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ORIGINAL RESEARCH PAPER
Year : 2007 | Volume : 20 | Issue : 2 | Page : 42
Towards Unity for Health in the Barceloneta: An Innovative Experience in Community-Based Primary Health Care
A Segura1, FA Miller1, G Foz2, A Oriol y Bosch1
1 Institut d´Estudis de la Salut, Barcelona, Spain
2 Institut Catalá de Salut, Barcelona, Spain
Date of Submission 28-May-2007
Date of Web Publication 29-Aug-2007
A Segura
Institut d´Estudis de la Salut, Barcelona
Context: This paper describes a unique experience in community-based primary care in the Barceloneta, an economically deprived neighbourhood in Barcelona, Spain. The paper analyzes the reasons for the successes and failures of the project in light of TUFH principles.
Methods: The Primary Care Team (PCT) that staffed and ran the Health Centre in the Barceloneta facilitated the active participation of entities and individuals from the neighbourhood in deciding questions of care provision and resource allocation. They also collaborated with other service providers in the neighbourhood including pharmacists, with whom the PCT developed a program for monitoring diabetic and hypertensive patients in the local pharmacies.
Results: The health centre registered some of the best outcomes in Barcelona, including: time spent with each patient; capacity for the physicians to resolve patient visits without a referral; and patient satisfaction. Outcomes for patients followed by their local pharmacists were equivalent to those seen in the clinic, with lower costs. Despite these impressive results, conflicts among and between various stakeholders led to the project's termination.
Conclusions: Innovations in any system can lead to conflicts of interest between stakeholders, derailing even demonstrably effective programs. A stable partnership with other stakeholders, particularly the community and health care administrators, in this case, is key. However, the community is not monolithic, and efforts must be made to ensure that other stakeholders do not widen intercommunity disputes. Effective dissemination of information on the impact of the project on the population is important to maintain relationships with the various stakeholders.
Keywords: Community health, Community-based Primary Care, Integrating medicine and public health, Towards Unity for Health (TUFH), Pharmacists, Community Participation
Segura A, Miller F A, Foz G, Oriol y Bosch A. Towards Unity for Health in the Barceloneta: An Innovative Experience in Community-Based Primary Health Care. Educ Health 2007;20:42
Segura A, Miller F A, Foz G, Oriol y Bosch A. Towards Unity for Health in the Barceloneta: An Innovative Experience in Community-Based Primary Health Care. Educ Health [serial online] 2007 [cited 2021 Jan 21];20:42. Available from: https://www.educationforhealth.net/text.asp?2007/20/2/42/101625
The compartmentalization currently seen in health care and social services is an important obstacle to achieve more relevance, responsibility, equity, and better results in the delivery of health care. At the conference "Towards Unity for Health" that took place in Phuket in 1999, it was proposed that there be an effort to foment an organization of health care services that is truly oriented towards the needs of local populations. The strategy to accomplish this would be through the integration of the key stakeholders impacting the health of a community, amongst whom a primary actor is the community itself (Boelen, 2000).
It was in this context that the WHO sent out a request for proposals to select field projects from around the world that would be able to develop the initiative "Towards Unity for Health". One of the twelve projects selected was the AUPA Project of the Barceloneta, submitted by the primary care team (PCT) that provided health care to the neighbourhood of the Barceloneta, in Barcelona, Spain since 1993 (AUPA are the initials for "Towards Unity for Health" in Spanish and Catalán. In Catalán "Aupa!" also means "Upwards and Onwards!"). This paper describes the innovative aspects of the AUPA Barceloneta project, the evidence of the impact it had on the population, and then analyzes its successes and some reasons for its eventual termination in light of TUFH principles.
In 1993, the PCT, a private group of physicians, was contracted by the Catalán Government to provide health services for the Barceloneta, a poor neighbourhood near the port of Barcelona. As the first private provider contracted to work within the publicly financed Catalán health system, the PCT was characterized by a strong ethic of professional responsibility to care for the entire health needs of the population. This perspective led to uncommon efforts to coordinate activities with other agents working to improve the health of the population in the neighbourhood. Activities included collaborations with medical specialty services, the neighbourhood pharmacists, public health professionals and with teachers in the primary and secondary schools.
The Basic Health Area of the Barceloneta coincides geographically with the neighbourhood itself, which has conserved a very strong identity. [Note: The entire territory in Spain is divided up into Basic Health Areas. Each Basic Health Area has at least one team of health professionals (family physicians, nurses, paediatricians, frequently a social worker, and occasionally podiatrists and dentists) that is responsible for the health care for that population. By law this involves direct patient care as well as health promotion activities for the reference population. However in practice, most primary care teams do little in terms of health promotion activities.]
The Barceloneta's population is particularly affected by aging and social and economic deprivation, with a notable burden of illness and disability. Life expectancy at birth for males is 8 years less than the city average, and for females it is 4 years less (the city average is 77.5 and 84.3 years, respectively). The health and social needs of this area are markedly higher than the rest of the city, which translates into a higher demand for health services. This is accentuated by the fact that medical care is a benefit with universal access in Spain, which is not the case with social services (Segura, 2004).
Local Services and Civic Entities
The PCT worked with a variety of civic entities including the neighbourhood associations, the commercial associations, the senior centre, the civic centre, and the schools, from day care centres to high schools. Most of the activities were health promotion interventions consisting of health education presentations, and prevention of disease activities such as school health examinations and vaccinations. The PCT also had a regular article and readers' advise column in each edition of the local newspaper, "La Barceloneta", which distributed 5000 free copies each month. Moreover, they established regular meetings with these civic organizations to discuss health problems in the community, such as the legionnaire's disease outbreak during the winter of the year 2000 (Jansa et al., 2002).
Particularly important was the participation of the neighbourhood associations. They shared responsibility with the PCT for making decisions that affected the organization and accessibility of the centre. This, in turn, permitted the adoption of initiatives intended to improve the rational and fair use of health care resources, such as the procedure for making same day appointments.
Medical care was provided by family physicians and paediatricians. When patients were referred to a specialist, instead of going to their office, the specialist consultant came to the clinic and saw the patient together with their family doctor. These joint visits were included within the program of continuing medical education, which served to keep the PCT up-to-date, as well as increase their prestige in the eyes of the patients. Another important consequence was the capacity for the PCT to resolve their patients' health problems. The proportion of referrals to external specialists in the Barceloneta was two for every one hundred patient visits, while the proportion of referrals in the rest of the city was approximately seven per hundred. It also resulted in more appropriate use of emergency services in the hospital, which decreased by 20% in the first five years of operation. Finally, the patients referred to the hospital from the centre were admitted more quickly given that the hospitalization was part of a process of continuity in care (Segura, 2004).
Between Professionals
In assuming the responsibility that comes with the exercise of professional autonomy, peoples' creativity is stimulated to deal with problems and enact solutions, in internal clinical activities as well as relations external to the clinic. With regard to self-budgeting, the organization of service delivery was based on a functional conception of the team in which every service developed their own competencies in a way that was autonomous, yet coordinated. The primary doctor, as the person responsible for their patient's care, played a central role in the prescription of medications, the requesting of diagnostic tests, and referrals to specialty services. The nursing personnel developed their own activities to monitor patients with chronic diseases, and carry out complimentary exams (EKGs, spirometry, etc.), extractions for analysis and treatment procedures.
All of the care delivery was registered in a database, which was either exhaustive, or, in the case of same day visits, was registered as a representative sample. The physicians had absolute freedom to prescribe medications, to solicit diagnostic tests and to do referrals. Common criteria were established in a consensual manner, and in some cases, such as with the pharmacy prescriptions, the medications were pre- selected. The physicians were nevertheless able to make the clinical decisions they saw as necessary, with all the providers' decisions under systematic supervision by the Clinical Director (CD). This information was all registered electronically using software developed by the PCT, which allowed for the budget to be shared with the financial backers and with the community in the external realm. It also was useful internally for sharing data with the PCT, thus guaranteeing the internal transparency necessary to reach the standards and objectives established by the PCT, as well as to correct for deviations from these objectives.
Neighbourhood Pharmacists
The centre began collaborating with the local pharmacists after an initiative to promote the rational use of medications following an audit done by the University Institute of Public Health of Catalunya in 1995. This audit led to a decrease of 24% in the number of prescriptions originating from the centre and a 26% decrease in the cost within a year of its implementation. It was thus necessary to explain to the local pharmacists the goals and criteria used to make these modifications so that the pharmacists could adequately explain these changes to the patients to whom they were supplying the medications. To do this, joint sessions between the pharmacists and the PCT were arranged. These meetings lead to the pharmacists participating more actively in the care of patients, such as periodic joint sessions analyzing problems that derived from the population's use of medications and ultimately to new joint initiatives, such as the Community Program for the Control of Patients with Diabetes and Hypertension. The program allowed patients to go to their neighbourhood pharmacist for blood glucose and blood pressure checks, with an electronic linkage to the patients´ records in the clinic. Without diminishing effectiveness, this innovative program improved access, efficiency, and satisfaction for the patients who participated, which was half of the patients who were offered this option (Segura & Miller, 2006).
In similar fashion, a joint program was started to integrate pharmacists with the rest of the health professionals on the PCT in the detection, analysis and eventual correction of medication incidences, the majority of which were problems of non-compliance. Finally, the PCT and the pharmacists jointly carried out a personalized dosing program for patients taking multiple medications who had difficulty adequately self-administering their drugs.
The PCT maintained multiple relationships with academic institutions. Sixth year medical students at the Autonomous University of Barcelona did two month rotations with the PCT. Pharmacy and Podiatry students from the University of Barcelona did practical rotations. Several Master's students in Public Health at the University of Pompeu Fabra worked on thesis projects with the PCT (Valero et al., 2006), and the University Institute of Public Health did the audit of the drug prescriptions, as mentioned above. Lastly, the Institute for Health Studies supported the participation of a public health professional (the lead author of this paper) in the spirit of social responsibility, as well as to assist the PCT in documenting the trajectory of their project.
In the first two years of operation, the clinic was able to decrease the number of monthly visits by the high frequency patients (those who came to be seen more than 50 times a year) by almost 20%.
The quality ratings for the Barceloneta health centre were the highest in the city for patient visits resolved without a referral, patient satisfaction, and time the patient spent with their doctor.
Patient visits with their physicians averaged 12 minutes for an urgent care visit and 24 minutes for a scheduled visit, compared with the city average of 6 minutes for all types of patient visits.
Emergency Room visits to the nearby hospital were decreased by 20%.
Greater autonomy resulted in a more satisfying work environment for health professionals, as did working with specialists in the clinic.
Pharmacists felt more satisfaction in playing a role as health providers in the care of chronic patients.
Patients were more satisfied with the program that allowed them the convenience of being monitored at their neighbourhood pharmacy, with equally good outcomes (Segura, 2004).
Negative Outcomes
Despite these excellent results, tensions had been mounting between the CD and the municipal government over professional autonomy issues. The CD insisted that to better respond to the needs of the population, as well as to encourage a sense of professional responsibility for the members of the PCT, it was essential to have a large degree of autonomy to decide policies and allocate resources. Over time, however, new people were appointed to assume political roles in the local administration and the health care administration who were not in agreement with this level of autonomy. In the summer of 2004, a conflict arose between different factions within the community on how the centre should handle urgent care visits. The health administration stepped in and imposed a solution, which, in the view of the CD, violated the PCT´s privileged relationship with the community, diminished their credibility as well as further divided the community. The CD left, along with half the PCT, effectively ending the project.
In light of TUFH principles, this experience would suggest several observations:
