Daily Archives: October 12, 2017

Great Ormond Street Hospital ‘failing’ intersex children

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Great Ormond Street Hospital is not meeting care standards for intersex children, a BBC investigation says.

It found that some patients who had been born with sexual development disorders, and their families, had no access to psychological care.

And not all cases were properly discussed before the patient had life changing, irreversible surgery.

Health regulator CQC is investigating. The hospital said it was committed to working with seriously ill children.

Intersex, also known as disorders of sexual development (DSD), is when sex characteristics – including genitals, reproductive organs and chromosome patterns – do not fit into the typical notions of female or male bodies.

The BBC has learned that at Great Ormond Street Hospital (GOSH):

  • There is currently no face-to-face psychological support for children and their families who have been referred in the last six months despite surgery continuing. The BBC understands tens of families are waiting for therapy. For several years not all children and their families have had access to face-to-face support, before having surgery
  • Not all cases were discussed at full the multidisciplinary team meetings at GOSH
  • Information about this surgery is complex but information given to parents is not in a written form that they can take away, to ensure proper comprehension prior to giving informed consent for surgery. The BBC has been told that this raises doubts as to whether parents have given truly informed consent on behalf of their child before irreversible surgery.

Over the last decade, standards and guidelines say DSD cases should be discussed by specialist teams of experts, to ensure the best possible outcome. They also say that it is crucial that families and children should be seen by a psychologist.

Prof Ieuan Hughes, emeritus professor of paediatrics at the University of Cambridge and an expert in hormone disorders told the BBC that DSD was a “very complicated area of medicine”.

He said it was vital families got support from a psychologist prior to making decisions about surgery, so parents were fully aware of the life long-implications on children.

When asked by the BBC if surgery should continue in hospitals not meeting the national standards, Prof Hughes said: “It seems reasonable to me to just take a pause, get the problem sorted and get back on track as soon as possible.”

‘I went to bed a boy and woke up a girl’

When Joe Holliday was born in 1988 it was not clear if he was a boy or a girl.

During development in the womb his genitals did not fully form and he was born with a large hole in his abdomen.

The 29-year-old says specialists at Great Ormond Street Hospital told his mother he would be better being a girl, because it was easier surgically and he would not handle being a man without male genitalia.

On Joe’s first birthday, his mother put him to bed and the next day brought him up as Joella. As advised by the medical team, she changed all his clothes from blue to pink overnight.

He featured in a BBC documentary in 1998, when he was 10 years old, which followed his family’s legal fight to get him recognised as a girl on his birth certificate.

But from 10 years old onward, Joella suffered with depression and anxiety. He self-harmed and attempted suicide.

“I had years of feeling like I was in a black hole and not knowing why,” he told the BBC.

In his 20s, by chance, he saw his medical notes and read that blood tests had shown his chromosomes to be XY – genetically male.

He also learned his testes had been removed when he was eighteen months old, despite being perfectly healthy, he said.

“I felt I feel like I lost such a large part of my life – 15 years of my life that I spent depressed and almost a recluse at one point,” he said.

At the time, the decision over raising Joe as a Joella, was considered to be best practice, but now most children now born with this condition are raised as male.

He said that although the advice was different when he had his surgery 30 years ago, it was “not acceptable” that patients were not being supported now.

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Experts have told the BBC that Great Ormond Street Hospital for Children NHS Foundation trust is seen as the leading hospital for care for these children and regional centres refer in for specialist opinions of the multi-disciplinary team.

In a statement the hospital said that patients diagnosed at GOSH were discussed and treatment decisions were taken through these multi-disciplinary teams.

A specialist psychologist is due to start at the hospital “in the coming weeks”, the trust said, but it would not comment on if the post had been filled.

The trust declined to comment on the other concerns the BBC uncovered, on whether children referred from other hospitals for specialist opinion benefitted from input from their specialist team at GOSH prior to surgery and on whether it was meeting national standards.

What is intersex?

  • There are many congenital variations of disorders of sex development
  • Some traits are visible at birth, others not until puberty and some variations in chromosomes may not be physically apparent at all
  • Worldwide, up to 1.7% of people have intersex traits, according to the Office of the United Nations High Commissioner of Human rights

NHS Choices: Disorders of sex development

An NHS England spokesperson said: “Disorders of sexual development (DSD) are rare and complex, but it is right that children and their families should be appropriately involved in decisions about their care.”

Professor Ted Baker, the chief inspector of hospitals at the Care Quality Commission said: “We have asked Great Ormond Street Hospital to provide further information about the concerns, which were brought to our attention by the BBC.”

He added: “We are clear that NHS trusts and all providers of health and social care must have regard for nationally recognised guidance about delivering safe care and treatment.”

The CQC has currently rated the surgical department at Great Ormond Street Hospital for Children NHS Foundation Trust as requiring improvement.

Dr Faye Kirkland is a reporter for the BBC but also a working GP

Baby talk: Mums’ voices change when speaking to infants

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Mums alter the timbre of their voice when speaking “motherese” – or baby talk – say scientists in the US.

Timbre refers to the unique quality of a sound and is why a piano sounds different to a violin, even when playing the same note.

