims became more strongly related to voter decisionmaking in 2016 compared to 2012.”

Sides argues that, even before 2016, there was “an increasing alignment between race and partisanship” and among whites there was “an increasing division based on education,” with non-college-educated whites mov-

BRYAN R. SMITH/AGENCE FRANCE-PRESSE VIA GETTY IMAGES

ing away from the Democratic Party, especially after the election of Obama in 2008.

“The shifts among white people overall and white people without a college degree occurred mostly among white people with less favorable attitudes toward black people,” he writes. “No other factor predicted changes in white partisanship during Obama’s presidency as powerfully and as consistently as racial attitudes.”

Economic stress also was a factor, with those who expressed negative views about the economy in 2012 “more likely to express key negative cultural attitudes in 2016,” according to a news release summarizing the findings.

Partisan loyalty was high in 2016, with 86 percent of Obama voters siding with Clinton and 89 percent of Mitt Romney’s voters supporting Trump. But Trump won a bigger share of those who had backed Obama than Clinton won among those who supported Romney. Had Clinton won a similar level of support from Romney defectors that Trump won among Obama defectors, she probably would be president, Olsen said, based on his analysis of the findings.

Sides examined possible reasons for those who switched from Obama to Trump. He found that there was “no statistically significant relationship between trade attitudes and vote choice in either election [2012 or 2016].

Nor was the widely discussed issue of economic anxiety more important in 2016 than in 2012.

Even before the 2012 election, Sides writes, a substantial number of white Obama supporters had views about Muslims, blacks and

Supporters of President Trump hold a rally Feb. 5 near Trump Tower in New York. Four recent reports debunk some of the assertions of why Trump won the election.

immigration that were less favorable. What did change between 2012 and 2016 was the increased significance in voters’ minds of issues about immigration and attitudes toward blacks and Muslims, among whites both with and without college degrees.

Even among GOP primary voters, those who backed Trump had less favorable attitudes toward Muslims and were more likely to say that immigration by foreigners should be made harder, according to data offered in a paper by Robert Griffin and Ruy Teixeira of the Center for American Progress. This was even more the case on immigration among those voters who switched from Obama to Trump.

“Those who held views of immigrants, Muslims, minorities and feminist women as the undeserving ‘other’ were particularly susceptible to Trump’s appeal in both the primaries and general election,” they write.

Emily Ekins of the Cato Institute provides a typology of the Trump coalition. She labels his core constituency as “American Preservationists” who make up about a fifth of his supporters and are less loyal Republicans than are other Trump voters. They lean economically progressive, think the political systems are rigged and have “nativist immigration views and a nativist and ethnocultural conception of American identity.”

About 1 in 3 Trump supporters are “Staunch Conservatives.” Ekins writes that they are “steadfast fiscal conservatives, embrace moral traditionalism and have a moderately nativist conception of American identity and approach to immigration.”

“Free Marketers,” a quarter of Trump supporters, hold more moderate-to-liberal views on race and immigration and supported Trump primarily because of their dislike for Clinton. “Anti-Elites,” about a fifth of the Trump coalition, are motivated by a belief that the political systems are rigged but take a more moderate position on immigration, race and national identity. She labeled a small fraction of his supporters as “The Disengaged” and said they feel unable to influence political and economic institutions.

Lee Drutman of the New America think tank writes that, by making issues related to national identity more prominent, Trump was able to attract economically liberal but socially conservative voters who had backed Democrats previously.

“Trump’s candidacy has brought more economic liberals into the Republican Party, moving the party’s center of gravity on these issues to the left,” he writes. “Trump has also moved the party to a much more nativist position on questions of national identity,” adding that these shifts are creating strains in the GOP. n

© The Washington Post

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NATION

Opioid epidemic not bound by race Its toll on minorities increases as death rates rise for almost everyone 25 to 44

BY J OEL A CHENBACH AND D AN K EATING

T

he opioid epidemic that has ravaged life expectancy among economically stressed white Americans is taking a rising toll among blacks, Hispanics and Native Americans, driving up the overall rate of death among Americans in the prime of their lives.

Since the beginning of this decade, death rates have risen among people between the ages of 25 and 44 in virtually every racial and ethnic group and almost all states, according to a Washington Post analysis. The death rate among African Americans is up 4 percent, Hispanics 7 percent, whites 12 percent and Native Americans 18 percent. The rate for Asian Americans also has increased, but at a level that is not statistically significant.

After a century of decreases, the overall death rate for Americans in these prime years rose 8 percent between 2010 and 2015.

The jump in death rates has been driven in large measure by drug overdoses and alcohol abuse, according to The Post’s analysis of mortality data from the U.S. Centers for Disease Control and Prevention.

“What it reflects is an out-ofcontrol epidemic right now,” said Josh Sharfstein, director of the Bloomberg American Health Initiative at Johns Hopkins. “It’s affecting the economy. It’s affecting the entire community. This is an absolute call to action for public health.”

Ashish Jha, a health policy professor at the Harvard School of Public Health, added, “These are people who are in the most productive years of their lives — the years where they’re supposed to be raising kids and becoming leaders of the next generation.”

The Post confirmed the contours of the rise in death rates with CDC officials. The rate is adjusted for the nation’s changing age profile, and every fiveyear age group (for example, 35 to 39, or 40 to 44) showed an in-

Death rate rising for young adults since 2010 Deaths per 100,000 people ages 25-44 160

151.3

154.4 DETAIL

139.8

140

0

120

-9.5%

1999

NATIVE AMERICAN

AFRICAN AMERICAN

2010

WHITE

HISPANIC

4% 16%

-25% 7%

8.2%

2015

ASIAN

300

200

100

20% 18% -26% 4%

0 ’99

-17% 3%

’10 ’15

Source: Centers for Disease Control and Prevention mortality data

crease in mortality.

Preliminary data from the first half of 2016 suggests that the trend is continuing, said Robert Anderson, chief of mortality statistics for the CDC. “I think we’re in for another steep increase in the drug overdose deaths overall,” Anderson said.

The rash of deaths is a statistical echo of the 1980s and early 1990s, when the combination of the crack cocaine and HIV epidemics took a heavy toll on young Americans.

Many factors are probably contributing to the current spike, but opioids stand out. The widespread abuse of prescription drugs has become a national crisis, with addicts overdosing on prescription opioids, their illegal cousin heroin, and, increasingly,

THE WASHINGTON POST

synthetic drugs such as fentanyl and carfentanil, which are far more powerful and deadly.

Alcohol-related deaths also have increased among whites, blacks and Hispanics, the data show. Meanwhile, homicide, the leading cause of death among young blacks, also has risen since the beginning of this decade.

The new mortality spike is occurring in almost every state.

The breadth of the nation’s deteriorating health has not been widely appreciated. Academic researchers and the news media in recent years have focused on the most intensely affected regions, such as Appalachia and rural New England, and on premature deaths among white Americans, a trend that began around 1999 and continues unabated.

For more than a century, Amer-

icans lived much longer lives because of improvements in medicine, sanitation, control of contagious diseases, nutrition and individual health care. But American mortality appears to have reached an inflection point around 2010, in the immediate aftermath of the Great Recession.

Generally positive mortality trends among blacks and Hispanics flattened out, then gradually worsened.

For blacks and Hispanics, the biggest increase in deaths came in 2015, data for which was released earlier this year.

The geography of the epidemic also expanded dramatically.

From 1999 to 2010, only seven states showed an increase of more than 10 percent in the death rates of people ages 25 to 44: West Virginia, Kentucky, New Hampshire, Oklahoma, North Dakota, Wyoming and Montana. All have predominantly white populations and few if any big cities.

The data from 2010 to 2015 tell a different story. During that period, 33 states showed death rates rising by at least 10 deaths per 100,000 people in the 25-44 age bracket, including all of New England and the Midwest Rust Belt. The death rate in Indiana rose by 31 per 100,000. Only in Hawaii and the District of Columbia has the death rate continued to decline since 2010.

Moreover, a phenomenon most pronounced among whites in small cities and rural areas appears to be spreading to the nation’s suburbs and biggest cities. Before 2010, death rates had been declining for whites, blacks and Hispanics in metropolitan areas of at least 1 million people.

Since 2010, the rates are up everywhere.

“The data is very concerning,” said Leandris Liburd, director of the CDC’s Office of Minority Health and Health Equity. “We do not want to see death rates going up for any age, or any ethnic or racial group. The rise in mortality is likely due to multiple factors, and opioids are certainly a part of the problem.” n ©The Washington Post

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NATION

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A lot of poor people are still smoking Despite overall declines, tobacco still heavily affects those with little money or education and those in rural areas

W ILLIAM W AN Martinsville, Va. BY

A

fter decades of lawsuits, public campaigns and painful struggles, Americans have finally done what once seemed impossible: Most of the country has quit smoking, saving millions of lives and leading to massive reductions in cancer.

That is, unless those Americans are poor, uneducated or live in a rural area.

Hidden among the steady declines in recent years is the stark reality that cigarettes are becoming a habit of the poor. The national smoking rate has fallen to historic lows, with just 15 percent of adults still smoking. But the socioeconomic gap has never been bigger.

Among the nation’s lesseducated people — those with a high-school-equivalency diploma — the smoking rate remains more than 40 percent, according to the Centers for Disease Control and Prevention. Today, rural residents are diagnosed with lung cancer at rates 18 to 20 percent above those of city dwellers. By nearly every statistical measure, researchers say, America’s lower class now smokes more and dies more from cigarettes than other Americans.

This widening gap between classes carries huge health implications and is already reshaping the country’s battle over tobacco control. Cigarette companies are focusing their marketing on lower socioeconomic communities to retain their customer base, researchers say. Nonprofit and advocacy groups are retooling their programs for the complex and more difficult work of reaching and treating marginalized groups.

As inequality in America continues expanding by many measures, smoking is a growing aspect of that divide that is a matter of life and death, with wealthier and more-educated Americans now largely spared the cost and deadly effects of the vice.