Implications for Health Care Professionals: By giving the health professionals a new role in deciding how to run their clinic, they were able to organize resources to the greater satisfaction of their patients as well as themselves. Granting them the charge of caring for the entire population, including those who might not present as patients, lead to an extension of their sense of responsibility to provide preventive and health promotion activities for the whole population - a form of professional commitment and responsibility not frequently seen in the Catalán, or any, health system.
Civic Participation: Making efforts to involve community representatives as key stakeholders for running a clinic is an effective way for patients to assume more responsibility in the use of health resources. The CD stressed that they were able to achieve a decrease in high frequency users only by dialoguing with them and coming to agreement on various measures to decrease this behaviour in order to provide better access for more patients (Segura, 2004).
Collaboration with Neighbourhood Pharmacists: Pharmacists have a unique position in the community in that they are very accessible, they often have a good deal of credibility with the population as a resource for medical advice, and many would like to be of more service for patients. They should be considered as potential stakeholders in the local health care arena in the TUFH approach. Having pharmacists participate in monitoring chronic care patients can lead to greater patient satisfaction, lower costs, and equivalent outcomes to patients followed in the health care centre.
The Need for Stable Commitments Between Different Stakeholders: Much of what the PCT was able to accomplish was thanks to their degree of autonomy to do what they felt was most important. The PCT was not constrained by protocols imposed from above in a highly centralized system that dictated how they should arrange their patient schedules or allocate funds for specialty care. In this way they could negotiate appointments protocols directly with patients, or make contracts with specialists to come to the clinic and do joint visits with the PCT. Recent appointees in the local political arena and health administration had a different view of management and did not allow the PCT adequate autonomy to continue its work with the community and other local providers. In light of the TUFH approach, it should be emphasized that once relationships are created with key stakeholders, every effort must be made to maintain these relationships when there is change in personnel.
Evidence of Impact: While the CD kept local politicians and health care administrators informed about the project's successes, the population could have been better informed about these quantitative results. Perhaps if the community was more aware of the many positive outcomes of the project, they might have found a way to come together and support the PCT when their autonomy was threatened by external political forces.
Communities are not Monolithic: The split within the community on how to handle urgent care appointments demonstrates clearly that communities often do not speak with one voice. To handle such delicate situations it is very important for the other stakeholders to not take sides and further exacerbate the conflict.
Involving Other Service Sectors: Interventions in health promotion and prevention increasingly are involving other service sectors - education and social services in particular. This tendency could receive more emphasis in the TUFH model.
Acknowledgement: Special gratitude is owed to Dr. Juanjo Avendaño, former Clinical Director of the Barceloneta, for his leadership and dedication towards putting TUFH principles into health care practice.
Boelen, C. (2000). Towards Unity for Health: Challenges and opportunities for partnerships in health development. A Working Paper. Geneva: World Health Organization.
Jansa J.M., Cayla J.A., Ferrer D., et. al. (2002). An Outbreak of Legionnaires´ Disease in an Inner City District. International Journal of Tubercular Lung Disease, 6:831-838.
Segura, A. (2004). Monografía 12. El projecte AUPA Barceloneta. (El CAP Barceloneta/Serveis Mèdics: 1993-2003). Barcelona: Institut d´Estudis de la Salut. (Executive summary in English).
Segura A. & Miller F. (2006). Health Services for the Barceloneta. The Network: Towards Unity for Health Newsletter. Vol. 25, No. 01, Pg 21.
Valero Parilla F., Segura Benedicto A., Segú Tolsa J.L. (2006). Utilización de la ecuación de Framingham-REGICOR en un centro de atención primaria. Impacto sobre la prevención primaria de las enfermedades cardiovasculares". Atención Primaria. 38:490-495.
Segura A
Miller F A
Foz G
Oriol y Bosch A
Community-based Primary Care
Integrating medicine and public health
Towards Unity for Health (TUFH)
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1999: My Dinner with Frank Black
,Frank Black has since reunited with the Pixies, and continues his prolific solo career. Roy Zimmerman gigged here in Tucson last month, and his upcoming appearances are posted here. The two of them shared a stage again last August at the Great American Music Hall in SF.
Being in LA again reminded me of everything I love and hate about it. Flying in, you can take in the awful vastness of it, and look down on the morning overcast that's both smog and fog, and you're never sure how much of which. Down on the ground, when you're on the coast, you know it's mostly fog. Conversely, when you're in Pasadena or Pomona and you can barely make out the mountains a few miles away, you get that sickening certainty about what's going into your lungs. All the clean air regulations imposed since I last lived there, in 1978, haven't appreciably improved the atmosphere - there are just that many more cars to make up the difference.
But on that other hand is the great confluence of culture that comes from throwing millions of people together. The variety of options available to me on the radio dial, in the movie theaters, and in the music clubs was overwhelming. And driving through the gray vastness of it all, you could catch glimpses of truly delightful architecture, as well as more intriguing restaurants than you could sample in a year. Not to mention all the great museums I didn't have time for.
I'd placed myself back in LA for two reasons. One was to visit my grandmother, who, at 88, is somewhere in the slow-moving checkout line in the supermarket of life. And the other was to sample one of those many cultural options: my old high school buddy Roy Zimmerman was holding forth that evening at McCabe's Guitar Shop with one of my musical idols, Frank Black (AKA Black Francis of the Pixies, AKA Charles Thompson).
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Roy pulled up in front of the terminal in his '73 Nova and swiftly navigated the roads up to his home in Pacific Palisades, where I met his charming pooch Superdog, a dachshund/chihuahua mix. Then we grabbed some lunch in a little Mexican place nearby. Afterwards, Roy picked up some equipment out of a little office he rents there, and we set out for Santa Monica. Roy had guitar lessons to teach that afternoon, so he gave me the keys to the Nova and I had about four hours to kill. I set sail for my old stomping grounds in Westwood. Though it was now about 2 in the afternoon, the streets were more or less gridlocked, often charging me two or more red light cycles to clear a few blocks.
Eventually I reached my destination, the original retail outlet for Rhino Records. Back in the 70s, before Rhino became the world's premier reissue label, it was just a goofy little store with hilarious memorabilia on the walls, the world's most knowledgeable clerks, sarcastic little reviews affixed to various albums, and shockingly cheap prices. Today the six bucks that used to get me six used LPs got me just one used CD, which is still mighty cheap. The CD in question was the latest release from Mr. Frank Black, and as I made my way back into Santa Monica, I stopped from time to time to enjoy a beer, a coffee and a milkshake at various little haunts along the way, reading the lyric sheet along with the LA Times and the LA Weekly.
Around 6 I showed up for soundcheck at McCabe's. Since its founding in 1958, this little store has probably hosted more great musicians than any other space of comparable size. John Hiatt had just passed through; next night was David Lindley. Pictures of the greats, Richard Thompson, Ry Cooder, Gracia, lined the walls. As the retail portion was shutting down, I could hear the patrons namedropping to each other: I was playing this up at Leonard Nimoy's place last week; yesterday I was jamming with Stephen Stills, etc. Customers would sit down with various instruments and spew forth expertly and deftly, while I checked out the museum of vintage guitars all over the walls. In the back room, clerks wheeled away display cases and set up exactly 155 chairs.
Roy came out on stage with my idol, who looks quite a bit like Curly of the Three Stooges. In between setting levels with the sound engineer, Roy introduced me. "Charles, this is my friend Mark; he's the editor of the Tucson Comic News." We chatted a bit about Tucson and the gigs I had seen him play there. In fact, I told him, my wife had fallen in love with me at one of his shows. We'd been going out for about a month and she still hadn't made up her mind about me. But when she saw me dancing with wild abandon and joy to Frank Black's music, well, that was the clincher.
Charles unrolled a huge BLM map of the state of California and affixed it to the wall behind the stage, then gave us a hilarious mini-lecture on the history of the Salton Sea and his experiences shooting a video there. Just before he went backstage I asked him to autograph a CD booklet and I gave him a copy of my book The CIA's Greatest Hits. He seemed a bit embarrassed by the attention. I asked him how he had hooked up with Roy to begin with. "I heard one of his songs on the radio, and then we saw he was playing at Luna Park. Pretty soon I was going there every week, drinking way too much Guinness Stout and laughing my ass off."
Roy asked me to save a seat in the fourth row for his wife Melanie, so I sat in the empty hall and watched it fill up with twenty-somethings. I was guessing the crowd was about evenly split between Frank's fans and Roy's, but Melanie estimated it was about 90% for Frank. The truth was probably somewhere in between, but either way they managed to sell the place out with very little publicity; the gig had been arranged on such short notice that there had been no notice in the Times' or the Weekly's calendar sections.
If you guessed there was little overlap between the two audiences you'd be correct. Roy is a satirist, a brilliant writer of comedy songs, first with his folk/rock band the Foremen and now as a solo act. Much of it is overtly political, while the later songs focus more on relationships, but all of it is mighty amusing, with or without Guinness Stout.
Charles is a surrealist; while some of his songs tell a story, and are not without humor, they're less literal and more oblique than Roy's. He made five albums as the leader of my beloved Pixies, with material ranging from gentle pop to ferocious punk. His five subsequent albums as Frank Black are nearly as eclectic, with an ever-growing craftsmanship. One thing he has in common with Roy is a predeliction for clever rhymes: while the former has combined "queryin'" with "Hyperion," the latter followed "obstacle" with "knobs tickle."
Many of the fans expected Roy to be the warmup act, but in fact they sat on stage together with acoustic guitars and traded songs back and forth, each playing solo. Frank Black was first, and he began by pointing to the map and asking the audience for help in pronouncing the name of an Indian tribe from up north. Then he sang a new song, "Humboldt County Massacre," about the ethnic cleansing of those unfortunate folks. Roy followed up with his excellent song "TMI (Too Much Information)" and immediately began winning over the Black fans. It was great to hear them cracking up all around me.
Charles himself was a big Zimmerman fan, and watched with a grin on his face, sometimes interjecting "Oh, I love this one," or "Do you stil play that song, "Branded?" Between songs they chatted amiably, though Charles later confessed to some nervousness, as Roy is the king of banter, and "at rock shows you never really have to talk to the audience." Roy would deftly guide the conversation into a brief monologue which served to introduce his next song. Charles knew he would need to do the same, but his speeches were as oblique as his tunes: the apricot seedling growing from his car's vinyl roof, or his cat's problems with a urinary tract infection. Then he'd shrug and launch into another excellent number.
Both guys played mostly songs I had never heard before, and the acoustic setting made it easy to pick out the lyrics (plus I had just read some of them before the show). Roy's stage presence and timing were impeccable, though he later confessed to some nervousness over the unfamiliar audience. Charles took nifty little rhythmic guitar breaks in the middle of his songs, though he later confessed to self-consciousness over his playing. We all assured him he was wonderful, and one of Roy's pals accurately noted similarities to Pete Townshend's playing. Charles was also in fine voice (he's been taking lessons, of late) with none of the hot-pokers-in-the-eyes shrieking of yore (not that there's anything wrong with that) and sometimes adding in his own backup vocals.
Melanie and I hoped they would play at least one song together, and we sort of got our wish. For the final encore, Frank Black suggested that they each play a different song at the same time. Roy got into the spirit of this suggestion immediately, and, just as if it were April Fool's Day, they proceeded to simultaneously flail away at their guitars and shout over each other, having a great time, though nobody could quite make out a word they were singing ( I did pick out that Charles was performing his only Pixies number of the evening, "Nimrod's Son").
Afterwards we all went out to dinner down the street at another wonderful Mexican restaurant and chatted about the show. It was a triumph for both of them. The Frank Black fans got a great kick out of Roy, and the Roy Zimmerman fans were mighty impressed with Charles. As the more famous musician, it was a generous move on Charles' part, but it was so much fun for all involved that it will likely be repeated at some point.
Posted by MZepezauer at 11:05 AM
Labels: 1999, music
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NEWCASTLE UPON TYNE: Thompson Building Centres has made two new appointments as it presses ahead with expansion plans. The new posts are part of a development programme by Thompson and its subsidiary, TAPS.
Karl Dennett newly-appointed roofing director, will be based in South Shields and oversee all five of Thompson's regional depots, where he plans to streamline the roofing materials on offer and make them more accessible to customers.
Dave Harding has been appointed sales director for TAPS Plumbing and Heating Supplies, based in Hendon, Sunderland.