Experiments at the Princeton Baby Laboratory found women use different timbres when talking to adults and babies.

The same vocal shift was found across women speaking 10 languages.

Dr Elise Piazza said: “It’s so consistent across mothers, they all use the same kind of shift to go between those modes.”

‘Vocal footprint’

Many of the traits of baby talk, such as differences in speed and pitch, are thought to help infants develop language skills, but this is the first time a shift in timbre has been discovered.

When you describe a voice as nasal or hoarse, gravelly or velvety, then you are talking about its timbre.

The mums were recorded while they interacted with their child, aged between seven and 12 months, and to the adult researchers.

The scientific team then took “vocal fingerprints” by measuring the spectrum of sounds within the recordings.

The results on 12 English-speaking mums, published in the journal Current Biology, showed a unique speech pattern was directed at infants.

‘Highly reliable’

A computer programme was trained to spot the difference and it could then find it – in less than one second – in mums speaking other languages.

The difference was found in 12 non-English speakers communicating in languages including Hebrew, Mandarin and Cantonese.

Dr Piazza told the BBC: “There is wide-ranging research showing infants learn better from infant-directed versus adult-directed speech.

“Specifically they can segment words into syllables better and they can learn novel words better and that probably encompasses these timbre features.”

The study did not look at dads or grandparents, but the researchers anticipate similar timbre adjustments.

Prof Jenny Saffran, from the University of Wisconsin-Madison, commented: “This is the first study to ask whether [mothers] also change the timbre of their voice, manipulating the kinds of features that differentiate musical instruments from one another.

“This is fascinating because clearly speakers are not aware of changing their timbre, and this new study shows that it is a highly reliable feature of the way we speak to babies.”

Follow James on Twitter.

Inside American Caitlan Coleman’s five-year ordeal as a Taliban prisoner

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A Taliban-linked faction has freed American Caitlan Coleman and her Canadian husband, Joshua Boyle, who were abducted more than five years ago in Afghanistan and had three children in captivity. (The Washington Post)

It must have felt like such an exciting time: Caitlan Coleman and her husband, Joshua Boyle, were embarking on a six-month adventure through Central Asia.

But their exuberant trip ended in a nightmare: In the fall of 2012, they were kidnapped by Taliban fighters. Over the next five years, relatives and friends could do little but pray for the couple’s well-being. Hope came in the form of short video clips released by the captors. It was through that footage that the couple’s families got to glimpse Coleman and Boyle’s three children, born in captivity.

Though U.S. or Canadian officials got close to negotiating the family’s release a couple of times, each attempt was scuttled.

Finally, Wednesday, the family was freed.

Here’s a look at how Coleman and Boyle’s ordeal unfolded:

July 4, 2012: Shortly before she hopped on a plane, Coleman sent an email to her friends. “Our flight leaves at 4 p.m.,” she wrote. “Only God knows exactly where it will lead or what all can be accomplished, seen, experienced or learned while we travel. So we put ourselves in His hands.”

Coleman and Boyle planned to spend several months hiking through Tajikistan, Kazakhstan and Kyrgyzstan, the “safe ’stans,” Coleman told her parents. She promised that she wouldn’t go to Afghanistan, though Boyle spoke Arabic and was fascinated by the country. Coleman and Boyle had another secret, too — Coleman was pregnant.

September 2012: Coleman emailed with friends every several weeks. In one missive, she wrote:

“I enjoy getting to know some of the most unique, quirky people I have ever met, and learning from them. It really gives you a different perspective on the world. We in the U.S. are taught to fear it … to the point that the U.S. State Department website’s current ‘travel advisory’ is advising people to simply not travel outside of the U.S. … but it’s a whole different world outside.”

In another email, she described her border crossing from Kyrgyzstan into Tajikistan at night as the “strangest, sketchiest ride yet.” The pair flagged an early-morning taxi and were driven to a farmhouse, where they were made to wait for 18 hours until they could leave in a caravan of travelers. “All turned out to be okay. … They didn’t try to demand any more money from us, and we were able to get some dinner.”

Caitlan Coleman and Joshua Boyle in an undated photo. (Coleman Family/AP)

Oct. 8, 2012: Boyle sent an email to Coleman’s parents, saying they were in an “unsafe” part of Afghanistan. The next day, the couple made their final withdrawal from their bank account. Soon after, they were abducted in Afghanistan’s Wardak province, a Taliban stronghold southwest of the capital. Officials believe they were eventually moved to Pakistan.

June 4, 2014: Coleman’s family released the two videos it received in 2013 of the couple with their children. As The Washington Post reported at the time: “The videos offer the first and only clues about what happened to Caitlan Coleman and Joshua Boyle after they lost touch with their families 20 months ago while traveling in a mountainous region near the capital, Kabul.”

The video clips were emailed to Coleman’s father in July and September by an Afghan man who said he had ties to the Taliban. In one, Coleman — her head covered — appeals to “my president, Barack Obama” for help. “I would ask that my family and my government do everything that they can to bring my husband, child and I to safety and freedom,” Coleman, then 28, says.