Advocacy groups say funding for smoking cessation is dropping, and they worry that the

Smoking has declined for all, but not equally Change in U.S. adult smoking rates from 1966 to 2015, by education level Some high school

HS degree

Some college

College degree

0%

-25%

-39% -50%

-52% -61%

−75%

-83% −100%

1966

1970

1980

1990

Source: National Health Interview Survey

attention and political will needed for tobacco control are also waning as America’s upper and middle classes see smoking as an already solved, bygone problem.

“If you’re educated and live in a well-off area, the smoking problem we’re talking about these days is now largely invisible to you,” said Matthew L. Myers, president of the Campaign for Tobacco-Free Kids. “In some places, you can go days without bumping into a smoker. So you start to hear the question, why push more resources into this? Meanwhile, the need is getting even greater, because the people left smoking are the ones who can least afford to.”

Debbie Seals, 60, has fought on the front lines of this new class battle for the past six years from her home in the rural foothills of Virginia’s Blue Ridge Mountains.

She has driven her tiny blue Fiat to the farthest corners of southern Virginia and West Virginia to hold classes aimed at helping smokers quit. Her cessation clinics are often the only ones offered for miles around.

“It’s like there’s two worlds now,” Seals said.

Every month, she travels to Northern Virginia to visit her

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2010 2015 THE WASHINGTON POST

grandchildren in the Washington, D.C., suburbs. In Alexandria, she sees couples jogging on the streets and buying expensive organic groceries at Whole Foods — and not a single one smoking.

But in her home town of Martinsville, Va., cigarettes are ubiquitous. People smoke on their morning drive to work and on weekends mowing their lawns.

Tobacco stores line the strip malls, and cigarette ads are in the windows of every gas station and convenience store.

The smoking is a symptom of deeper problems here, Seals said on a recent afternoon as she headed out to check on three former students from her cessation class.

Martinsville was once known as the “Sweatshirt Capital of the World,” a booming center of textile mills and furniture factories.

Now it is littered with abandoned factories and vacant storefronts.

So many families here live in poverty that all children in elementary and middle school automatically qualify for free and reducedprice meals.

“People down here smoke because of the stress in their life,” Seals said. “They smoke because of money problems, family prob-

lems. It’s the one thing they have control over. The one thing that makes them feel better. And you want them to give that up? It’s the toughest thing in the world.”

Seals — who retired years ago from a career with Girl Scouts of the USA — began teaching her classes as a volunteer for the American Lung Association. After seeing the desperate need, she began working full time on cessation for the nonprofit.

She’s taught many classes in recent years at the handful of furniture factories left. Many of the participants attend her clinic over and over, unable to stop smoking. She is careful not to make any of them feel like failures.

“If they manage to quit for a week or even a day, they succeeded,” she said. “I tell them if you were able to quit once, you can do it again.”

When smoking first gained popularity in the early 20th century, it was a habit of the rich, a token of luxury dusted with Hollywood glamour. Then came the 1964 surgeon general’s report on its deadly effects, and during the next 31/2 decades, smoking among the nation’s highest-income families plummeted by 62 percent. But among families of the lowest income, it decreased by just 9 percent.

“There’s this tendency now to blame the ones still smoking,” said Robin Koval, president of Truth Initiative, a leading tobaccocontrol nonprofit group. “The attitude is: ‘You’re doing it to yourself. If you were just strong enough, you’d be able to quit.’ ” What isn’t taken into account, Koval said, are the vast resources tobacco companies are spending to hold on to their last remaining strongholds.

“Poorer people don’t smoke because anything’s different or wrong about them,” Koval said.

“Their communities are not protected like others are. They don’t have access to good health care and cessation programs. If you have a bull’s eye painted on your back, it’s harder to get away.” n © The Washington Post

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‘Jungle’ is gone; migrant crisis isn’t J AMES M C A ULEY Calais, France BY

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e was walking alone, to a place that no longer exists.

These days, Baz — a 25-year-old Afghan who has been in Calais for 20 months, he said — could use a place to sleep. Not so long ago, he had one: a tent in the “Jungle” encampment, where nearly 10,000 migrants and refugees from the Middle East and East Africa languished for months, even years, in hopes of eventually reaching Britain, a short 20 miles across the English Channel.

But in late October, the French government — after a devastating sequence of terrorist attacks and the spike in anti-immigrant rhetoric that followed — demolished the camp. The migrants there were either transported to “welcome centers” throughout France or simply evicted from the makeshift city that teemed with smugglers and violence.

In any case, the Jungle is gone, and Baz — like so many other migrants still here — now sleeps on the streets.

The end of the camp was not the end of the migrant crisis in France, and hundreds more have continued to trickle into this working-class city on the shores of northern France, which remains the closest point in continental Europe to Britain. If no longer in the headlines, the problem is no less urgent, aid workers say, insisting that conditions for newcomers have never been worse.

“This!” Baz, who declined to give his surname, said recently, gesturing at the asphalt on a road near the old entrance to the Jungle, far outside of town. “This!

This is where you sleep.”

“We are literally trying to get drinking water to people. We don’t have water, we don’t have food — and no sanitation,” said Clare Moseley, the founder of Care4Calais, an aid organization active throughout France.

“There’s skin disease, gum disease. It really, really is the abso-

MICHAEL ROBINSON CHAVEZ/THE WASHINGTON POST

Calais, France, tore down the encampment, but people keep coming — and to worse conditions lute basics of life here.”

“When we were in the Jungle, we were trying to get clothes to people and even some kinds of social care. It really was a step up from where we are now.”

Since the Jungle, major elections have come and gone in France and Britain, whose border with the European Union’s Schengen zone begins at the French coast.

In France, despite the victory of the centrist, pro-migrant Emmanuel Macron over the fiercely anti-immigrant Marine Le Pen last month, little has happened to suggest any immediate change in policy toward migrants seeking either temporary residence or asylum.

“The duty of Europe is to offer asylum to those who are persecuted and ask for its protection,” Macron’s campaign platform read. “In this context, France must take its fair share in the reception of refugees. It must issue permits to all those whom it

deems entitled to asylum in its territory.”

But just this month, Gérard Collomb, Macron’s interior minister, authorized the transfer of three extra police squadrons to the Calais region. In an interview with the Le Parisien newspaper, Collomb said that the transfer would amount to roughly 150 additional officers and gendarmes.

“Our priority,” Collomb said, “is that Calais and Dunkirk do not remain places of fixation and that ‘Jungles’ do not reconstitute.”

In Britain, where Prime Minister Theresa May narrowly survived her own snap election recently, Brexit will still mean Brexit, and strict immigration regulations for migrants and refugees are unlikely to be reconsidered anytime soon.

Unlike many of the migrants now here, Baz is a legal adult.

About 150 of the 400 migrants who have recently arrived in the Calais area are unaccompanied minors, Moseley said.

French police watch over a group of migrants and refugees eating a meal provided by a local nongovernmental organization in Calais, France, on April 1. Many of them are forced to sleep on the streets.

After the destruction of the Jungle, there is no longer a central gathering place for these younger migrants, who have begun to seek refuge in odd locations throughout the city.

Two of them, for instance, were huddled on a recent evening under a covered drive-in outside a Pizza Hut in central Calais. Customers came in and out, paying the two boys little notice. Pizza deliveries proceeded; cars passing through the nearby roundabout drove by.

“Calais people don’t like refugees,” said Kiya Rabbira, 16, from Ethiopia, one of these refugees.

He was sitting with his friend, Fiiri Nanaki, 15, also from Ethiopia. “They’re always calling the police, and they never give us food. They see us sleeping here, and say, ‘Don’t sleep here — go.’ ” This was never supposed to happen.

In the fall, leading up to the Jungle’s demolition, the U.K. government pledged to take in a host of unaccompanied minors.

Last year, the British Parliament approved an amendment to an immigration bill that also permitted the resettlement of unaccompanied minors with no family in Britain. Sponsored by Alf Dubs, a member of the House of Lords, the “Dubs amendment” harked back to one of the proudest moments in modern British history, when the United Kingdom sheltered Jewish children from Nazi persecution in central Europe in the late 1930s.

Dubs, now 84, was one of those children.

In the months since, however, the United Kingdom has reneged on its commitment, largely because the final text of the new amendment mandated no specific number of unaccompanied minors to admit, Dubs said in an interview.

“Unfortunately, we weren’t able to tack a number on it, so the government could go back on the amendment,” he said. “We simply said they had to do it, never thinking they would cut it short like that.” n ©The Washington Post

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awaher has lived in this tiny nation her whole life. But a political showdown threatens to unravel her world, potentially forcing her to move to a country she hardly knows and splitting her family apart.

Jawaher’s mother is a Qatari citizen, and her father is Bahraini.

That fact seldom has caused problems. But when several other Arab nations severed ties with Qatar this month, three of them — Bahrain, Saudi Arabia and the United Arab Emirates — also ordered their citizens to return home or face stiff penalties.

Under the laws of Qatar and other Gulf countries, children take the citizenship of their father. That leaves Jawaher and thousands of others like her with a difficult decision.

“If we are made to go to Bahrain, what are we going to do there?” said the 21-year-old university student, who spoke on the condition that her family name not be revealed because she feared repercussions. “And we are going to have to leave our mom behind.

“Our family will be divided.”

In a region where cultural and tribal ties extend beyond national borders, the deepening crisis is creating havoc in Qatari families like Jawaher’s in ways many had never expected.

Parents and spouses traveling abroad are unable to return home.

Some have already lost jobs. Children worry about becoming stateless or that their education will be disrupted, and family members in different countries are feuding.

There’s a collective sense that they are trapped by the quest for influence and control in the Middle East.

“We have relatives all over the region,” said Rashed al-Jalahma, 22, who is also the child of a QatariBahraini union. “We were in shock and awe when we learned we can no longer see them because of politics. What does the population have to do with the problems of the politicians?”

On June 5, Saudi Arabia, Bah-

KARIM JAAFAR/AGENCE FRANCE-PRESSE VIA GETTY IMAGES

As governments clash, citizens are unable to return home or face separation from loved ones rain and the UAE ordered Qatari nationals to leave their territories within 14 days and banned their own citizens from entering Qatar.