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South African govt consults faith leaders on easing COVID-19 restrictions
President Cyril Ramaphosa was consulting religious leaders to identify needs in different communities
A South African National Defense Force soldier directs and checks the movement of South Africans at a checkpoint in Cape Town, South Africa, 13 May 2020. (Photo by EPA/NIC BOTHMA/MaxPPP)
By La Croix International staff | South Africa
South African President Cyril Ramaphosa has consulted various faith leaders on his government's preparations for reopening of the economy while at the same time prioritizing the saving of lives.
Consultations between the president and interfaith leaders took place in a virtual meeting on Wednesday, the SA News reported.
Taking part in that meeting were leaders from the South African Catholic Bishops Conference, the South African Council of Churches, the National Interfaith Council of South Africa, the Muslim Judicial Council, the Jewish Board of Deputies, the South African Hindu Maha Sabha, African Independent Churches, Charismatic/Pentecostal churches, African Traditional Faiths, the National Religious Leaders Council and the Southern African Interfaith Council.
"The meeting was held amid government's planning, in partnership with civil society, for the progression of large parts of the country to alert Level 3 of the national lockdown that will enable further easing of economic activity and personal movement," said a communique from the president's office.
Under Level 3, all types of manufacturing are to be allowed to run at 50% capacity with a select few allowed to scale up to 100%. Presently, South Africa has some of the most severe lockdown rules in the world including no jogging or walking outside of homes except between 6-9 am, no sales of alcohol or cigarettes, no walking of dogs, no leaving home except for essential journeys with heavy penalties for transgressors.
The meeting was an effort by government to take stakeholders into its confidence regarding progress and challenges in the management of the pandemic as well as identifying needs in different communities.
South Africa with 57 million people has recorded 17,200 COVID-19 cases and 312 related deaths. However, scientists have warned that at least 40,000 people could die from the infection in South Africa by the end of the year.
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Hospital Chaplains Bring Hope And Solace To COVID-19 Patients And Staff
By Lulu Garcia-Navarro
One of the hardest things about serious cases of COVID-19 is that people end up in the hospital in isolation and unable to be close to their loved ones. As the death toll mounts in the United States, hospital chaplains have become a much needed source of hope and solace. And some are supporting hospital staff as much as they are patients and families. We're joined now by Mike Yonkers, a chaplain for the University of Washington Medical Center in Seattle, one of the epicenters of the outbreak. Chaplain, welcome to the program. Thank you so much for joining us today.
MIKE YONKERS: I'm glad to be here.
GARCIA-NAVARRO: Can you tell us about the last case of COVID-19 that you had to deal with and describe what happened?
YONKERS: Oh, yeah. Our profession is very much trying to get close to people. We try to empathize with people in person. And most of our care is often given nonverbally, really, to patients, a holding of the hand, an anointing of your forehead with oil. So the last person I actually worked with was one of our patients who is about to be on the way out of the hospital because he's on the way to be getting better. So I called him up, and he didn't know that I was calling. But I basically said, hey, I'm one of the supportive care folks here to check in on your spirit. Would you welcome just to chat and see how you're coping?
And he was happy to have a visit, really. And what we do as chaplains are often trying to think about how do you cope during this time? What are your inner resources to be able to make it? If you need bread for your soul, what is that bread essentially? But what he really was reflecting on is, I think - not to quote him exactly, but he said I feel blessed to fall into the hands of really, really, really good care here. And so he was reflecting on how he's essentially mostly made it through this at this point.
GARCIA-NAVARRO: Yeah. I understand you've had to get creative in other ways - not just phone calls, but you actually printed out a prayer for a nurse to hold over a patient's bed at the request of his family. Can you tell me about that?
YONKERS: Yeah, they were hoping for someone to pray over their loved one. And I thought, OK, I can't physically go into the room to pray over them, but I can get creative another way. So what I did as I walked over just to the nursing area, got to know the nurse a little bit and then just asked everything I could know about the patient. Who is he? How old is he? Does he have family? Do we know anything about what he likes in life?
And then essentially, once I got a little bit of a picture of him, I went back to my office, wrote up a prayer as quick as I could. We gathered outside of the room and offered this prayer that I wrote. And then to put the prayer over him, the nurse who can go into the room brought it in and then hung it over this patient over their head, I believe. And I don't know how they did it. They taped it or strung it up or whatever. But I know that the prayer is over this person.
GARCIA-NAVARRO: Of course, amongst all this is the hospital staff who are feeling overwhelmed. Can you talk a little bit about how you are helping them to cope with this frightening time? What do you ask them to think about?
YONKERS: Oh. People can drop in, and we do mindfulness exercises with them. And then some people who may be spiritual - to offer them a blessing or prayer. However, it is that you find grounding in your life, we're happy to talk about that with you when you're feeling anxious or ungrounded. But really, we're trying to engage the many - in different ways in which people are coming here with fears and also courage and bravery at the same time and trying to honor all of that, really. It's mostly just an acknowledgement of the fact that you are here and that your work doesn't go unacknowledged and it that is essential, really.
GARCIA-NAVARRO: As a man of faith, what words of comfort do you have for those who are listening right now who are feeling frightened?
YONKERS: Yeah, I really do draw from my own spiritual tradition where we acknowledge that people often do have to go or societies have to go through exile or wilderness at different times and that even when you're in a wilderness or exile - the pandemic could be something like that. And when you're in that wilderness, you can still work for the peace or the shalom of wherever you live for your neighborhood. And my words of hope are really just that anyone can be a peace bringer during this time and that it's similar to Mister Rogers, where he says look for the helpers. But look for the peacemakers. And also, you can be a peacemaker at this time, too.
GARCIA-NAVARRO: That was hospital chaplain Mike Yonkers in Seattle, Wash. Thank you very much.
YONKERS: Thank you.
NPR's Weekend Edition
Lulu Garcia-Navarro
Lulu Garcia-Navarro is the host of Weekend Edition Sunday and one of the hosts of NPR's morning news podcast Up First. She is infamous in the IT department of NPR for losing laptops to bullets, hurricanes, and bomb blasts.
See stories by Lulu Garcia-Navarro
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text:
Share this Story: GOLDSTEIN: The fiscal follies of Justin Trudeau
GOLDSTEIN: The fiscal follies of Justin Trudeau
Lorrie Goldstein
Liberal leader and Canadian Prime Minister Justin Trudeau speaks at a news conference after an English language federal election debate at the Canadian Museum of History in Gatineau, Quebec, Canada October 7, 2019. REUTERS/Stephane Mahe ORG XMIT: SIN523 Photo by STEPHANE MAHE /REUTERS
While the fiscal plans of all the political parties heading into the Oct. 21 election should be taken with a huge grain of salt, criticism by Prime Minister Justin Trudeau of the financial platforms of his opponents has zero credibility.
GOLDSTEIN: The fiscal follies of Justin Trudeau Back to video
In his 2015 campaign platform, Trudeau said the federal government would record three years of "modest deficits" under his leadership.
That would be followed by a balanced budget in the fourth year, which Trudeau specifically and emphatically promised Canadians he would achieve during the 2015 leaders' debate on the economy.
Trudeau's 2015 predictions were:
A $9.9 billion deficit in 2016-17;
A $1 billion surplus in 2019-20.
Trudeau's actual numbers have been:
A $19 billion deficit in 2016-17;
A (projected) $19.8 billion deficit in 2019-20.
In 2015, Trudeau promised his accumulated deficits over the next four years would be $24.1 billion.
His actual record puts them at $71.8 billion.
Trudeau missed his combined deficit target of $24.1 billion by $47.4 billion ($71.8 billion – $24.1 billion), or by almost 200%.
So that's what happened in the past.
Now let's look ahead to what Trudeau is predicting for his next four years in power if he wins the election.
In his March 19, 2019 budget, the last before the federal election, Trudeau projected the following deficits, with no return to the balanced budget he promised and failed to deliver for this year.
According to his 2019 federal budget, Trudeau projected:
A $19.7 billion deficit in 2020-21;
A $9.8 billion deficit in 2023-24.
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On September 29 — a bit more than six months after Trudeau delivered his March budget — Trudeau released his 2019 election platform.
Trudeau is now projecting:
A $27.4 billion deficit for 2020-21;
A $21 billion deficit for 2023-24.
That means that in his March budget, the last before the Oct. 21 election, Trudeau predicted his accumulated deficits would be $56.4 billion over the next four years.
Now, six months later, he's predicting his accumulated deficits will be $93.9 billion over the next four years, or $37.5 billion higher ($93.9 billion – $56.4 billion) than he predicted in March.
That means he's already 66% over his March budget predictions.
The debt-to-GDP ratio is an important measure of the government's overall economic health, the lower the better.
The good news it that Canada has the lowest debt-to-GDP ratio in the G7.
The bad news is that under Trudeau it's heading in the wrong way.
In his 2015 campaign platform, Trudeau promised that by 2019-20, Canada's debt-to-GDP ratio would be 27%.
His March, 2019 budget put it at 30.7%, and he said that by 2023-24 it would drop to 28.6%.
Six months later, Trudeau's election platform says it will be 30.2% in 2023-24.
Clearly, Trudeau's fiscal platforms are just numbers on a page that don't mean anything.
In fairness, that's true of all the so-called "costed" fiscal plans of all parties these days.
But for Trudeau to criticize the platforms of any of his opponents, based on his own dismal record, should not be taken seriously.
lgoldstein@postmedia.com