November 2015: Coleman’s family received a letter stating that she has given birth to a second child in captivity. “I pray to hear from you again, to hear how everybody is doing,” the letter said.

June 11, 2015: Lt. Col. Jason Amerine, a member of the U.S. Army Special Forces, testified before Congress that the military had nearly negotiated the release of Coleman and six other American hostages held by the Taliban in Afghanistan and Pakistan, only to see the deal collapse because of “infighting within the Obama administration.” The deal would have freed all seven hostages; in exchange, the United States would have had to release an Afghan drug lord.

January 2016: Canadian officials brokered a deal to free Colin Rutherford, another Canadian held captive by militants, along with Coleman and Boyle. Rutherford was freed, but the couple and their children remained in custody.

This image from video provided by the Coleman family shows Caitlan Coleman and Joshua Boyle. The videos offered the first clue about what happened to Coleman and Boyle after they lost touch with their family. (Coleman family/AP)

June 2016: Coleman’s family sent a videotaped message to the Taliban during the holy month of Ramadan, thanking the militant group for keeping their daughter alive and pleading for her safe return. “We desperately want to be with and hold our daughter and grandsons,” James Coleman said in the video. “As a man, father and now grandfather, I am asking you to show mercy and release my daughter, her husband and their beautiful children.”

Aug. 31, 2016: Another video was released. In it, Coleman is dressed in a traditional Muslim women’s covering known as an abaya and avoids eye contact with the camera. The couple begs for their lives, warning that their captors will kill them and their kids unless the United States and Canada stop killing Taliban fighters. “Because of their fear, they are willing to kill us, willing to kill women, to kill children, to kill whomever to get these policies reversed or to take revenge,” Coleman says. “… I know that this must be very terrifying and horrifying for my family to hear that these men are willing to go to these lengths. But they are, so if you are willing, if you are able to do anything to help, if you could, please try to help stop this depravity.” (A Taliban spokesman told the Associated Press that the video was recorded in 2015.)

A senior Taliban official told Reuters that the video was released to pressure the Afghan government not to execute Anas Haqqani, son of Jalaluddin Haqqani, founder of the feared Haqqani network. Anas Haqqani was on trial in Afghanistan and faced the death penalty.

December 2016: The Taliban released a fourth video of the family. “We have waited since 2012 for someone to understand our problems, the Kafkaesque nightmare in which we find ourselves,” Coleman says in the video. “My children have seen their mother defiled. We ask, in our collective 14th year of prison, that the governments on both sides reach some agreement to allow us freedom.”

An image of the family from a video posted by the Taliban on social media on Dec. 19, 2016. (Taliban video/Reuters)

September 2017: The Boyle family released a video of Coleman and Boyle it had received in February. In it, Coleman is cradling an infant. The couple’s 4-year-old sits with his father. In the video, Boyle jokes about the letters he received from his family. “Things here are going about as can be expected,” he says. “But we were buoyed to receive your letter, and for the first time we have hope that things might wrap up soon, God willing.” Coleman tells her father that in prison “I’ve become more of a Belle than an Ariel.” Her father explained to ABC News that his daughter was trying to contrast the Disney character Ariel from “The Little Mermaid” — who was rebellious and defied her father — with Belle from “Beauty and The Beast,” who tried to protect her father from evil.

Oct. 11, 2017: Coleman, Boyle and their children are freed. According to the Toronto Star, the family was being transported in the trunk of a car when they were rescued. A shootout ensued, and all five kidnappers were killed. Boyle was injured by shrapnel but said he’s recovering and “doing well for someone who spent the last five years in an underground prison.”

Ryanair to challenge Lufthansa’s Air Berlin deal

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Ryanair is set to challenge a Lufthansa deal to to buy parts of failed German carrier Air Berlin.

The budget Irish airline said it would take the €210m deal to European competition authorities.

Lufthansa plans to use Air Berlin planes to expand its Eurowings budget airline business.

Air Berlin filed for bankruptcy in August after its main shareholder, Etihad, said it would not give further financial support.

Flights continued after a transitional loan of €150m from the German government.

Germany’s second-largest carrier has since been negotiating with potential buyers for parts of its business.

Lufthansa has agreed to buy Air Berlin’s Austrian leisure travel airline Niki, its LG Walter regional airline and 20 additional aircraft.

Ryanair previously described the negotiations as a “stitch-up” intended to strengthen Lufthansa.

“We will be referring the matter to the EU competition authority in due course,” a Ryanair spokesman.

Andreas Mundt, head of Germany’s cartel office, said the European Commission would take a close look at the deal and that German authorities would follow the process closely.

Lufthansa chief executive Carsten Spohr said earlier he expected the Air Berlin deal to receive European Union approval by the end of the year.

Shares in Lufthansa rose 2.8% in Frankfurt.

Air Berlin, which accumulated debt for almost a decade, reported a record loss of €782m (£713m) for last year.