Citizens living in Qatar were given a similar deadlines to return.

More than 11,000 citizens of the three countries live in Qatar, according to Qatar’s National Human Rights Committee. And thousands of Qataris live and work in Saudi Arabia, Bahrain and the UAE. At least 6,500 Qatari nationals are married to citizens from these three nations, according to Qatari government figures.

Before the crisis, citizens of the six-country Gulf Cooperation Council, or GCC — which includes Saudi Arabia, the UAE, Bahrain, Qatar, Kuwait and Oman — could live and travel freely across the member states. They often refer to themselves as “Khaleejis” — the people of the Gulf.

Tensions, however, between Qatar and its neighbors have been simmering for years over accusa-

tions that Qatar supports terrorist groups and Qatar’s ties to Iran’s Shiite theocracy, the primary rival of Saudi Arabia’s Sunni monarchy.

That lead to the expulsions of diplomats and the closing of ports, airspace and borders to isolate Qatar.

The small, energy-rich nation, home to a U.S. air base and 10,000 U.S. servicemen, has rejected the allegations as “baseless,” saying that it “condemns terrorism in all its forms.”

Few here expected such a fullblown crisis, especially as millions in the region prepare to celebrate the end of the Muslim fasting month of Ramadan, a time to visit families and friends.

“This has made me so sad,” said Wafa al-Yazeedi, a Qatari doctor and Jalahma’s mother. “We lived and felt like all the Gulf is one country. I have a cousin everywhere.”

She divorced her Bahraini husband when her three children

Passengers walk through Hamad International Airport in Doha, the Qatari capital, on Monday.

On June 5, Saudi Arabia, Bahrain and the United Arab Emirates ordered Qatari nationals to leave their countries within 14 days and gave a similar deadline for their citizens living in Qatar to return.

were small. He returned to Bahrain, and her children grew up here with little contact with their father or other relatives.

Now, the children are in a dilemma. Settling in Bahrain means leaving behind their mother, other relatives, lifelong friends — and their expensive university educations, which the Qatari government pays for.

Staying in Qatar could result in statelessness if Bahrain takes away their citizenship. Qatar has allowed citizens from Bahrain, Saudi Arabia and the UAE living here to remain, and provides free health care and other services if their mother is Qatari.

Still, being stateless would limit their future opportunities, especially if they want to travel abroad for more studies or work.

The crisis has already had immediate consequences. In a report the other week, the human rights watchdog Amnesty International described the case of a Saudi man living in Qatar who was unable to visit his hospitalized mother in Saudi Arabia because he feared he would not be able to return to his children and Qatari wife.

Jawaher’s family is already divided, at least temporarily. Her father was on a work trip in Bahrain when the crisis erupted, and he has been stuck there ever since.

“There’s no way now for him to come back,” she said.

Last Sunday, Saudi Arabia, Bahrain and the UAE said they had created hotlines to help families who face separation but gave few details. Qatar’s National Human Rights Committee dismissed the move as “little more than a facesaving” exercise. Amnesty International called the measures “vague and insufficient.”

Some affected families worry the hotlines are ways to gather data on those who complain. Both Bahrain and the UAE declared it a crime to criticize their policies toward Qatar or show sympathy with Qatar.

“It’s fake,” said Yazeedi, referring to Bahrain’s hotline. “I cannot trust them. I won’t call them from my number.” n ©The Washington Post

Recess had finally started, so Ava Olsen picked up her chocolate cupcake, then headed outside toward the swings. And that’s when the 7­year­old saw the gun. ¶ It was black and in the hand of someone the first­graders on the playground would later describe as a thin, towering figure with wispy blond hair and angry eyes. Dressed in dark clothes and a baseball cap, he had just driven up in a Dodge Ram, jumping out of the pickup as it rolled into the chain­link fence that surrounded the play area. It was 1:41 on a balmy, blue­sky afternoon in late September, and Ava’s class was just emerging from an open door directly in front of him to join the other kids already outside. At first, a few of them assumed he had come to help with something or to say hello. ¶ Then he pulled the trigger. ¶ “I hate my life,” the children heard him scream in the same moment he added Townville Elementary to the long list of American schools redefined by a shooting.

COVER STORY BY JOHN WOODROW COX IN TOWNVILLE, S.C.

violence echoes for these shooting survivors A round struck the shoulder of Ava’s teacher, who was standing at the green metal door before she yanked it shut. But the shooter kept firing, shattering a glass window.

Near the cubbies inside, 6-year-old Collin Edwards felt his foot vibrate, then burn, as if he had stepped in a fire. A bullet had blown through the inside of his right ankle and popped out beneath his big toe, punching a hole in the sole of his Velcro-strapped sneaker.

As his teachers pulled him away from the windows, Collin recalled later, he spotted a puddle of blood spreading across the gray wax tile floor in the hallway. Someone else, he realized, had been hurt, too.

Outside, Ava had dropped her cupcake. The Daisy Scout remembered what her mom had said: If something doesn’t feel right, run. She sprinted toward the far side of the building, rounding a corner to safety. Nowhere in sight, though, was Jacob Hall, the tiny boy with oversize, thick-lensed glasses Ava had decided to marry when they grew up. He had been just a few steps behind her at the door, but she never saw him come out. Ava hoped he was okay.

Standing on the wood chips near a yellow tube slide, Siena Kibilko felt stunned. Until that moment, her most serious concern had been which “How to Train Your Dragon” toy she would get for her upcoming seventh birthday.

“Run!” Siena recalled a teacher shouting, and she did.

Karson Robinson, one of the biggest kids in class, hadn’t waited for instructions. At the initial sound of gunshots, he scrambled over a fence on the opposite side of the playground and briefly headed toward the baseball fields where, as a Townville Giant, he had gotten his first recreation league hit. Karson then turned back to the school and found his classmates banging on a door.

“Let us in,” Siena begged, and the kids were hustled inside.

The gunfire had stopped by then, and, in a room on the other side of the school, Collin had

Opposite page: After the Sept. 28 shooting, a school bus transported shaken students to a nearby church in Townville, S.C. Katie McLean, Independent-Mail via Associated Press

discovered the source of all that blood.

Sprawled on the floor was Jacob, the boy Ava adored. At 3 1/2 feet tall, he was the smallest child in first grade — everyone’s kid brother. On the green swings at recess, Collin would call him “Little J” because that always made Jacob cackle in a way that made everyone else laugh, too. But now his eyes were closed, and Collin wondered whether they would ever open again.

“Press, press, press,” an automated defibrillator repeated as the school nurse pushed on Jacob’s chest, trying to keep him alive. “Give breath. Give breath.”

“Look at me,” a teacher urged Collin, but the boy couldn’t stop staring at his friend.

least six churches. Gable-roofed chicken houses stand among cow pastures and rolling fields of hay, wheat, corn and soybeans, and everyone shops at Dollar General, nicknamed the “Townville Target.”

Overwhelmingly white, it is home to families that have farmed for decades, retirees with lake houses, college-educated professionals who commute up the road to Clemson University and hundreds of people in mobile homes living from one paycheck to the next.

What connects them is a beloved two-story, red-brick school where generations of children have gathered to learn and play and grow up together.

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n a gray wall inside Townville Elementary’s front lobby hangs a framed dreamcatcher, and beneath its blue beads and brown feathers is a Native American phrase: “Let Us See Each Other Again.”

It was among hundreds of items — letters, ornaments, photos, posters, plush toys — that deluged the school of 290 students after the Sept. 28 attack. But the dreamcatcher held special meaning. It had been sent to four other schools ravaged by gun violence, and the names of each were listed on the back: Columbine High in Colorado, Red Lake High in Minnesota, Sandy Hook Elementary in Connecticut, Marysville Pilchuck High in Washington state.

It is slated to travel next to North Park Elementary in San Bernardino, Calif., where in April a man killed his estranged wife, who was a teacher there, and fatally wounded an 8-yearold before taking his own life.

In each shooting’s wake, the children and adults who die and those who murder them become the focus of intense national attention.

Often overlooked, though, are the students who survive the violence but are profoundly changed by it.

Beginning with Columbine 18 years ago, more than 135,000 students attending at least 164 primary or secondary schools have experienced a shooting on campus, according to a Washington Post analysis of online archives, state enrollment figures and news stories. That doesn’t count dozens of suicides, accidents and after-school assaults that have also exposed children to gunfire.

“A meaningful number of those kids are going to have significant struggles,” said Bruce D. Perry, a psychiatrist who worked with families from Columbine and Sandy Hook. “It’s stunning how one event can have this echo that will impact so many more individuals than people realized.”

Every child reacts differently to violence at school, therapists have found. Some students, either immediately or later, suffer posttraumatic stress similar to that of combat veterans returning from war. Many grapple with recurring nightmares, are crippled by everyday noises, struggle to focus in classes and fear that the shooter will come after them again.

Because of the lasting damage, Townville’s teachers, administrators, first responders, counselors, pastors, and parents and their children agreed to speak to The Post about what the community of 4,000 has endured over the past eight months.

They’d always felt safe in this swath of countryside, a place 40 miles southwest of Greenville that claims a single stoplight but at

he gunman paced the sidewalk, a cellphone in his hand.

Moments earlier, as he had shifted his aim from the green metal door to the playground, his .40-caliber pistol jammed, ending his rampage 12 seconds after it began. Now Townville Principal Denise Fredericks and some of her staff congregated at the end of a second-floor hallway to keep track of him until help arrived.

From behind a sign on a windowsill that read “Dream,” they peered down as he walked beside the school.

Then he looked up.

“That’s Jesse Osborne,” a teacher gasped.

He was 14 years old.

Jesse had attended Townville — walked its halls and romped on its playground — through fifth grade, before he transferred and was later home-schooled. Not once, Fredericks said, had his behavior prompted concern. He was quiet, earned good grades and almost never got into trouble. He played catcher in the recreation league. He got invited to birthday parties.

Jesse had called his grandmother, Patsy Osborne, just minutes before he’d driven to the school that afternoon. He was screaming, she said. She couldn’t understand him.