Alison Hicks is the author of full-length poetry collection Kiss (PS Books, 2011), chapbook Falling Dreams (Finishing Line Press, 2006), novella Love: A Story of Images (AWA Press, 2004), and an anthology, Prompted (PS Books, 2010). Her work has appeared in Eclipse, Fifth Wednesday, Gargoyle, Licking River Review, The Ledge, Louisville Review, Passager, Permafrost, Sanskrit, Whiskey Island, and other journals. Her poem "Color" was nominated for a Pushcart Prize by Green Hills Literary Lantern. Awards include the 2011 Philadelphia City Paper Poetry Prize and two Pennsylvania Council on the Arts fellowships. She is founder of Greater Philadelphia Wordshop Studio, which offers community-based writing workshops. She lives with her husband and son in Havertown, Pennsylvania.
Her book You Who Took the Boat Out can be found here.


3 Doors Down, performing at Rose Music Center in Huber Heights on Wednesday, Aug. 8, formed in Escatawpa, Miss., in 1996. However, for the past decade, band members Brad Arnold (vocals), Chris Henderson (rhythm guitar), Chet Roberts (lead guitar), Justin Biltonen (bass) and Greg Upchurch (drums) have lived outside of Nashville.
According to Henderson, who joined the rock band in 1998, the decision to live there has nothing to do with the city being ground zero for the country music industry.
When: 8 p.m. Wednesday, Aug. 8. Doors open at 7 p.m.