Iran nuclear deal: What you need to know

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Iran’s President, Hassan Rouhani, defended the international nuclear deal Saturday, Oct. 7, and warned President Trump against violating the deal. (Reuters)

Later this week, President Trump is expected to announce his decision to “decertify” the Iran nuclear deal, arguing that the arrangement isn’t in the best interests of the United States. The world has been bracing for this decision since Trump won the election in November. He has repeatedly derided the Iran accord as a stupid, loser deal, one of the worst he has ever seen. Most recently, he said on Fox News, “It’s a horrible, horrible embarrassment to our country, and we did it out of weakness, when actually we had great strength.”

But “decertifying” won’t kill the accord automatically. It’s much more complicated than that. Here’s what Trump may do this week and how it might play out domestically and internationally.

Why does Trump want to decertify the Iran deal?

By all accounts, Iran has complied with the terms of the deal. U.S. officials have said so; European allies have agreed. The United Nations watchdog tasked with monitoring compliance has visited Iran several times and certified that the country is limiting its nuclear activities, per the terms of the deal. Last week, the U.S. defense secretary and the chairman of the Joint Chiefs of Staff expressed qualified support for the deal before Congress.

But the president and his administration say Iran is not following the spirit of the accord, which they see as de facto noncompliance. Secretary of State Rex Tillerson and others have said that Iran has not positively contributed to regional and international peace and security, an “expectation” embedded in the deal’s preamble. They noted that Iran still supports militant groups such as Hezbollah and Hamas and backs militias in Syria and Yemen. Iran has also continued to test ballistic missiles, something that irks the United States, even though such tests do not constitute a violation of the agreement.

What does “decertification” actually mean?

The U.S. president is required by Congress to certify every 90 days that Iran is complying with the deal. Trump has done so twice; his next deadline is Oct. 15. Administration officials say Trump will announce that he has decided to decertify the deal, arguing that the agreement is not in the United States’ national security interest.

On its own, that won’t mean much. If the United States doesn’t impose new sanctions, it’s not technically in violation of its obligations under the agreement. And The Washington Post has reported that Trump will hold off on recommending that Congress do so. Sources have told my colleagues that he will push Congress to come up with “new legislation codifying Trump’s conditions for remaining in the deal formally known as the Joint Comprehensive Plan of Action.” As a Republican aide explained, “To get us on the right foot on the Iran strategy, we do need to use this certification decision, this moment, to launch a real effort to plug the holes and the weaknesses in the JCPOA.”

Interestingly, the administration could have chosen to kill the deal on its own, without Congress’s help. Every 120 days, the administration issues waivers to keep old sanctions from being reimposed. Skip that step, and the administration could have restarted sanctions unilaterally come January. The president chose not to do that. My colleagues have explained the maneuver as “a middle ground of sorts between Trump, who has long wanted to withdraw from the agreement completely, and many congressional leaders and senior diplomatic, military and national security advisers, who say the deal is worth preserving with changes if possible.”

President Trump spoke about the agreement with Iran on their nuclear program when meeting with military leaders on Oct. 5. (The Washington Post)

Could Congress decide to reimpose sanctions?

If Trump decertifies the deal, Congress will have 60 days to decide whether to reimpose sanctions on Iran, the ones that were suspended in exchange for that country’s curbs on its nuclear program.*

That seems pretty unlikely. Congress would need only 51 votes to impose those sanctions. But it doesn’t seem as if Republicans have the support they need to push something through. As The Post reports, Senate Majority Leader Mitch McConnell (R-Ky.) does not want to add another contentious issue to the legislative calendar, especially not with midterm elections right around the corner. Republican Sens. Jeff Flake (Ariz.), John McCain (Ariz.) and Susan Collins (Maine) have also said they’re not sure how they would vote on sanctions. Sen. Rand Paul (R-Ky.) and House Foreign Affairs Committee Chairman Edward R. Royce (R-Calif.) say they don’t think Trump should retreat from the deal. And Democrats seem universally opposed to new sanctions.

Given that, it’s hard to imagine Republicans mustering the votes they need to impose any serious sanctions.

So, then, what is the president trying to accomplish? 

Even many proponents of decertification don’t think the United States needs to reimpose sanctions. They reckon that the Trump administration can use the process as a way of persuading European allies to join the United States in advocating for a stronger Iran deal. In a speech at the Council on Foreign Relations last week, Sen. Tom Cotton (R-Ark.) laid out what that might look like. He has called for a bill that would eliminate “sunset clauses” that lift restrictions on some Iranian nuclear activities after 10 or 15 years. He’d also like to see tougher inspections and new curbs on Iran’s ballistic and cruise missile programs.

At an Oct. 3 Senate Armed Services Committee hearing, Defense Secretary James Mattis was asked whether it was in the U.S. national interest to stay in the Iran nuclear deal. After pausing, he answered yes. (U.S. Senate Committee on Armed Services)

Will European allies sign on? 

It’s impossible to know for sure. But early indications suggest that if the United States backs out of the deal, it will do so alone.

The other parties involved in the deal and the U.N. watchdog tasked with monitoring compliance say things are working. “We will not follow the United States in reneging on our international obligations with this deal,” a European Union official told The Post on Thursday. Russian Foreign Minister Sergei Lavrov told reporters, “It is very important to preserve it in its current form, and, of course, the participation of the United States will be a very significant factor in this regard.”