Patsy and her husband, Thomas, sped to his house, where they discovered their son — Jesse’s father — slumped on a couch, eyes still open.

He’d been shot to death. And Jesse had disappeared.

Then Thomas’s phone rang.

It was his grandson.

“I told him not to,” he recalled the teenager saying. “I told him not to do that.”

His grandfather asked where he’d gone.

“I’m behind the school,” Jesse said.

Thomas pulled up moments after Jesse had been subdued by an armed volunteer firefighter, arriving in time to see his handcuffed grandson loaded into the back of a patrol car.

Inside the school, 300 children and teachers cowered in locked classrooms, bathrooms and storage closets. Siena remembered someone covering up windows with paper. Karson remembered playing with markers and magnets.

Ava remembered a teacher reading a story about sunflowers. They all remembered the sound of weeping.

By then, Townville’s fire chief, Billy McAdams, had hurried through the first-grade door with the shot-out glass. In the classroom, he saw an alphabet rug soaked with blood.

Down the hallway, he found Jacob, whose femoral artery had been sliced by a bullet that struck his left leg. Eventually, the 6-year-old was loaded onto a gurney and taken to an awaiting helicopter, and Collin would never see

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his friend’s eyes open again.

ground.

Even at home, she’d lost her sense of security.

Siena would deadbolt the front door when no one was looking, and at the sight of unfamiliar cars, she’d scurry inside.

One afternoon, she stood in her bedroom as Marylea ran her fingers through the girl’s shoulder-length brown hair. Siena again thought of Jesse as her dark eyes fixed on a pink heart taped to the wall.

“Are they going to let him out?” she asked, her finger picking at the decoration.

“Nope,” her mother said.

“Ever?”

Marylea didn’t want to lie. She searched for the right response, still stroking her 7-year-old’s hair.

“Not any time when you’re still a kid.”

A

week later, on a Wednesday morning in October, Jacob lay inside a miniature gray casket topped with yellow chrysanthemums and a Ninja Turtles figurine. He was dressed in a Batman costume.

Ava couldn’t bear to look at him, so she sat on her mother’s lap near the back of Oakdale Baptist Church and turned away.

She called him “Jakey.” He was the only boy she’d ever kissed.

Nineteen days before he was shot, she had written him a note.

“Come play with me please,” she scribbled in pencil. “You can play with my cats. Do you want to get married when you come? My mom will make us lunch.”

At the bottom of the page, she’d drawn herself in a pink dress standing next to a bespectacled Jacob, who appeared about half her height. “I love you!” she added beside a red heart.

After the shooting, Ava realized she’d forgotten to give Jacob the letter and crumpled it into a plastic bin in her bedroom. Now she was at his funeral.

“He’s not really dead, is he?” she whispered to her mother.

“Yes,” Mary Olsen told her. “He is.”

Jacob’s family had asked that people attending the service dress like superheroes because of the boy’s infatuation with them. Ava wore a Ninja Turtles top with a purple cape. Siena and Collin, who was still in a wheelchair, both dressed as Captain America.

Karson had also come, his shirt displaying a “J” within a Superman logo. But he’d hesitated in the parking lot.

“Mama, that looks like that boy’s truck. Is he here?” Karson had asked, motioning toward a dark pickup.

From their seats, the children listened to the same pastor who presided at the funeral for Jesse’s father three days earlier. They watched as, midway through the service, Jacob’s mom staggered to his casket, then collapsed to the floor. They stared as his body was wheeled up the center aisle at the end of the memorial.

Then, just hours after their friend’s funeral, they returned for the first time to the place he’d been shot.

The school, scheduled to resume classes the next day, hosted an open house that afternoon. No one knew how the kids would react, but Fredericks, the principal, believed the small step of a brief return might help with the big step of a permanent one. In Townville, where nearly 7 in 10 of the school’s students live in poverty, it wasn’t viable to construct a new building or bus them elsewhere.

They had to go back.

When they did that afternoon, some kids even returned to the playground. Collin rolled out on his light blue medical scooter. Siena climbed a play set.

But Ava lingered behind with her mom.

“Please don’t make me go out there again,” Ava said, before they eased onto the sidewalk,

A

holding hands. With each step, the girl’s fingernails dug deeper into her mother’s skin.

“W

hat if he gets out?” Siena asked her parents in the days after the shooting.

Then she never stopped asking.

They explained that Jesse was in jail, that she was safe. But still, Siena obsessed over him coming for her again. Next to a sign beside her top bunk that read “Night, Night, Sweet Pea — Sweet Dreams,” she relived the shooting in her nightmares.

Fredericks and her staff did all they could think of to ease the kids’ dread on that first full day back, Oct. 6, when all but 10 students showed up for class. They were welcomed by uniformed officers, therapy dogs, volunteers in superhero costumes, more than 20 counselors, a line of signs — “Have a Great Day at School!” — in the parking lot.

For Siena, though, each morning included a negotiation with her parents.

“I don’t want to go to school today,” she would say. “I don’t feel good.”

At drop-off, she would search the parking lot for the cruiser of the police officer assigned to Townville Elementary after the shooting. She needed to know he was there.

One day, Siena announced to her mother, Marylea, that she couldn’t go to summer camp anymore: “They don’t have a police officer.”

Like many of her classmates, loud, unexpected sounds petrified her. Once, outside a Publix, a car backfired, and she dropped to the ground before dashing inside. Another time, after a balloon popped at a school dance, the entire gymnasium went silent as the principal rushed to turn the lights on. Fredericks later banned balloons at the spring festival.

“Noises are different now,” she said.

Siena and her friends began carrying stuffed animals as a form of protection. In those first days back at school, she would slip a tiny pink teddy bear named Lovie into her pocket and squeeze it when she walked onto the play-

Siena Kibilko, 7, began carrying stuffed animals after the shooting as a form of protection.

“Are they going to let him out?” Siena would ask her mom, referring to the shooter. “Ever?”

FAMILY PHOTO

“I told him not to. I told him not to do that.”

Jesse Osborne, above with the father he fatally shot in September, in a phone call to his grandfather on the day of the attack. One theory is that the teen shot his father because he thought he had killed a pet bunny.

month had passed since the shooting, and Karson was beginning to sleep and eat normally again, but a sense of guilt still haunted him.

“Maybe I should have waited on Jacob,” he told his mother, Kayla Edmonds. “He could have jumped over the fence with me.”

She insisted that he couldn’t have saved Jacob’s life, but Karson wouldn’t be convinced.

He’d stood half a foot taller than his friend. The big kids were supposed to help the little ones.

The trauma had left him with intense separation anxiety — he’d follow his mother, who works at Subway, when she stepped out for a smoke — and profound grief. He’d known Jacob since they were toddlers. They’d bounced together for hours on a trampoline. They’d giggled together playing “Grand Theft Auto,” the video game with the bad words in it.

When Jacob died three days after the shooting, Karson’s mom didn’t tell him right away. It was his seventh birthday, and they were celebrating at Chuck E. Cheese’s. On their way home, he asked, yet again, if Jacob was getting better. In that moment, she told him his friend had gone to heaven, and Karson began to cry.

After that, he didn’t like it when people mentioned Jacob’s name. For Valentine’s Day, Karson wrote a card in his memory: “I loved him but he diyd but he is stil a life in my hart.”

I

n the corner of his room, Collin rummaged through a blue plastic toy bin. His medical boot had come off months earlier, and the bullet wound had healed, leaving a dark, nickel-sized splotch on his ankle. He could run again, too, though sometimes he had to take breaks because of the pain.

Then Collin found what he was searching for and held up a plastic pistol with an orange cap on the barrel.

“His gun looked like that,” he said, his tone matter-of-fact.

Of all the children who survived that day, Collin seemed the most vulnerable to psychological damage in the eyes of many Townville parents and teachers. Before learning to tie his shoes, he’d been shot and seen his friend covered in blood. But he didn’t have nightmares, and he didn’t think much about Jesse. At

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COVER STORY school, as long as one of his stuffed animals was within reach, he felt fine.

His father, a 200-pound construction worker, broke down about what had happened more often than Collin did. It wasn’t that the boy didn’t care, because he did, especially for Jacob’s 4-yearold sister, Zoey, whom he’d often hug when he saw her at school.

But Collin, now 7, can discuss that day with clarity and composure.

About the bullet: “It was moving through the air super fast.”

About how much it hurt: “I didn’t even feel the exit hole. It was just the enter hole that had the most pain in it.”

About Jacob: “He wasn’t even moving.”

Researchers who have studied kids for years still aren’t certain why they react to trauma in such different ways.

Perhaps no one understands that better than Nelba Marquez-Greene, whose son survived the Sandy Hook massacre but whose daughter did not.

“That’s a factor you can’t predict — how your child is going to deal with it,” said MarquezGreene, a family therapist for the past 13 years.

She warned, however, that parents can’t assume their kids have escaped the aftereffects, which sometimes don’t surface for years.

“We still have this tendency to want to say, ‘Okay, it’s done. He’s good. She’s good,’ ” Marquez-Greene said. “That’s not where the story ends.”

A

va sat on the edge of a brown exam table, her eyes on the floor. It was mid-February, five months after the shooting, and her pediatrician kept asking questions.

Did she still feel scared a lot?

“Yes,” Ava’s mother recalled her answering.

Did she feel safe at school?

“No.” What did she not like about school?

Ava, clutching a stuffed Ninja Turtle that had once belonged to Jacob, didn’t answer.

Three weeks later, the doctor filled out a state form recommending that she be homeschooled. His diagnosis: “Severe PTSD/depression, exacerbated by school attendance.”

Ava — the only student pulled from Townville this school year because of the shooting — alternated between long stretches of quiet anguish and explosions of rage, her mother said.

She started hitting herself and yanking out her eyelashes, and she once clawed her nails so deep into her elbow that it became infected.

She began repeating what the shooter had screamed on the playground: “I hate my life.”

She stopped watching “Frozen” because Elsa’s parents die. She erupted when her mother took off the necklace with the vial of Jacob’s ashes his family had given them. She couldn’t look at the pistol her father, a former police officer, kept in the house. She snipped glittery green and red stickers into tiny pieces, then used them to cover up scary words in “Little House on the Prairie”: gun, fire, blood, kill.

The shooting had lasted just 12 seconds.

Ava’s parents worried it would torment their

PHOTOS BY RICKY CARIOTI/THE WASHINGTON POST

daughter for years.

They didn’t know what to do, in part because their son, Cameron — just 10 months younger — had also been on the playground that day, but he fared far better in the aftermath. They sent Ava to two therapists, took her to doctors who gave her medication for anxiety, encouraged her to record her thoughts in a leopard-print journal.

“I miss Jacob,” she wrote one day in March.

“I can’t stop feeling mad,” she scribbled one day in April.

“No one ever listens to me,” she confided a few days later.

“I hate guns,” she scrawled a week after that.

Ava had made progress, her parents thought, until the day before Easter, when she and her brother were playing “boat” in the bed of their dad’s Chevrolet pickup outside the family’s home. Suddenly, Cameron frightened her. She pushed him and he fell backward, hitting his head against a stone well. Blood trickled down the back of his neck.

“Oh, my God,” she screamed.

Their parents loaded the kids into the car and rushed to the emergency room.

“I don’t want to die,” Cameron cried. Then Ava, fearing what she’d done to him, said: “I’m just like Jesse.”

F

orty miles away, the 14-year-old at the center of it all sat inside a juvenile detention center on a recent evening and considered his future.

“I don’t want to go to hell,” he told Patsy, his grandmother.

Jesse, who hasn’t entered a plea but could serve decades in prison if he’s tried as an adult, spends most of his time reading, particularly about Mars, his family said. He wants to fly there one day.

They don’t dispute the accusations against him, but they’ve struggled to understand why their “baby,” who stands taller than 6 feet, would harm anyone.

Karson Robinson, 7, wonders whether he could have done more to protect his friend Jacob (below), who was half a foot shorter than he was.

“He could have jumped over the fence with me.”

KERRY BURRISS

KLMNO WEEKLY

The teen had handled guns since he was young, but so had many other kids in Townville.

They’ve all heard the theory that he shot his father because he thought Jeffrey had killed a pet bunny, Floppy. Maybe, his grandfather said, that’s what Jesse meant in the call — “I told him not to do that.” But maybe he fired the gun for some other reason. Father and son, Tiffney said, sometimes had heated arguments.

Jesse, his mother said she’d learned, had retrieved the pistol from her husband’s nightstand and shot him from behind. After his arrest, he confided to her that he didn’t want his dad to suffer, so when Jesse realized Jeffrey was still moving after the first bullet, he kept firing.

The teen told the firefighter who restrained him that he’d lost faith in God and didn’t know what else to do, said McAdams, the fire chief.

Jesse also told the firefighter that he was sorry.

His mother and grandparents insist they didn’t see that bloody day coming, but Jesse may have offered at least one sign he was capable of violence. In seventh grade, his family said, he was kicked out of school after bullies harassed him and he snapped. A fellow student, Patsy said, had spotted something frightening in his backpack: a hatchet.

O

n another balmy, blue-sky afternoon, seven months to the minute after a stranger with angry eyes pulled up and pointed a gun, the first-graders rushed onto Townville Elementary’s playground.

Some kids headed to the swings and others to the play sets. Collin, wearing a black T-shirt with a green smiley face, talked to a friend at a picnic table near where the truck had careened into the chain-link fence, since replaced by a shiny new section. He held his stuffed turtle, Tortle.

A game of tag broke out, and Karson chased a friend, just as he used to when he played the Joker and Jacob played Batman.

Collin darted by the green swings where he used to call out “Little J” to make Jacob laugh.

Siena, gripping a stuffed purple cheetah named Glamour, wandered past a pink metal ladder with a hole, probably the result of rust, that she believed had come from a bullet.

Four miles away, Ava’s mother said, the girl lay in bed next to Jacob’s old Ninja Turtle, her eyes still watery from another outburst.

As recess neared its end, a half-dozen of the kids carefully placed their stuffed animals atop a green metal bench.

Siena leaned down and pointed at Glamour.

“Stay there,” the girl said, racing to the monkey bars to see who could swing the farthest.

A pair of teachers — each holding red bags packed with first-aid kits — watched while their students ran, jumped, climbed and laughed.

When it was time to go back to class, the playground grew quieter as the first-graders returned to the bench. Then they picked up the stuffed animals and disappeared inside their school. n ©The Washington Post

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TECHNOLOGY

The ability to walk, but at a high cost BY

T RAVIS M . A NDREWS

A

shley Barnes was 35 years old when doctors told her she would never walk again.

A botched spinal procedure in 2014 paralyzed her from the waist down. The Tyler, Tex., resident had been an avid runner, clocking six miles daily when not home with her then-9-year-old autistic son, whom she raised alone. Life in a wheelchair was not an option.

“I needed to be the best mom I could be,” Barnes said. “I needed to be up and moving.”

So she threw herself into physical therapy, convinced she would one day run again. Soon she realized that wasn’t a reality.

Although she wore a brave face, “I would save my moments of crying for my room,” she said.

About a year later, hope resurfaced when she learned of the ReWalk system, a battery-powered robotic exoskeleton that attaches to the legs and lower back.

It contains motors at the knee and hip joints and sensors to help it adjust with each footfall. While wearing the device and holding two forearm crutches, someone with complete lower-limb paralysis can walk.

Rehabilitation centers often employ such devices in physical therapy, which is how Barnes first encountered one at the Baylor Tom Landry Center, a rehab clinic in Dallas. After seven months without being able to stand, she did. Then she took a step as she began to learn how to walk again.

In 2014, the ReWalk system became the first personal robotic exoskeleton approved by the Food and Drug Administration. The following year, the Department of Veterans Affairs agreed to cover the exoskeletons for qualifying vets. Meanwhile, several companies began touting similar devices. For example, Ekso makes units used to rehabilitate people after spinal cord injury or stroke.

Health insurers, however, generally don’t cover the expensive equipment.

After working with the ReWalk system at her rehab center,

EKSO BIONICS

Robotic exoskeletons can help paralyzed people, but insurers usually won’t cover the equipment Barnes, who uses a wheelchair at home to get around, decided she wanted one of her own. But Tricare, her insurer, denied the request.

In a statement, Tricare said it “does not cover these devices for use on a personal basis due to concerns with their safety and efficacy. This is particularly important due to the vulnerability of paralyzed users in the event of a fall.”

Two years and countless no’s later, Barnes still doesn’t have one because, according to Tricare, it isn’t “medically necessary.”

Barnes strongly disagrees.

“This is medically necessary,” she said. If she had one of the devices, “I’d be able to go to the bathroom. I would be able to walk around, exercise in it. I would love to be able to stand up and cook things in my microwave or on my stove.”

She paused before adding, “I would no longer have to look up at

my son.”

The ReWalk Personal 6.0 System costs, on average, $81,000.

Ottobock’s C-Brace is priced at $75,000. For the Indego Personal, which received FDA approval last year, it is $98,000.

About 28 percent of the more than 5.2 million Americans living with paralysis survive on an annual household income of less than $15,000, according to the Christopher and Dana Reeve Foundation. The basic expenses of living with paraplegia are, on average, $519,520 in the first year and $68,821 each subsequent year, according to the National Spinal Cord Injury Statistical Center. Furthermore, only 34.3 percent of people are employed 20 years after a paralysis-causing injury.

To date, ReWalk has sold only 118 personal devices in the United States.

Some people do get devices covered by insurance, but it can

Ekso makes exoskeletons used to help people after spinal cord injury or stroke.

Rehabilitation centers often use such devices in physical therapy, but some people want their own for personal use.

be an onerous process, as evidenced by Mark Delamere Jr. The Boston native, 19, was paralyzed in a car accident in 2013, on the third day of his freshman year of high school.

Like Barnes, he thought he would never walk again. Like Barnes, with the help of a robotic exoskeleton, he did. Unlike Barnes, though, he has an exoskeleton at home.

But for two of his teenage years, he sat in a wheelchair while his family filed claims and appealed denials.

“They don’t really classify these things with the purpose of you getting better, because they think the injury is never going to change,” said his father, Mark Delamere Sr. Eventually, though, Mark Jr. got approved by his insurance company and received the ReWalk, which he uses for at-home therapy and just to “walk around the house and the neighborhood, up and down the street.” Asked to describe the feeling, he was at a loss for words.

But his story is rare. “People are paying out of pocket or fundraising” for exoskeletons, said Dan Kara, research director for robotics at ABI Research, a technology analysis and consultant company.

The price of the devices exceeds their value in the eyes of insurers, which “want to be able to prove they actually improve quality of life and utility,” said Howard Forman, a Yale professor of diagnostic radiology and public health.

“Utility” means that an exoskeleton would provide a medical benefit beyond simply helping people move around and complete daily tasks.

Virginia Tech researchers found that these devices, by getting otherwise immobilized people to move around, can help them manage spasticity — a continuous contraction of muscles, which can be quite painful — and improve bowel function. Barnes said when she was training with the exoskeleton, tending to her bowels took about 20 minutes each day, not the customary hour.

One major concern is how rela-

SUNDAY, JUNE 18, 2017

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FAMILY tively untested the technology is outside the controlled environment of a rehabilitation facility.

Indeed, they don’t always work as planned.

Stacey Kozal, a 42-year-old Ohio resident, was paralyzed from the waist down after what she said was a devastating flareup of lupus. For more than a year, she fought with her insurance provider, Anthem, in hopes of obtaining Ottobock C-Braces.

Eventually, Anthem agreed to cover a C-Brace for each leg, which Kozal used to hike the Appalachian Trail, where limitations revealed themselves. The battery required constant recharging.

Rain was problematic because the C-Brace isn’t waterproof.

C-Braces are heavier than traditional devices, so when their batteries died on the trail, they made it more difficult for her to move around.

Another major issue for insurers, though, is the price. But Forman said, “Though these technologies are incredibly expensive now, we have all kinds of evidence that eventually . . . they can become affordable to anyone.”