These Healthy Black Bean Spinach Enchiladas are incredibly easy to make, and full of amazing flavor. They take minutes to throw together, and only require a few simple ingredients. You will love how yummy these taste.
We love Enchiladas at our house. I wanted to find a way to stick some veggies in there and I came across a recipe from The Garden Grazer.
I changed things around a little bit to make it so my girls would eat it and it turned out delicious. Hope you love it as much as we did.
They were so easy to make and seriously had the most amazing flavor to them. They were very filling, yet so light.
They tasted so fresh, and my kids gobbled them right up. If you are looking for an easy and healthy meal, this is definitely one I recommend.
what tortillas work best for this recipe?
I prefer to use whole wheat tortillas for the nutrition benefits. However, really any tortilla would work. We also recommend using a 8 or 9 inch tortilla, so they fit best in the pan.
You could use white flour tortillas, corn tortillas, or whatever you prefer, but for healthy purposes, my family and I prefer to use whole wheat tortillas.
You could really use any meat. You could even turn these into breakfast enchiladas, with egg and bacon. Have fun with your enchiladas, and add all your favorite toppings.
In a large bowl, combine beans, 1 cup cheese, spinach, corn, green onions, cottage cheese, 2 tsp. cumin, and cilantro.
Preheat oven to 375. Lightly spray a 9x13 inch baking dish, and pour a small amount of the Enchilada sauce to coat the bottom.
This recipe sounds delish! Does the cottage cheese go in the mixture in the bowel with the beans and corn? Thanks!
Looks delicious! We love enchiladas and black beans, will have to try this!
Most of your recipes look AMAZING! But many of them contain gluten. I would like to see more alternative recipes for those of us cannot eat gluten. These enchiladas look soooo good. Maybe I'll try them without the tortillas. Thanks.
Sounds good but you never mention when to put in the cottage cheese? Also, could you sub ricotta instead?
Ricotta cheese would work fine. We are editing the recipe. Thanks for calling it to our attention. That step was left off! OOPS!
We love our enchiladas here in southern Az. too!! Love this new recipe, especially the cottage cheese addition.
You have 1 cup of cottage cheese in the directions. Do you use it? It's not in the instructions and the recipe from the Garden Grazer doesn't seem to use it either. Should I just add it to the bean mixture?
Thanks for the heads up. We'll check the recipe and make the correct changes. Sorry about that!
When do you use the cottage cheese? I don't see when to add it.
Hi-Sounds great but I still don't see where to put the cottage cheese. It's not in the directions.
So sorry! That one slipped through the cracks! We fixed it!
Loved this recipe the first time i made it. was very easy to make. Instead of using canned corn, I substituited fresh zuchinni, chopped up and low cal tortillas from trader joes at 60 calories each.
Made these a few nights ago, turned out amazing, I mixed the veggies and cottage cheese stuffed the tortillas and yum. For a veggie dish, bravo. They were awesome.
Can you use corn tortillas? Or would you recommend only whole wheat or flour? Thank you!
Corn tortillas will work just fine too!
What size tortillas do you use? The large ones look too big to me but the medium ones seem a bit small?
We use the regular 8 to 9 inch tortillas.