It’s not totally clear how the international community will respond to Trump. But one thing is all but certain: If the administration backs out of the deal, it would isolate the United States from its allies and weaken its stature abroad. As my colleagues reported:

More than any other issue that has threatened transatlantic cohesion this year, President Trump’s decision to decertify Iranian compliance with the nuclear deal could start a chain of events that would sharply divide the United States from its closest traditional allies in the world. “After the Paris climate decision,” in which Trump withdrew the United States from a widely supported, painfully negotiated accord, “this could push multilateralism to the breaking point,” said a senior official from one of the three European signatories to the Iran deal.

How will the business community respond?

Since the deal was signed in 2015, several big companies have begun to do business in Iran. New sanctions by the United States would make things significantly more difficult. As Vox explained:

New sanctions would also force American allies to choose between doing business with Iran or with the U.S. Iran has begun to reintegrate itself into the global economy in the past year, and it has developed meaningful business ties with big companies that are based in the countries that struck the Iran deal. For example, this summer Iran signed a $5 billion agreement with France’s Total SA and China’s state-run China National Petroleum Corporation to develop its South Pars natural gas field.

Already, the European Union has begun taking steps to protect its businesses from U.S. retaliation. Officials are looking at measures used in the 1990s to shield companies and individuals from secondary U.S. sanctions. “I’ve no doubt that if this scenario materializes, the European Union will act to protect the legitimate interests of our companies,” David O’Sullivan, the E.U. ambassador to the United States, said at a September meeting.

U.S. sanctions may even make it easier for European companies to compete in Iran. “U.S. decertification would not necessarily end the deal — the U.S. just wouldn’t be part of it anymore,” Robert Litwak, a member of the National Security Council under President Bill Clinton and an expert on international security at the Woodrow Wilson Center, told CNBC. “The Europeans won’t return to sanctions so quickly. If this enables Airbus to beat out Boeing, they’d be delighted.”

How might Iran respond?

Iranian President Hassan Rouhani said last month that he will not reopen negotiations, and Iranian Foreign Minister Mohammad Javad Zarif has said that his country would consider walking away from the deal if the United States withdraws. But Iran may stay in the agreement as long as the other signatories also stick to the deal.

As CNBC put it:

If the U.S. decertifies the deal, “the ball immediately goes to Iran’s court,” said Michael O’Hanlon, a foreign policy expert at the Brookings Institution. Iran “could have their cake and eat it too.”

Iranian Foreign Minister Javad Zarif spoke with Charlie Rose about threats to cancel the Iran nuclear deal on Sept. 27 at the Asia Society in New York. (Reuters)

It would be possible, O’Hanlon explained, for Iran to keep the benefits it gets from the agreement — namely, to continue to legally export oil. Then, a few years down the road it could argue that the agreement is null due to a lack of compliance from the United States. It could then resume nuclear activities.

That’s not an attractive prospect for U.S. decision-makers, because it would force them to make a choice: either attack Iran’s nuclear facilities, or push for new sanctions from a group of countries that will almost certainly be reluctant to give up business ties with Iran.

* Correction: An earlier version of this article incorrectly stated that Iran had a nuclear weapons program. It has a nuclear power program. Iran never developed or acquired a nuclear weapon.

It’s not illegal to be gay in Indonesia, but police are cracking down anyway

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Indonesian plainclothes policemen stand guard over men who were arrested in a raid at a sauna in Jakarta, Indonesia, on Oct. 9. According to media reports, Indonesian national police arrested 51 men for allegedly holding a gay party at the sauna. (Adi Weda/European Pressphoto Agency-EFE)

JAKARTA, Indonesia — In Indonesia, the world’s largest Muslim-majority nation, homosexuality is legal and the state largely stays out of issues of private morality. But as conservative religious groups become more prominent in political life here, police are increasingly finding other ways to crack down on LGBT communities.

This weekend they arrested 58 Indonesians and foreigners at a Jakarta sauna popular with gay men, allegedly for violating the country’s pornography laws. Indonesia’s pornography legislation — passed in 2008 and often criticized by legal experts and human rights activists for being too vague — technically prohibits any public depiction of sex for profit, but in practice it is often used against politically vulnerable groups.

“We’ve increasingly seen police targeting LGBT groups using pornography laws,” said Ricky Gunawan, the director of the Community Legal Aid Institute in Jakarta. In fact, last week’s incident was the third of its kind that has been reported this year. In April, police in the city of Surabaya broke up a party at a hotel for similar reasons, arresting 14 men, and in May, 141 men were arrested at a sauna in Jakarta.

“These communities have always been targeted by police, but we’ve seen this worsen since 2016, when a number of high-level politicians made statements portraying LGBT communities as immoral or a threat to the nation,” Gunawan said.

There have been several public comments that may have led police to believe a crackdown was in order, but the most famous was probably delivered by Defense Minister Ryamizard Ryacudu, who said last year that the LGBT agenda was like a “proxy war” threatening national sovereignty.

“This is a kind of modern warfare,” he said, according to Tempo magazine. “It’s dangerous as we can’t see who our foes are, but out of the blue everyone is brainwashed — now the [LGBT] community is demanding more freedom, it really is a threat.”