Indeed, some entrepreneurs are working on cheaper solutions.

Silicon Valley start-up SuitX created a lightweight model called the Phoenix. While most exoskeletons have motors powering each joint, the Phoenix simply uses two hip motors. Even so, if approved by the FDA, the device would cost $40,000, according to SuitX. “The rehabilitation marketplace is limited by the number of people who have these conditions,” Kara said. The exoskeletons are “basically handcrafted, which is expensive. If you could up the volume, you could lower the price.”

The key would be expanding the user base. One way to do that, he noted, is to sell the devices for purposes other than rehabilitation. Warehouse workers might wear them to assist with lifting heavy loads. Some companies are already testing this idea.

Waiting for exoskeleton prices to drop is tremendously frustrating, Barnes said. “We take so much for granted when we don’t have physical problems,” she said.

“Like just being able to reach up and grab something in my laundry cabinet without having to break my neck to get it.” n © The Washington Post

KLMNO WEEKLY

Study finds dads play rough with sons, sing to daughters BY

A RIANA E UNJUNG C HA

T

he idea that fathers have a sweet spot for their daughters and are stricter with their sons is something of a cliche. Researcher Jennifer Mascaro wanted to find out to what extent this was true. So she persuaded 52 new dads to give her an intensely intimate glimpse at 48 hours of their lives through recording devices that documented interactions with their children, who were ages 1 to 2.

Mascaro and her colleagues at Emory University and the University of Arizona took apart each exchange and coded them to see whether there were any patterns based on the children’s genders.

The differences were startling.

With their boys, the dads tended to engage in more rough-andtumble play. They also favored language related to achievement, such as “proud,” “win” and “top.”

Fathers of daughters sang more and used more emotional words, especially as related to sadness, and more analytical words, such as “all,” “below” and “much.”

“Historically, this is a thorny thing to study,” Mascaro said in an interview. “It isn’t something that’s very amenable to asking people, so we’ve never really had a good handle on how the gender of a child influences the behavior of a parent.”

Until recently, little research has looked at the role of fathers in parenting. Part of that was because not until this generation did fathers in Western society begin to spend significant time with their children. One study, presented at a conference in 2014, found that today’s working fathers spend an average of 35 minutes a day focused on their offspring. That’s seven times more than the five minutes their predecessors were spending in 1974 — but still only about half the full hour mothers spend with their children daily.

The analysis of the recordings

by Mascaro and her colleagues, published in Behavioral Neurosci-

ence, a journal of the American Psychological Association, is one component of a larger study about paternal relationships. Although the study is small and limited to fathers who live with their partners, it captures what is considered to be a key stage in a child’s development. At age 1, breastfeeding is typically over and children are starting to walk, and that’s often when a father’s relationship with his child really begins to blossom.

that a dad’s strong reaction to a boy’s neutral facial expression appeared to be correlated with the amount of their more physical play.

All social mammals do this play when they are young, and scientists have theorized that it may be important training for social competence.

“Rough and tumble is this special situation where this kind of movement is okay, but you really have to attend to your partner’s

ISTOCKPHOTO

The Behavioral Neuroscience paper also revealed the results of a second experiment in which those same dads were shown pictures of their child with happy, sad and neutral expressions while MRI images were taken of the men’s brains.

Based on the finding that fathers tend to attend to and talk about emotions more with girls, Mascaro said she predicted fathers would respond more to daughters. That turned out to be true, with greater neural responses in the regions for reward and processing emotions when the men were shown the happy pictures. Their reaction to the boy pictures were slightly less expected, she said, as they tended to respond more robustly to neutral facial expressions.

Mascaro is not sure how to explain this, but the researchers noticed one “potential clue,” she said:

emotions: Are they still having fun? I think it’s really intriguing to think that attending to more ambiguous facial expressions might be important,” she said.

Mascaro, an assistant professor in family and preventive medicine at the Emory School of Medicine, said there isn’t nearly enough information yet to draw conclusions about children’s future outcomes from the study. Nor is there evidence to figure out much about the origins of the fathers’ brain responses, such as whether they were caused by some genetic component or a matter of conforming to societal norms about gender.

“Findings like this shouldn’t necessarily be taken as ill-intent or negative on the part of the fathers,” she said. “It really could indicate fathers trying to do the best they can to prepare their children for the world.” n ©The Washington Post

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KLMNO WEEKLY

BOOKS Biography

Ernest Hemingway

A Biography

By Mary V. Dearborn (Knopf) This thorough reexamination of Hemingway shows the writer to be a more troubled, complex and tragic figure than most previous biographies have allowed.

Madame President

The Extraordinary Journey of Ellen Johnson Sirleaf

By Helene Cooper (Simon & Schuster) A penetrating history of Liberia and the story of Ellen Johnson Sirleaf, who became the first woman elected president of an African nation.

Richard Nixon

The Life

By John A. Farrell (Doubleday) By employing recently released government documents and oral histories, Farrell has written the best one-volume, cradle-to-grave biography that we could expect about such a famously elusive subject.

Rising Star

The Making of Barack Obama

By David Garrow (William Morrow) Garrow shows us the calculations Obama made in the decades leading up to winning the presidency.

Robert Lowell

Setting the River on Fire

By Kay Redfield Jamison (Knopf) There are no half measures to Kay Redfield Jamison’s medicobiographical study of poet Robert Lowell. It is impassioned, intellectually thrilling and often beautifully written.

Current Events

An American Sickness

How Healthcare Became Big Business and How You Can Take It Back

By Elisabeth Rosenthal (Penguin Press) An authoritative account of the distorted financial incentives that now drive medical care in the United States.

37 WE’VE LOVED SO FAR IN 2017

B

ooks are the most willing travel companions. No matter how much you’ve overpacked your bags, there’s always room to squeeze in an engrossing novel, a nail­biting thriller or an illuminating biography.

What’s more miraculous: Even if you can’t travel this summer, a good book can still take you to a place far away. Get those suitcases ready, because we’ve picked 37 titles that we’ve loved so far this year. n — Ron Charles, Book World editor

(Simon & Schuster) A poignant account of how the people of Janesville, Wis., reacted to the closure of their General Motors plant.

No One Cares About Crazy People

The Chaos and Heartbreak of Mental Health in America

By Ron Powers (Hachette) Powers argues that the future of mental health in the United States is being shaped along two trajectories: a flourishing research enterprise juxtaposed with a chaotic system of delivering care.

On Tyranny

Twenty Lessons From the Twentieth Century

By Timothy Snyder (Tim Duggan) Steeped in the history of interwar Germany, Snyder writes with bracing immediacy about how to prevent, or at least forestall, the repression of lives and minds.

Fiction

American War

By Omar El Akkad (Knopf) When climate change sparks a devastating civil war in the United States in the late 21st century, one young woman fights to avenge her family’s destruction.

Anything Is Possible

By Elizabeth Strout (Random House) In these short stories, Strout returns to Amgash, Ill., where the protagonist of her 2016 novel, “My Name Is Lucy Barton,” was raised.

A Book of American Martyrs

By Joyce Carol Oates (Ecco) An explosive story about the family of an abortion doctor and the family of the man who murdered him.

Borne

By Jeff VanderMeer (FSG) In a ruined city littered with discarded biotech experiments, a young woman finds a strange life form that she decides to raise.

Exit West

Janesville

By Mohsin Hamid (Riverhead)

An American Story

By Amy Goldstein

Two Middle Eastern lovers fleeing

SUNDAY, JUNE 18, 2017

19

KLMNO

BOOKS the migrant crisis arrive in California, where they must contend with natives, other refugees and their grief for what they have left behind.

ny so that she can work on her memoir, but the nanny has a secret project of her own.

Written in the final two years of her life, a mother’s poignant memoir about her life, family and last days.

Lincoln in the Bardo

History

Hunger

By George Saunders (Random House) When President Lincoln’s 11-yearold son, Willie, is laid to rest in Georgetown’s Oak Hill Cemetery, the ghosts engage in a spirited debate about how to move the boy along to the next level of existence.

The Blood of Emmett Till

By Timothy B. Tyson (Simon & Schuster) Tyson clears away the myths that have accumulated over the decades and restores the immediacy of this quintessentially American tragedy.

The Ministry of Utmost Happiness

By Arundhati Roy (Knopf) In her first novel since “The God of Small Things” (1997), Roy draws us through a kaleidoscopic story about the struggle for Kashmir’s independence.

No One Is Coming to Save Us

By Stephanie Powell Watts (Ecco) In a North Carolina town ground down by factory closings, an African American family struggles to survive. Then a handsome young man returns home promising to make a new life and lift them up.

The Evangelicals

By Frances FitzGerald (Simon & Schuster) FitzGerald shows how a movement that began in reaction to the Calvinist establishment of New England shaped American identity in the first decades of the 19th century.

Jefferson

Architect of American Liberty

By John B. Boles (Basic) Perhaps the finest one-volume biography of an American president.

Norse Mythology

Killers of the Flower Moon

By Neil Gaiman (Norton)

The Osage Murders and the Birth of the FBI

By David Grann (Doubleday)

Gaiman transmutes the tales of ancient Scandinavia into expertly paced short stories for the 21st century.

Saints for All Occasions

By J. Courtney Sullivan (Knopf) Two Irish sisters come to the United States. One begins a family and the other becomes a cloistered nun, but their very different lives remain tethered by a fateful deception.

Standard Deviation

By Katherine Heiny (Knopf)

For present-day Osage communities, the events related in “Killers of the Flower Moon” are not last century’s news but yesterday’s.

Many members of the tribe still wonder what exactly happened to their relatives.

Memoir

The Bright Hour

A Memoir of Living and Dying

By Nina Riggs (Simon & Schuster)

A Memoir of (My) Body

By Roxane Gay (Harper) From the author of “Bad Feminist,” a long-awaited memoir about her struggles with weight and childhood traumas.

Option B

Facing Adversity, Building Resilience, and Finding Joy

By Sheryl Sandberg and Adam Grant (Knopf) Sandberg, whose husband died in 2015, illustrates with heartbreaking honesty that nothing can inoculate you against the pain of grief.

Priestdaddy

By Patricia Lockwood (Riverhead) Poet Patricia Lockwood’s darkly comic memoir about returning home to her parents’ house in Kansas, where she is forced to reassess her relationship with her eccentric father, a married Catholic priest.

The Skin Above My Knee

By Marcia Butler (Little, Brown) How did this distinguished oboist save herself from a detached, withholding mother and a sexually abusive father? In this insightful memoir, she reveals the answer and more.

Mysteries & Thrillers The Long Drop

By Denise Mina (Litttle, Brown) Based on the true story of Scotland’s most infamous serial killer,

WEEKLY

a chilling novel set in 1950s Glasgow.

Not a Sound

By Heather Gudenkauf (Park Row) Two years after losing her hearing, a nurse discovers the corpse of a co-worker in the woods near her Minnesota cabin — and realizes her life is in jeopardy.

Since We Fell

By Dennis Lehane (Ecco) Lehane’s 14th novel, which takes the author back to his old New England stomping grounds of “Mystic River,” is a pleasantly twisted character study of a disgraced television journalist who shoots her second husband in the first scene.

Pop Culture & Social Sciences Homo Deus

A Brief History of Tomorrow

By Yuval Noah Harari (Harper) Harari presents three possible futures: In one, humans are expendable. In a second, the elite upgrade themselves, becoming another species that sees everyone else as expendable. In a third, we all join the hive mind.

Letterman

The Last Giant of Late Night

By Jason Zinoman (Harper) A definitive and enjoyable biography of the late-night legend and why he was better at his job than Jay Leno.

The Poetry of Pop

By Adam Bradley (Yale) Are pop music lyrics poetry? A tour of musical history that gets to the bottom of this age-old question. © The Washington Post

At the center of this witty novel on family life is a mother with an outsize personality who must deal with things such as a son who’s an origami prodigy.

The Twelve Lives of Samuel Hawley

By Hannah Tinti (Dial) A widower with a violent criminal past moves into a small Maine fishing town hoping to establish a safe space for his daughter, who gradually learns the stories behind her father’s 12 bullet scars.

Woman No. 17

By Edan Lepucki (Hogarth) A mother of two boys hires a nanLISK FENG FOR THE WASHINGTON POST

SUNDAY, JUNE 18, 2017

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KLMNO WEEKLY

OPINIONS

I backed it, but it’s time to end the death penalty BILL RICHARDSON is a former governor of New Mexico and a former United States ambassador to the United Nations. He is the founder of the Richardson Center for Global Engagement.

He wrote this for The Washington Post.

I’ve always viewed it a sign of wisdom to demonstrate the ability to change your mind — that goes double if you’re an elected official. As New Mexico’s governor in 2009, I changed my mind regarding the death penalty and signed a bill to abolish it after having supported it for decades.

Empirical evidence and common sense convinced me that the death penalty is an ineffective deterrent, is unfairly applied and has become increasingly costly for states.

Since 1973, according to the Death Penalty Information Center, the number of wrongly sentenced men and women freed from death row has climbed to 159.

A DPIC study found 88 percent of criminologists don’t believe the death penalty is an effective deterrent to crime. Numerous studies suggest the same.

In its 2015 ruling outlawing capital punishment in Connecticut, that state’s Supreme Court explained why the death penalty is unfair: “The death penalty has been imposed disproportionately on those whom society has marginalized socially, politically, and economically: people of color, the poor and uneducated, and unpopular immigrant and ethnic groups. It always has been easier for us to execute those we see as inferior or less intrinsically worthy.”

The practice is wrong, and I hope it isn’t long for this world.

More recently, one method of execution, lethal injection — once seen as “more humane” than others — has made the debate not just one about the morality of the death penalty, but one about the way that it can lead to a failure of governance and damage to a state’s reputation.

As the second-poorest state in our nation, Arkansas sorely needs private investment to boost growth and employment. It’s recent initiative, “Arkansas Inc”,

exists to present the state as a “pro-business environment operating leaner, faster and more focused through a streamlined state government.” But at the same time Arkansas is trying to bolster its image as a well-run state, officials rushed to carry out a flurry of executions in April to beat the expiration date of Arkansas’s supply of one of its lethal injection drugs.

Arkansas carried out these lethal injections even though more than 20 firms worldwide now oppose the sale of their products for this use, and have taken steps to effectively close the market for these drugs. This string of executions followed the passage of a law in the state legislature (upheld in the state’s Supreme Court) giving officials cover to secretly obtain these drugs, whether or not drugmakers want to sell them for use in executions.

Several court challenges briefly delayed several of the executions, including one ultimately unsuccessful suit that contended Arkansas purchased the drugs and sought to conceal their intended use.

Pharmaceutical distributor McKesson Medical-Surgical, a subsidiary of the country’s fifthmost-successful company, according to Fortune — the type of firm Arkansas should be courting, not battling — sued the state for using “false pretense, trickery, and bad faith.” Two other

STEPHEN LAM/REUTERS

companies filed supporting legal briefs, arguing the state’s actions were not only anti-business but created “a public-health risk by undermining the safety and supply of lifesaving medicines” that could otherwise be used “to treat 1,800 patients in life-saving operations.” In their effort to push through these executions, state officials needlessly hastened the application of an unjust policy while senselessly placing Arkansas at odds with the private sector.

Delaware hasn’t seen a similar spate of executions, and last year its Supreme Court struck down the state’s death penalty statute as unconstitutional. But last month, the state’s House of Representatives voted to reinstitute it. As a state that has worked successfully for decades to build an international brand as America’s leading incorporation venue, a major source of its revenue, Delaware could lose if the globally disfavored death penalty once again becomes law.

In the same way that the private sector responded to antiLGBT laws passed in states such as Indiana and North Carolina, death-penalty states have to recognize that our increasingly small world is watching, and organizing against wrongheaded public policy by redirecting investment dollars.

Escalating costs of prosecuting death-penalty cases also means a higher burden on governments. A report produced for lawmakers in

my home state showed it would cost as much as $7.2 million to reintroduce capital punishment.

Arkansas, Delaware and other death-penalty states have a choice. They can pursue a just and prudent course, or they can cling to this failed policy even though it hurts their residents.

As a former ambassador to the United Nations and the sole United States commissioner on the International Commission Against the Death Penalty, I worry about America’s isolation on this critical human rights issue. States that continue to employ the death penalty will remain isolated from the growing international consensus.

The death penalty won’t be abolished by a single judicial decision, legislative act or election cycle, but there are signs that the tide is turning to end it for good. In local elections, notably for district attorney, antideath-penalty candidates — Charles Todd Henderson in Jefferson County, Ala., and Jason Krasner in Philadelphia — are showing they can win. The results coincide with changing public opinion: Last year, Pew Research found public support for the death penalty at a four-decade low.

To effectively represent the interests of citizens, and protect our nation’s role as a global leader, a new generation of policymakers and politicians must put the death penalty to rest once and for all. n

SUNDAY, JUNE 18, 2017

21

OPINIONS

KLMNO WEEKLY

TOM TOLES

Tragedy puts Congress on one team DANA MILBANK writes about political theater in the nation’s capital. He joined The Washington Post as a political reporter in 2000.

There was an eerie silence in the House chamber when the gavel fell to open Wednesday morning’s session.

This was supposed to be the time for “morning-hour” speeches, those short partisan jabs and one-liners. But not a single lawmaker was on the floor, the brown-leather benches and speakers’ tables all empty.

Without even the invocation or the pledge, the speaker pro tempore immediately declared the still chamber in recess.

The partisan guns had been silenced by a real one. Not three hours earlier, a would-be assassin critically wounded Steve Scalise, the House majority whip, and injured four others on a baseball field before falling to police bullets. In an instant, members of Congress were transformed from Democrats and Republicans into Americans — and humans.

Reminded suddenly of their own mortality, they remembered, too, that their opponents are people.

Democrats at their baseball practice — the two teams were preparing separately Wednesday morning for Thursday night’s Congressional Baseball Game — gathered in their dugout upon hearing the news and bowed their heads in prayer for their Republican colleagues.

When the House reconvened at noon, Rep. Chuck Fleischmann (R-Tenn.) looked stunned as he

walked onto the House floor, still wearing his cap, jersey, baseball pants and muddy cleats. Spotting Rep. Mike Doyle of Pennsylvania, manager of the Democrats’ team, he called out “Hey, Coach!” — and the two embraced.

“We are united in our anguish,” House Speaker Paul Ryan told the House, now nearly full. “An attack on one of us is an attack on all of us.” Democrats and Republicans alike rose in the first of four standing ovations for the speaker.

The Democratic leader, Nancy Pelosi, rose to say that “I pray for all of you,” and “I pray for Donald Trump, that his presidency will be successful.” The gunman, she said, caused “an injury in the family.”

Ryan’s words echoed those of his predecessor, John Boehner, six years ago when then-Rep. Gabby Giffords (D-Ariz.) was shot in the head: “An attack on one who

serves is an attack on all who serve.” Then, members of Congress paid tribute to Giffords for eight hours on the House floor, and both sides pledged to temper their rhetoric as they waited for Giffords to return.

She never returned to Congress, but the sniping did, and, with the rise of President Trump, it got dramatically worse.

Undoubtedly, business-as-usual will return this time, too. Even on Wednesday, there were hints of a breakdown in the comity. Rep. Jeff Duncan (R-S.C.), taking a distinctly different tack from Ryan, proclaimed repeatedly before the cameras that the shooter was “targeting Republicans.” Rep. Joe Crowley (D-N.Y.) took a swipe at the “no holds barred” firearm laws in Virginia, where the shooting occurred, and he reminded reporters that responsible rhetoric “starts at the top.”

True, but the shooting is a reminder to those of us who have warned of Trump’s incitements to violence that there are deranged people of all ideologies who can be inflamed by angry rhetoric.

For the moment, there was at least a tacit recognition that the toxic tone had to change.

Lawmakers gathered in the Capitol Visitor Center during the late morning for a members-only

briefing. It was a solemn processional: Only a few stopped to talk to some of the 200 journalists lining the hallway, the rest silently filing in to learn more about the attempt to kill their colleagues.

One who did pause was a shaken Rep. Joe Barton (Tex.), manager of the Republican team.

He choked up twice as he thanked the Capitol Police for preventing a massacre. “They attacked the shooter, and that saved our lives,” Barton said, accompanied by his young son, who had also been at the shooting.

The lawmakers moved next to the House floor, where Father Pat Conroy, the chaplain, prayed that “Republicans and Democrats be mindful of the rare companionship they share.”

Ryan, in perhaps his best speech, continued the homily: “I ask each of you to join me,” he said, “to show the country, to show the world that we are one house, the people’s house, united in our humanity.”

The baseball game was played Thursday, as scheduled.

There is something magical about the national pastime uniting our leaders — and something tragic that it takes the bullets of a madman to remind them that their opponents aren’t their enemies. n

SUNDAY, JUNE 18, 2017

22

KLMNO WEEKLY

OPINIONS

BY SIGNE WILKINSON FOR THE PHILADELPHIA DAILY NEWS

Restrict Big Pharma from doctors NICOLE VAN GRONINGEN is an internal medicine physician at the University of California at San Francisco. She wrote this for The Washington Post.

The last time you left your doctor’s office with a new prescription, you probably assumed she thoughtfully selected it as the best treatment for your condition. But if your doctor — like half of American physicians — accepts visits and the occasional free lunch from pharmaceutical representatives, there’s a good chance that drug choice was heavily biased.

Physicians — myself included — aren’t immune to the behavioral manipulation of marketers, and Big Pharma knows it. In 2012, the pharmaceutical industry spent $24 billion marketing its premium branded drugs to health-care professionals — eight times the amount it spent on advertising to consumers. In recent years, a growing segment of the medical community has spoken out against the industry’s inordinate efforts to influence doctors. Since 2006, a number of teaching hospitals have enacted policies that restrict or ban visits from pharmaceutical representatives in hopes of limiting the industry’s influence.

And last month, the California Senate passed a bill that would ban drug companies from giving gifts to doctors.

The bill coincides with the release of hard evidence that spending money to influence

doctors actually works. A study published last month in JAMA found that physicians from hospitals that restricted visits and gifts from drug representatives ordered significantly fewer promoted brand-name medications and prescribed more cost-effective generic versions than those in other hospitals.

The study isn’t the first to highlight the disconcerting link between doctors’ prescribing habits and their interactions with pharmaceutical representatives.

A 2016 ProPublica analysis found that physicians who received payments from drug and medical device companies were significantly more likely to prescribe high-cost branded medications.

My own experience with the pharmaceutical industry bears witness to this unsettling phenomenon. Once, as a junior medical resident, a

BY ADAM ZYGLIS FOR THE BUFFALO NEWS

pharmaceutical representative visited my department and offered to take a handful of us to a trendy Manhattan restaurant as part of an “educational” dinner. I went. The drug that was promoted that evening, which cost roughly 500 percent more than a dirt-cheap (and just as effective) alternative, still sticks out in my mind as a go-to treatment option for a common disease in my field. I’m sure this isn’t a coincidence.

The losers in this interaction between the pharmaceutical industry and physicians are, of course, patients. The high costs of branded drugs are revenue to drug companies, but out-ofpocket expenses to health-care consumers. Almost a quarter of Americans who take prescription drugs report that they have difficulty affording their medications, and the high costs of these drugs is a leading reason that patients can’t adhere to them. Most branded drugs offer minimal — if any — benefit over generic formulations. And if doctors prescribe brand-name drugs that are prohibitively more expensive than generic options, patients might forgo the medications altogether — causing greater harm.

On a national scale, the financial burden imposed by

branded drugs is enormous.

Current estimates place our prescription drug spending at more than $400 billion annually, and branded drugs are almost entirely to blame: Though they constitute only 10 percent of prescriptions, they account for 72 percent of total drug spending.

Even modest reductions in our use of branded prescription drugs — on par with the roughly 8 percent relative reduction seen in the JAMA study — could translate to billions of dollars in national health-care savings.

As any doctor can tell you, truly valuable drugs sell themselves.

Adoptions of new antiviral medications for hepatitis C, for instance, went through the roof — even with their hefty price tags — in the wake of clinical trials that showed the extraordinary benefit of the new medications over the old standard of care. The case for these drugs was made with high-quality clinical evidence, not with marketing.

Admittedly, the problem of rising prescription drug prices has deep and complicated roots that extend beyond the drug industry’s direct influence on physicians. But restricting pharmaceutical representatives’ access to our clinics and hospitals is a low-effort and high-yield first step in bending the cost curve. n

SUNDAY, JUNE 18, 2017

23

KLMNO WEEKLY

FIVE MYTHS

Famine BY

G AYLE S MITH

As the looming threat and tragic reality of famine spread across South Sudan, northern Nigeria, Somalia and Yemen, 20 million peo­ ple are in urgent need of food and other assistance. But even with grim reports from the United Nations’ relief agencies and images of starving children, there is widespread confusion about what famine is and what we can do to help.

MYTH NO. 1 Famine is caused by drought or overpopulation.

The Horn of Africa has seen many droughts, and not all have resulted in famine. And the countries at greatest risk of famine today are hardly the most densely populated.

Famine strikes countries and regions when poverty and vulnerability go untended because of government neglect, underinvestment in development and, sometimes, willful obstruction.

The United Nations and famine experts agree that the four crises we are witnessing now, for example, are man-made and made worse by chronic conflicts.

Poor communities in northern Nigeria are the playing fields of the terrorist group Boko Haram.

The presence of al-Shabab in Somalia constrains commerce and the operations of a new and still weak government. The government and opposition in South Sudan continue to wage a bloody war. And in Yemen, a devastating war between coalition forces and Houthi rebels has pounded that country’s economy into the Stone Age and impeded relief efforts.

MYTH NO. 2 To prevent famine, we need better ways to predict it.

The Famine Early Warning Systems Network (FEWS NET), created by the U.S. Agency for International Development, analyzes weather, food prices, nutrition data, population displacement and other

indicators, pooling information and comparing assessments with other countries and the United Nations to collectively determine the level of risk. FEWS NET and most aid agencies rank situations on a five-point scale, going from “minimal” food insecurity to “stressed,” “crisis,” “emergency” and finally “famine.”

When this information is acted upon by governments and international partners, particularly in the early stages, famine can be and often is prevented. The specificity of the available data and analysis not only allows the global community to intervene but helps inform the kinds of intervention that are needed.

The challenge arises when governments refuse to act or when combatants prevent action.

HANI MOHAMMED/ASSOCIATED PRESS

Yemenis receive food rations provided by a local charity in Sanaa on April 13. Yemen is one of several nations on the brink of famine.

MYTH NO. 3 A country on the brink of famine is on the verge of crisis.

A crisis is well underway by the time conditions merit the “famine” label. At Level 5, there are two deaths per 10,000 people, or four child deaths per 10,000 children, happening every day from a lack of food; at least 1 in 5 households is experiencing an extreme lack of food; and acute malnutrition exceeds 30 percent in a given area.

leaving people susceptible to diseases, such as malaria or cholera, that are not always killers in other contexts but can be fatal to people whose bodies are compromised by starvation.

Famine emergencies can also aggravate noncommunicable diseases, such as heart disease, high blood pressure, diabetes and cancer. Diarrhea, too, is extremely common. Because of the lack of healthy food, clean water and medical care, treatable diseases and conditions rapidly turn into deadly ones.

Moreover, famine can inflict irreparable harm on those who survive. Children are most vulnerable in these settings.

Inadequate nutrition and repeated infections during the first 1,000 days of a child’s life can cause stunting, which has irreversible long-term effects on their physical and mental development. In 2015, according to the World Health Organization, there were 156 million stunted children under 5.

MYTH NO. 4 During famine, the greatest risk is starving to death.

Starvation is typically not the primary cause of death.

The process of starving weakens the immune system,

MYTH NO. 5 Famine relief and other aid enables corrupt officials and doesn’t help people in need.

True, some self-described “leaders” care so little for their people that they loot

international relief aid or abandon their citizens to the international community, as the government in South Sudan has done. And corruption is often rife in poor countries. But local and international humanitarian workers have proved time again that they can reach people in need, often at great personal risk.

The sweeping assertion that we are wasting our money also discounts potential and positive trends that could prove far more potent over time. A growing number of developing countries are investing in the agricultural sector, upon which millions depend, and generating lasting results by combining policy reforms, money from their own budgets and donor assistance.

According to Feed the Future’s 2016 progress report, poverty has fallen between 7 and 36 percent in 11 focus countries since 2011.

Child stunting has been reduced by more than 20 percent among 604,000 participating households. In areas of Ethiopia where Feed the Future works, poverty is down 12 percent. n Smith is president and chief executive of the ONE Campaign and a former administrator of the U.S. Agency for International Development. She wrote this for The Washington Post.

SUNDAY, JUNE 18, 2017

24

GREAT WINE. GREAT FOOD. GREAT FUN.

It’s the largest gathering of wineries in the region, and the only professionally-judged wine event dedicated to wines produced in Chelan, Douglas, Grant and Okanogan counties. And this year it’s bigger than ever—more food, wine, beers, ciders, distilleries and eateries.

Saturday, August 26, 2017

6pm to 9pm

Town Toyota Center, Wenatchee

Tickets $45 each • A limited number of VIP tickets available for $75 each Available online at wenatcheewineandfood.com or at the door Presented by Foothills Magazine

oothills

Interested in having a booth at this event?

E-mail us at info@wenatcheewineandfood.com

WENATCHEE ❆ LEAVENWORTH ❆ CHELAN AND ALL OF NORTH CENTRAL WASHINGTON

Presented by

Port of Chelan County • Banner Bank • Tastebuds Coffee & Wine • Spokane Industries • Port of Douglas County • Moss-Adams, LLP • Great Northwest Wine Visconti’s Italian Restaurant • Blue Horizon Insurance & Financial Services • Haglund’s Trophies • Wenatchee Valley Museum & Cultural Center • Town Toyota Center