text:
Washcult
A View Looking Out from the Nation's Capital
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Miss Julie/Mies Julie – Strindberg's Classic Brought to Vivid Life
Posted on November 13, 2013 by Steve
Hilda Cronje, Bongile Mantsai. Photo by Rodger Bosch
I'll admit it. I didn't get Strindberg. Introduced to the talky, stagey play The Pelican in college — I had a bit part — I thought he was one of those playwrights that made sense long ago, but was no longer relevant. Like many impressions from my shallow youth, this one was all wrong.
Mies Julie, a production of the Baxter Theatre Centre at the University of Cape Town is a reinvention of Strindberg's classic set in South Africa. It's now on view at The Shakespeare Theatre in Washington, DC.
This production is vital, feral, ablaze from the moments before the play starts — as the stage fills with smoke and ominous sound — to the final, inevitable end.
Maybe you've read or seen the play? If not, you can catch up in just a second. John, a servant, is polishing master's boots. Julie, the daughter of the estate's owner, is drunk, and dancing provocatively at a midsummer party for the estate's workers. (At least in the Swedish original it's midsummer; in South Africa it's always hot, so no season needs to be specified).
In both versions, John and Julie grew up together, separated by class, looking across the gulf at each other. On this night, they pledge their love to each other, but measuring that gulf, they ultimately find it uncrossable.
Tellingly, Strindberg had complicated John's life with a third character, Christine, who is his peer and fiancée. In Yael Farber's African retelling, Christine is instead John's mother. A fourth character — a musician, dancer, witch, and very solid white-faced black ghost — joins her as an ancestor. The two women embody spirits who will never rest until many more generations work out the class and racial catastrophe that is the South Africa's history.
John and Julie are almost never off the stage for Farber's intermission-less 90 minutes, and if there's one small complaint I have about this powerful production it is the unrelenting pitch of Hilda Cronje's performance in the title role. She begins in a fever, and never wavers or varies the intensity of her performance. From seduction to sorrow to self-injury, she throws off so many sparks that you wonder why and how John can even catch her for the moment it takes for them to consummate their union.
She's crazy in some deep significant way, and that should allow her some freedom to be sweet and sexy, or girlish, just to give us a break for a moment.
Bongile Mantsai is John, and the power of his performance comes from the fact that he never forgets his "place" as a servant — until he gives in for just a moment to his fantasy. Willing to use his attractiveness and power as a ticket out of the prison he's trapped in, he finally realizes that the power will always lie with his masters, no matter what he does.
The complication of race, in a play that was first staged in apartheid South Africa, is never out of sight. We understand that John can be killed for his transgression, whether or not Julie carries through on her threat to cry "rape." And yet, without that complication, Strindberg has provided the foundation of the story and its churning engine of sex and class, privilege and want.
And so, this South African adaptation is not a twisting or improvement of Strindberg's original, only a version. And that's why I'm going to start paying a little more attention to his work when I find it in the future. Like I said, it sometimes takes me a while to catch on.
This entry was posted in arts news, Theater and tagged Mies Julie, Miss Julie, Shakespeare Theatre Company, South Africa, Theater, Washington DC. Bookmark the permalink.
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text:
using System;
using System.ComponentModel;
using Xamarin.Forms;

namespace HelloXamarinForms
{
	public class ClockViewModel:INotifyPropertyChanged
	{
		public ClockViewModel()
		{
			this.CurrentDateTime = DateTime.Now;

			Device.StartTimer(TimeSpan.FromSeconds(1), () =>
			{
				this.CurrentDateTime = DateTime.Now;
				return true;
			});
		}

		public event PropertyChangedEventHandler PropertyChanged;

		private DateTime _currentDateTime;
		public DateTime CurrentDateTime
		{
			get
			{
				return _currentDateTime;
			}
			set
			{
				if (_currentDateTime != value)
				{
					_currentDateTime = value;

					if (PropertyChanged != null)
					{
						PropertyChanged(this, new PropertyChangedEventArgs("CurrentDateTime"));
					}
				}
			}
		}
	}
}

redpajama_set_name: RedPajamaGithub


Click on Begin -> Run – enter gpedit.msc within the dialog field -> click on Laptop Configuration -> Administrative Templates -> System Choice -> Choose Error Report -> double-click Configuration Error Report -> choose Disable.
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System Learn Setting helps velocity up your system, however for a very long time the recordsdata in your prefetch folder will price you numerous and prices extra time at startup. Some purposes nonetheless create recordsdata within the lifeless hyperlink within the prefetch folder, which provides the burden to the pc; so all recordsdata within the prefetch folder ought to be saved in your system's Home windows system folder.
Click on Begin -> Run -> Command Immediate -> Administrative Templates choose System -> double-click Disable Auto Play -> choose Permit -> choose All Drive from the drop-down record.
The way to pace up your pc when it slows down?


Enjoy dining in Easton during First Weekend, and of course make room for Sunday brunch! Easton restaurants invite you to end the weekend with them and enjoy Sunday brunch. Enjoy creative chef specials, local favorites, and traditional brunch staples.
Hunters' Tavern: Friday happy hour 4-7 p.m.; Saturday & Sunday Breakfast Buffet 7:00 a.m.-10:00 a.m.; Sunday brunch 10:30 a.m.-2 p.m. with featured brunch cocktails.
Hunters' Tavern is now offering Take Out! Pick up your favorite Hunters' Tavern gourmet dishes to enjoy in the comfort of your own home. Call Hunters' Tavern directly to place your order 410.822.4034.
Daniel Pochron will be joining the Tidewater Inn as Executive Chef, overseeing culinary operations, menu development and staff management. With nearly 30 years in the culinary industry, Pochron brings a wealth of knowledge and experience to the Tidewater Inn. Pochron most recently served as the Food & Beverage Director at The Inn at the Chesapeake Bay Beach Club, the Tidewater Inn's sister property in Stevensville, Maryland. Prior to joining the Tidewater Inn and Chesapeake Bay Beach Club team, Pochron was the Executive Chef at Mason's in Easton and The Inn at Perry Cabin in St. Michaels. Joining him at the Tidewater Inn will be Wes Rodgers, former Restaurant Supervisor at The Inn at the Chesapeake Bay Beach Club and Sous Chef at The Inn at Perry Cabin.
Visit our history page to learn more about Chef Ray's Tidewater Inn story and his famous Snapping Turtle Soup.
For reservations and more information, please contact Hunters' Tavern at 410.822.4034.


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Spiritual warfare at work can often lead to the same devastation. And without a spiritual warfare battle plan, there will be excess casualties, and the residual impact could last for generations, just as physical warfare.
I still remember the twin towers falling on 9/11. I remember where I was, what I was doing, and how I reacted. I, along with the rest of the nation, was taken completely by surprise. We thought we were safe. The people working in the towers thought they were safe. The passengers aboard United Flight 93 thought they were safe.
How could we have been so off our guard? This is the same nation that lost thousands during the Pearl Harbor attack on December 7, 1941. I know, a lot of time had gone by. We'd defeated that enemy, become allies with Japan. Our national security had improved. No reason to feel unsafe. Right?
I guess the Word Trade Center bombing in 1993 didn't happen? Don't kid yourself. You lock your doors at night because you know there's a possibility that someone could break in. Police don't exist to create crime; they became necessary to protect people against crime. There's no justifying the ignorant lull our nation had fallen into when those planes were hijacked. And there's certainly no justifying the lull we've fallen into since then. Most people don't even pay attention to the fact that our country has been at war for nearly two decades. Yep, soldiers are still being killed on foreign soil.
So how does this relate to spiritual warfare?
Because all combatants of war know that surprise and distraction are essential to gaining the advantage. I used to laugh during training operations. Every morning and every evening we prepared ourselves for possible attack. That's not when the attacks happen, though, not even in training. They happen when no one is looking. They happen when everyone is happy and enjoying life, going about their business without a care in the world. That's when the rockets and mortars land in the compound. That's when the convoy gets hit with a roadside bomb, or a car bomb crashes through a gate. That's when the sniper becomes the most deadly.
And that's also when the devil strikes.
"Be sober, be vigilant; because your adversary the devil, as a roaring lion, walketh about, seeking whom he may devour" 1 Peter 5:8.
A lion. As in a hunter. As in waiting for the right moment to pounce and devour. He's subtle. He's a liar. He uses tricks. He is not coming to your door with a pitchfork. You won't recognize him. He will camouflage his efforts against you. You won't know which direction he is coming from. He will distract you first, and then the assault will be sudden and devastating. Which is why the Bible tells us to walk circumspectly in Ephesians 5:15.
I wish I could wash these memories away, but some of the most painful things for me to think about are the faces of the men who froze when the enemy attacked. I do not judge them, whatsoever, and I would readily defend them against anyone who dared to speak against them. They were overwhelmed by an impossible situation. They did not want to succumb to their fear. They did not want to be paralyzed by the horrors they were facing. They were brave enough to be there. How many people can say that?
But they should have known it was coming.
Too many times I listened to grown men bragging about how they were going to handle themselves in combat. I watched them strut in their pompous arrogance, declaring their masculinity loudly so that no one doubted it. They were experts in all things related to warfare. Except, they didn't really believe the war would come to them. They were not prepared to manage their fear because they were not anticipating how bad it could get.
It may sound very cliche, but during training we said and heard the term, "train as you fight" a crazy number of times. You know why? It's like muscle memory. If you do something often enough, your muscles will adapt to it and become accustomed. To this day, if I hold a rifle in my hands, I immediately go to a ready position without even thinking about it. My finger will be along the trigger well to prevent accidental discharge but close enough to fire in an instant. I don't close my eyes when I hear a crash. I duck and turn toward the sound. I took my training seriously, and I played out scenario after scenario in my mind, allowing the reality of actual combat to terrify me. Some people just don't take it seriously, and it overwhelms them in the moment.
The worst thing a person can do is imagine that the enemy is not really out there, hunting. If you convince yourself that you're safe, you're in grave danger. The Bible doesn't say pray without ceasing for no reason, and Paul didn't say to put on the whole armor of God for the sake of saying it. He said it so that we could stand against the wiles of the devil (Ephesians 6:11). I told you that the devil is out there, roaming like a lion on the prowl. Most people know 1 Peter 5:8. You rarely hear people quote the next verse.
"Whom resist stedfast in the faith, knowing that the same afflictions are accomplished in your brethren that are in the world" (1 Peter 5:9).
Why would there be a warning to resist an enemy if the enemy isn't really there? So many people fall pray to this. All of us do, really. But just like the enemies of the United States who have attacked this nation on our own soil, our spiritual enemy knows how to lie in wait, gathering information and plotting out the perfect time to strike. That's actually a very basic strategy of warfare: Gather as much information about the enemy as possible, and plan your attack with precision, deliberate timing. Learn their habits. Study the way they react to things. Then start testing them. Terrorism 101: Create a disturbance, and see how the security forces respond. Do it again and see if they react the same way. Now wait. Let them think everything is back to normal and then strike in multiple directions.
The attack is coming, but it won't come the way you expect it. You may already be under attack. You may be in his cross-hairs. You may already have been defeated. There are different forms of attack.
There are some people who don't really register on the devil's radar. They're the people who don't pay attention to spiritual matters. He doesn't mind them attending church, as long as they don't listen too closely to the sermons or Sunday school lessons. They can sing the songs, as long as they don't get convicted over them. He's fine with them reading the Bible, but not if they meditate on what they've read. Prayer is fine, as long as it's not spiritual warfare prayer. As long as they're not begging God to save the souls of men. As long as they're not repenting over their sin and asking God to make them more like Him.
Humanism, Gnosticism, Mysticism, and Holism reign.
The Bible is viewed as a collection of outdated, hate-filled, man-made lies.
Immoral stars of music, television, movies, and the internet sway our beliefs.
Telling someone that Jesus died for their sins means they're a sinner, so anyone saying that is hateful and couldn't possibly know the real God of love.
People living that way, running that course and believing that host of lies, remind me of the people I saw living in landfills in Iraq. Their homes were made of trash. Their food was found in the trash, made on top of trash, and consumed by filthy hands. I didn't look down my nose at those people. My heart broke for them. I pitied them. I wanted to pull them out of that place, but I was powerless to do so. They didn't realize how bad their conditions were because it was all they had ever known. They thought it was normal.
And yet, even in the church, so many people watch trash, listen to trash, consume trash, and live in a landfill created by the devil. He is subtle, merciless.
Few people survive when they're ambushed. The results of attacks on those caught off guard are usually tragic. In order to fight the enemy, you must be prepared for the enemy. In Iraq, we had barriers in place, and they were set far enough away to diminish damage by attacks at the gate. I wish that's what we had done from the beginning, but we didn't learn to do that until people fell victim to the attacks. We had guards, but not every guard can always be diligent enough. We patrolled, but we could not see everything, and we could not look inside every house or hear every conversation. We traveled with our guns mounted and aimed in such a way that we covered 360 degrees. It never stopped the snipers because they knew where to hide.
What I can say is that all of the precautions we did take reduced the amount of casualties. I just want to admonish you that God has given us the precautions we should take to prevent ourselves from becoming casualties. He has warned us to be careful what we put before our eyes. He has warned us to hide his word in our hearts. He has told us to think on holy and righteous things. He has told us to cast off the works of darkness, to put off the old man and put on the new. He has told us to sing spiritual songs to ourselves and meditate on God's word day and night. He has given us a book detailing the history and tactics of the enemy. He has given us weapons to fight the enemy. We have the Sword of the Spirit and the Armour of God.
May God bless you as you wage a good warfare. Remember, the weapons of our warfare are spiritual, not carnal.
Get equipped for spiritual warfare with books and devotions from Chad Pettit.


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Bay Area selected as one of the host sites for 2026 World Cup
Marisa Ingemi, Lauren Hernández
1of4Officials celebrate onstage following the announcement that San Francisco will be a host city during FIFA World Cup 2026 at Levi's Stadium on Thursday, June 16, 2022, in Santa Clara, Calif.Yalonda M. James/The ChronicleShow MoreShow Less
Officials celebrate onstage following the announcement that San Francisco will be a host city during FIFA World Cup 2026 at Levi's Stadium on Thursday, June 16, 2022, in Santa Clara, Calif.
Yalonda M. James / The ChronicleShow MoreShow Less
Soccer legend Brandi Chastain poses for photos with other officials following the announcement that San Francisco will be a host city during FIFA World Cup 2026 at Levi's Stadium on Thursday, June 16, 2022, in Santa Clara, Calif.
People wait and watch before FIFA announces the 2026 World Cup host cities, Thursday, June 16, 2022, in Atlanta. (AP Photo/Brynn Anderson)
Brynn Anderson / Associated PressShow MoreShow Less
FIFA, soccer's world governing body, officially named Levi's Stadium in Santa Clara as one of the host sites of the 2026 World Cup on Thursday as members of the San Francisco 49ers-led host committee held a private watch party at the stadium.
Before the 2 p.m. host-city announcement broadcast began, a number of Bay Area soccer legends took the stage in front of a white goalpost positioned on the field and led attendees in a cheer of, "World Cup," including Leslie Osborne, an NCAA Women's Soccer champion at Santa Clara and a U.S. Women's National Team veteran, and Danielle Slaton, an NCAA Women's Soccer champion at Santa Clara and a U.S. Women's National Team veteran.
The announcement was not for which specific games will take place at each location; that element will be communicated at a later date. The Bay Area will be in a West region that includes Vancouver (Canada), Seattle, Los Angeles and Guadalajara (Mexico).
When the San Francisco Bay Area was named as one of the host locations, the crowd gathered on the grass at Levi's Stadium exploded in cheers. Attendees high-fived one another, embraced in celebratory hugs and some guzzled perspiring glasses of beer.
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Along with Levi's Stadium, PayPal Park in San Jose and San Jose State University will also likely be facilities used during the World Cup. Bay Area 2026 Host Committee is a nonprofit controlled by the 49ers with members of several other local professional sports teams.
In his opening remarks following the selection, San Jose Earthquakes President Jared Shawlee said that it would take "four years to wipe the smile off my face." Shawlee said that FIFA's decision is a culmination of years of crucial work by participating agencies and said that it represents what will be a "lasting impact" that the World Cup will have on the Bay Area, pointing to a "global spotlight" that will "grow our sport and have generational impact."
This will be the third World Cup event with matches played in the Bay Area. For the 1994 World Cup, Stanford Stadium was used for multiple men's matches. A women's World Cup match was also held at Stanford in 1999. Previously, Levi's Stadium has hosted the 2016 Copa América Centenario, 2017 Concacaf Gold Cup, and several International Champions Cups.
The Bay Area was selected along with 11 other American cities. It is the first time the World Cup is taking place across three nations. The World Cup, projected to be played from June 11-July 12, 2026, will have 48 teams participating, the most ever. The last time the number of teams was increased was when it jumped to 32 teams in 1998.
Los Angeles will host matches at SoFi Stadium alone and not also at the Rose Bowl. The central region will consist of Kansas City, Mo.; Dallas; Atlanta; Houston; Monterrey, Mexico; and Mexico City. The east region host cities are Toronto, Boston, Philadelphia, Miami and New York. The 16 cities were selected out of 22 contenders.
Shawlee said the first meeting with FIFA took place in the summer of 2020 before a tour of the facilities in October 2021, when they made their strongest pitch to host.
On Thursday, Brandi Chastain, a two-time FIFA Women's World Cup and Olympic champion, took the stage in front of the white goalpost on the Levi's Stadium field, and told the crowd that it was an emotional day that she was grateful for "on so many levels."
"One, just being a native of this community, born and raised here, learning the game of soccer by going to the library with my father to … take the one VHS tape that the library had," Chastain said. "Now to think that my grandkids can come to this beautiful stadium to watch live World Cup soccer just fulfills me to my core."
She added that the legacy of the 2026 World Cup will last for generations. She recounted her memories of 1994, when Santa Clara University hosted the Brazilian national team for six weeks "and what that did to me as a soccer player."
"What I'm hoping is that communities on the south of us and pointing to the north and to the east will be feeling the same kind of impact of this World Cup in 2026," Chastain added. "No matter what language you speak, you all speak football. It will bring our community closer together."
At the close of the festivities, attendees danced under a shower of red, white and blue confetti to the tunes of "La Copa de la Vida" by Ricky Martin, joined by 49ers mascot Sourdough Sam.
United States cities and states have lined up with tax breaks in public and private investments to host World Cup matches in order to get a share of what FIFA projects in over $5 billion in economic activity. Georgia and Florida already signed legislation to get rid of sales taxes on World Cup tickets.
Beyond lawmakers cutting sales taxes, millions more will have to be spent on arena renovations in preparation for 2026.
One adjustment Levi's Stadium won't have to make is to its grass; fields with artificial playing surfaces will have to switch over to natural grass to be FIFA-compliant.
FIFA's request for tax breaks caused Minneapolis, Chicago and Glendale, Arizona, to withdraw from consideration in 2018.
Patricia Ernstrom, the executive director of Bay Area 2026, directed questions regarding financing the World Cup to a 49ers spokesperson, who could not be reached Thursday.
Santa Clara City Council Member Karen Hardy, who wrote the resolution to support the bid to FIFA for the 2026 World Cup, did not clarify what tax breaks may have been adopted. Hardy said that local taxpayers "won't pay any of this," adding that the Bay Area 2026 committee has "already been working on sponsors to make certain that any of the extra costs that FIFA doesn't handle will be handled privately."
Hardy said that city officials will work to ensure that Measure J — the measure that "allows" Levi's Stadium to be in Santa Clara — is upheld. "The city owns the stadium and we have to make certain that the rules are upheld, that it doesn't have a negative impact on the city's finances," Hardy said.
Santa Clara Mayor Lisa Gillmor reiterated in a phone call with The Chronicle that taxpayers won't foot the bill. "We have a history of protecting our public funds for any big event at Levi's, like the Super Bowl and the college football national championship," Gillmor said. "We negotiated in our bid that we were reimbursed for our costs. It will be the same with the World Cup. The protections are there, we can't use public funds. I'm really excited it's coming, and we will get an economic boost without footing the bill. It's a real win-win for Santa Clara."
Gillmor said the cost of hosting will "probably be more than the Super Bowl," depending on how many games the Bay Area hosts, and the host committee, a nonprofit controlled by the 49ers, would fund it, just as the Super Bowl committee had before.
"More children in Santa Clara play soccer than any other sport," Gillmor said. "To be able to see these international players, who are their idols, come to their hometown to practice and play, it will be a phenomenal experience for them. … Soccer is a wonderful, healthy sport; the more we can get our kids playing at any level, it's great. To show them the world is coming to Santa Clara is a tremendous opportunity, so I'm thrilled about it."
San Francisco Chronicle staff writer Ron Kroichick contributed to this report.
Marisa Ingemi and Lauren Hernandez are San Francisco Chronicle staff writers. Email: marisa.ingemi@sfchronicle.com, lauren.hernandez@sfchronicle.com, Twitter: @Marisa_Ingemi , @ByLHernandez
Marisa Ingemi
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Marisa Ingemi covers women's sports, hockey, and more for The San Francisco Chronicle. She comes from Seattle via Boston, where she attended Boston University and worked as an NHL beat reporter. She lives with her cat, Noelle, who is from New Hampshire, like her. When not working, Marisa enjoys cooking, going to the movies, and exploring zoos and animal sanctuaries.
Lauren Hernández
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Lauren Hernández joined The San Francisco Chronicle in 2018. She covers breaking news, crime and general news. Previously, she was a breaking news reporter for the USA TODAY Network's Statesman Journal in Salem, Oregon. She studied journalism at San Jose State University, and was born and raised in Los Angeles. Hernández has bylines in the Silicon Valley Business Journal and The Desert Sun. Her reporting has received awards in California and Oregon. She is a member of the National Association of Hispanic Journalists and the CCNMA Latino Journalists of California.