President Joko “Jokowi” Widodo said last year that the job of police was to defend LGBT communities and other groups from discrimination, but he has largely stayed on the sidelines of the debate as the crackdown has intensified.

Since the end of 2016, radical Islamists have also been playing a larger role in Indonesia’s politics. Groups like the Islamic Defenders Front, or FPI, were influential in organizing mass rallies calling for the imprisonment of Christian Governor Basuki Tjahaja Purnama for allegedly committing blasphemy against Islam. They got their wish in May.

Ironically, pornography laws have also been used to target Islamist FPI leader Rizieq Shihab. Police accused him of violating them by sending sexually explicit images by phone, or “sexting,” with a mistress. He fled the country, and many analysts suspected authorities were using the laws to clip the wings of an Islamist movement that had gotten too powerful for their liking.

The glaring exception to Indonesia’s tolerance of private sexuality is the conservative and semi-autonomous Aceh province, where sharia courts now dole out public punishments. In May, two men were publicly caned for having sex.

But even in more liberal cities like Jakarta, where gay clubs and queer advocacy groups operate openly, the spate of arrests has had a chilling effect on the LGBT community.

“The situation right now is very sad,” said Azril Hadimirza, the head of People’s Diversity Network, a new support organization for LGBT Indonesians and other minorities. “LGBT persons have always faced discrimination in the workplace, or in their family lives, but now the police are using the power of the state against us in our private spaces, too.

Read more: 

Indonesia’s top court weighs ban on sex outside marriage

Indonesia wants to banish ‘gay’ emoji

Why banning ‘extremist groups’ is dangerous for Indonesia

NHS staff urged to get flu jabs to protect patients

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NHS leaders are urging nurses, doctors and other healthcare workers to have a flu vaccination to protect their patients this winter.

Vulnerable groups, such as children, pregnant women and older people are also reminded to have their free jab.

Sir Bruce Keogh, NHS England’s medical director, told the BBC he was worried about how staff would cope with a major flu outbreak.

He said the NHS was under “severe and unrelenting” pressure.

His comments come following reports of a much higher incidence of flu in the Australian winter and the possibility that the same strain of the virus will be seen in Europe.

NHS bosses said many people with flu showed no symptoms so healthcare workers could be unintentionally infecting vulnerable patients.

Getting vaccinated was the best way to stop the spread of flu and prevent deaths, they said.

NHS staff are offered the vaccine free and NHS England will also offer it free to more than one million care-home workers this winter.

It wants employers to report how many people don’t get the vaccines – at some hospitals only 30% of staff have the jab while at others it is nearer to 90%.

NHS England said 21 million people would be eligible for the vaccine in total this winter.

It has expanded the nasal flu vaccination programme to include children from the age of two up to and including those in school Year 4. Children in reception year can now get their vaccine in school instead of going to their GP.

Sir Bruce said: “Many people are very worried that this winter will be particularly difficult – the thing that I worry about most is that we have an outbreak of flu or an outbreak of norovirus which puts an added strain on the NHS service.”

Royal Mail wins strike injunction

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Royal Mail has won an injunction in London’s High Court preventing next week’s 48-hour strike.

The postal firm’s workers had been set to walk out from 19 October in protest over pensions, wages and jobs.

But the company said the strike would be “unlawful” if the Communication Workers Union (CWU) did not follow dispute resolution procedures.

A strike ballot of the CWU’s 110,000 members had produced an 89.1% vote in favour on a 73.7% turnout.

It would have been the first national strike since Royal Mail was privatised four years ago.

The CWU said it was “extremely disappointed” at the ruling and described it as “a desperate delaying tactic from a board who are increasingly out of touch with the views of its workforce”.

Royal Mail said in a statement: “We will now make contact with the CWU as a matter of urgency to begin the process of external mediation.

The firm said it expected the process to take until Christmas and added: “We are very committed to working closely with the CWU in order to reach agreement as a matter of priority.”

‘Unaffordable’ scheme

Mr Justice Supperstone, who granted the injunction, said: “I consider the strike call to be unlawful and the defendant is obliged to withdraw its strike call until the external mediation process has been exhausted.”

The CWU has said that Royal Mail’s move to reform workers’ pensions means that its members will lose up to a third of their retirement entitlements.

The company said pension scheme members would indeed build up smaller benefits in future, but that was because the plan in its current form was unaffordable.

Earlier this year, the Royal Mail announced that it would close its current defined benefit scheme in March 2018.

Although the pension fund is in surplus, Royal Mail, which was privatised in 2013, claims that its current annual contribution of £400m a year would swell to £1.26bn.

The company also said it was one of the few firms offering to replace one defined-benefit scheme with another.

CWU general secretary Dave Ward said: “The company are deluded if they believe their courtroom politics will resolve this dispute. Instead, the company’s actions will have the complete opposite effect.

“Postal workers’ attitude towards the company will harden and it makes us more determined than ever to defend our members’ pensions, jobs, service and achieve our objectives.”

Shares in Royal Mail closed 0.7% higher at 388.3p.

Hollywood doesn’t make many movies about poverty. ‘The Florida Project’ bucks the trend.

