A CO Donegal man has been jailed for 14 days for refusing to provide for his children.Judge Paul Kelly handed down the sentence at a sitting of Carndonagh District Court.The case was a family law case, so the parties cannot be identified. The man had claimed he didn’t have any money.But under cross-examination by a solicitor he admitted spending money on weekend events and going out.He said he didn’t go to see his children because he didn’t have a car; and didn’t want to drive to see them in his tractor.The solicitor then produced Facebook pictures – posted by the man himself on his own Facebook Page – showing the man out at sea fishing in recent weeks.The solicitor said this left a huge question mark over the man’s claims that he didn’t have any money.Judge Paul Kelly said he believed the man was hiding income from his ex partner and their children. He jailed the man for 14 days for non-payment of maintenance towards them.14 DAYS BEHIND BARS FOR DONEGAL MAN WHO REFUSES TO PAY MAINTENANCE FOR CHILDREN was last modified: October 26th, 2014 by John2Share this:Click to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Reddit (Opens in new window)Click to share on Pocket (Opens in new window)Click to share on Telegram (Opens in new window)Click to share on WhatsApp (Opens in new window)Click to share on Skype (Opens in new window)Click to print (Opens in new window) Tags:CarndonaghFamily lawmaintenance
The HSE has again emphasised its commitment to the upgrade of St Joseph’s Community Hospital in Stranorlar.A statement from the authority to Donegal comes on the eve of a major march expected in the Twin Towns today organised by the St Joseph’s Hospital Action Group.Chairman of the group, Fr John Joe Duffy, has accused the HSE and the Government of making false promises to locals over the facility. A march in the Twin Towns today starting at 1pm is to allow people to voice their concerns about the future of the facility.However, the HSE has said they are “committed’ to the long-term future of St Joseph’s.The statement reads “The redevelopment of St Joseph’s Community Hospital, Stranorlar is included in the HSE Capital Plan.“An application for funding in 2019 is part of the capital bid submitted by HSE Estates North West. “The HSE 2019 Capital Plan is currently being finalised and it is intended to proceed with the procurement of a Design Team for this project this year, subject to normal approvals.“The HSE is committed to the long term future of the Hospital at St Joseph’s and will continue to work to ensure full HIQA compliance at the facility.”Twin Towns protest: HSE says it is committed to “long-term future” of St Josephs was last modified: March 25th, 2019 by StephenShare this:Click to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Reddit (Opens in new window)Click to share on Pocket (Opens in new window)Click to share on Telegram (Opens in new window)Click to share on WhatsApp (Opens in new window)Click to share on Skype (Opens in new window)Click to print (Opens in new window) Tags:donegalFr John Joe DuffyST JOSEPH’S COMMUNITY HOSPITALtwin towns
Why Tech Companies Need Simpler Terms of Servic… Tags:#Product Reviews#web 8 Best WordPress Hosting Solutions on the Market Using a feature called Fytch channels, you can find sites based on category as opposed to a specific URL. For example, there are channels like “Sports,” “Computers and the Web,” “Travel and Going Out,” etc. Supposedly, you can track topics with a special button but – call us blind – we didn’t see it. Instead, Channel pages seem to feature Digg-like voting buttons for promoting comments up or voting them down. Also, when browsing the specific channel’s page, if you click on a particular headline, you’ll see options to add that site to either “My Favorites” or “My Radar.” Unfortunately, these choices are a bit confusing since there doesn’t seem to be a specific section of the pop-up dashboard for tracking favorites (it’s only on the website itself), and clicking “My Radar” will actually have you then tracking the comments by that user on the site, not all the comments on the site itself. More useful is the “Add Website to My Radar” option, which lets you enter in the URL of a site to track instead. We wish an option to track a website would be added to the main Fytch toolbar, though. Finally, on the Fytch website, a section called “The Pulse” tracks hot topics in a hand-picked list of sites with a lot of Fytcher comments. Issues and ChallengesAlthough you have the option to choose between English and German on the site’s homepage, this preference doesn’t copy over to the comments themselves as you browse around the site’s Channels. That means you’ll end up seeing a lot of comments in the language you didn’t choose. For now, German seems to be more popular – probably because the company is based there. Another problem we experienced was removing a user we were tracking in Fytch. Although the user appeared on our My Fytch page, going to their profile didn’t give us the option to “unfollow” them, only the option to follow them (but we already were!). As it turns out, the “remove” option for deleting sites and users is tucked away under a small “edit” button on the main My Fytch page. We think that’s something that should be more prominently placed on the pop-up dashboard.While Fytch does make it easy to leave comments on any website, it faces the same challenges of any new startup relying on user-inputted data: it needs more users before it really becomes attractive. Besides, the majority of the sites you would want to track have their own commenting systems already built-in. Unless you feel you’re being heavily censored there, you may not see the value in using Fytch instead, especially since your comments would be seen by a much smaller audience. However, we like the way Fytch has implemented their service – a bookmarklet! Finally, a company that thinks the browser itself is the future, not another downloadable app. Since they’re still in beta, we’ll give them time to work out the other kinks we mentioned. If you want to try Fytch yourself, you can sign up here. A Web Developer’s New Best Friend is the AI Wai… There’s also a “Fytch Dashboard” where you can track the comments on your favorite sites, your comments with replies, and your Fytch friends list. Related Posts Top Reasons to Go With Managed WordPress Hosting Over the past couple of years, we’ve seen multiple social browsing experiments launch with plans to unite online users to collaborate, chat, and connect as they visit various websites. Services like Me.dium and Browzmi debuted with much fanfare, but in practice, the take-up on them has been limited to a relatively small set of users. More recent initiatives, like Adaptive Blue’s Glue, have fared a little better yet still seem to attract only the core audience of early adopters. Now a new service called Fytch aims to join this group with their “social commenting” service which allows you to leave comments on any website, whether or not that site supports comments or not. Will it do any better?Why Fytch?Fytch claims their technology allows for more “freedom of speech” since you’re now able to leave comments on any site on the web even if the site doesn’t have a commenting system in place. Plus, the comments left on a site using Fytch can’t be moderated or deleted by the site’s owners. The service seems most similar to Glue, a social browsing plugin which lets you identify what books, movies, and music your friends are into by tracking users’ activities on the web and then sharing that along with your personal comments with your online network. However, unlike Glue, Fytch doesn’t operate as a browser plugin. (Glue is limited to IE and Firefox only). Instead, all that’s required to use Fytch is a browser bookmarklet. For some reason, their website identifies this as a “Safari bookmarklet” but it actually works in any web browser. Before you can start using Fytch, you have to create a Fytch account. However, you’re able to sign in using Facebook Connect, Twitter, Google, Yahoo, or OpenID, so the process is relatively painless. Using FytchTo leave a comment, the process is simple. You click the bookmarklet, then click a button on the toolbar which appears so that you can leave your comment. This activity takes place in a pop-up window of sorts which hovers over the web page itself as opposed to a sidebar window, as many co-browsing services have used in the past. sarah perez
Derrick Rose #1 of the Cleveland Cavaliers dribbles the ball against the Washington Wizards at Capital One Arena on November 3, 2017 in Washington, DC. NOTE TO Rob Carr/Getty Images/AFPCLEVELAND — Derrick Rose’s injuries may have pushed him to a breaking point.The former league MVP, who has been trying to revive his career with the Cavaliers, left the team earlier this week to handle a personal matter. A team spokesman said Friday that Rose has been excused since Wednesday and there is no timetable for his return.ADVERTISEMENT Japan ex-PM Nakasone who boosted ties with US dies at 101 “We want him to take his time — just know the team, the coaches, the organization, we all have his back and wish him well,” Lue said before the Cavs, who have won six straight, hosted the Charlotte Hornets. “We expect to have him back. I reached out to him and texted him and told him that we support him. We know he’s going through a tough time right now.”Rose has played in just seven of Cleveland’s 18 games this season because of a left ankle injury the point guard sustained while driving to the basket on Oct. 20 in Milwaukee. He’s averaging 14.3 points per game in his first season with Cleveland.Rose’s career has been slowed by knee injuries, which have required surgeries. He sat out the entire 2012-13 season in Chicago and played only 10 games the following year due to injury.The medical issues have taken an understandable toll on Rose.“He has been through injury after injury for the last few years,” Hornets coach Steve Clifford said. “When you’ve played at an MVP level like he has, I’m sure that’s hard to take. Listen, he’s still playing at a high level. I think he averaged 18 points last year with New York and was playing well when he got hurt this month. They always say the toughest thing for the great ones is when you lose a step.”ADVERTISEMENT Kammuri turning to super typhoon less likely but possible — Pagasa Read Next The team did not offer any other details about Rose’s absence.ESPN reported that Rose is taking personal time “to evaluate his future in the NBA.” A team source told ESPN that Rose’s numerous injuries are “taking a toll on him mentally.”FEATURED STORIESSPORTSWATCH: Drones light up sky in final leg of SEA Games torch runSPORTSSEA Games: Philippines picks up 1st win in men’s water poloSPORTSMalditas save PH from shutoutRose’s agent, B.J. Armstrong, did not immediately return messages from the AP seeking comment.Cavs coach Tyronn Lue expects Rose to return to the team. Don’t miss out on the latest news and information. QC cops nab robbery gang leader, cohort MOST READ The 29-year-old Rose had been excited about a new start with Cleveland after spending last season with the New York Knicks. He signed a one-year, $2.1 million free agent contract this summer with the Cavs and was expected to be the team’s backup point guard behind Isaiah Thomas.However, Thomas is still recovering from a hip injury sustained last season with Boston, and Rose was thrust into a starting role.Rose dropped some weight to pressure off his knee joints, and showed flashes of his former self before getting hurt. The ankle had been bothering him for nearly a month when Cavs coach Tyronn Lue announced last week that Rose would be sidelined for “at least” two more weeks.Rose had been wearing a walking boot and undergoing treatment on his ankle. Typhoon Kammuri accelerates, gains strength en route to PH Stronger peso trims PH debt value to P7.9 trillion Rivals kick off title clash View comments Trending Articles PLAY LIST 00:50Trending Articles00:50Trending Articles02:04Hazing is a matter of perception, PNP chief Albayalde says01:29Police teams find crossbows, bows in HK university01:35Panelo suggests discounted SEA Games tickets for students02:49Robredo: True leaders perform well despite having ‘uninspiring’ boss02:42PH underwater hockey team aims to make waves in SEA Games01:44Philippines marks anniversary of massacre with calls for justice01:19Fire erupts in Barangay Tatalon in Quezon City LATEST STORIES Kris Aquino ‘pretty chill about becoming irrelevant’ CPP denies ‘Ka Diego’ arrest caused ‘mass panic’ among S. Tagalog NPA Brace for potentially devastating typhoon approaching PH – NDRRMC
Login/Register With: DIRECTOR’S BIO: Kris Booth’s many short films have screened in film festivals all over the world (including Tribeca, Palm Springs, Sprockets (TIFFkids), Giffoni, Iran International, Montreal) winning numerous awards. His award winning feature, “At Home By Myself… With You” (2009) screened in festivals across Canada, and took Kris to Cannes as one of Telefilm’s selections for the 2010 Marché du Film. The film is distributed by Mongrel Media. Since 2011 Kris has been keeping busy working in television.FILM: Ordinary DaysDIRECTED BY: Kris Booth, Jordan Canning, Renuka Jeyapalan WHAT WAS THE INSPIRATION FOR YOUR FILM?I’m fascinated how we communicate with people and how we base our actions on that communication… or miscommunication. How that interaction with people changes us and sets us on a path that hopefully shows us who we really are, or can be.WHAT WERE THE GREATEST CHALLENGES YOU FACED DURING THE FILM?Letting go of my expectations of how I believed the film was going to be made. Learning to let go, and go with the flow.WHAT APPEAL DO YOU THINK YOUR FILM WILL HAVE FOR AUDIENCESThe fact that there are 3 directors with 3 POV’s. also, the Thriller aspect, what happened to Cara.WHAT INSPIRED YOU TO BECOME A CREATOR?Jaws.WHAT ARE YOU WORKING ON NEXT?Surfing? That sounds good.WHAT ADVICE WOULD YOU GIVE TO ASPIRING FILMMAKERS?Forgive yourself everyday and continue dreamingWHAT ARE YOUR TOP 3 FAVOURITE FILMS OF ALL TIME?Jaws, Empire Strikes back and Raiders of the lost arc.IF YOU HAD TO DESCRIBE YOUR FILM IN THREE WORDS … WHAT WOULD THEY BE?Point of ViewIF YOU COULD RESHOOT ANY FILM MADE IN THE PAST 20 YEARS, WHICH ONE WOULD YOU CHOOSE AND HOW WOULD YOU CHANGE IT?Transformers, and I would add Heart, Character, and make it a metaphor for peace in the middle east.WHO ARE YOUR MENTORS? (AND WHY)My mom, she is the strongest person I knowMy wife, she is the smartest and most loving person I knowMy Brother, he taught me that the more you pull yourself up the stronger you become.WHISTLER FILM FESTIVAL SHOWTIMES:– DECEMBER 2, 2017, 9:30 PM – MYACGET YOUR TICKETS AT: https://whistlerfilmfestival.com/film/ordinary-days/SYNOPSIS: Cara Cook is a bright, athletic, college student who disappears without a trace. Five days play out three times from a trio of perspectives; her spiraling parents, the troubled detective assigned to her case and finally, Cara herself.CASTING AND CREDITS:Executive Producer: Relay Station, SeedaylightProducers: Glenn Cockburn, Brian Robertson, Ramona Barckert, Bryce MitchellCast: Jacqueline Byers, Michael Xavier, Torri Higginson, Richard Clarkin, Joris JarskyCinematographer: Michael McLaughlinEditing: Aren HansenScreenplay: Ramona Barckert. Ordinary Days Jacqueline Byers Michael Xavier Joris Jarsky Torri Higginson Richard Clarkin Mena Massoud Kimberly Laferriere GET YOUR TICKETS FOR THE WHISTLER FILM FESTIVAL TODAY LEAVE A REPLY Cancel replyLog in to leave a comment Facebook Advertisement Twitter Advertisement Advertisement
08Mar Rep. Eisen votes to support recreation opportunities for Harsens Island State Rep. Gary Eisen voted this week in favor of a plan to complete a recreation project from Harsens Island along the Krispin Blueway and Harsen’s Island bike trail in St. Clair County.The legislation approved by the Michigan House of Representatives, with Eisen’s support, includes $86,200 to acquire approximately nine acres located on Harsens Island along the Krispin Blueway and Harsen’s Island bike trail.Plans are to add an accessible kayak launch with a wetland boardwalk, parking, bathrooms, nature trail and a 25-foot-high observation tower looking out over the marsh.“Harsen’s Island is a great place to enjoy St. Clair County,” said Eisen, of St. Clair Township. “This plan will allow for needed updates and give our residents more outdoor opportunities.”The full plan includes $26 million for 34 recreational development projects and 30 land acquisition projects statewide, including the Harsens Island Kayak Access project.The project investments outlined in the proposal were recommended by the Natural Resources Trust Fund Board in December. Recommendations are subject to approval by the Michigan Legislature, a process started in the House Appropriations Committee last week. House Bill 4244 next advances to the Senate for further consideration.Money in the Natural Resources Trust Fund comes from the development of minerals on state land and is designated on an annual basis in partnership with local governments.### Categories: Eisen News
UK adults aged 18 to 24 years old spend more time watching video content on laptops than any other device, according to new research by GfK.The study reveals that young adults spend 41% of their daily viewing time watching on laptops, compared to 35% on TV, 14% on smartphones and 10% on tablets.The figures show a generational divide, with the overall adult population of the UK still opting for the TV as their preferred device for watching video.Among adults as a whole spend 65% of viewing time tuning in on TVs, 20% on laptops, 8% on smartphones and 7% on tablets.“There are many reasons underlying these findings, including the trend for this younger age group to view less live or scheduled TV content and more on-demand and online streamed video,” said Julia Lamaison, director of media research and insights at GfK.“Added to that is the fact that access to a TV set is lower amongst this group than for all adults: only 84% of these young adults say they own a TV set, compared to 95% amongst all adults.”British adults spend around 55 minutes viewing video content via a PC or laptop – with 67% of that content comprising of traditional TV programmes and movies.For those aged 18 to 24 years old, time spent viewing on a PC or laptop almost tripled to 2 hours and 35 minutes per day, with nearly 73% of that content TV programmes and movies.“This underlines the importance of content derived from linear broadcast channels. Whilst this may be watched on-demand or time-shifted, as well as live, traditional TV and movie content still drives the majority of our time spent viewing,” said GfK.GfK’s ViewScape study interviewed 1,147 adults aged 18 and over online in UK at the end of 2015.
The clinical work, strength of character and determination that characterised Ignaz Semmelweis should serve as an example and inspiration to us all. Ignaz Semmelweis can be counted as one of the ten greatest clinical doctors in the world. He championed his theory throughout his entire life and his insights saved millions of lives. I am delighted that his memorial now stands here at MedUni Vienna – because, after Budapest, Semmelweis’s life is primarily associated with Vienna.”Béla Merkely, Rector of Semmelweis University Budapest Feb 21 2019Gift from Semmelweis University Budapest to mark 200th birth anniversary of the “inventor” of hand hygieneThe 200th anniversary of Ignaz Semmelweis’ birth was commemorated on 1 July 2018. On Wednesday evening, a statue of the doctor, kindly donated by Semmelweis University Budapest, was unveiled at MedUni Vienna, in memory of the “inventor” of hand hygiene. The unveiling ceremony was attended by Hungarian State President Janos Ader, the first President of Vienna State Parliament, Ernst Woller, Director of Vienna General Hospital Herwig Wetzlinger, Béla Merkely (Rector of Semmelweis University Budapest) and MedUni Vienna Rector Markus Müller. The statue was created by Hungarian artist Péter Párkányi Raab. The statue is a gift from Semmelweis University Budapest to mark the 200th birth anniversary of the “inventor” of hand hygiene. Ignaz Semmelweis was one of the most important doctors of his time and an ardent champion of medical innovation. Medicine has much to thank him for. If he were alive today, he would certainly be a favorite candidate for a Nobel prize. Sadly, his immense achievements were only recognized after his death at the tender age of 47,” said Markus Müller, Rector of MedUni Vienna, underscoring the huge importance of Ignaz Semmelweis.About Ignaz SemmelweisRelated StoriesPesticide exposure may increase risk of depression in adolescentsStudy finds slime and biofilm hidden in hospital sinks, faucetsHow measles detectives work to contain an outbreakThe Budapest-born, Viennese surgeon and obstetrician (1 July 1818 to 13 August 1865) is regarded as the pioneer of medical hygiene and a champion of medical progress. In the face of strong opposition, he established the strict hospital hand hygiene regulations in around 1847 at the first Viennese Maternity Hospital. This measure significantly reduced mortality due to puerperal (childbed) fever. Semmelweis observed that the mortality rate on obstetric wards where patients were cared for by nuns or midwives was much lower than onwards where doctors and medical students worked, since the latter also performed autopsies.Semmelweis discovered that the infections, and hence the associated mortality, were caused by the transfer of infectious material (bacteria were not known about at the time). He instructed the doctors and medical students to disinfect their hands thoroughly with a chlorine solution, and later with chlorinated lime, before each delivery or before examining a pregnant woman. This hygiene measure proved extremely effective and the mortality rate fell from a maximum of around 8% to 1.3%. Later on, Semmelweis tightened up these regulations so that doctors had to disinfect their hands before every examination, with the result that, after a few months, there were no fatalities at all.About the artistPéter Párkányi Raab, Hungarian sculptor, born in Balassagyarmat on 6 September 1967. He commenced his studies at the Hungarian Academy of Fine Arts in 1987, studying old masters István Kiss and György Jovánovics. He graduated in 1992 and three years later gained his master’s degree at the Hungarian Academy of Fine Arts. He strives for integrity in his synthetic materials and seeks beauty, grace, inner harmony and truth in his works. He sees the Semmelweis bust as a salute to the man “who saved wives for their husbands and mothers for their children”. Source:https://www.meduniwien.ac.at/web/en/about-us/news/detailsite/2019/news-im-februar-2019/statue-of-ignaz-semmelweis-unveiled-at-meduni-vienna/
Source:Rutgers University-New Brunswick Halkitis, the author Out in Time: From Stonewall to Queer, How Gay Men Came of Age Across the Generations, addresses how Stonewall and the AIDS crisis have brought awareness and changes the ways the medical profession addresses health care of LGBTQ people.How did the Stonewall riots empower LGBTQ people to advocate for their health?The riots allowed gay people to say “We exist” and created a demand for health equity. The civil disobedience of Stonewall served as a catalyst to the activism of the AIDS era, which in turn has contributed to the foundations of how public health today emphasizes social justice and health equity.The riots were a boisterous pronouncement by the LGBTQ population that they would no longer hide and that they would not have their health undermined by a system that chose to ignore them. AIDS catapulted this social movement even further: If the health profession had been more attentive, we would have caught AIDS earlier. But no one was watching.As the riots framed the basis for the recognition of gay people as viable members of the population, the AIDS crisis of the 1980s and ’90s created the circumstances by which they would come to demand that the government and society attend to their well-being. Before then, gay people kept silent and were invisible to their doctors, who were unaware they were gay or did not understand the mental health and drug issues they were facing. The AIDS crisis shined a light on the fact that there was this population that needed specific health services beyond what was given to the general population.Related StoriesIncreasing access to mental health services improves outcomes for people with HIVGender inequality bad for everyone’s health finds researchGovernment policy and infrastructure have substantial impact on hospitalization of seniorsWithout Stonewall we would have no AIDS activism, and without AIDS activism we would have no marriage equality-;a social condition that surely has had a beneficial effect on LGBTQ health.How did the riots impact the HIV/AIDS epidemic?There is an unsubstantiated notion that the riots precipitated the HIV epidemic, based on the misconception that gay men began to engage in more promiscuous sexual behaviors after this social revolution. However, gay men were very sexually active well before Stonewall, albeit less openly for fear of prosecution.The challenge in foreseeing the AIDS crisis was due in part to a health care system that was ill-equipped and unwilling to meet the needs of the LGBTQ population. The health burdens faced by LGBTQ people were present before and after the riots and before the first indication of AIDS in 1981, but services were scarce and underfunded.What health care challenges do LGBTQ people face today?The crises of the past are very much the crises of the present. Today’s generation is changing the norms of what it means to be an LGBTQ person, while continuing to shoulder the burden of AIDS, stigma and discrimination faced by their predecessors.The biggest challenge for this generation is finding health care providers who understand their unique health considerations. Gender and sexuality are more fluid today, and LGBTQ people navigate a healthcare industry that is ill-equipped to address their specific issues, such as gender identity, gender-affirming surgery and the social and physical implications that accompany these issues. To this end, Rutgers is working with Garden State Equality on an interactive online map, which will launch next year, that will allow people to find providers who are knowledgeable about LGBTQ health. Reviewed by James Ives, M.Psych. (Editor)Jun 17 2019June 28 marks the 50-year anniversary of the Stonewall riots -; sparked when police raided the Stonewall Inn, a gay club in New York City -; which are credited with launching the gay rights movement. In many ways, the riots also brought attention to the unique health care needs of the gay population and served as a catalyst for the improvements in health care seen today -; though we still have far to go.”Perry N. Halkitis, dean of Rutgers School of Public Health and director of the school’s Center for Health, Identity, Behavior and Prevention Studies
This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente. Then “I got the email on Jan. 15,” said Reta Baker, the hospital’s CEO. It informed her that Cancer Center of Kansas, the contractor that operated and staffed the unit, had decided to shut it down too, just two weeks later.”There are too many changes in that town” to keep the cancer center open, Yoosaf “Abe” Abraham, chief operating officer of the Cancer Center of Kansas, later told KHN. He added that patients would be “OK” because they could get treated at the center’s offices in Chanute and Parsons.From Fort Scott, those facilities are 50 and 63 miles away, respectively.For Endicott-Coyan and dozens of other cancer patients, the distance meant new challenges getting lifesaving treatment. “You have a flat tire, and there is nothing out here,” Endicott-Coyan said, waving her arm toward the open sky and the pastures dotted with black Angus and white-faced Hereford cattle on either side of the shoulderless, narrow highway she now must drive to get to her chemo appointment.Nationwide, more than 100 rural hospitals have closed since 2010. In each case, a unique but familiar loss occurs. Residents, of course, lose health care services as wards are shut and doctors and nurses begin to move away.But the ripple effect can be equally devastating. The economic vitality of a community takes a blow without the hospital’s high-paying jobs and it becomes more difficult for other industries to attract workers who want to live in a town with a hospital. Whatever remains is at risk of withering without the support of the stabilizing institution.The 7,800 residents of Fort Scott are reeling from the loss of their 132-year-old community hospital that was closed at the end of December by Mercy, a St. Louis-based nonprofit health system. Founded on the frontier in the 19th century and rebuilt into a 69-bed modern facility in 2002, the hospital had outlived its use, with largely empty inpatient beds, the parent company said. For the next year, Kaiser Health News and NPR will track how its citizens fare after the closure in the hopes of answering pressing national questions: Do citizens in small communities like Fort Scott need a traditional hospital for their health needs? If not a hospital, what then?Traveling The Distance For Cancer CareReta Baker, the hospital’s president who grew up on a farm south of Fort Scott, understood that the hospital’s closure was unavoidable. She scrambled to make sure basic health care needs would be met. Mercy agreed to keep the building open and lights on until 2021. And Baker recruited a federally qualified health center to take over four outpatient clinics, including one inside the hospital; former employees were bought out and continue to operate a rehabilitation center; and the nonprofit Ascension Via Christi Hospital in Pittsburg reopened the emergency department in February.But cancer care in rural areas, which requires specialists and the purchase and storage of a range of oncology drugs, presents unique challenges.Rural cancer patients typically spend 66% more time traveling each way to treatment than those who live in more urban areas, according to a recent national survey by ASCO, the American Society of Clinical Oncology. Dr. Monica Bertagnolli, a cattle rancher’s daughter who is now chair of ASCO’s board, called this a “tremendous burden.” Cancer care, she explained, is “not just one visit and you’re done.”ASCO used federal data to find that while about 19% of Americans live in rural areas, only 7% of oncologists practice there.People in rural America are more likely to die from cancer than those in the country’s metropolitan counties, according to a Centers for Disease Control and Prevention report in 2017. It found 180 cancer deaths per 100,000 people a year in rural counties, compared with 158 deaths per 100,000 in populous metropolitan counties.The discrepancy is partly because habits like smoking are more common among rural residents, but the risk of dying goes beyond that, said Jane Henley, a CDC epidemiologist and lead author of the report. “We know geography can affect your risk factors, but we don’t expect it to affect mortality.”From an office inside a former Mercy outpatient clinic, Fort Scott’s cancer support group, Care to Share, continues its efforts to meet some of the community’s needs — which in some ways have increased since the Unit of Hope closed. It provides Ensure nutritional supplements, gas vouchers and emotional support to cancer patients.Lavetta Simmons, one of the support group’s founders, said she will have to raise more money to help people pay for gas so they can drive farther to treatments. Last year, in this impoverished corner of southeastern Kansas, Care to Share spent more than $17,000 providing gas money to area residents who had to travel to the Mercy hospital or farther away for care.The group expects to spend more on gas this year, having spent nearly $6,000 during the first four months of 2019.And the reserves of donated Ensure from Mercy are running out, so Simmons is reaching out to hospitals in nearby counties for help.With Mercy Hospital Fort Scott closed, the likelihood of residents here dying from their cancer will grow, experts worry, because it’s that much harder to access specialists and treatments.Krista Postai, who took over the Fort Scott hospital’s four primary care clinics, said it’s not unusual for her staff to “see someone walk in [with] end-stage cancer that they put off because they didn’t have money, they didn’t have insurance, or it’s just the way you are. … We wait too long here.”‘If They Can’t Cure Me, I’m Done’Art Terry, 71, a farmer and Vietnam veteran, was one of them. Doctors discovered Terry’s cancer after he broke a rib while bailing hay. When they found a mass below his armpit, it was already late-stage breast cancer that had metastasized to his bones.With his twice-weekly chemotherapy treatment available in the “Unit of Hope,” Terry spent hours there with his son and grandchildren telling stories and jokes as if they were in their own living room. The nurses began to feel like family, and Terry brought them fresh eggs from his farm.”Dad couldn’t have better or more personalized care anywhere,” said his son, Dwight, bleary-eyed after a factory shift.Related StoriesStudy reveals link between inflammatory diet and colorectal cancer riskIt is okay for women with lupus to get pregnant with proper care, says new studyTrends in colonoscopy rates not aligned with increase in early onset colorectal cancerTerry knew it was difficult to find trustworthy cancer care. The shortage of cancer specialists in southeastern Kansas meant that many, including Mercy Hospital Fort Scott’s patients, counted on traveling oncologists to visit their communities once or twice a week.Wichita-based Cancer Center of Kansas has nearly two dozen locations statewide. It began leasing space in Fort Scott’s hospital basement in the mid-2000s, the center’s Abraham said. The hospital provided the staff while the Cancer Center of Kansas paid rent and sent roving oncologists to drop in and treat patients.At its closing, the Unit of Hope served nearly 200 patients, with about 40% of them on chemotherapy treatment.When Art Terry was diagnosed, his son tried to talk to him about seeking treatment at the bigger hospitals and academic centers in Joplin, Mo., or the Kansas City area. The elder Terry wasn’t interested. “He’s like, ‘Nope,'” Dwight Terry recalled. “I’m going right there to Fort Scott. If they can’t cure me, I’m done. I’m not driving.'” In the end, as the elder Terry struggled to stay alive, Dwight Terry said he would have driven his father the hour to Chanute for treatment. Gas — already a mounting expense as they traveled the 20 miles from the farm near tiny Prescott, Kan., to Fort Scott — would be even more costly. And the journey would be taxing for his father, who traveled so little over the course of his life that he had visited Kansas City only twice in the past 25 years.As it turned out, the family never had to make a choice. Art Terry’s cancer advanced to his brain and killed him days before the hospital’s cancer unit closed.What Happens Next?As Endicott-Coyan and her friend Palmer drove to Chanute for treatment, they passed the time chatting about how the hospital’s closure is changing Fort Scott. “People started putting their houses up for sale,” Palmer said.Like many in Fort Scott, they had both spent their days at the Fort Scott hospital. Endicott-Coyan worked in administration for more than 23 years; Palmer volunteered with the auxiliary for six years.The hospital grew with the community. But as the town’s fortunes fell, it’s perhaps no surprise that the hospital couldn’t survive. But the intertwined history of Mercy and Fort Scott is also why its loss hit so many residents so hard.Fort Scott began in 1842 when the U.S. government built a military fort to help with the nation’s westward expansion. Historians say Fort Scott was a boomtown in the years just after the Civil War, with its recorded population rising to more than 10,000 as the town competed with Kansas City to become the largest railroad center west of the Mississippi. The hospital was an integral part of the community after Sisters of Mercy nuns opened a 10-bed hospital in 1886 with a mission to serve the needy and poor. Baker, Mercy Hospital Fort Scott’s president, said the cancer center was an extension of that mission.The Unit of Hope began operating out of the newest hospital building’s basement, which was “pretty cramped,” Baker said. As cancer treatments improved, it grew so rapidly that Mercy executives moved it to a spacious first-floor location that had previously been the business offices.”Our whole purpose when we designed it was for it to be a place where somebody who was coming to have something unpleasant done could actually feel pampered and be in a nice environment,” Baker said.The center, with its muted natural grays and browns, had windows overlooking the front parking lot and forested land beyond. Every patient could look out the windows or watch their personal television terminal, and each treatment chair had plenty of space for family members to pull up chairs.When Endicott-Coyan and Palmer arrived at the Cancer Center of Kansas clinic in Chanute in February, things looked starkly different. Patients entered a small room through a rusted back door. Three brown infusion chairs sat on either side of the entry door and two television monitors were mounted high on the walls. A nurse checked Endicott-Coyan’s blood pressure and ushered her back to a private room to get a shot in her stomach. She was ready to leave about 15 minutes later.The center’s Abraham said the Chanute facility is “good for patients for the time being” and not a “Taj Mahal” like Mercy’s Fort Scott hospital building, which he said was too expensive to maintain. Cancer Center of Kansas plans to open a clinic at a hospital in Girard, which is about 30 miles from Fort Scott, he said.Some oncology doctors would say driving is not necessary. Indeed, a few health care systems across the country, such as Sanford Health in South Dakota and Thomas Jefferson University Hospitals in Pennsylvania, are administering some chemotherapy in patients’ homes. Oncologist Adam Binder, who practices at Thomas Jefferson in Philadelphia, said “over 50% of chemotherapy would be safe to administer in the home setting if the right infrastructure existed.”But the infrastructure — that is, the nurses who would travel to treat patients and a reimbursement model to pay for such care within our complex health care system — is not yet in place.Back in the car, Palmer took the wheel and Endicott-Coyan began planning for future cancer treatments in the void left by Mercy Hospital Fort Scott’s closure. “I put a note on Facebook today and said, ‘OK, I have drivers for the rest of February; I need drivers for March!'”This is the first installment in KHN’s year-long series, No Mercy, which follows how the closure of one beloved rural hospital disrupts a community’s health care, economy and equilibrium. Reviewed by James Ives, M.Psych. (Editor)Jul 1 2019One Monday in February, 65-year-old Karen Endicott-Coyan gripped the wheel of her black 2014 Ford Taurus with both hands as she made the hour-long drive from her farm near Fort Scott to Chanute. With a rare form of multiple myeloma, she requires weekly chemotherapy injections to keep the cancer at bay.She made the trip in pain, having skipped her morphine for the day to be able to drive safely. Since she sometimes “gets the pukes” after treatment, she had her neighbor and friend Shirley Palmer, 76, come along to drive her back.Continuity of care is crucial for cancer patients in the midst of treatment, which often requires frequent repeated outpatient visits. So when Mercy Hospital Fort Scott, the rural hospital in Endicott-Coyan’s hometown, was slated to close its doors at the end of 2018, hospital officials had arranged for its cancer clinic — called the “Unit of Hope” — to remain open.