Published by:

Carolyn Van Houten

The Washington Post

Bria Vinaite, left, and Brooklynn Prince, center, who star in “The Florida Project,” with the film’s director, Sean Baker.

Some of the best movies in history have dealt with characters who were just barely scraping by — “Bicycle Thieves” and “The Grapes of Wrath,” “Midnight Cowboy” and “Modern Times.” But filmmakers today tend to avert their eyes from the horrors of financial hardship. Superhero stories are just more photogenic.

Sean Baker is one exception. He gravitates toward overlooked subjects, such as the black transgender prostitutes at the center of his acclaimed low-budget marvel “Tangerine” in 2015. His latest feature, the rapturously received “The Florida Project,” is about homelessness, and could be a blueprint for filmmakers who want to explore social issues because of the savvy way it’s captivating audiences: It may be the most joyful movie about poverty ever screened.

[In the seedy shadows of Disney World, a child tries to make a magic kingdom]

That’s because it’s told from the perspective of Moonee, played by 7-year-old Brooklynn Prince. Moonnee and her mother, Halley (Bria Vinaite) live in the purple-painted Magic Castle motel, a stone’s throw from Disney World, and they’re part of Florida’s hidden homeless population — people who don’t have prospects for permanent housing so they resort to couch surfing with relatives or find other temporary alternatives. That means, statistically, they often aren’t counted as homeless.

According to Shelley Lauten, the chief executive of the Central Florida Commission on Homelessness, the movie is important not just because it depicts characters without stable housing, but because it shows the non-stereotypical side of a nationwide epidemic. This isn’t about the physically or mentally ill middle-aged man living under a bridge.

Moonee, a precocious 6-year-old girl, lives with her mother Halley in a community of extended-stay motel guests in pastel-streaked Kissimmee, Fla.

“It’s what I call our tsunami of homelessness,” she said over the phone recently. “It’s the group that, across the country, we’re not doing a very good job of figuring out how to stabilize.”

According to a recent JP Morgan Chase study, in Florida alone, there are 72,000 homeless school-age children, which doesn’t even account for those younger than five, Lauten said incredulously. That includes kids whose families are living doubled up or staying at motels like the one in the movie. Although the reasons that families end up in this situation vary, it usually goes back to economic instability. Many of the parents work, but they simply don’t make enough to afford housing.

In the movie, Halley can’t find a job so, to make ends meet, she buys perfume from a wholesaler and sells it outside a swanky nearby resort. Moonnee and her friends, meanwhile, go searching for fun while stirring up trouble. They run to a pasture and moo at cows and have spitting contests. They wander into abandoned buildings and cajole strangers into buying them ice cream. Occasionally they drop by the motel’s main office where they terrorize Bobby, the tenderhearted but long-suffering manager (played by a transcendent Willem Dafoe).

“These are the rooms we’re not supposed to go in,” Moonee mischievously tells a new friend, before squealing, “but let’s go in anyways!”

All the while the children are naive to the dangers around them, including the creepy guy hanging around nearby and the fast-moving traffic on the highway just beyond their temporary home. They’re none the wiser that their parents are getting into fistfights about adult problems that kids can’t yet understand.

The world is simply a fun place to be.

“When there’s no moment of levity in a movie, I don’t believe it,” Baker said by way of explanation after a recent preview screening. Homelessness is a tragedy, but a movie about it doesn’t have to be.

Rebecca Cabage


The stars of “Tangerine,” Mya Taylor, left, and Kitana Kiki Rodriguez, right, pose for a portrait with Baker, who directed the film.

Baker had wanted to make “The Florida Project” since 2011 when his co-writer, Chris Bergoch, told him about hidden homelessness. In the meantime, the pair made “Tangerine,” which became known as “that movie shot on an iPhone,” but it was so much more: a kinetic, farcical romantic comedy set on the seedier streets of Los Angeles. Baker has a habit of making movies about characters who are overlooked by other filmmakers, not to mention society at large.

He’s glad he made “Tangerine” first because it inspired an epiphany.

“I make dramedies, but ‘Tangerine’ really has a lot of comedy, and I saw that it had a great effect — it reached a larger audience,” he said during a recent visit to The Washington Post offices alongside Prince and Vinaite. “People were saying, ‘Oh I loved laughing with [the main characters] Alexandra and Sin-Dee so much that I fell in love with them, and now I’m concerned about the real trans women of color who resort to the underground economy.’”

In other words, “Tangerine,” like “The Florida Project,” was an issue film dressed up as offbeat entertainment. They’re meant to open our eyes to the travails of neglected Americans living on the fringes, even if Baker insists, “I don’t have the answers. I’m just posing questions.”


Willem Dafoe and Prince in “The Florida Project.”

“The Florida Project” isn’t alone in bringing poverty to the big screen. Last year’s best picture Oscar winner, “Moonlight,” followed a boy growing up in Miami, living with a drug-addicted mother. But dramas about poverty are few and far between, especially in this era when midsize movies are rarely greenlit, because they aren’t guaranteed to bring in huge amounts of cash at the box office. The movies that do get made about a struggling demographic, such as “Hell or High Water,” are often couched in another genre, like a heist movie or murder mystery.

“The Florida Project” isn’t all fun and games. There are moments that will surely break your heart. But it never resorts to melodrama.

For research, Baker and Bergoch traveled to Florida and met with motel residents and managers, plus nonprofits and social agencies. None of them tried to dictate how to tell the story.

“One thing I got from everybody in the area is there was a real desire to have the stories told,” Baker said. An early draft had Halley struggling with an addiction that was later excised from the script. “But even that, when we passed it by some of the agencies, they were fine with it. It’s a very complicated issue and if you look into the reasons why certain families are stuck in this situation, there are so many numerous reasons.”

Halley is a particularly complicated character. Bitter and volatile, she curses like a sailor and throws tantrums like a toddler. But Vinaite sees plenty of redeeming qualities in her.

Indie director Sean Baker found the star of his new movie “The Florida Project” on Instagram. But what made her trust he was the real deal? And how do you actually say her last name?

“The thing I admire about Halley the most is that, as much as she’s going through — all these struggles — she never puts it on her daughter,” Vinaite said. “Imagine not having anyone to talk to or any family to help and also having to take care of a child that you don’t want to overwhelm with problems of the household.”

According to Lauten, that depiction is very realistic. Many people across the country may be struggling financially but they aren’t in danger of homelessness, because they have support networks of family and friends to help them. Hidden homelessness is often, in part, the product of broken relationships.

But even in a place where people don’t have much, there’s a generosity of spirit. In the movie, you see it when mothers agree to look after each other’s kids or let another family crash in their room for a night. Baker saw it, too, when he was doing research. One motel manager, who partially inspired the character of Bobby, was especially helpful. Baker said he kept offering the man a consulting credit or some kind of compensation, but he said no. He just wanted this story told.

Lauten, who saw an early screening of the movie, praises the film for portraying the characters sensitively, realistically and with a great deal of respect. Now the trick is spreading the word — letting audiences know this is a very real problem, not just in Florida, but nationwide.

“I really do believe that people will be shocked that this is not fantasy,” Lauten said. “This is reality.”

Children’s door-crush finger injuries ‘can be lifelong’

Published by:

Children and toddlers whose fingers are crushed by closing doors can end up with lifelong problems, plastic surgeons are warning.

The British Association of Plastic and Reconstructive Surgeons (Bapras) said the injuries in some cases could lead to amputation and long-term pain.

They said parents should fit safety catches on all suitable doors at home.

About 30,000 children trap their fingers in doors each year and more than 1,500 of them need surgery.

The figures are from the Royal Society for the Prevention of Accidents.

It says more than two million children under 15 have accidents in and around the home every year and require emergency medical care.

According to Bapras, self-shutting fire safety doors, car doors and hinges are the top three causes of finger and hand injuries in children.

Hinge protectors

It recommends putting small C-shaped devices made of foam or rubber over doors to prevent them slamming – but these are not suitable for fire doors because they prevent the door from closing.

Hinge protectors can also be fitted on most doors.

Bapras spokeswoman Anna De Leo, a plastic surgeon at the Royal Free Hospital, London, said finger injuries were not a joke.

“The injuries are so serious that the patient would need to undergo a clinic appointment, an X-ray, day surgery, a follow-up nurse appointment and possibly physiotherapy.”

And she said the effects could be long-term.

“It’s easy to underestimate how important your hands are to doing everyday tasks.

“Injuries to fingers and hands mean tying your shoelaces, typing, holding a mobile phone or eating become a lot more challenging.

“And this is nothing compared to the impact of a finger amputation.”

Ms De Leo said people in that situation could also experience elbow pain, migraines and even depression.

“Fingertip injury alone can result in 20% loss of hand strength and can prevent people from pursuing their chosen career,” she added.

‘No finger tip’

In the late 1960s when Jane was about three years old, her older brother was asked to lay the table.

“When he tried to extend the gate leg table, the tip of my right hand ring finger was severed,” she says.

“Mom picked up the tip and I went to the hospital.

“Apparently I had nine stitches but it didn’t reattach so now I no longer have a tip on that finger.”

Colin was a toddler when he pulled himself up using the door frame while my friend tried to close the door.

“The door wouldn’t close (because my thumb was in the way) so my friend kept on pushing the door.

“It took my Mum a while to work out where I was making all the noise from,” he says.

The doctors wanted to amputate the top half of his thumb but his parents persuaded them not to.

Now he has a misshapen but fully-functional tenth digit.

“People only notice it’s misshapen if I point it out, which I very rarely do.”

Accidents that happen in the home

  • Falls from height and burns and scalding result in the most severe injuries
  • Most accidents tend to happen in the kitchen and on the stairs
  • Children under four years old are most prone to accidents
  • Boys are more likely to hurt themselves than girls
  • Poisoning, choking, suffocating, glass-related incidents and strangulation are also common

Have you suffered problems after a finger injury when young? Are you the parent of a child who has injured their fingers? Let us know about your experiences. Email haveyoursay@bbc.co.uk with your stories.

Please include a contact number if you are willing to speak to a BBC journalist. You can also contact us in the following ways: