The_Atlantic_-_07_2018

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS In Sirte, some squirters turned around and launched attacks launching an attack against a modern military adversary. But the from the rear. Others squirted into the cities, where they dis- high cost of the mission was perhaps an attraction by bureau- appeared. One relatively small group—no more than 100 men— cratic if not military logic—you may lose money if you don’t squirted into the desert about 30 miles southwest of town. They spend it—or the B-2s might have just needed some work to do. established two camps, about 10 miles apart. The Pentagon The Air Force says simply that after a formal process of consid- would later state that they were planning attacks on Europe. eration, the B-2 was deemed the appropriate platform. On the evidence, they were also unusually inefectual people. Despite the known presence of American drones overhead, they Here’s how the process worked: Waldhauser wanted the B-2. had chosen to congregate in the open desert, away from any While his request was being studied at the White House, the Joint protections ofered by the presence of civilians. Their incompe- Chiefs of Staf formally asked Strategic Command about the avail- tence was Waldhauser’s liberation. For once there was no need ability of the assets. Stratcom is headquartered at Ofutt Air Force to know who was who in the zoo. Base, in Nebraska, where the B-29s that demolished Hiroshima and Nagasaki—the Enola Gay and the Bockscar—were built, in IV. 1944. Stratcom occupies a building named after Curtis LeMay. It “READY TO passed word of a possible B-2 strike to one of its subordinate units, Air Force Global Strike Command, which is headquartered at DO THIS?” Barksdale Air Force Base, in Louisiana. Global Strike Command controls all of the Air Force’s heavy bombers and intercontinental Early last January, Waldhauser concluded that taking action was ballistic missiles. It contacted the 509th Bomb Wing, home to the a matter of grave national importance. Cost was apparently not a B-2s at Whiteman. All the way down through the chains of com- factor. The objective was to kill every man in the two ISIS camps mand, the only thing anyone asked was “Are your guys available without placing Americans at signiicant risk. The use of Special and ready to do this?” Stupid question. The 509th is the direct Forces was unlikely to achieve either goal. Only air strikes would descendant of a bomber group formed in 1944 for the purpose of do. Now there was a choice to be made among weapons plat- dropping nuclear weapons on Japan. It was commanded last Janu- forms: Navy cruise missiles; Air Force drones; Navy, Air Force, or ary by the grandson of its commander then. Hundreds of military Marine Corps ighter-bombers; Army or Marine Corps helicopter personnel at Whiteman—pilots and ground crews alike—had been gunships; Air Force strategic bombers; or some combination of training for years, and were not just ready but straining to go. these options. In theory, the decision-making process should have been clean. Waldhauser would have come up with several Preparations for the air strike began immediately, more courses of action as well as a recommendation, and he would than a week before the launch. The planning was shrouded in have run the package through the Joint Chiefs of Staf to the sec- secrecy, most of it taking place in a secure basement. The room’s retary of defense, who would have taken it across the Potomac screens displayed classiied information from the military’s vast to the National Security Council, and ultimately to the president command, control, and intelligence systems, and were closely for a decision. The president could have responded with a simple linked to a team at Global Strike Command in Louisiana, which conirmation of the recommended plan and an order to proceed— was making the targeting decisions. The feeds included video of leaving the operational details to the military. the intended targets, streaming in from the armed drones that were maintaining a round-the-clock watch overhead. The light In this case, after the initial presentation was made, long crews and B-2s—both primary and standby—were selected. On discussions ensued in the White House. As usual, the weap- Wednesday evening, January 11, six days before the launch, the ons had constituencies at the Pentagon. The Navy in particular munitions squadron received orders to assemble several hundred made a case for its cruise missiles, at more than $1 million each, bombs. The assembly involved 3,500 pieces and 78,000 pounds because they would allow the killing to be done from ofshore. The of explosives. The task, starting Thursday morning at 5 a.m., problem was that the targets, though clustered around the two was carried out in 30 hours by more than 100 people working camps, did not dwell in structures that could be hit, and tended 12-hour shifts. The senior sergeant in charge knew that this to spend their days and nights widely dispersed. A cruise-missile was for real and not just another exercise. Many of the people strike would likely allow many to escape. In the end, the idea of doing the work were young recruits, new to the Air Force, but they using Air Force heavy bombers prevailed because of their ability got the job done. The sergeant said, “Trust the process. Trust the to deliver dozens of self-steering, individually targeted bombs; training.” He himself seemed young to me when I met him, but he then to linger in the vicinity, waiting for surveillance assess- had been in the Air Force for 18 years, and was planning to retire in ments from the drones; and if necessary to deliver more bombs. another two. He loved the Air Force for the lifestyle it had aforded him. He did not have to go into the ield as he would have if he had The Air Force has three types of heavy bombers, any of which joined the Army. About the ield, he said, “They call it ‘the suck.’ ” could have done the job. The choice of the B-2 was surprising Compared with any Army outpost, Whiteman is Pleasantville. because it is by far the most expensive airplane to ly and main- The sergeant was proud of his team. Thinking back on the efort, tain, and Libya post-Qaddai had no air defenses that might he told me, “They were in Missouri—central Missouri—ighting require a stealth capability to penetrate. Bombing ignorant gun- terrorists all the way from here. They got to see what they had men camped out in a desert of a non-country is a far cry from raised their hands for, what they had signed up to do.” THE ATLANTIC JULY/AUGUST 2018 49

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS V. seemed surreal. The pilots crossed the coastline, entered their BENGHAZI ON launch acceptability regions about 10 miles from their targets, opened their bomb-bay doors exactly on schedule, and released THE LEFT their weapons as planned. Scatter released 62 of his 80, and the other aircraft commander released 23. That left 75 bombs in the In advance of the mission, the pilots were told to go home for a airplanes should another attack be needed. The B-2s did not mandatory crew rest of three days, but they all had wives and lurch when the bombs were released. A slight vibration could young children, and that weekend there was an ice storm. Fatigue be felt when the bomb-bay doors opened, but that was all. The was of no concern to Scatter when he got the call on Monday after- doors were open only for about 30 seconds. From above, Scatter noon to report for duty. He drove to the base in his paid-of 2002 saw the impacts as orange glows through an undercast of cloud. Dodge Ram truck. The light across the Atlantic was smooth. At The efect was oddly beautiful. 35,000 feet the skies were clear. To avoid the political complica- tions of overlying countries on such a raid, the route to the Medi- VI. terranean lay farther south than the shortest great-circle course. RIPPED APART The pilots were in contact with oceanic air traic control. Commu- nication between military aircraft and controllers is routine, and It looked different on the ground. The ISIS camps consisted necessary for safety in ordinary airspace; the controllers would of a few small structures with walled dirt yards—too small to have assumed that the B-2s were on a training mission. serve as living quarters, but useful for the storage of weapons. They stood along a rarely traveled track, in terrain that for all its The pilots were in contact as well with their Air Force mission desolation allowed for a scattering of bushes and scrubby trees. controller in Louisiana. And they were busy. A quarter of their For several weeks, the Air Force drones had watched the scene bombs had been programmed before takeof to hit any vehicles from above, establishing detailed proiles known as “patterns or physical structures, but the rest of the bombs had to be pro- of life,” which mapped out daily activities, mealtimes, and the grammed in light based on the latest information coming from outdoor locations to which individuals dispersed in the darkness the drones—essentially, the precise geographic coordinates of individual ISIS ighters who could be seen settling in for the night. That information began to low to the airplanes two hours shy of their reaching the Mediterranean. The programming-and- conirmation process took hours. Scatter told me, “It’s not like Steve Jobs designed the interface.” Night came quickly after a short day. Once they passed into the Mediterranean, the pilots used their radar to ind three tank- ers that had come from Germany to meet them for their second refueling, and to map some thunderstorms that were active in the area at the time. Because of its composite structure, the B-2 is particularly vulnerable to static discharges and lightning strikes, and is required to stay 40 miles away from thunderstorms—twice as far as other airplanes. During the refueling and afterward, the B-2 pilots spoke with European air traic control. The skies cleared. Approximately 250 miles north of the Libyan coastline, the pilots turned south, switched of their transponders, and disappeared from air-traic- control radar. They had now been lying for 15 hours. Still of- shore, they went into a holding pattern that had been planned as a cushion to allow them to get the timing just right. It was nearly midnight Zulu Time—two in the morning local time. They heard the mission controller order the drones to clear out to the south, and authorize them to return immediately after the strike to kill anyone who survived. The drones were MQ-9 Reapers armed with laser-guided supersonic Hellire missiles. Their pilots were sitting in front of control panels back in the United States. Scatter was surprised by the blanket authorization to ire. He had never heard that one before. The B-2s left the holding pattern and moved toward the camps at 35,000 feet, on autopilot, doing 480 miles an hour. They spread into a rough line-abreast formation, each headed for a virtual hockey puck in the sky, a “launch acceptability re- gion,” where all they had to do was release the bombs, which would guide themselves to their targets. As the B-2s approached the coast, Scatter could see the lights of Misrata on the right and Benghazi on the left. For some reason he thought of vacation- ing with his family in Europe. He told me that the view of Libya 50 JULY/AUGUST 2018 THE ATLANTIC

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS to sleep—typically by certain bushes or trees. The images in day- picking of anyone spotted trying to get away. Killing with Hell- light were high resolution and in full color. The images at night ires is very diferent from killing with GPS-guided bombs. It were of the ghostly night-vision kind. There were no women or requires the Reaper crews to get personal, laying a laser device children. The combatants spent their days talking and some- on magniied images of each individual victim and then watch- times handling small arms, or perhaps explosives. They had ing the missile as it strikes. A Hellire missile has a blast radius some Japanese pickup trucks, which they tried to hide under of 50 feet and a “wounding radius” of up to 300 feet. It could camoulaged tarpaulins. kill hundreds of people as easily as it could kill one. Once the Hellires had mopped up, the only sound in the desert was the It was a chilly night on the ground, with temperatures in the hum of the Reapers’ engines. 40s. From my own experience in that desert, I imagine that the ISIS ighters were sleeping fully clothed and wrapped in blankets, VII. and perhaps were nestled for comfort in undulations of the ter- CRICKETS rain. If any were awake, they would not have heard the jets high overhead; the only forewarning of the attack would have been a After releasing their bombs, the B-2s banked gently to the left brief sound of rushing air before the irst bomb hit. and retreated to a holding position safely offshore. The ride was smooth, pressurized, and comfortable. Plans called for For the next 30 seconds, the bombs came at them with the bombers to stay quietly on station for another six hours in demonic accuracy. Each 500-pound bomb was set to deto- case their services were needed again. Scatter explained it this nate just above its target for maximum lethality, operating way: “You’ve got a desert with people camped out in the middle more through overpressure than fragmentation. The resulting of nowhere. You drop a bomb on them; it’s like kicking an ant- vacuum condition sucks air from the lungs while the shock wave hill. They may run. They may need a reattack.” Scatter listened pulverizes bone and ruptures or liqueies the internal organs of on the mission-control frequency over the next hour, until the anyone within about 50 yards. That is how most of the ISIS ight- Reaper crews inished up. It was obvious, even without a formal ers died: hugging the earth to no avail as their innards turned to battle-damage assessment, that the toll on the ground was heavy. mush and the night was ripped apart by the explosions. Eventually the mission controller asked for any signs of life, and the Reaper crews answered in the negative. Scatter said, “Then For the handful of survivors, the ordeal was not yet over. The it was just, like, crickets on the radio.” dust had hardly settled when the Reaper drones moved back in, looking for squirters. Figures could be seen in real time, run- Not long after, the B-2s got the clearance to return to Missouri. ning frantically. With their Hellire missiles, the Reapers began They refueled over the Mediterranean south of France. Then they went over the Strait of Gibraltar and out across the Atlan- THE MOST tic. The return trip seemed slow, as return trips do. Scatter spent EXPENSIVE much of the time writing a formal mission report. He left his seat, TOOL IN stretched out on the loor in the back of the cockpit, and took a THE AIR two-hour nap. His pilot did the same. In the other B-2, the aircraft FORCE commander took an oicially issued “go pill” to stay alert. He got ARSENAL out of his seat, stripped down to nothing, sponged himself with HAD BEEN camping towelettes, washed his face, brushed his teeth, put on a DEPLOYED fresh light suit, and made sure that his hair looked good. He told AGAINST me a lot of guys do the same thing, and it refreshes them. I took it A GROUP as further evidence that the Air Force is not the Army. OF FIGHTERS ASLEEP IN They refueled again over Maine, with the same crews who THE DESERT. had refueled them on the way out. When they got back to Mis- WHEN THE souri, the weather was low, and they had to shoot an approach to CREWS GOT 200 feet of the ground before they could make out the runway BACK TO at Whiteman. They had been 33 hours in the air. As the second MISSOURI, B-2 came in, the control tower canceled its landing clearance THEY FOUND because of a coyote on the runway. The pilot was too tired to be A MEAL OF bothered. He called back, “Negative. I’m landing this jet,” and STEAK AND the coyote obliged by getting out of the way. When they taxied EGGS AND to the ramp and shut down their engines, they were surprised to BEER LAID ind a ilm crew waiting, along with half the colonels on the base. OUT FOR THEM. A meal of steak and eggs and beer had been laid out for them. Scatter got home that afternoon. He had been up since for- ever, but he’d have to stay awake a little while longer. His wife put the baby in his arms. She had an errand to run. William Langewiesche, a former national correspondent for The Atlantic and a professional pilot, has written about subjects including aviation, national security, and North Africa. THE ATLANTIC JULY/AUGUST 2018 51

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS THE SEARCH FOR THE ELIXIR THAT TURNS GOOD TEAMS INTO GREAT ONES I N THE FINAL REGULAR-SEASON GAME for the 1977 Los Angeles Dodgers, Dusty Baker hit a home run, giving him 30 for the season and making him the fourth Dodger to reach that milestone that year, a Major League Baseball record. As Baker rounded third, a rookie who had recently entered the game, Glenn Burke, approached the plate from the on-deck circle and, seized by joy, raised his hand high above his head. Baker was taken aback by the gesture and, in a mix of celebration and confusion, decided to smack Burke’s hand. Their high ive was clumsy, but then again it had every right to be: Reportedly, it was the irst one ever. Baseball has always been a strange mix of social and solo. In American fashion, the game stresses the collective, but demands that you play for yourself. Despite all the intimacy of the sport’s language—crowding the plate, touching base—its play is quite lonely. Other sports require a tacit harmony between players—setting a pick for a teammate, blocking for someone 10 yards behind. In contrast, a baseball hitter stands in the solitary coninement of the batter’s box, facing a pitcher on the desert island of the mound. The players on the defense align themselves, except for the occasional shift, to be as far from one another as the limits of the ability to recuperate lost space per- mit. Defensive errors are unfailingly—and oicially—attributed 52 JULY/AUGUST 2018 THE ATLANTIC

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS FINDING THE FORMULA FOR TEAM CHEMISTRY BY BEN ROWEN ILLUSTRATIONS BY ISRAEL G. VARGAS THE ATLANTIC J U L Y / A U G U S YT 2 0 1 8 53

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS to individual players. The rule book, irrespective of out-of-play Pence spoke up after the team’s manager, Bruce Bochy, concluded butt slaps and handshakes, does not sanction contact. his pregame talk. No one had expected remarks from a player, let alone a newish one. And no one expected such intensity: Pence And yet somehow, despite this loneliness—or perhaps because made feverish eye contact, and allegedly spoke with the passion of it—the sport is now at the center of an intensifying search for of a revivalist preacher about the need for the team to reawaken. the nebulous, nearly mythical quality of team chemistry. In the popular conception, almost all great teams are alike in possessing It seems to have worked. The Giants, of course, did win that it. But what exactly the quality is, and just how strongly it governs night, and they won the next two games as well, and then they success, remains unclear. The ’77 Dodgers possessed some of it, won the next two series to become the champs. You could argue but apparently not enough: After storming into the World Series, that Pence’s motivational speech, and its taken-to-heart recep- they lost to a feuding New York Yankees squad that had been cyni- tion, proves the team had a superior clubhouse atmosphere. cally described as “the best team money could buy.” Alternatively, you could note that the Giants didn’t play par- In 2014, Harvard Business Review deemed chemistry the “Holy ticularly well in the game right after the speech—they got just Grail” of performance analytics, the statistical discipline that one hit in the irst nine innings. Grant Brisbee, who used to run irst swept the sport wholesale some 20 years ago. The choice of McCovey Chronicles, a Giants blog, says that luck almost cer- image was telling; the Grail, of course, remains elusive. Nonethe- tainly gave them the win. With two outs in the top of the 10th less, a number of research groups are now taking a bet that they inning and two runners on base, Joaquin Arias, a scrap-heap can pin down chemistry, through advanced math or anthropologi- pickup who had entered the game earlier to pinch-hit, knocked a cal forays into the clubhouse. Some researchers, believing that ground ball toward Scott Rolen, the Cincinnati Reds’ third base- team chemistry may emerge from literal chemistry, are collecting man. Rolen is the ifth-best defender ever at third base according and analyzing biometrics: testosterone levels, hormonal states. to one analytics site, Fangraphs, and in the top 20 of all time by traditional stats such as ielding percentage. And yet, as the ball Whatever the approach, much of the research is led by approached Rolen, it took an in-between hop and bobbled of his outsiders—economists and organizational-development scholars who seek to use baseball, as it is frequently used, to better SOME understand the American workforce. Because individual RESEARCHERS success or failure is so easy to isolate in baseball, the sport BELIEVE TEAM itself is also easy to study; individual performance can be related clearly to team success. “Moneyball” is already CHEMISTRY used to explain changes in everything from company MAY EMERGE hiring to restaurant operations. Now, it is hoped, solving FROM LITERAL baseball chemistry might advance corporate teamwork CHEMISTRY: where Myers-Briggs tests and other methods have failed. “Baseball is a team game,” Pete Rose, the former player and manager, once said. “But nine men who reach their individual goals make a nice team.” Surely that’s too simple. A good team helps those men reach their individual goals, and harnesses them to something larger. The question is how. I N ITS T YPICAL INVOCATION, chemistry is a cop- TESTOSTERONE out—an after-the-fact explanation of why a team won, LEVELS, especially against the odds. It lets us avoid uncomfort- able truths: that baseball, like the workforce, is not always HORMONAL a meritocracy; that mediocre teams can capitalize on luck STATES. to beat very good ones; that the sport can be cosmically unjust. In the postgame twilight, chemistry coalesces as a narrative—the “It’s not you, it’s me” of baseball heart- break. It rings hollow, but is not provably false. The 2012 San Francisco Giants were widely lauded by sports mitt. Buster Posey scored on the error, giving the Giants a lead bufs and journalists alike for their extraordinary chemistry, they wouldn’t relinquish. One lucky bounce might have been following their improbable World Series victory. The team responsible for San Francisco’s championship. made it through the three rounds of the playofs, as the under- That’s not to say the team lacked chemistry. (Though the dog each time, and twice fought back from a two-game deicit, Giants missed the playofs altogether in 2013, they made another on the brink of elimination. improbable run to the championship in 2014; they’d also won in Barry Zito, then a declining Giants pitcher who miraculously 2010.) But chemistry has a way of getting entangled with con- outdueled opposing pitcher and reigning American League MVP current explanations. “It’s a lot easier for us to process a narra- Justin Verlander in a game that had been billed as “one of the great tive,” Brisbee told me, “rather than ‘This guy was standing two mismatches of World Series history,” told me recently about the inches to his left, and that changed the whole postseason.’ ” team’s postseason turning point, which he ofered as proof of its chemistry. It was a speech, he said, made early in the playofs by T HERE IS NO I IN TE AM, but there is in statistics. Baseball, Hunter Pence, a mid-season acquisition. The team was down two like no other sport, has stats that make a special snowlake games to none in its opening-round, best-of-ive playof series, and out of every player. During the moneyball era of the early would have to win the next three games straight—all on the road. 2000s, these stats proliferated, and their relative importance 54 JULY/AUGUST 2018 THE ATLANTIC

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS was hotly debated, as analysts tried to ind clearer links between full season as a starter during his 15-year career, which ended in individual performance and team success. But for the most part, 2016. He nevertheless won championships as a backup catcher to the analytics community of that era, chemistry was not worth with both the Boston Red Sox and the Chicago Cubs, and wrote investigating. Some thought it couldn’t be measured or, worse, a memoir, with Don Yaeger, a sports journalist, called Teammate. was total “bullshit,” as the analyst Rob Neyer once put it. Billy Wherever he went, as the economists conirmed, teams seemed Beane, the Oakland Athletics’ general manager who became syn- to play better than their individual player statistics suggested onymous with the moneyball revolution, believed that chemistry they should have. existed, but that it was brought about by winning, not the other way around. I spoke with Ross during Major League Baseball’s Winter Meet- ings in December. He was advising the Cubs, and had some time Still, front oices did consider chemistry, as any hiring body on his hands. (The meetings, typically a frenzy of free-agent sign- would. Zito, who played for the Athletics before he joined the ings, were of to a plodding start; the only news was that the canon- Giants, told me that Beane “had a good grip of how signings would ical team-chemistry guy, the ex-Yankee and now Miami Marlins afect the clubhouse.” The team, Zito said, was highly compatible, co-owner Derek Jeter, was spatting with his team’s star players.) and would often gather for dinners. In a general sense, Ross told me, chemistry isn’t hard to snif out— “It’s like walking into a bar and getting a vibe.” But what specii- Meanwhile, as the moneyball movement grew, its acolytes cally it’s made of, and how it can be measured, is a harder question. began to think they might be missing something. Performance analytics do not predict team success with anything close to cer- Ross said that chemistry is “deinitely something that can be tainty. PECOTA, one of the top stats-based projection systems, was learned.” The foreword to his memoir, written by Theo Epstein, of by an average of nine wins per team in its best season, accord- the Cubs’ president of baseball operations and a former Red Sox ing to Neil Paine of FiveThirtyEight. Luck and injuries play a large general manager, explicitly notes that when Epstein was inter- part in statistics falling short. Even so, researchers and writers are ested in acquiring Ross in August 2008 for the Red Sox, he heard coming to think, there’s ample space for chemistry to play a role. reports that the catcher was “not a good teammate” in Cincin- nati. Ross attributes this old reputation to a time, early in his Two economists at the Federal Reserve Bank of Chicago and career, when he barged into the team manager’s oice to com- one from Indiana University recently attempted to locate team plain that he wasn’t starting. chemistry by inding places where existing performance metrics fall short. In a paper titled “In Search of David Ross,” presented In the book, Ross writes about learning to better communicate at the 2017 MIT Sloan Sports Analytics Conference, R. Andrew with players over time, and highlights one moment in 2016 when Butters, Scott A. Brave, and Kevin Roberts looked at teams whose the Cubs’ rookie catcher, Willson Contreras, signaled for an of- win/loss record difered greatly from what would be predicted by speed pitch to try to fool a hitter ahead in the count, instead of the sum of individual performance. Studying more than 15 sea- directing the pitcher to pitch around him to face a better matchup. sons’ worth of data, they identiied the speciic players who were Ross noticed the mistake from the bench as he read the sign from on teams that repeatedly overperformed. These players, the Contreras, but he waited a few innings before addressing it. If you economists hypothesized, create chemistry—they have shown call out mistakes immediately after the fact, he notes, you catch repeated ability to elevate their team above the sum of its parts. people at their most defensive, and if you address every one of them, you can lose goodwill. David Ross, the paper’s namesake, is “the epitome of where advanced metrics and player intangibles are at odds,” the The analysis by the economists echoes some of what Ross authors wrote. Ross is a retired journeyman who played only one told me. They found that players do seem to “learn” to create chemistry—intangible contributions to team success tend to rise with age and, for the most part, only become appreciable in play- ers’ mid-to-late 30s, which is very late in a player’s career. (Good- chemistry players may also just stick around the league longer.) In many cases, the economists found, stars make the largest intan- gible contributions, just as they make the largest tangible ones— Mike Trout, the best current player by performance metrics, is also the best by raw chemistry rating. By contrast, many “clubhouse cancers”—players who worsen a team’s chemistry—began their career with seeming star potential, but never really panned out. Perhaps the stars are better able to inluence a clubhouse by dint of their on-ield prowess (or, critics of the Fed paper may note, perhaps they simply cover for other players’ poor perfor- mance on the field); maybe the never-turned-into-stars leak toxic embitterment. This is speculation. The Fed economists weren’t studying clubhouse behavior, nor were they seeking to understand the particular alchemy by which chemistry is cre- ated. Other analysts, however, are doing just that. Which brings us back to the high ive. L A S T Y E A R , according to Wall Street Journal reports, a research group was granted access to the San Francisco Giants’ minor-league ailiate in San Jose, where it installed cameras with the goal of monitoring associations between dug- out interactions—high fives, back pats—and team success. A THE ATLANTIC JULY/AUGUST 2018 55

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS similar efort is under way in the major leagues, where Dacher Bezrukova, a professor at the University at Bufalo School of Keltner and Hooria Jazaieri, psychologists at UC Berkeley, are Management, looked at the demographic breakdowns of all 30 conducting research with the goal of inding associations between MLB teams over ive seasons, analyzing age, race, nationality, the supposed subtle physical tells of chemistry and team success. tenure, and salary, on the theory that while diversity was neces- The entire approach might seem absurd. Can a high ive or ist sary for success, teams with players who were isolated—those bump really create—or even stand in for—camaraderie, in all its without any or many demographic peers—would develop “fault- complexity? Then again, as Barry Zito told me, “guys that don’t lines,” or breaks in chemistry that might be exposed and exacer- respect each other won’t go out of their way to congratulate each bated when the team struggled. Her model shows that these fault other after a big moment.” And a celebratory touch can demon- lines could be mitigated if players in the underrepresented group strate a deeper level of acceptance and intimacy. Notably, Glenn happened to be clustered together in similar roles (Latino play- Burke, the rookie who ofered a raised hand to Dusty Baker after ers sitting together in the bull pen as relief pitchers, for example). the latter’s historic home run, was out of the Over the course of a season, she found, a team closet to his teammates by the time of that with fewer fault lines will win more games, all else being equal. MANY “CLUBHOUSEgame back in 1977, the irst openly gay player in American professional sports. That moment Bezrukova’s work has been criticized for being demographically reductive. Its conclu- CANCERS”—of contact, in retrospect, helps undercut regres- sive but still prevalent assumptions about base- PLAYERS WHO sions are uncomfortably similar to the thought ball’s culture. QUANTIFIABLY processes of general managers who balked at integration before Branch Rickey signed Research is still in progress, but David Ross told me he’s dubious. He said chemistry Jackie Robinson, for instance. But players seem to agree that being isolated makes the WORSEN A TEAM’Sis “deinitely not about high ives and rah-rah stuff; it’s about respect.” Nonetheless, his CHEMISTRY— game tougher to play. Johnny Cueto, a pitcher book seems to place a high premium on the BEGAN THEIR on the 2017 Giants, which inished the season gesture. Ross recounts barking at the Atlanta 64–98, has spoken about feeling alone as the Braves’ irst-string catcher, Brian McCann, after squad’s only Dominican pitcher for most of the season: “When I was with Kansas City, it CAREER WITHMcCann once forgot to ofer him a high ive, as SEEMING STARwas their usual custom, when Ross returned was a team, I think; it was a very happy bunch to the dugout after a half inning of defensive because we had a lot of players” from the Dominican Republic. “But here, it’s diferent.” POTENTIAL, BUTwork. He also writes about creating a new high ive to celebrate home runs, which he calls the NEVER REALLY In 2014, ESPN the Magazine used a “cock bump”—the two players square up to each PANNED OUT. model designed by Bezrukova and Ches- other and thrust, bumping their cups. And he ter Spell, a Rutgers University business has strong praise for other ritualistic acts, most professor, in its preseason MLB predictions, notably the naked dance his Cubs teammate selecting both the Giants and the Royals— Anthony Rizzo did, to the musical accompaniment of the theme the eventual World Series participants—as two of the strongest from Rocky, before each of the inal three games of the 2016 World teams on the chemistry metric. This remains, to date, the stron- Series. It kept the team loose, he said, despite being on the brink of gest evidence that chemistry research can have predictive value. elimination—and the Cubs miraculously won all three. Russell Carleton, a writer for Baseball Prospectus, has found W HATEVER INSIGHTS INTO CHEMISTRY the study of evidence that chemistry can be cultivated in the long term baseball eventually enables, their application to the game through careful organizational management—one analysis of may be tricky. Understanding chemistry is an interesting his, for example, reveals that having less roster turnover from philosophical problem; creating it is a practical one. Research year to year helps a team slug more home runs. But he also notes has no value if players (or, for that matter, other types of work- that undigniied rituals, like Rizzo’s dance, can go a long way to ers) won’t buy into its conclusions. “Twenty-something hyper- creating cohesion more spontaneously. A child psychologist by competitive males aren’t always well known for being in touch training, Carleton has been a consultant to three Major League with their feelings,” Carleton told me. The study of chemistry Baseball teams. In 2015, when Ben Lindbergh and Sam Miller— has been hampered by that fact. baseball geeks and former editors at Baseball Prospectus—were Even so, the turn of the analytics crowd toward intangibles given control of the Sonoma Stompers, a team 10 levels below the might be welcome in some quarters. Many players have been majors, they turned to Carleton for guidance on creating chem- resistant to much of the new analytics, charging that they suck all istry, a skill outside their wheelhouse. In their book, The Only the joy and humanity from the game. When the 2017 Washington Rule Is It Has to Work, they detail Carleton’s advice: Corporate Nationals, a team highly regarded by the analytics crowd, clinched icebreakers are ine, but also have a water-balloon ight—or any a postseason berth last September, the outielder Jayson Werth other activity that would be welcome at a 12-year-old’s birthday touted the team’s superior chemistry, claiming that it was some- party. (Notably, childish spectacles—holding bufoonish dress- thing the “people upstairs who read books and do math, bullshit up days, bringing bear cubs to practice—are a core team-building like that,” could not understand. activity deployed by Joe Maddon, the Cubs’ manager, to keep As it happened, neither the analysts nor Werth had the team his players energized.) As Carleton likes to say: “The irst rule of right: For the fourth time in four recent playof appearances—on child psychology is that it applies throughout all of life.” account of something unmeasurable, or just by dumb luck—the So does high-school psychology, according to other research- Nationals were eliminated in the irst round as the higher seed. ers who are looking, essentially, at the isolation of individual play- ers and the development of cliques on diferent teams. Katerina Ben Rowen is an associate editor at Paciic Standard. 56 JULY/AUGUST 2018 THE ATLANTIC

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РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS WHEN THE NEXT PLAGUE HITS The epidemics of the early 21st century revealed a world unprepared, even as the risk Workers at the University of Nebraska Medical Center’s biocontainment unit practicing safe proce- dure on a mannequin 58 JULY/AUGUST 2018 THE ATLANTIC

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS | THE HEALTH REPORT | of pandemics continues to multiply. Much worse is coming. Is Donald Trump ready? PHOTOGRAPHS BY JONNO RATTMAN

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS Atlanta, scientists identiied the virus. It took the name Ebola from a river near Yambuku. And, having been discovered, it largely vanished for almost 20 years. In 1995, it reemerged in Kikwit, about 500 miles to the south- west. The first victim was 35-year-old Gaspard Menga, who worked in the surrounding forest raising crops and making char- coal. In Kikongo, the predominant local dialect, his surname A means “blood.” He checked into Kikwit General Hospital in January and died from what doctors took to be shigellosis—a diarrheal disease caused by bacteria. It was only in May, after the simmering outbreak had lared into something disastrous, after wards had illed with screams and vomit, after graves had illed with bodies, after Muyembe had arrived on the scene and again sent samples abroad for testing, that everyone realized Ebola T 6 O’CLOCK IN THE MORNING, shortly after the sun spills was back. By the time the epidemic abated, 317 people had been over the horizon, the city of Kikwit doesn’t so much wake up as infected and 245 had died. The horrors of Kikwit, documented ignite. Loud music blares from car radios. Shops ly open along by foreign journalists, catapulted Ebola into international infamy. the main street. Dust-sprayed jeeps and motorcycles zoom east- Since then, Ebola has returned to the Congo on six more occa- ward toward the town’s bustling markets or westward toward sions; the most recent outbreak, which began in Bikoro and then Kinshasa, the Democratic Republic of the Congo’s capital city. spread to Mbandaka, a provincial capital, is still ongoing at the The air starts to heat up, its molecules vibrating with absorbed time of this writing. energy. So, too, the city. Unlike airborne viruses such as influenza, Ebola spreads By late morning, I am away from the bustle, on a quiet, only through contact with infected bodily luids. Even so, it is exposed hilltop some ive miles down a pothole-ridden road. As I capable of incredible devastation, as West Africa learned in 2014, walk, desiccated shrubs crunch underfoot and butterlies lit past. when, in the largest outbreak to date, more than 28,000 people The only shade is cast by two lines of trees, which mark the edges were infected and upwards of 11,000 died. Despite the relative of a site where more than 200 people are buried, their bodies diiculty of transmission, Ebola still shut down health systems, piled into three mass graves, each about 15 feet wide and 70 feet crushed economies, and fomented fear. With each outbreak, it long. Nearby, a large blue sign says IN MEMORY OF THE VICTIMS reveals the vulnerabilities in our infrastructure and our psyches OF THE EBOLA EPIDEMIC IN MAY 1995. The sign is partly obscured that a more contagious pathogen might one day exploit. by overgrown grass, just as the memory itself has been occluded These include forgetfulness. In the 23 years since 1995, new by time. The ordeal that Kikwit sufered has been crowded out by generations who have never experienced the horrors of Ebola have the continual eruption of deadly diseases elsewhere in the Congo, been born in Kikwit. Protective equipment to shield doctors and and around the globe. nurses from contaminated blood has vanished, even as the virus Emery Mikolo, a 55-year-old Congolese man with a wide, has continued to emerge in other corners of the country. The city’s angular face, walks with me. Mikolo survived his own encounter population has tripled. New neighborhoods have sprung up. In one with Ebola in 1995. As he looks at the rest- of them, I walk through a market, gazing at ing place of those who didn’t, his solemn delectable displays of peppers, eggplants, demeanor cracks a bit. In the Congo, when avocados, and goat meat. Pieces of salted people die, their bodies are meant to be ish sell for 300 Congolese francs—about cleaned by their families. They should be the equivalent of an American quarter. dressed, caressed, kissed, and embraced. Juicy white grubs go for 1,000. And the These intense rituals of love and com- THE ORDEAL biggest delicacy of all goes for 13,000—a munity were corrupted by Ebola, which KIKWIT roasted monkey, its charred face pre- harnessed them to spread through entire served in a deathly grimace. SUFFERED families. Eventually, of necessity, they The monkey surprises me. Mikolo were eliminated entirely. Until Ebola, “no HAS BEEN is surprised to see only one. Usually, he one had ever taken bodies and thrown CROWDED says, these stalls are heaving with mon- them together like sacks of manioc,” keys, bats, and other bushmeat, but rains Mikolo tells me. OUT BY THE the night before must have stranded any The Congo—and the world—first CONTINUAL hunters in the eastern forests. As I look learned about Ebola in 1976, when a ERUPTION around the market, I picture it as an eco- mystery illness emerged in the northern logical magnet, drawing in all the varied village of Yambuku. Jean-Jacques Muy- OF DEADLY animals that dwell within the forest—and embe, then the country’s only virologist, DISEASES all the viruses that dwell within them. collected blood samples from some of ELSEWHERE The Congo is one of the most bio- the irst patients and carried them back diverse countries in the world. It was to Kinshasa in delicate test tubes, which IN THE here that HIV bubbled into a pandemic, bounced on his lap as he trundled down CONGO. eventually detected half a world away, undulating roads. From those samples, in California. It was here that monkey- which were shipped to the Centers pox was irst documented in people. The for Disease Control and Prevention in country has seen outbreaks of Marburg 60 JULY/AUGUST 2018 THE ATLANTIC

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS virus, Crimean-Congo hemorrhagic fever, chikungunya virus, afected by the 2014 West African outbreak. About eight inter- yellow fever. These are all zoonotic diseases, which originate in national lights depart daily from the city’s airport. animals and spill over into humans. Wherever people push into wildlife-rich habitats, the potential for such spillover is high. If Ebola hit Kikwit today, “it would arrive here easily,” Muy- Sub-Saharan Africa’s population will more than double during embe tells me in his office at the National Institute for Bio- the next three decades, and urban centers will extend farther medical Research, in Kinshasa. “Patients will leave Kikwit into wilderness, bringing large groups of immunologically naive to seek better treatment, and Kinshasa will be contaminated people into contact with the pathogens that skulk in animal immediately. And then from here to Belgium? Or the U.S.?” He reservoirs—Lassa fever from rats, monkeypox from primates laughs, morbidly. and rodents, Ebola from God-knows-what in who-knows-where. “What can you do to stop that?,” I ask. “Nothing.” O NE HUNDRED YEARS AGO, in 1918, a strain of H1N1 flu swept the world. It might have originated in Haskell County, Kansas, or in France or China—but soon it was everywhere. In two years, it killed as many as 100 million people—5 percent of the world’s population, and far more than the number who died in World War I. It killed not just the very young, old, and sick, but also the strong and it, bringing them down through their own violent immune responses. It killed so quickly that hospitals ran out of beds, cities ran out of coins, and coroners could not meet the demand for death certiicates. It lowered Americans’ life expectancy by more than a decade. “The lu resculpted human popu- lations more radically than anything since the Black Death,” Laura Spinney wrote in Pale Rider, her 2017 book about the pan- demic. It was one of the deadliest natural Survivors of the Kikwit Ebola epidemic, from left: Emilienne Luzolo, disasters in history—a potent reminder of Shimene Mukungu, and Emery Mikolo in 1995. Mikolo, the irst of the three to be the threat posed by disease. infected, later donated his antibody-rich blood to Luzolo and Mukungu. Humanity seems to need such remind- ers often. In 1948, shortly after the irst flu vaccine was created and penicillin became the first mass-produced anti- On average, in one corner of the world or another, a new infec- biotic, U.S. Secretary of State George Marshall reportedly tious disease has emerged every year for the past 30 years: MERS, claimed that the conquest of infectious disease was imminent. Nipah, Hendra, and many more. Researchers estimate that In 1962, after the second polio vaccine was formulated, the Nobel birds and mammals harbor anywhere from 631,000 to 827,000 Prize–winning virologist Sir Frank Macfarlane Burnet asserted, unknown viruses that could potentially leap into humans. Valiant “To write about infectious diseases is almost to write of some- eforts are under way to identify them all, and scan for them in thing that has passed into history.” places like poultry farms and bushmeat markets, where animals Hindsight has not been kind to these proclamations. Despite and people are most likely to encounter each other. Still, we likely advances in antibiotics and vaccines, and the successful eradi- won’t ever be able to predict which will spill over next; even long- cation of smallpox, Homo sapiens is still locked in the same epic known viruses like Zika, which was discovered in 1947, can sud- battle with viruses and other pathogens that we’ve been ighting denly develop into unforeseen epidemics. since the beginning of our history. When cities irst arose, dis- The Congo, ironically, has a good history of containing its dis- eases laid them low, a process repeated over and over for millen- eases, partly because travel is so challenging. Most of the country nia. When Europeans colonized the Americas, smallpox followed. is covered by thick forest, crisscrossed by just 1,700 miles of road. When soldiers fought in the irst global war, inluenza hitched a Large distances and poor travel infrastructure limited the spread ride, and found new opportunities in the unprecedented scale of of Ebola outbreaks in years past. the conlict. Down through the centuries, diseases have always But that is changing. A 340-mile road, lanked by deep val- excelled at exploiting lux. EMERY MIKOLO leys, connects Kikwit to Kinshasa. In 1995, that road was so badly Humanity is now in the midst of its fastest-ever period of maintained that the journey took more than a week. “You’d have change. There were almost 2 billion people alive in 1918; there to dig yourself out every couple of minutes,” Mikolo says. Now are now 7.6 billion, and they have migrated rapidly into cities, the road is beautifully paved for most of its length, and can which since 2008 have been home to more than half of all human be traversed in just eight hours. Twelve million people live in beings. In these dense throngs, pathogens can more easily spread Kinshasa—three times the combined population of the capitals and more quickly evolve resistance to drugs. Not coincidentally, THE ATLANTIC JULY/AUGUST 2018 61

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS the total number of outbreaks per decade Bill Gates, whose foundation has has more than tripled since the 1980s. studied pandemic risks closely, is not a Globalization compounds the risk: Air- THE WHITE man given to alarmism. But when I spoke planes now carry almost 10 times as many HOUSE with him upon my return from Kikwit, passengers around the world as they did he described simulations showing that a IS NOW HOME four decades ago. In the ’80s, HIV showed severe lu pandemic, for instance, could how potent new diseases can be, by TO AN kill more than 33 million people world- launching a slow-moving pandemic that INATTENTIVE, wide in just 250 days. That possibility, has since claimed about 35 million lives. and the world’s continued inability to In 2003, another newly discovered virus, CONSPIRACY adequately prepare for it, is one of the SARS, spread decidedly more quickly. A MINDED few things that shake Gates’s trademark Chinese seafood seller hospitalized in PRESIDENT. optimism and challenge his narrative of Guangzhou passed it to dozens of doctors global progress. “This is a rare case of me and nurses, one of whom traveled to Hong WE SHOULD being the bearer of bad news,” he told me. Kong for a wedding. In a single night, he NOT UNDER “Boy, do we not have our act together.” infected at least 16 others, who then carried the virus to Canada, Singapore, ESTIMATE Preparing for a pandemic ultimately boils down to real people and tangible and Vietnam. Within six months, SARS WHAT things: A busy doctor who raises an eye- had reached 29 countries and infected THAT COULD brow when a patient presents with an more than 8,000 people. This is a new unfamiliar fever. A nurse who takes a MEAN. epoch of disease, when geographic barri- travel history. A hospital wing in which ers disappear and threats that once would patients can be isolated. A warehouse have been local go global. where protective masks are stockpiled. A Last year, with the centennial of the 1918 factory that churns out vaccines. A line on lu looming, I started looking into whether a budget. A vote in Congress. “It’s like a America is prepared for the next pandemic. chain—one weak link and the whole thing I fully expected that the answer would be no. What I found, after falls apart,” says Anthony Fauci, the director of the National Insti- talking with dozens of experts, was more complicated—reassuring tute of Allergy and Infectious Diseases. “You need no weak links.” in some ways, but even more worrying than I’d imagined in others. Certainly, medicine has advanced considerably during the past A MONG ALL KNOWN PANDEMIC THREATS, inlu- century. The United States has nationwide vaccination programs, enza is widely regarded as the most dangerous. Its vari- advanced hospitals, the latest diagnostic tests. In the National ous strains are constantly changing, sometimes through Institutes of Health, it has the world’s largest biomedical research subtle mutations in their genes, and sometimes through dramatic establishment, and in the CDC, arguably the world’s strongest reshules. Even in nonpandemic years, when new viruses aren’t public-health agency. America is as ready to face down new sweeping the world, the more familiar strains kill up to 500,000 diseases as any country in the world. people around the globe. Their ever-changing nature explains why Yet even the U.S. is disturbingly vulnerable—and in some the lu vaccine needs to be updated annually. It’s why a disease respects is becoming quickly more so. It depends on a just-in- that is sometimes little worse than a bad cold can transform into time medical economy, in which stockpiles are limited and even a mass-murdering monster. And it’s why lu is the disease the U.S. key items are made to order. Most of the intravenous bags used has invested the most in tracking. An expansive surveillance net- in the country are manufactured in Puerto Rico, so when Hurri- work constantly scans for new lu viruses, collating alerts raised by cane Maria devastated the island last September, the bags fell doctors and results from lab tests, and channeling it all to the CDC, in short supply. Some hospitals were forced to inject saline with the spider at the center of a thrumming worldwide web. syringes—and so syringe supplies started running low too. The Yet just 10 years ago, the virus that the world is most prepared most common lifesaving drugs all depend on long supply chains for caught almost everyone of guard. In the early 2000s, the CDC that include India and China—chains that would likely break in a was focused mostly on Asia, where H5N1—the type of lu deemed severe pandemic. “Each year, the system gets leaner and leaner,” most likely to cause the next pandemic—was running wild among says Michael Osterholm, the director of the Center for Infectious poultry and waterfowl. But while experts fretted about H5N1 in Disease Research and Policy at the University of Minnesota. “It birds in the East, new strains of H1N1 were evolving within pigs doesn’t take much of a hiccup anymore to challenge it.” in the West. One of those swine strains jumped into humans in Perhaps most important, the U.S. is prone to the same forget- Mexico, launching outbreaks there and in the U.S. in early 2009. fulness and shortsightedness that befall all nations, rich and The surveillance web picked it up only in mid-April of that year, poor—and the myopia has worsened considerably in recent years. when the CDC tested samples from two California children who Public-health programs are low on money; hospitals are stretched had recently fallen ill. perilously thin; crucial funding is being slashed. And while we tend One of the most sophisticated disease-detecting networks in to think of science when we think of pandemic response, the worse the world had been blindsided by a virus that had sprung up in the situation, the more the defense depends on political leadership. its backyard, circulated for months, and snuck into the country When Ebola lared in 2014, the science-minded President unnoticed. “We joked that the inluenza virus is listening in on Barack Obama calmly and quickly took the reins. The White our conference calls,” says Daniel Jernigan, who directs the CDC’s House is now home to a president who is neither calm nor Inluenza Division. “It tends to do whatever we’re least expecting.” science-minded. We should not underestimate what that may The pandemic caused problems for vaccine manufacturers, mean if risk becomes reality. too. Most lu vaccines are made by growing viruses in chicken 62 JULY/AUGUST 2018 THE ATLANTIC

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РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS eggs—the same archaic method that’s been used for 70 years. cookers that use steam to sterilize equipment—so that soiled lin- Every strain grows differently, so manufacturers must con- ens and clothes can be immediately decontaminated. The space stantly adjust to each new peculiarity. Creating lu vaccines is is under negative air pressure: When doctors enter the hallway, or an artisanal afair, more like cultivating a crop than making a any of the ive patient rooms, air lows in with them, preventing pharmaceutical. The process works reasonably well for seasonal viruses from drifting out. This also dries the air. Working here, lu, which arrives on a predictable schedule. It fails miserably for I’m told, is murder on the skin. pandemic strains, which do not. Almost everything in the unit is a barrier of some form. Floor In 2009, the vaccine for the new pandemic strain of H1N1 lu seams are welded. Light and plumbing ixtures are sealed. The arrived slowly. (Then–CDC Director Tom Frieden told the press, ventilation and air-conditioning systems are separate from those “Even if you yell at the eggs, it won’t grow any faster.”) Once the for the rest of the hospital, and rigorously iltered. Patients can be pandemic was oicially declared, it took four months before the wheeled in on a tented gurney with built-in glove ports; it looks doses even began to roll out in earnest. By then the disaster was like a translucent caterpillar whose legs have been pushed inward. already near its peak. Those doses prevented no more than 500 A separate storage room is stocked with full-body suits, tape for deaths—the fewest of any lu season in the surrounding 10-year sealing the edges of gloves, and space-suit-like hoods with their period. Some 12,500 Americans died. own air ilter. A videoconferencing system allows team members— and family—to monitor what happens in the patient rooms without The egg-based system depends on chickens, which are them- having to suit up themselves. A roll of heavy-duty metallic wrap- selves vulnerable to lu. And since viruses can mutate within the ping paper can be used to seal the body of anyone who dies. eggs, the resulting vaccines don’t always match the strains that are circulating. But vaccine makers have few incentives to use The unit is currently empty, as it has been for most of its exis- anything else. Switching to a diferent process would cost billions, tence. The beds are occupied only by four hyperrealistic manne- and why bother? Flu vaccines are low-margin products, which quins, upon which nurses can practice medical procedures while only about 45 percent of Americans get in a normal year. So when wearing cumbersome protective layers. “We’ve named all the demand soars during a pandemic, the supply is not set to cope. mannequins,” Boulter tells me. Pointing to the largest one: “That one’s Phil, after Dr. Smith.” American hospitals, which often operate unnervingly close to full capacity, likewise struggled with the surge of patients. Pedi- Phil Smith began pushing the hospital to build the atric units were hit especially hard by H1N1, and staf became biocontainment unit in 2003, back when he was a professor exhausted from continuously caring for sick children. Hospitals of infectious diseases. SARS had emerged from nowhere, and almost ran out of the life-support units that sustain people whose monkeypox had broken out in the Midwest; Smith realized the lungs and hearts start to fail. The health-care system didn’t break, U.S. had no facilities that could handle such diseases, beyond but it came too close for comfort—especially for what turned out a few high-security research labs. With support from the state to be a training-wheels pandemic. The 2009 H1N1 strain killed health department, he opened the unit in 2005. merely 0.03 percent of those it infected; by contrast, the 1918 strain had killed 1 to 3 percent, and the H7N9 strain currently And then, nothing happened. circulating in China has a fatality rate of 40 percent. For nine years, the facility was dormant, acting mostly as an overlow ward. “We didn’t know if it would be needed, but we “A lot of people said that we dodged a bullet in 2009, but nature planned and prepared as if it would,” says Shelly Schwedhelm, the just shot us with a BB gun,” says Richard Hatchett, the CEO of head of the hospital’s emergency-preparedness program, who for the Coalition for Epidemic Preparedness Innovations. Tom years kept the unit aloat on a shoestring budget. Her eforts paid Inglesby, a biosecurity expert at the Johns Hopkins Bloomberg of in September 2014, when the State Department called, telling School of Public Health, told me that if a 1918-style pandemic Schwedhelm and her team to prepare for possible Ebola patients. hit, his hospital “would need in the realm of seven times as many Over 10 weeks, the unit’s 40 staf members took care of three critical-care beds and four times as many ventilators as we have infected Americans who had been evacuated from West Africa. on hand.” They worked around the clock in teams of six, some stafers treat- ing the patients directly, others helping their colleagues put on That the U.S. could be so ill-prepared for lu, of all things, and take of their gear, and still others supervising from the nurses’ should be deeply concerning. The country has a dedicated station. Two of the patients—Rick Sacra, a physician, and Ashoka surveillance web, antiviral drugs, and an infrastructure for mak- Mukpo, a journalist—were cured and discharged. The third—a ing and deploying lu vaccines. None of that exists for the major- surgeon named Martin Salia—was already sufering from organ ity of other emerging infectious diseases. failure by the time he arrived, and died two days later. A green- marble plaque now hangs in the unit to honor him. A S I WALK DOWN a seventh-loor hallway of the Uni- The University of Nebraska Medical Center is one of the best versity of Nebraska Medical Center, Kate Boulter, a in the country at handling dangerous and unusual diseases, Ron nurse manager, points out that the carpet beneath my Klain, who was in charge of the Obama administration’s Ebola feet has disappeared, exposing bare loors that are more easily response, tells me. Only the NIH and Emory University Hos- cleaned. In an otherwise unmarked corridor, this, she says, is the pital have biocontainment units of a similar standard, he says, irst sign that I am approaching the biocontainment unit—a spe- but both are smaller. Those three hospitals were the only ones cial facility designed to treat the victims of bioterror attacks, or ready to take patients when Ebola struck in 2014, but within two patients with a deadly infectious disease such as Ebola or SARS. months, Klain’s team had raised the number to 50 facilities. It was “a lot of hard work,” he says. “But ultimately, we had 144 There is nothing obviously special about the 4,100 square beds.” A more contagious and widespread disease would have feet, but every detail has been carefully designed to give patients overwhelmed them all. maximal access to the best care, and viruses minimal access to Preparing hospitals for new epidemics is challenging in the anything. A supply room is stocked with scrubs, underwear, and United States, Klain says, because health care is so decentralized: socks, so that no piece of clothing staf members wear at work will make its way home. There are two large autoclaves—pressure 64 JULY/AUGUST 2018 THE ATLANTIC

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS “You and I could decide that every hospital should have three beds them with immunosuppressants? If ICUs are full, where could capable of isolating people with a dangerous disease, and Trump they create clean spaces for post-transplant recovery? It matters could agree with us, and there’s no way of making that happen.” that the hospital has considered these questions. It matters just Hospitals are independent entities; in this fractured environ- as much that the people in charge have met, talked, and estab- ment, preparedness is less the result of governmental mandate lished a bond. and more the product of individual will. It comes from dedicated visionaries like Smith and skilled managers like Schwedhelm, The members of the team running the biocontainment who can keep things going when there’s no immediate need. unit all work in diferent parts of the hospital, as pediatricians, critical-care specialists, obstetricians. But even during the unit’s The trio of Ebola patients in 2014 produced 3,700 pounds of long dormancy, Schwedhelm would gather them for quarterly contaminated linens, gloves, and other waste among them, all training sessions. That’s why, when the moment came, they were of which demanded careful handling. Treating them cost more ready. When they escorted the Ebola patients of their respective than $1 million. That kind of care quickly reaches its limits as an planes, the staf members recalled what they had learned during epidemic spreads. In June 2015, the Samsung Medical Center, in practice drills. Seoul—one of the most advanced medical centers in the world— was forced to suspend most of its services after a single man with “We do a lot of team building,” Boulter says, showing me a MERS arrived in its overcrowded emergency room. American photo of the group at a ropes course. hospitals wouldn’t fare much better. But at the very least, they can plan for the worst. “It was the scariest thing I’ve ever done,” Schwedhelm says. They followed that up with something more sedate—a movie Schwedhelm, with a 100-person team, has been creating plans night in the hospital auditorium. They watched Contagion. for how every aspect of hospital operation would need to work during a pandemic. How much should hospitals stockpile? How K IKWIT GENERAL HOSPITAL has no biocontainment would they provide psychological support during a weeks-long cri- unit. Instead, it has Pavilion 3. sis? How could they feed people working longer-than-usual shifts? Emery Mikolo, who works at the hospital as a nurse When would they cancel elective surgeries? Where could they get supervisor, takes me into the blue-walled, open-windowed extra disinfectant, mop heads, and other cleaning supplies? building that is now the pediatrics ward. In one room, mos- quito nets are suspended hammocklike over 16 closely packed At a single meeting, I hear two dozen people discuss how beds, on which mothers care for young children and newborn they would care for the 400 or so patients on the hospital’s babies. This is a place of new life. But in 1995, it was the infamous organ-transplant list. How would they get such patients into the “death ward,” where Ebola patients were treated. Exhausted doc- facility safely? At what point would it become too risky to pump tors struggled to control the outbreak; outside the hospital, the Counterclockwise from bottom right: Phil Smith, who opened Nebraska’s biocontainment unit in 2005; Shelly Schwedhelm, who directs the hospital’s emergency-preparedness program; a containment vessel for infected patients

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS military established a perimeter to turn back leeing patients. allowed the virus to spread among the staf of Kikwit’s hospital, The dead were laid in a row on the pavement. just as it did among nurses in Dallas, where an infected patient We walk into another room, which is largely empty except landed in September 2014. In Kikwit, a lack of running water for a poster of a cartoonish girafe, a few worn mattresses, and makes hygiene a luxury, but even in the U.S., getting medical some old bed frames. Mikolo touches one of them. It was his, he professionals to wash their hands or follow other best practices is says. He looks around quietly and shakes his head. Many of the surprisingly hard; every year, at least 70,000 Americans die after people who shared this room with him were his colleagues who picking up infections in hospitals. And most of all, the people in had become infected while they cared for patients. Ebola’s symp- both countries worry that brief spates of foresight and prepared- toms are sometimes mythologized: Organs don’t liquefy; blood ness will always give way to negligence and entropy. seldom pours from oriices. But the reality is no less gruesome. In the U.S., attention and money have crested and then crashed “It was like a horror movie,” he says. “All these people I worked with each new crisis: anthrax in 2001, SARS in 2003. Resources, with—my friends—throwing up, screaming, dying, falling out of hurriedly assembled, dwindle. Research into countermeasures bed.” At one point, delirious with fever, he too rolled of his mat- izzles. “We fund this thing like Minnesota snow,” Michael Oster- tress. “There was vomit and piss and shit on the ground, but at holm says. “There’s a lot in January, but in July it’s all melted.” least it was cool.” Take the Hospital Preparedness Program. It’s a funding Many of the people who worked at the hospital during the plan that was created in the wake of 9/11 to help hospitals ready outbreak are still there. Jacqui, a nurse, worked in Pavilion 3 and themselves for disasters, run training drills, and build their surge returned there only three years ago. She was terriied at irst, capacity—everything that Shelly Schwedhelm’s team does so well but she soon habituated. I ask whether she’s worried that Ebola in Nebraska. It transformed emergency planning from an after- might return. “I’m not afraid,” she says. “It’s never coming back.” hours avocation into an actual profession, carried out by skilled If it does, is there any protective equipment at the hospital? specialists. But since 2003, its $514 million budget has been halved. “No,” she tells me. Another fund—the Public Health Emergency Preparedness Mikolo laughs. “Article 15,” he says. program—was created at the same time to help state and local Article 15 is something of a Congolese catchphrase, referring health departments keep an eye on infectious diseases, improve to a ictional but universally recognized 15th article of the coun- their labs, and train epidemiologists. Its budget has been try’s constitution, “Débrouillez-vous”—“igure it out yourself.” I pruned to 70 percent of its $940 million peak. Small wonder, hear it everywhere. It is simultaneously a testament to the Congolese love for droll humor, a weary acknowledgment of hard- Ron Klain was appointed the “Ebola czar” by President Obama in 2014 ship, a screw-you to the establishment, to provide speed and order to a federal response that required and a motivational mantra. No one’s going many agencies and was marked by unclear lines of responsibility. to ix your problems. You must make do with what you’ve got. In a nearby room, dried blood dots the loor around an old operating table, where a sick lab technician once passed Ebola to five other medical staff mem- bers, starting a chain of transmission that eventually enveloped Mikolo and many of his friends. The phlebotomist who drew the blood samples that were used to conirm Ebola also still works at the hos- pital. I watch as he handles a rack of sam- ples with his bare hands. “Ask someone here, ‘Where are the kits that protect you from Ebola?,’ ” Donat Kuma-Kuma Kenge, the hospital’s chief coordinator, tells me. “There aren’t any. I know exactly what I’m meant to do, but there are no materials— here, in the place where there was Ebola. “Débrouillez-vous,” he adds. The hospital’s challenges are con- siderable, but as I walk around, I realize that they are familiar. Even though the United States is 500 times as wealthy as the Congo, the laments I heard from people in both countries were uncannily similar—different in degree, but not in kind. Protective equipment is scarce in the Congo, but even America’s stock- piles would quickly be depleted in a seri- ous epidemic. Unfamiliarity with Ebola 66 JULY/AUGUST 2018 THE ATLANTIC

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS then, that in the past decade, local health most likely to cause a pandemic. Those departments have cut more than 55,000 doses are stockpiled, and can be used to jobs. That’s 55,000 people who won’t be THOUGH immunize health-care workers, govern- there to answer the call when the next THE U.S. ment employees, and the military while epidemic hits. IS VASTLY the Holly Springs plant churns out more. These sums of money are paltry com- Yet even this strategy is imperfect. pared with what another pandemic might WEALTHIER When H7N9 irst appeared in China, in cost the country. Diseases are exorbi- THAN THE 2013, the plant did its job, creating a vac- tantly expensive. In response to just 10 cine that was then stockpiled. Since then, cases of Ebola in 2014, the U.S. spent CONGO, THE H7N9 has mutated, and the hoarded $1.1 billion on domestic preparations, LAMENTS doses may be inefective against the cur- including $119 million on screening and I HEARD rent strains. “We occasionally have to quarantine. A severe 1918-style flu pan- chase a pre-pandemic,” says Anthony demic would drain an estimated $683 bil- IN BOTH Fauci, the National Institute of Allergy lion from American cofers, according to COUNTRIES and Infectious Diseases (NIAID) direc- the nonproit Trust for America’s Health. ABOUT HOW tor. “We have to do it,” but the strategy The World Bank estimates that global remains wasteful and reactive. output would fall by almost 5 percent— THINGS What society really needs, Fauci tells totaling some $4 trillion. COULD GO me, is a universal lu vaccine—one that protects against every variant of the The U.S. is not unfamiliar with the WRONG virus and provides long-term protection, concept of preparedness. It currently spends roughly half a trillion dollars on WERE just as the vaccines against measles and its military—the highest defense budget UNCANNILY mumps do. One vaccine to bind them in the world, equal to the combined bud- all: It’s hard to overstate what a win that gets of the next seven top countries. But SIMILAR. would be. No more worrying about strain against viruses—more likely to kill mil- mismatches or annual injections. “It lions than any rogue state is—such consis- would be the epitome of preparedness,” tent investments are nowhere to be found. Fauci says, and he has committed his institute to developing one. A T A MODERN BUILDING in Flu viruses are studded with a mole- Holly Springs, on the outskirts of Raleigh, North Caro- cule called hemagglutinin (the H in H1N1 and other such names), lina, I walk down a wide corridor where the words IT which looks like a stumpy Pez dispenser. Vaccines target the head, REALLY IS A MATTER OF LIFE AND DEATH have been stenciled but that’s the part that varies most among strains, and evolves most on a yellow wall. The walkway leads to a refrigerator-cool ware- quickly. Targeting the stem, which is more uniform and stable, house, where several white containers sit on a blue pallet. The might yield better results. The stem, however, is usually ignored by containers are full of flu vaccine, and each holds enough to the immune system. To draw attention to it, Fauci’s team decapi- immunize more than 1 million Americans. When their contents tates the molecule and sticks the stem onto a nanoparticle. The are ready to be used, they head toward a long, Rube Goldberg– result looks like a lu virus, but encourages the immune system to esque machine that dispenses the vaccine into syringes—more go after the stable stem instead of the adaptable head. In a prelimi- than 400,000 a day. nary study, his team used this approach to build a vaccine using Instead of eggs, the facility grows lu viruses in lab-grown dog an H1 virus, which then protected ferrets against a very diferent cells, which ill 5,000-liter steel vats one loor above. The cells H5N1 strain. are infected with lu viruses, which quickly propagate. The tech- This type of work is promising, but flu is such an adaptive nique is faster than using eggs, and produces vaccines that are a adversary that the quest for a universal vaccine might take years, closer match to circulating strains. even decades, to fulill. Progress will be incremental, but each This facility is the result of a partnership between the pharma- increment will have value in itself. A universal-ish vaccine that, say, ceutical company Seqirus and a government agency called the protected against all H1N1 strains would have prevented the 2009 Biomedical Advanced Research and Development Authority. pandemic. And reducing lu’s menace, even in some of its variants, Established in 2006, BARDA acts more or less as a venture-capital would free up resources and intellectual capacity for dealing with irm, funding the development of vaccines, drugs, and other epi- other deadly diseases for which no vaccines exist at all. demic countermeasures that would otherwise be unproitable. In Many of those diseases strike poor countries irst and are—for 2007, it entered into a $1 billion partnership to create the Holly now—rare. Creating vaccines for them is painstaking and often Springs plant, which started making vaccines in 2011. “No one unprofitable, and therefore little gets done. Last year, to help would have taken the risk of disposing of egg manufacturing change that, the Coalition for Epidemic Preparedness Innovations unless they could reach the scale we have here,” says Marie Mazur, was created, and now has $630 million pledged by governments Seqirus’s vice president of pandemic response. and nonproits. It will focus irst on Lassa fever, Nipah, and MERS, The facility will soon be able to make 200 million doses of vac- and its ambition is to yank promising vaccines out of developmen- cine within the irst six months of a new pandemic—enough to tal purgatory, push them through trials, and stockpile them by the immunize more than one in every three Americans. Six months hundreds of thousands. (One goal is to avoid a repeat of 2014, is still a long time, though, and there are limits to how quick the when Ebola ravaged West Africa while an experimental vaccine process can be. To vaccinate people during that window, Seqirus that could potentially have stopped it was languishing in a freezer, also prepares vaccines against the lu strains that BARDA deems where it had been for a decade.) THE ATLANTIC JULY/AUGUST 2018 67

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS More important, the coalition is look- Anthony Fauci, who as head of the National Institute of Allergy and Infectious Diseases has, ing to fund so-called platform technolo- until now, helped every president starting with Ronald Reagan manage pandemic risk, gies that could create a vaccine against says the responses of the presidents varied widely. He has yet to meet with Donald Trump. any new virus far more quickly than can be done today: within 16 weeks of its discovery. Most current vaccines work by presenting the immune system with dead, weakened, or fragmented microbes. Every microbe is unique, so every vaccine must be unique, which is one reason they’re so time-consuming to create. But by loading key parts of a given microbe onto a stan- dard molecular chassis, scientists could build plug-and-play vaccines that could be swiftly customized. In the same way that movable type revolutionized printing by allowing peo- ple to rapidly set up new pages without carving bespoke woodblocks, such vac- cines could greatly accelerate the defense against emerging infections. In 2016, a team of researchers used the concept to create a vaccine against Zika that is now being tested in clinical trials across the Americas. The process took four months— the shortest development time in vaccin- ology’s 222-year history. The possibilities of vaccine science— a universal flu vaccine, plug-and-play platforms—are exciting. But they are only possibilities. No matter how brilliant and dedicated the people involved, they face a long and uncertain road. Missteps and failures are assured along the way; dogged efort and consistent support are essential to sustain the journey. These latter neces- sities, unavoidably, bring us to politics— where they are, predictably, in short supply. A NTHONY FAUCI’S oicewalls There surely will be, though. At some point, a new virus will are plastered with certificates, emerge to test Trump’s mettle. What happens then? He has no magazine articles, and other mementos from his 34-year background in science or health, and has surrounded himself career as NIAID director, including photos of him with various pres- with little such expertise. The President’s Council of Advisers idents. In one picture, he stands in the Oval Oice with Bill Clinton on Science and Technology, a group of leading scientists who and Al Gore, pointing to a photo of HIV latching onto a white blood consult on policy matters, is dormant. The Oice of Science and cell. In another, George W. Bush fastens the Presidential Medal Technology Policy, which has advised presidents on everything of Freedom around his neck. Fauci has counseled every president from epidemics to nuclear disasters since 1976, is diminished. from Ronald Reagan through Barack Obama about the problem of The head of that oice typically acts as the president’s chief sci- epidemics, because each of them has needed that counsel. “This entiic consigliere, but to date no one has been appointed. transcends administrations,” he tells me. Other parts of Trump’s administration that will prove crucial Reagan and the elder Bush had to face the emergence and during an epidemic have operated like an Etch A Sketch. Dur- proliferation of HIV. Clinton had to deal with the arrival of West ing the nine months I spent working on this story, Tom Price Nile virus. Bush the younger had to contend with anthrax and resigned as secretary of health and human services after using SARS. Barack Obama saw a lu pandemic in his third month in taxpayer money to fund charter flights (although his replace- oice, MERS and Ebola at the start of his second term, and Zika ment, Alex Azar, is arguably better prepared, having dealt with at the dusk of his presidency. The responses of the presidents anthrax, lu, and SARS during the Bush years). Brenda Fitzgerald varied, Fauci told me: Clinton went on autopilot; the younger stepped down as CDC director after it became known that she Bush made public health part of his legacy, funding an aston- had bought stock in tobacco companies; her replacement, Robert ishingly successful anti-HIV program; Obama had the keenest Redield, has a long track record studying HIV, but relatively little intellectual interest in the subject. public-health experience. And Donald Trump? “I haven’t had any interaction with him yet,” Fauci says. “But in fairness, there hasn’t been a situation.” 68 JULY/AUGUST 2018 THE ATLANTIC

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РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS Rear Admiral Tim Ziemer, a veteran malaria fighter, was Counterintuitively, light bans increase the odds that outbreaks appointed to the National Security Council, in part to oversee will spread by driving fearful patients underground, forcing the development of the White House’s forthcoming biosecurity them to seek alternative and even illegal transport routes. They strategy. When I met Ziemer at the White House in February, he also discourage health workers from helping to contain foreign hadn’t spoken with the president, but said pandemic prepared- outbreaks, for fear that they’ll be denied reentry into their home ness was a priority for the administration. He left in May. country. Trump clearly felt that such Americans should be denied Organizing a federal response to an reentry. “KEEP THEM OUT OF HERE!” emerging pandemic is harder than one he tweeted, before questioning the evi- might think. The largely successful U.S. dence that Ebola is not as contagious as response to Ebola in 2014 beneited from is commonly believed. the special appointment of an “Ebola Trump called Obama “dumb” for czar”—Klain—to help coordinate the many deploying the military to countries sufer- agencies that face unclear responsibilities. ing from the Ebola outbreak, and he now In 2016, when Obama asked for $1.9 bil- SEVERE commands that same military. His dislike lion to ight Zika, Congress devolved into OUTBREAKS of outsiders and disdain for diplomacy partisan squabbling. Republicans wanted TEAR could lead him to spurn the cooperative, to keep the funds away from clinics that outward-facing strategies that work best worked with Planned Parenthood, and COMMUNITIES to contain emergent pandemics. Democrats opposed the restriction. It APART, Perhaps the two most important took more than seven months to appropri- ate $1.1 billion; by then, the CDC and NIH FORCING things a leader can personally provide in the midst of an epidemic are reliable had been forced to divert funds meant to PEOPLE information and a unifying spirit. In deal with lu, HIV, and the next Ebola. TO FEAR the absence of strong countermeasures, severe outbreaks tear communities apart, How will Trump manage such a situ- ation? Back in 2014, he called Obama THEIR forcing people to fear their neighbors; the a “psycho” for not banning lights from NEIGHBORS. longest-lasting damage can be psycho- Ebola-afflicted countries, even though social. Trump’s tendency to tweet rashly, no direct lights existed, and even though delegitimize legitimate sources of infor- health experts noted that travel restric- mation, and readily buy into conspiracy tions hadn’t helped control SARS or H1N1. theories could be disastrous. 70 JULY/AUGUST 2018 THE ATLANTIC

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS Left to right: A plaque memorializing Dr. Martin Salia, who died from Ebola at the University of Nebraska Medical Center in 2014; a worker sealing her gloves; mother and baby mannequins used for practicing treatment E MERY MIKOLO GREET S ME WARMLY, with one Congo, Rimoin has shown that monkeypox is on the rise, helped outstretched hand. We shake, do a little ankle tap, and discover a new virus, and worked to create the irst truly accu- say, “Nous sommes ensemble”—“we are together.” This is rate maps of the country, down to the most-isolated villages. The the greeting of the Kikwit Ebola Survivors’ Association, of which Congo is a second home for her. When Rimoin’s father died Mikolo is a co-founder and the vice president. Fifteen of the 42 shortly before her wedding, Muyembe, the virologist who irst members ile into the breakfast room of Hotel Kwilu, the men in encountered Ebola, lew to Los Angeles to walk her down the aisle. simple shirts and the women in glorious kaleidoscopic dresses. The youngest are in their mid-30s, the oldest in their late 70s. Rimoin emphasized to me the social rupture that disease out- They speak softly as they reconnect over plates of bread, cheese, breaks wreak on unprepared communities, and the diiculty of and Nutella. repair. She also said that until the Congo and other developing countries can control the diseases at their doorsteps, it is impera- There is still no deinitive treatment for Ebola. In 1995, like tive for richer nations like the United States to help them. That was most of the survivors, Mikolo fought the virus of on his own, over a truth acknowledged by every expert I spoke with: The best way to three grueling weeks. After he recovered, he donated his blood— prevent pandemics is to contain outbreaks at their source. The U.S. and the virus-ighting antibodies within it—to others, saving the cannot possibly consider itself protected if other nations are not. lives of Shimene Mukungu and Emilienne Luzolo, who are also here today. Blood spreads Ebola. Sometimes, blood cures it. America’s prior investments in global health preparedness— the largest of any nation’s—have already made a tangible difer- The outbreak destroyed entire families. Afterward, some of ence. In 2010, the CDC helped Uganda set up a new surveillance the survivors found themselves the sole providers for several system for viral hemorrhagic fevers like Ebola and Marburg. children. Others were orphans. Worst of all, they became pariahs. Health workers there are now trained to recognize these diseases, “Here, for we who live in communities, it is solitude that kills us,” and have tools for collecting samples safely. Labs have diagnostic Mikolo says. He rolls up his trouser leg and shows me the scars equipment. Response teams are ready to go. “It’s been incred- inlicted by fearful neighbors, who hurled stones at him when he ible to watch,” says Inger Damon, who oversaw the CDC’s 2014 tried to return home. Like others, he discovered that his house Ebola response. “It used to take two weeks to respond to an out- and belongings had been burned. break. By the time you understood what was going on, you’d have 20 to 30 cases, and eventually hundreds. Now they can respond The survivors banded together. “We had to take care of our- in two days.” Sixteen outbreaks have been detected since 2010, selves,” Norbert Mabanza, the association’s president, tells me. but they were typically much smaller and shorter than before. “Those with a little bit of strength could support those who were Half of them involved just one case. weaker. Débrouillez-vous.” And in July 2014, in the midst of the West African Ebola I listen to their stories in the company of Anne Rimoin, an outbreak, those investments very likely prevented a horrific epidemiologist from UCLA. During her 16 years working in the THE ATLANTIC JULY/AUGUST 2018 71

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS Emery Mikolo in March 2018 in Pavilion 3, which housed Kikwit’s Ebola patients in 1995, and is now a pediatrics ward catastrophe that might otherwise still be unfolding today. A Libe- relationships they have built will crumble. Trust is essential for ED YONG rian American man brought the virus into Lagos, Nigeria, home controlling outbreaks; it is hard won, and not easily replaced. “In to 21 million people and one of Africa’s busiest airports. “If it had an outbreak, there’s so little time to learn things, make connec- gone out of control in Lagos, it would have gone all over Africa for tions, learn how to not ofend people,” Rimoin tells me. “We’re years,” Tom Frieden, the former CDC director, says. “We were here in the Congo all the time. People know us.” right on the edge of the abyss.” Until Rimoin arrived in Kikwit last summer, the Ebola survi- But Nigeria responded quickly. For years, it had used invest- vors had for decades refused to collaborate with outsiders. “Oth- ments from the U.S. and other countries to build infrastructure ers see us as people to study,” Mikolo tells her. “But you came for eradicating polio. It had a command center and a crack team to us with friendship and humanity. You haven’t abandoned us.” of CDC-trained epidemiologists. When Ebola hit Lagos, the Indeed, while Rimoin is studying the blood of the survivors, she team dropped its polio work. It found every person who’d con- is also trying to set up a clinic where survivors, half of whom are tracted Ebola, and every person with whom those infected had medically trained, can provide primary care to one another and had contact. In only three months, after just 19 cases and eight to their communities. She has used donations and some of her deaths, it brought Ebola to heel and stopped it from spreading to own money to help Mabanza, the association’s president, get a any other country. master’s degree in public health. With patience and money—not even very much money com- Rimoin and I take the same light out of Kinshasa; she will pared with the vastness of rich-country spending—this kind of likely be back in a few months. I think about her ties to the victory could be commonplace. An international partnership Congo as our plane soars over one of the most biodiverse rain called the Global Health Security Agenda has already laid out forests in the world, on the irst of three legs that will put me back a road map for nations to plug their vulnerabilities against within a stone’s throw of the White House in 28 hours. Below infectious threats. Back in 2014, the U.S. committed $1 billion my light path, the sparks of a new Ebola outbreak are lickering, to the efort over ive years. With it came a clear, if implicit, unbeknownst to me or any of the scientists with whom I’d spo- statement: Pandemic threats should be a global priority. Nous ken. (It would be discovered in the weeks that followed.) sommes ensemble. I think about the survivors of Kikwit, and how our connected- Given that sense of commitment, and with the related fund- ness is both the source of our greatest vulnerability and the ing in hand, the CDC made a large bet: It began helping 49 coun- potential means of our salvation. I think about whether it is pos- tries improve their epidemic preparedness, on the assumption sible to break the old cycle of panic and neglect, to fully transition that demonstrating success would assure a continued low of from Débrouillez-vous to Nous sommes ensemble. I think about this money. But that bet now looks uncertain. Trump’s budget for amid bouts of restless sleep, as the plane lies westward across 2019 would cut 67 percent from current annual spending. the Atlantic, stuck in the shadow of the world, until inally, dawn catches up. If investments start receding, the CDC will have to wind down its activity in several countries, and its ield oicers will Ed Yong is a staf writer at The Atlantic. look for other jobs. Their local knowledge will disappear, and the 72 JULY/AUGUST 2018 THE ATLANTIC

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS Cheryl Windless thought it was a simple flu infection. But, assist device (LVAD), which functions like an artificial heart. she was in severe cardiogenic shock and many of her organs In fact, it was a typical Mount Sinai success story: one that began were failing. She was given only a ten percent chance of survival. with very little hope of success. One hospital wouldn’t admit her because they thought she couldn’t be saved. At Mount Sinai Heart, doctors performed 1-80 0-MD-SINAI emergency surgery to implant a HeartMate II left ventricular mountsinai.org/msheart OUR DOCTORS WORK ON HEARTS OTHER DOCTORS DON’T HAVE THE HEART TO TOUCH.

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS Kiarra Boulware and her niece at Penn North, an addiction- recovery center in Baltimore

B E I N G B L A C KРЕЛИЗПОДГОТОВИЛАГРУППА\"What'sNews\"VK.COM/WSNWS| THE HEALTH REPORT | IN AMERICA CAN BE HAZARDOUS Across the United TO YOUR States, African Americans have a lower life expectancy than whites. In Baltimore and other segregated cities, this gap is as much as 20 years. One young woman’s struggle to get better shows why. BY OLGA KHAZAN Photographs by Jared Soares THE ATLANTIC JULY/AUGUST 2018 75

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS Kiarra resolved to get healthy after visiting a diabetic friend in the hospital who’d had her toe amputated. Kiarra’s own diabetes is already causing her vision to blur. ONE MORNING THIS PAST SEPTEMBER, KIARRA BOULWARE BOARDED THE 26 BUS TO BALTIMORE’S BON SECOURS HOSPITAL, where she would seek help for the most urgent prob- not even the best hospitals in America can keep you lem in her life: the 200-some excess pounds she from getting sick in the irst place. carried on her 5-foot-2-inch frame. It was lunchtime, but Kiarra didn’t have any cash— To Kiarra, the weight sometimes felt like a great her job, working the front desk at the recovery center burden, and at other times like just another fact of where she lived, paid a stipend of just $150 a week. life. She had survived a childhood marred by death, When she did have money, she often sought comfort drugs, and violence. She had recently gained control in fast food. But when her cash and food stamps ran over her addiction to alcohol, which, last summer, out, she sometimes had what she called “hungry had brought her to a residential recovery center in nights,” when she went to bed without having eaten the city’s Sandtown neighborhood, made famous by anything all day. the Freddie Gray protests in 2015. But she still strug- gled with binge eating—so much so that she would When I’d irst met Kiarra, a few months earlier, I’d eat entire plates of quesadillas or mozzarella sticks been struck by how upbeat she seemed. Her recov- in minutes. ery center—called Maryland Community Health Initiatives, but known in the neighborhood as Penn As the bus rattled past rowhouses and corner North—sits on a grimy street crowded with men sell- stores, Kiarra told me she hadn’t yet received the ing drugs. Some of the center’s clients, fresh of their CPAP breathing machine she needed for her sleep habits, seemed withdrawn, or even morose. Kiarra, apnea. The extra fat seemed to constrict her airways though, had the bubbly demeanor of a student- while she slept, and a sleep study had shown that she council president. stopped breathing 40 times an hour. She remem- bered one doctor saying, “I’m scared you’re going to She described the rough neighborhoods where die in your sleep.” In the haze of alcoholism, she’d she’d grown up as fun and “familylike.” She said never followed up on the test. Now doctors at Bon that although neither of her parents had been very Secours were trying to order the machine for her, but involved when she was a kid, her grandparents had insurance hurdles had gotten in the way. provided a loving home. Regarding her diabetes, she told me she was “grateful that it’s reversible.” After Kiarra’s weight brought an assortment of old- finishing her addiction treatment, she planned to person problems to her 27-year-old life: sleep apnea, reenroll in college and move into a dorm. diabetes, and menstrual dysregulation, which made her worry she would never have children. For a while, Now, though, a much more anxious Kiarra sat she’d ignored these issues. Day to day, her size mostly before her doctor, a young white man named Tyler made it hard to shop for clothes. But the severity of her Gray, who began by advising Kiarra to get a Pap smear. situation sank in when a diabetic friend had to have a toe amputated. Kiarra visited the woman in the hospi- “Do we have to do it today?” she asked. tal. She saw her tears and her red, bandaged foot, and “Is there something you’re concerned about or ner- resolved not to become an amputee herself. vous about?,” Gray asked. Kiarra was nervous about a lot of things. She Kiarra arrived at the hospital early and waited in “deals by not dealing,” as she puts it, but lately she’d the cafeteria. Bon Secours is one of several world-class had to deal with so much. “Ever since the diabetes hospitals in Baltimore. Another, Johns Hopkins Hospi- thing, I hate hearing I have something else,” she said tal, is in some respects the birthplace of modern Amer- softly, beginning to cry. “I’ve been fat for what seems ican medicine, having invented everything from the like so long, and now I get all the fat problems.” medical residency to the surgical glove. But of course “I don’t want to be fat,” she added, “but I don’t know how to not be fat.” 76 JULY/AUGUST 2018 THE ATLANTIC

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS Kiarra’s struggles with her weight are imbued with this sense, that getting was a little girl, Baltimore thin is a mystery she might never solve, that diet secrets are literally secret.   W H E N  K I A R R A   was, as it is today, mired in On a Sunday, she might diligently make a meal plan for the week, only to ind violence, drugs, and poverty. In 1996, the city had herself reaching for Popeyes fried chicken by Wednesday. She blames herself the highest rate of drug-related emergency-room for her poor health—as do many of the people I met in her community, where visits in the nation and one of the country’s highest obesity, diabetes, and heart disease are ubiquitous. They said they’d made homicide rates. bad choices. They used food, and sometimes drugs, to soothe their pain. But these individual failings are only part of the picture. With her father in and out of jail for robbery and drug dealing, Kiarra and her mother, three siblings, In Baltimore, a 20-year gap in life expectancy exists between the city’s and three cousins piled into her grandmother’s poor, largely African American neighborhoods and its wealthier, whiter areas. home. It was a joyous but chaotic household. Kiarra A baby born in Cheswolde, in Baltimore’s far-northwest corner, can expect describes her grandmother as “God’s assistant”—a to live until age 87. Nine miles away in Clifton-Berea, near where The Wire deeply religious woman who, despite a house burst- was ilmed, the life expectancy is 67, roughly the same as that of Rwanda, and ing with hungry mouths, would still make an extra 12 years shorter than the American average. Similar disparities exist in other dinner for the addicts on the block. Kiarra’s mother, segregated cities, such as Philadelphia and Chicago. meanwhile, was “the hood princess,” a woman who would do her hair just to go to the grocery store. She These cities are among the most extreme examples of a national phe- was a teen mom, like her own mother had been. nomenon: Across the United States, black people sufer disproportionately from some of the most devastating health problems, from cancer deaths and Many facets of Kiarra’s youth—the fact that her diabetes to maternal mortality and preterm births. Although the racial dis- parents weren’t together, her father’s incarceration, parity in early death has narrowed in recent decades, black people have the the guns on the corners—are what researchers con- life expectancy, nationwide, that white people had in the 1980s—about three sider “adverse childhood experiences,” stressful years shorter than the current white life expectancy. African Americans face events early in life that can cause health problems a greater risk of death at practically every stage of life. in adulthood. An abnormally large proportion of the children in Baltimore—nearly a third—have two or Except in the case of a few specific ailments, such as nondiabetic more ACEs. People with four or more ACEs are seven kidney disease, scientists have largely failed to identify genetic diferences times as likely to be alcoholics as people with no ACEs, that might explain racial health disparities. The major underlying causes, and twice as likely to have heart disease. One study many scientists now believe, are social and environmental forces that afect found that six or more ACEs can cut life expectancy African Americans more than most other groups. by as much as 20 years. Kiarra had at least six. To better understand how these forces work, I spent nearly a year report- She and others I interviewed recall the inner- ing in Sandtown and other parts of Baltimore. What I found in Kiarra’s city Baltimore of their youth fondly. Everyone lived struggle was the story of how one person’s eforts to get better—imperfect as crammed together with siblings and cousins, but they may have been—were made vastly more diicult by a daunting series of people looked out for one another; neighbors hosted obstacles. But it is also a bigger story, of how African Americans became stuck back-to-school cookouts every year, and people took in profoundly unhealthy neighborhoods, and of how the legacy of racism can pride in their homes. Kiarra ran around with the literally take years of their lives. Far from being a relic of the past, America’s other kids on the block until her grandma called her racist and segregationist history continues to harm black people in the most in each night at 8 o’clock. She made the honor roll in intimate of ways—seeping into their lungs, their blood, even their DNA. ifth grade and got to speak in front of the whole class. She read novels by Sister Souljah and wrote short sto- ries in longhand. Yet Kiarra also describes some jarring incidents. When she was 8, she heard a loud bop bop bop outside and ran out to ind her stepbrother lying in the street, dead. One friend died of asthma in middle school; another went to jail, then hanged himself. (Other peo- ple I spoke with around Penn North and other recov- ery facilities had similarly traumatic experiences. It seemed like every second person I met told me they had been molested as a child, and even more said their family members had struggled with addiction.) Kiarra told me she got pregnant by a friend when she was 12, and gave birth to a boy when she was 13. Within a year, the baby died unexpectedly, and Kiarra was so traumatized that she ended up spending more than a month in a psychiatric hospital. When she came home, her boyfriend physically and sexually abused her. He “slapped me so hard, I was seeing stars,” she said. She took solace in eating, a common refuge for victims of abuse. One 2013 study of thousands of women found that those who had been severely physically or sexually abused as children had nearly THE ATLANTIC JULY/AUGUST 2018 77

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS double the risk of food addiction. Kiarra ate “everything, anything,” she The way African Americans became trapped in said, “mostly bad foods, junk food, pizza,” along with chicken boxes—the Baltimore’s poorest—and least healthy—neighbor- fried-chicken-and-fries combos slung by Baltimore’s carryout joints. hoods mirrors their history in the ghettos of other major cities. It began with outright bans on their At irst, she thought the extra weight looked good on her. Then she started presence in certain neighborhoods in the early feeling fat. Eventually, she said, “it was like, Fuck it. I’m fat.” As her high- 1900s and continued through the 2000s, when pol- school graduation approached, she tried on the white gown she’d bought just icy makers, lenders, and fellow citizens employed weeks earlier and realized that it was already too tight. subtler forms of discrimination. Kiarra didn’t know many college-educated people, but she wanted to go to In the early 1900s, blacks in Baltimore dispropor- Spelman, a historically black college in Georgia, and join a sorority. Her fam- tionately sufered from tuberculosis, so much so that ily talked her out of applying, she said. Instead, she enrolled in one local col- one area not far from Penn North was known as the lege after another, but she kept dropping out, sometimes to help her siblings “lung block.” In 1907, an investigator hired by local with their children and other times because she simply lost interest. After charities described what she saw in Meyer Court, a accumulating $30,000 in student loans, she had only a year’s worth of credits. poor area in Baltimore. The contents of an outdoor toilet “were found streaming down the center of this So Kiarra put college on hold and worked at Kmart and as a home health narrow court to the street beyond,” she wrote. The aide—solid jobs but, as she likes to say, “not my ceiling.” She longed for a smell within one house was “ ‘sickening’ … No provi- purpose. Sometimes, she had an inkling that she was meant to be an impor- sion of any kind is made for supplying the occupants tant person; she would picture herself giving a speech to an auditorium full of this court with water.” Yet one cause, the housing of people. But she remained depressed, stuck, and, increasingly, obese. investigator concluded, was the residents’ “low stan- dards and absence of ideals.” She began doing ecstasy, and, later, downing a pint of vodka a day. She remembers coming to her home-health-aide job drunk one time and leaving When blacks tried to lee to better areas, some a patient on the toilet. “Did you forget me?” the woman asked, half an hour had their windows smashed and their steps smeared later. Kiarra broke down crying. with tar. In 1910, a Yale-educated black lawyer named George McMechen moved into a house in Soon after, she checked into Penn North for her irst try at recovery. This a white neighborhood, and Baltimore reacted by past year’s attempt is her third. adopting a segregation ordinance that The New York Times called “the most pronounced ‘Jim Crow’ mea- 97 percent black, and half of its families live in sure on record.” Later, neighborhood associations   S A N D T O W N  I S   poverty. Its homicide rate is more than double that urged homeowners to sign covenants promising of the rest of the city, and last year about 8 percent of the deaths there never to sell to African Americans. were due to drug and alcohol overdose. Still, its top killers are heart dis- ease and cancer, which African Americans nationwide are more likely to die from than other groups are. 78 JULY/AUGUST 2018 THE ATLANTIC

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS Kiarra lives For much of the 20th century, the Federal Hous- Penn North’s aging air con- in Sandtown, ing Administration declined to insure mortgages   A L L  S U M M E R,   ditioners strained against the the Baltimore for blacks, who instead had to buy homes by signing soupy heat outside. For Kiarra, the irst few months neighborhood contracts with speculators who demanded payments at the recovery center felt like boot camp. The staf made famous by that, in many cases, amounted to most of the buyer’s woke the residents before 7 a.m., even if they didn’t the Freddie Gray income. (As a result, many black families never reaped have anywhere in particular to be. Kiarra’s days were protests, where the gains of homeownership—a key source of Ameri- packed with therapies: acupuncture in the mornings, heart disease and cans’ wealth.) Housing discrimination persisted well meant to help reduce cravings; individual meetings cancer are the beyond the Jim Crow years, as neighborhood associa- with peer counselors; Narcotics Anonymous ses- leading killers. tions rejected proposals to build low-income housing sions, in which dozens of strangers slumped on metal in aluent suburbs. In the 1990s, house lippers would folding chairs and told stories of past drug binges. buy up homes in Baltimore’s predominantly black neighborhoods and resell them to unsuspecting irst- Once a week, Kiarra would leave her post at the time home buyers at inlated prices by using falsiied front desk and walk across an empty playground for an documents. The subsequent foreclosures are a major appointment with her psychotherapist, Ms. Bea (who reason so many properties in the city sit vacant today. asked that I not use her full name). Kiarra would climb the steep, narrow staircase of Penn North’s clinical Some of Baltimore’s rowhouses are so long- building, then stop at the landing to catch her breath. forsaken, they have trees growing through the win- dows. These dilapidated homes are in themselves Ms. Bea’s goal was to help Kiarra understand how harmful to people’s health. Neighborhoods with her substance abuse, her weight, and her diicult poorly maintained houses or a large number of childhood were interconnected. Like many young abandoned properties, for instance, face a high risk people in Baltimore, Kiarra had spent her life trying of mouse infestation. Every year, more than 5,000 to attain ordinary things—love, respect—that seemed Baltimore children go to the emergency room for always to skid beyond her grasp. She wanted male an asthma attack—and according to research from attention, but then she got pregnant. The baby made Johns Hopkins, mouse allergen is the biggest envi- her happy, but the baby died. Her siblings started ronmental factor in those attacks. having kids and she loved them, but she was jealous. She fell into a deep-sink depression. She’d eat a sec- The allergen, found in mouse urine, travels ond dinner, then get so drunk that she’d scream at her through the air on dust, and Johns Hopkins research- friends. She’d realize that she was going to wake up ers have found high levels of it on most of the beds to a blistering hangover and would keep drinking. It of poor Baltimore kids they have tested. When kids was coming anyway, so why not? “Struggle days,” she inhale the allergen, it can spark inlammation and called these times. mucus buildup in their lungs, making them cough and wheeze. These attacks can cause long-term During one appointment in August, Kiarra told harm: Children with asthma are more likely to be Ms. Bea that she had been attending Overeaters obese and in overall poorer health as adults. Getting Anonymous meetings by phone. Something another rid of the mice requires sealing up cracks and holes in member had shared, about why people are some- the house—a process that can cost thousands of dol- times reluctant to shed weight, had stuck with her. lars, given the state of many Baltimore homes. “He was saying when you lose the fat, you lose a part of you,” Kiarra recalled. The mice, of course, are just one symptom of the widespread neglect that can set in once neighbor- A few years earlier, she had founded a club for hoods become as segregated as Baltimore’s are. One plus-size women called Beautiful Beyond Weight, study estimated that, in the year 2000, racial seg- with some of her best friends. The goal was to help regation caused 176,000 deaths—about as many as overweight women feel better about themselves. were caused by strokes. They put on fashion shows that she described as “Beyoncé big, but on a Christina Aguilera budget.” SOME OF BALTIMORE’S ROWHOUSES She worried that if she lost too much weight, the ARE SO LONG FORSAKEN, THEY HAVE other girls in the club would think she was a hypocrite. She decided she would aim to be “slim-thicc”—not TREES GROWING THROUGH THE too skinny. WINDOWS. THEY ARE IN THEMSELVES “So imagine if you were a size 14,” Ms. Bea said. HARMFUL TO PEOPLE’S HEALTH. “What would be happening here—with you?” Ms. Bea was trying to help Kiarra see how she sometimes uses her size as a form of protection, a way of making her feel invisible to men, so that she could eventually work through her fear. In Kiarra’s experience, disappearing could be use- ful. She told me that once, when she was 17, before she had gotten so big, she met a guy in an online chat room. She went over to his place, where they watched TV and started having sex. But then—the skid—his three friends barged into the room and raped her. She led, half-dressed, as soon as she could. THE ATLANTIC JULY/AUGUST 2018 79

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS “Yeah,” Kiarra said, envisioning herself many sizes smaller. “I wouldn’t properties, allowing old paint to chip and leaded dust be able to take it.” to accumulate. Some landlords, seeking to avoid the expense of renovating homes and the risk of tenant   concentrating sometimes, and she thinks lawsuits, refused to rent to families with children, since they would face the greatest risk from lead   K I A R R A  H A S  T R O U B L E   the reason might be that she and her exposure. Poor families feared that if they com- brother were exposed to lead from old paint. When Kiarra was 6, her grand- plained about lead, they might be evicted. mother heard that a girl living in another property owned by the same land- lord had been hospitalized. She took Kiarra to get tested. The results showed Partly because of Maryland’s more rigorous that the concentration of lead in her blood was more than six times the level screening, the state’s lead-poisoning rate for chil- the Centers for Disease Control and Prevention considers elevated—an dren was 15 times the national average in the ’90s; amount that can irreversibly lower IQ and reduce attention span. Kiarra, too, the majority of the poisoned children lived in the was hospitalized, for a month. poor areas of Baltimore. In some neighborhoods, 70 percent of children had been exposed to lead. Scientists and industry experts knew in the 19th century that lead paint The city’s under-resourced agencies failed to was dangerous. “Lead is a merciless poison,” an executive with a Michigan address the problem. Clogged by landlords who lead-paint company admitted in a book in 1892. It “gradually afects the hid behind shell companies, Baltimore’s lead-paint nerves and organs of circulation to such a degree that it is next to impossible enforcement system had ground to a halt by the to restore them to their normal condition.” But as late as the 1940s and ’50s, time Kiarra was poisoned. According to Tapping Into trade groups representing companies that made lead products, including The Wire, a book co-authored by Peter L. Beilenson, the Lead Industries Association, promoted the use of lead paint in homes the city’s former health commissioner, Baltimore and successfully lobbied for the repeal of restrictions on that use. Lead-paint didn’t bring a single lead-paint enforcement action companies published coloring books and advised their salesmen to “not for- against landlords in the ’90s. (A subsequent crack- get the children—some day they may be customers.” According to The Balti- down on landlords has lowered lead-poisoning rates more Sun, a study in 1956 found that lead-poisoned children in the slums of dramatically.) Baltimore had six times as much lead in their systems as severely exposed workers who handled lead for a living. When Kiarra was 14, her family sued their land- lord for damages, but their lawyer dropped the case In speeches and publications, Lead Industries Association oicials cast because the landlord claimed he had no money and childhood lead poisoning as vanishingly rare. When they did acknowledge no insurance with which to compensate them. Kiarra the problem, they blamed “slum” children for chewing on wood surfaces— remembers her grandmother not wanting to give up, “gnaw-ledge,” as Manfred Bowditch, the group’s health-and-safety director, demanding of the lawyer, “What do you mean there’s called it—and their “ignorant parents” for allowing them to do so. In a letter to nothing you can do?”—only to get lost in a tangle of the Baltimore health department, Bowditch called the lead-poisoned toddlers legal rules she didn’t fully understand. “little human rodents.” this past August, Even after stricter regulations came along, landlords in segregated   O N   A   H O T   S AT U R D AY   Kiarra brought her neighborhoods—as well as the city’s own public-housing agency—neglected nieces with her to work and corralled them in the front oice. She was babysitting that day, and staing LIFE EXPECTANCY AT BIRTH IN BALTIMORE was short at the center. The girls climbed restlessly BY NEIGHBORHOOD on the stained oice chairs and under the tables. 85–89 Kiarra is close with her family. She spends much of her free time texting her favorite sisters on her 80–84 cracked cellphone, and she talks to her grandmother every few days. Any familial strife upsets her deeply: 75–79 She can vividly recount a long list of times her mother disappointed her. Then again, sometimes she feels like 70–74 she’s the one who has let everyone down, with all her drinking and dropping out. 65–69 Near the end of the day, Kiarra’s cellphone rang. SANDTOWN- It was her father, calling to yell at her because she WINCHESTER AND hadn’t come to see him recently. “I’ve been busy,” HARLEM PARK Kiarra told him. 2017 NEIGHBORHOOD HEALTH PROFILES/BALTIMORE CITY HEALTH When Kiarra was little, and when her father DEPARTMENT (NO DATA AVAILABLE FOR DETENTION FACILITIES) wasn’t incarcerated, he had provided for his children—unlike many dads she knew. She’d sought his approval by researching Islam, his religion, and trying to reconcile it with the strict Christianity of her grandmother’s home. A few years ago, she tried to impress him by joining a tough-seeming social club that turned out to be too much like a gang. (It “wasn’t a good it,” she told me.) On some level, she still respected her father. But he had an explosive personality and struggled with

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS Kiarra hung up, this time for good. Then she wept. “As long as I’m fucked up, this man is cool, but as soon as I decide I want to get my fucking life together it’s like …” Her voice trailed of. She turned and told me she wanted to go to McDonald’s. “McDonald’s is killing me,” she said, “but it’s a special treat.” She ordered her usual—a McDouble and a McChicken, along with a sweet tea—and waited silently amid the beeping of the cash registers. EVEN AMONG people I met at Penn North were optimistic and sur- PEOPLE MAKING   M O S T   O F   T H E   rounded by iercely loyal friends. But their lives also seemed, like Kiarra’s, unrelentingly stressful. Between the hugs and hand- $175,000 A shakes, I heard a lot of trepidation. I have to move again … Where will I go? YEAR OR MORE, Will I get this job at Target? Will I ever walk again? Will I get to eat today? BLACKS ARE Research shows that this kind of day-in, day-out worry can ravage a per- MORE LIKELY son’s health. Certain stressful experiences—such as living in a disordered, impoverished neighborhood—are associated with a shortening of the telo- TO SUFFER meres, structures that sit on the tips of our chromosomes, which are bundles FROM CERTAIN of DNA inside our cells. Often compared to the plastic caps on the ends of DISEASES THAN shoelaces, telomeres keep chromosomes from falling apart. They can also be a measure of how much a body has been ground down by life. WHITES ARE. Some researchers think stress shrinks telomeres, until they get so short depression and addiction. Kiarra told me he taught her that the cell dies, hastening the onset of disease. Diferent kinds of prolonged what men are supposed to be: ierce protectors who emotional strain can afect telomeres. In one study, mothers who had high sometimes turn their wrath on the women in their lives. stress levels had telomeres that were as short as those of a person about a decade older. Another study found that children who spent part of their Kiarra usually tried to see her father’s outbursts as childhood in Romanian orphanages had telomeres that shortened rapidly. a cry for help. But today, she decided to confront him. Their conversation escalated as they accused each Arline T. Geronimus, an expert on health disparities at the University of other of failing at fatherhood and daughterhood. Michigan, has found that African Americans have more stress-related wear and tear in their bodies than white people do, and the diference widens with “How many of my plays have you been to?,” age. By measuring telomere length in hundreds of women, Geronimus esti- Kiarra demanded. mated that black women were, biologically, about seven and a half years older than white women of the same age. Her father launched into a tirade. “I will come for your fucking dumb ass!,” I overheard him yell at one Unrelenting stress also afects our daily behaviors: Stress causes some point. “You going to respect me!” people to eat more, especially calorically dense foods, and to sleep less. On average, African Americans get about 40 minutes less sleep each night “Respect works both ways,” Kiarra said. “I’m not than white people do. Among women in one recent study, poor sleep alone that little girl that’s gonna let you slap the shit out of me.” explained more than half the racial disparity in cardiovascular-disease risk. What bothered Kiarra most was that her father had Living in a dangerous neighborhood like Sandtown requires a vigilance never hit his other daughter that way, so why her? Why that can lood the body with adrenaline and cortisol. These hormones are did it feel like he was always rejecting her? (Her father supposed to kick in only long enough for us to get away from an immediate later conirmed that he had hit her as a child, saying, threat. If they trickle through us constantly, they can raise the risk of heart “Discipline is a must, whatever form you choose.”) disease and compromise the body’s immune system. As he continued screaming—“I’m gonna put your These kinds of changes in body chemistry aren’t limited to people living fuckin’ head in the dirt”—Kiarra’s eyes glazed over. in poverty. Even well-of black people face daily racial discrimination, which “Death gotta be better than here,” she said. can have many of the same biological efects as unsafe streets. Thomas LaVeist, the dean of Tulane’s School of Public Health and Tropical Medicine, She hung up, then wiped away tears. Just today, has found, for example, that even among people earning $175,000 a year or he had called her at 12:30 a.m., 3:48 a.m., 7:47 a.m., more, blacks are more likely to sufer from certain diseases than whites are. 11:24 a.m., 3:33 p.m., and 4:44 p.m. One time when she didn’t answer the phone, Kiarra said, he showed up in In an emerging ield of research, scientists have linked stress, including person at Penn North. from prejudice, to compounds called methyl groups attaching to our genes, like snowlakes sticking to a tree branch. These methyl groups can cause Her father called back, rambling less coherently genes to turn on or of, setting disease patterns in motion. Recently, a study than before. “How much of my life did you spend linked racial discrimination to changes in methylation on genes that afect incarcerated?,” Kiarra asked him. When she was little, schizophrenia, bipolar disorder, and asthma. she would go out hustling with him. “I was 14 fucking years old seeing dead fucking bodies, and you’re talking Several studies also show that experiencing racism might be part of the about where the fuck did this drinking shit come from?” reason black women are about 50 percent more likely than white women to have premature babies and about twice as likely to have low-birth-weight babies. Researchers think the stress they experience might cause the body to go into labor too soon or to mount an immune attack against the fetus. This disparity, too, does not appear to be genetic: Black women from sub- Saharan Africa and the Caribbean are less likely to have preterm births than African American women are, possibly because they’ve spent less time living in America’s racist environment. THE ATLANTIC JULY/AUGUST 2018 81

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS the fall, Kiarra kept her doctor ONE REASON COLLEGE GRADUATES   THROUGHOUT   appointments, and she began LIVE LONGER, RESEARCHERS BELIEVE, working out at the small gym at Penn North, placing a IS THAT EDUCATION ENDOWS picture of Chrissy Lampkin, the curvaceous girlfriend PEOPLE WITH THE SENSE THAT THEY of the rapper Jim Jones, on her treadmill as motivation. CONTROL THEIR OWN DESTINY. ButKiarrastillwasn’t losingmuch weight.Like most one of the few luxuries around. Americans, she got advice from her friends on what Predominantly black neighborhoods tend to become what researchers to eat—but that advice at times proved confusing and contradictory. She tried a boiled-egg diet, which left her call “food swamps,” or areas where fast-food joints outnumber healthier with hunger pangs and a lot of leftover eggsin the fridge. options. (Food deserts, by contrast, simply lack grocery stores.) One study She went seven days without meat but wound up eating in New York found that as the number of African Americans who lived in more starches, which sent her blood sugar soaring. a given area increased, so did the distance to the nearest clothing store, pharmacy, electronics store, oice-supply store. Meanwhile, one type of One bright day in late September, Kiarra returned establishment drew nearer: fast-food restaurants. to Bon Secours to see Ebony Hicks, a behavioral- health consultant who, like Kiarra’s doctor, works That’s not a coincidence. After the riots of the 1960s, the federal govern- through Health Care for the Homeless, a Baltimore ment began promoting the growth of small businesses in minority neigh- nonproit that cares for the very poor. Hicks began by borhoods as a way to ease racial tensions. “What we need is to get private asking Kiarra what her goal was. Kiarra said getting enterprise into the ghetto, and put the people of the ghetto into private enter- down to an even 200 pounds “would be awesome.” prises,” President Richard Nixon said around the time he created the Oice of Her weight remained, stubbornly, about 150 pounds Minority Business Enterprise, in 1969. As Chin Jou, a senior lecturer at the Uni- higher than that. But she stayed optimistic, writing versity of Sydney, describes in her book, Supersizing Urban America, fast-food down Hicks’s aphorisms about needing to be patient companies were some of the most eager entrants into this “ghetto” market. and not expecting immediate results—“Anything over- night usually lasts about a night!”—in a notebook she’d Fast-food restaurants spent the next few decades “rushing into urban mar- brought with her. kets,” as one Detroit News report put it, seeking out these areas’ “untapped labor force” and “concentrated audience.” In the 1990s, the federal govern- Gently, Hicks asked Kiarra what she had eaten ment gave fast-food restaurants inancial incentives to open locations in inner that day. cities, including in Baltimore. The urban expansion made business sense. “The ethnic population is better for us than the general market,” Sidney Felten- “French fries,” Kiarra said. stein, Burger King’s executive vice president of brand strategy, explained to “All you’ve had is french fries?,” Hicks asked. the Miami Herald in 1992. “They tend to have larger families, and that means “Mm-hmm.” larger checks.” (Supermarket chains didn’t share this enthusiasm; in part It was 3:30 in the afternoon. because the widespread use of food stamps causes an uneven low of custom- They walked to a room across the hall, and Kiarra ers throughout the month, they have largely avoided expanding in poor areas.) stepped onto a scale. “I gained two pounds,” she said quickly, “so now Fast-food executives looked for ways to entice black customers. Burger I’m depressed. I eat too much.” King made ads featuring Shaft. KFC redecorated locations in cities like Bal- “We have to work on getting you more regularly timore to cater to stereotypically black tastes, and piped “rap, rhythm and eating throughout the day,” Hicks said. blues, and soul music” into the restaurants, Jou writes. “Employees were Kiarra asked whether “detox tea,” something given new Afrocentric uniforms consisting of kente cloth dashikis.” A study she’d heard about from a friend, was healthy. from 2005 found that TV programs aimed at African Americans feature “You can detox with lots of iber-illed vegetables,” more fast-food advertisements than other shows do, as well as more com- Hicks said. mercials for soda and candy. Black children today see twice as many soda “What’s that?,” Kiarra asked. and candy ads as white children do. Hicks pulled up a web page describing fruits and veg- etables that contain iber. She listed them of one by one. Would Kiarra eat avocados? No. Coconut? Also no. “I do eat berries,” Kiarra said. “Let’s put that down.” Kiarra doesn’t know why she dislikes so many fruits and vegetables. Her grandmother cooked healthy meals, putting turkey in big pots of greens for lavor. She had a rule that you could never leave the table without eating your vegetables. Kiarra would fall asleep at the table. Hicks gamely pressed on. “Peas? You like peas?” “I think I’m going to throw up,” Kiarra said, grimacing. “Chickpeas,” Hicks ofered. “You ever ate hummus?” “What is hummus?” has long been Kiarra’s legal   F R I E D  F O O D    high—cheap, easily acquired, something to brighten the gloomiest day. It is also 82 JULY/AUGUST 2018 THE ATLANTIC

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS Kiarra some- The marketing and franchising onslaught worked, When Kiarra felt especially adrift, she would visit times asks and the diets of low-income people changed dramati- Steve Dixon, Penn North’s director, in his tiny oice at cally. Before the rise of fast food and processed foods, the end of the hall, and ask him for advice on inding her Steve Dixon, many low-income black families grew their own food purpose. He would tell her to pray and meditate. “When the director of and ate lots of grains and beans. In 1965, one study you pray, it’s like you’re talking to God,” Kiarra told me found, poor and middle-income blacks ate healthier— once. “But when you meditate, it’s God talking to you.” Penn North, though often more meager—diets than rich whites for advice did. But over the next few decades, the price of meat, In November, some combination of prayer, medi- on how to junk food, and simple carbohydrates plummeted, tation, and research led Kiarra to enroll in a medical- while the price of vegetables rose. By the mid-’90s, assistant training program. The class added another find her pur- 28 percent of African Americans were considered by $7,000 to her student-loan debt, but Kiarra seemed pose in life. the U.S. Department of Agriculture to have a “poor” to thrive in it, and a few weeks before Christmas, diet, compared with just 16 percent of whites. she was excitedly planning her post–Penn North life. Once she had her medical-assistant certiicate Vocational-TechnicalHighSchool, in hand, she would move to Philadelphia, get a job   AT   C A R V E R       which Kiarra and Freddie Gray at Temple University, and take classes to become a attended at the same time, only about a third of registered nurse. Eventually, she hoped to become students go on to enroll in college—yet another fac- a nursing professor. That future held everything she tor that could be contributing to the area’s low life wanted: helping people, being a leader, making her expectancy, given that college graduates outlive own money, having her own place. high-school dropouts in every racial category. Feeling chipper, she decided to browse the wigs at One reason college graduates live longer, a nearby store, stroking the hairpieces and whisper- researchers believe, is that education endows people ing to the best ones that she would be back for them with the sense that they control their own destiny. on payday. She had a new reason to get dolled up: a Well-educated people seek out more nutritional truck driver, “ine as wine” and with no kids—and, information because they’ve been told they can accordingly, no messy entanglement with another achieve anything—why not perfect health, too? woman. She tried to boss him around, but he told her to mind her own business, and she kind of liked Kiarra, by contrast, wasn’t yet sure what she could that. His birthday was approaching, and she wanted accomplish. She wanted to live up to an image in her to take him someplace fancy. She would wear a black mind of a “ly, crazy, daring, dream-chasing girl,” but dress, and he would wear a black suit. she cycled between getting excited about new possi- bilities and being lattened by setbacks. Sometimes, To help pay for everything, Kiarra decided to reg- she would dream of turning Beautiful Beyond Weight ister as a Lyft driver. All that was required was a $250 into a business—one that would sell T-shirts and caps deposit; she began calling around to diferent rela- with empowering messages for plus-size women. But tives to raise the money. she wasn’t really sure how to do that. Twenty-seventeen, she thought, had been her best year yet. THE ATLANTIC JULY/AUGUST 2018 83

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS a bitter cold settled KIARRA FIGURED THAT IF SHE REALLY   A  F E W  W E E K S  L AT E R ,     through the East WANTED TO HAVE A SUCCESSFUL Coast, and Kiarra’s sunny mood had faded. Things PLUS SIZE CLOTHING BRAND, had ended with the truck driver over some mean SHE’D AT LEAST HAVE TO LIVE LONG Facebook posts and the fact that he’d lied to her ENOUGH TO SEE IT HAPPEN. about not having kids. She was also reconsidering her plans for the future, now thinking that instead Her new status as the child’s guardian meant that her stay at Penn North of setting her sights on Temple, she should focus on could be extended, through some alchemy of program deinitions, for nearly graduating and inding a job—any job—that would another year. Staying on would mean cheap housing for Kiarra and Brook- pay well enough and provide insurance that would lynn, two people who desperately needed it. cover her extensive health-care needs. Her grand- mother said driving for Lyft in Baltimore was too With that settled, Kiarra turned her attention to the six-month process of dangerous. She might not move to Philly after all. hoop-jumping that was required to qualify for the gastric-sleeve surgery. The irst pre-op class was an hour and a half long and took place at a hospital 30 But a new opportunity presented itself. Because minutes from Penn North. Kiarra thought the time commitment seemed of a change in her insurance plan, Kiarra had to excessive; with a smirk, she wondered aloud why the doctors couldn’t just tell switch doctors. Right away, her new doctor asked her and the other patients, “Y’all fat. We gonna cut you up.” her whether she had considered bariatric surgery. Kiarra said she was scared of the complications, such But the doctors needed Kiarra to understand that the surgery was not as digestive problems and infections, but the doctor something to take lightly. To qualify, she would have to get her sleep apnea reassured her that complications are rare. She was and diabetes under control. She would have to keep a food journal, submit to interested in the gastric sleeve, a procedure that behavioral evaluations, write an essay explaining why she no longer wanted would dramatically reduce the size of her stomach, to be morbidly obese. For the rest of her life, she’d need to wait 30 minutes causing hormonal changes that would help her lose between eating a meal and drinking a beverage. When one of Kiarra’s class- much of her body fat. mates said that after the surgery, eating too much would cause you to get violently sick for an hour, Kiarra recoiled a little. Kiarra still felt conlicted about losing her identity as an overweight woman. She couldn’t relate to the All of the rules and obligations seemed more intense than Kiarra had people on the Overeaters Anonymous calls who said expected. “Six months, you’re going on like 16 appointments,” she said. they hated their bodies. She liked hers. “People say, “Whoo, that’s a lot.” Given all she had to contend with, I wondered whether she ‘Hey, you’re fat,’ ” she said. “And I’m like, ‘That’s obvi- would end up meeting the requirements—and, given the stakes, what might ous.’ ” But she was motivated by her diabetes—which happen to her if she didn’t. was already causing her vision to blur and her feet to tingle—along with the looming threat of other “fat Tony Conn, a Penn North stafer with whom Kiarra is close, calls her a diseases,” as she called them, frightening ones like “wonderful, brilliant person.” Early on in my reporting, he told me her biggest heart failure. She igured that if she really wanted to law is that she sometimes doesn’t see things through to the end. “As soon as have a successful plus-size clothing brand, she’d at [something] looks like it’s gonna come to light, she’s like, ‘Okay, I did that. So least have to live long enough to see it happen. let’s ind something else,’ ” he said. She decided on the spot to go forward with the sur- But lately, Kiarra had shown a new sense of calm and dedication. One day gery, worried that she might change her mind other- while she worked the front desk, an older man lirted with her as he signed wise. She signed up for the mandatory pre-op classes the attendance sheet. that prepare participants to eat just half a cup of food for every meal, at least initially, after the surgery. “When you look in the mirror,” he said, “and see how beautiful you are, what Her mother was nervous, but her sisters were all for do you say to yourself?” it. Her grandmother told her to put it in God’s hands. “We’ve come a long way,” she said quietly. “Let’s stay there.” Kiarra had orga-   E A R L I E R  T H AT  M O N T H ,   nized a birthday Olga Khazan is a staf writer at The Atlantic. party for her 2-year-old niece, Brooklynn, in Penn North’s community room, decking out the dingy yellow walls with pink balloons and ribbons. Within a few weeks, it was decided that Kiarra would gain custody of Brooklynn for a while so that Kiarra’s sis- ter could go back to get her high-school diploma. Kiarra was happy with this arrangement—she already sometimes referred to Brooklynn as her “daughter-girl”—and she began to see Brooklynn as a reason to stay on track. Juggling coursework and single parenthood exhausted her at times, but she wanted to be the successful role model for Brooklynn that she never had herself. In the chatty toddler who loved dress-up and Moana, Kiarra had found, if not her purpose, at least a purpose. “It feels like the Earth is full, you know?” she told me one day this spring. 84 JULY/AUGUST 2018 THE ATLANTIC

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РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS SPONSOR CONTENT – MARCH ON WASHINGTON FILM FESTIVAL Witnessing From the 1947 Partition of India History to the 1963 March on Washington By Riddhi Sarkar W hen Cassandra Joseph was growing up, her Listening to Joseph, I could not help thinking about some family never spoke about the fact that her an- similarities between her story and that of my own grand- cestors had been slaves or that the family was mother Priti Basu. living in a segregated America. In her home, there was com- plete silence on the topics of slavery and the systemic When my grandmother was four years old, her family fled its oppression faced by African Americans for generations. hometown of Bandar, in the Chittagong region that is now part of Bangladesh, to Kolkata, India, to escape riots and re- But by the time Joseph got word that Dr. Martin Luther King ligious and political tension after India’s independence from Jr. was coming to her hometown in 1963, she was 21 years Great Britain, in 1947. Their first six months were spent at a old and had come to understand the truth about her family government refugee camp, after which the family settled history. She knew she had to drop everything and go. down in the outskirts of Kolkata. Although it proved dif- ficult to start a new life from scratch, her family was lucky As soon as she started recounting to me what happened that they were able to have made it safely across the border. in Washington, D.C., on August 28 of that year—which she Her uncle crossed the border in 1947 on a train on which he recalled was a bright and sunny day—the hint of excitement and one other passenger were the lone survivors after all in her voice was unmistakable. She told me how glad she the Hindus aboard were murdered. My grandmother told was that she decided to leave work that day to participate in me that he had been able to escape by hiding in the bath- the now famous March on Washington for Jobs and Free- room of the train. dom. She recalled Mary Travers from the American folk group Peter, Paul, and Mary accidentally stepping on her When the Indian subcontinent was broken apart during foot just before the trio’s onstage performance; the crowd the 1947 partition of India, it marked an upheaval across singing “We Shall Overcome” in unison; seeing small chil- the region, with many families having to leave their homes dren in strollers and on the backs of their parents. overnight as new borders were hastily drawn along religious lines. India was finally free from British rule, but the event The memories of the day are forever etched in her mind, led to one of the largest mass migrations in history and left as they are for many of the ordinary people who sacrificed a scar on the lives of many. Yet there was a silence around careers, families, and even their personal safety to make personal aspects of the topic in affected families for years up the massive effort that is now often reduced to a few afterward. Like Joseph’s family, my grandmother’s house- speeches by a few famous people. Highlighting the con- hold never discussed their family history at home. Even my tributions of ordinary citizens—the students who risked mother knew little about her mother’s migration experience being kicked out of school to demonstrate on campus, the while she was growing up. My grandmother only opened up canvassers who wore the soles of their shoes thin while to me when I implored her to tell me more. trying to register voters—was the goal of the 2017 March on Washington Film Festival, which every year strives to tell My grandmother, despite being one of the smartest students the stories of the untold events and unsung heroes of the at her school, had to give up her education and abandon civil-rights era. her dreams of becoming a doctor because her family had

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS SPONSOR CONTENT – MARCH ON WASHINGTON FILM FESTIVAL very little after they migrated as refugees. Taking care of the There must be a reason my grandmother never spoke home and getting her married became bigger priorities much about her history until her own granddaughter for her family than paying for her education, thus cutting was 18—and why Joseph’s family also remained silent short her career aspirations. I also learned about the strug- about its own. A deeply rooted pain caused by history gles her parents faced in keeping her and her siblings safe that I can only imagine sometimes stops us from having a among the violence caused by the partition of India. In the conversation about it. But events like the March on Wash- days prior to the family’s migration, her mother would stay ington Film Festival are powerful agents in sparking intel- awake holding her every night, waiting for daylight at a lectual and moral curiosity. In rekindling conversation about Muslim neighbor’s home since their own was at risk of be- the civil-rights movement and the sacrifices people made ing burned down—just like many other Hindu homes in the during those seminal events in our nation’s history, we neighborhood—in the religiously mo- create a space for dialogue that is tivated riots. To know that even in the crucial to understanding where we midst of the tension between Hindus No matter how painful are today and to shaping our future and Muslims there were individuals as a fair and just society. These con- who looked beyond religion to help it is to talk about the past, versations can start right at home, those in need gives me hope about if we remain silent and simply by questioning where we creating a more peaceful world by come from. No matter how painful it fighting the tension that still exists do not dig deep, the voices is to talk about the past, if we remain among religions. If tolerance, love, of our ancestors will silent and do not dig deep, the voices compassion, and open-mindedness be forever lost. of our ancestors will be forever lost, could transcend religious dogmas and with them a chance to create then, they certainly can now. and chronicle an accurate represen- While speaking with my grandmother, tation of history. I learned that her father had put his medical career second While it is essential to pay tribute to the work of prominent and activism first, often joining local activists in protesting leaders who advanced civil rights, we must never stop the nearly 200 years of British colonization of India. Inciden- seeking more witnesses of history and voices of unsung tally, it is that fight for independence—particularly Mahatma heroes—people who were less famous than King or Gand- Gandhi’s civil-disobedience strategy used to free India from hi but who did their part in our societal march to equality the shackles of British imperialism—that inspired Martin for all. If we do not recognize the contributions of Cassandra Luther King Jr. to use that very tactic in the American civil- Joseph, of my grandmother Priti Basu and her parents, we rights movement years later. are ignoring the fullness of history and thereby the op- M y grandmother told me all of this during the summer portunity to learn from the work not just of icons but of after my 18th birthday. After my grandparents were everyday people like you and me. married and started a family, they made numerous sacrifices I do not need expensive tripods or fancy recording equip- to ensure that their children would have more opportunities ment to preserve an important story; a genuine curiosity to than they had. As I sat across the table from my grandmother learn and ask critical questions is a great first step. Anyone in Kolkata two years ago, just as I was preparing to take off to can be a storyteller, and that is a gift we can give to honor attend American University, in Washington, D.C., I made sure the legacy of the past and, in the process, contribute to a this story of her sacrifices—the story of my family—would be better future. properly preserved. I turned on my iPhone’s video recorder one evening before leaving, trying my best to balance the phone on a stack of old newspapers and books. Then, with pen and paper in hand and a determination to ask long-bur- Riddhi Sarkar is a student at American ied questions that would help me get to the bottom of my University. Her essay, “Witnessing family’s migration story, I dived right into interviewing her. History,” was a winner of the Freedom’s Seeing how grateful my grandmother was to have her story Children Student Journalists shared was an unforgettable moment. By logging her story Competition for the 2017 March on and those of other witnesses, in my role as a citizen historian Washington Film Festival. for the 1947 Partition Archive, I am part of a movement that adds to the body of knowledge on the partition of India by gleaning witness accounts.

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS After a dark history in which transgender kids were routinely ignored, “repaired,” or persecuted, a new protocol of social and physical transition has emerged. For teens who experience persistent gender dysphoria, this protocol can provide profound relief from su ering. For some kids, however, gender dysphoria is temporary. And the e ects of transitioning can be permanent. BY JESSE SINGAL PHOTOGRAPHS BY MACIEK JASIK 88 JULY/AUGUST 2018 THE ATLANTIC

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS | THE HEALTH REPORT | YOUR CHILD SAYS SHE’S TR ANS. SHE WANTS HORMONES AND SURGERY. SHE’S 13.

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS L A I R E I S A 14 -Y E A R- O L D G I R L with short To Claire’s parents, her anguish seemed to come auburn hair and a broad smile. She lives outside Phila- out of nowhere. Her childhood had been free of gen- delphia with her mother and father, both professional der dysphoria—the clinical term for experiencing a scientists. Claire can come across as an introvert, but powerful sense of disconnection from your assigned she quickly opens up, and what seemed like shyness sex. They were concerned that what their daughter reveals itself to be quiet self-assuredness. Like many had self-diagnosed as dysphoria was simply the tra- kids her age, she is a bit overscheduled. During the vails of puberty. course of the evening I spent with Claire and her mother, Heather—these aren’t their real names— As Claire passed into her teen years, she continued theater, guitar, and track tryouts all came up. We to struggle with mental-health problems. Her parents also discussed the fact that, until recently, she wasn’t found her a therapist, and while that therapist worked certain she was a girl. on Claire’s depression and anxiety—she was waking up several times a night to make sure her alarm clock Sixth grade had been diicult for her. She’d strug- was set correctly—she didn’t feel qualiied to help her gled to make friends and experienced both anxiety patient with gender dysphoria. The therapist referred and depression. “I didn’t have any self-conidence the family to some nearby gender-identity clinics that at all,” she told me. “I thought there was something ofered transition services for young people. wrong with me.” Claire, who was 12 at the time, also felt uncomfortable in her body in a way she couldn’t Claire’s parents were wary of starting that process. quite describe. She acknowledged that part of it had Heather, who has a doctorate in pharmacology, had to do with puberty, but she felt it was more than the begun researching youth gender dysphoria for herself. usual preteen woes. “At irst, I started eating less,” She hoped to better understand why Claire was feel- she said, “but that didn’t really help.” ing this way and what she and Mike could do to help. Heather concluded that Claire met the clinical crite- Around this time, Claire started watching YouTube ria for gender dysphoria in the DSM-5, the American videos made by transgender young people. She was Psychiatric Association’s diagnostic manual. Among particularly fascinated by MilesChronicles, the chan- other indications, her daughter clearly didn’t feel like nel of Miles McKenna, a charismatic 22-year-old. His a girl, clearly wanted a boy’s body, and was deeply 1 million subscribers have followed along as he came distressed by these feelings. But Heather questioned out as a trans boy, went on testosterone, got a double whether these criteria, or much of the information mastectomy, and transformed into a happy, healthy she found online, told the whole story. “Psychologists young man. Claire had discovered the videos by acci- know that adolescence is fraught with uncertainty dent, or rather by algorithm: They’d showed up in her and identity searching, and this isn’t even acknowl- “recommended” stream. They gave a name to Claire’s edged,” she told me. discomfort. She began to wonder whether she was transgender, meaning her internal gender identity Heather said most of the resources she found for didn’t match the sex she had been assigned at birth. parents of a gender-dysphoric child told her that if “Maybe the reason I’m uncomfortable with my body is I’m her daughter said she was trans, she was trans. If supposed to be a guy,” she thought at the time. her daughter said she needed hormones, Heather’s responsibility was to help her get on hormones. The Claire found in MilesChronicles and similar You- most important thing she could do was airm her Tube videos a clear solution to her unhappiness. “I daughter, which Heather and Mike interpreted as just wanted to stop feeling bad, so I was like, I should meaning they should agree with her declarations that just transition,” she said. In Claire’s case, the irst step she was transgender. Even if they weren’t so certain. would be gaining access to drugs that would halt puberty; next, she would start taking testosterone to A S HEATHER WAS SEARCHING for develop male secondary sex characteristics. “I thought answers, Claire’s belief that she should that that was what made you feel better,” she told me. transition was growing stronger. For months, she had been insistent that she wanted both In Claire’s mind, the plan was concrete, though testosterone and “top surgery”—a double mastec- neither Heather nor her husband, Mike, knew about tomy. She repeatedly asked her parents to ind her any of it. Claire initially kept her feelings from her doctors who could get her started on a path to physi- parents, researching steps she could take toward cal transition. Heather and Mike bought time by transitioning that wouldn’t require medical inter- telling her they were looking but hadn’t been able to ventions, or her parents’ approval. She looked into ind anyone yet. “We also took her kayaking, played ways to make her voice sound deeper and into bind- more board games with her and watched more TV ers to hide her breasts. But one day in August 2016, with her, and took other short family trips,” Heather Mike asked her why she’d seemed so sad lately. She recalled. “We also took away her ability to search explained to him that she thought she was a boy. online but gave her Instagram as a consolation.” They told her they realized that she was in pain, but This began what Heather recalls as a complicated they also felt, based on what they’d learned in their time in her and her husband’s relationship with their research, that it was possible her feelings about her daughter. They told Claire that they loved and sup- gender would change over time. They asked her to ported her; they thanked her for telling them what start keeping a journal, hoping it would help her she was feeling. But they stopped short of encourag- explore those feelings. ing her to transition. “We let her completely explore this on her own,” Heather told me. 90 JULY/AUGUST 2018 THE ATLANTIC

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS Claire humored her parents, even as her frustration But when it comes to the question of physical inter- with them mounted. Eventually, though, something shifted. In a journal entry Claire wrote last November, ventions, this era has also brought fraught new chal- she traced her realization that she wasn’t a boy to one key moment. Looking in the mirror at a time when she lenges to many parents. Where is the line between was trying to present in a very male way—at “my baggy, uncomfortable clothes; my damaged, short hair; and not “feeling like” a girl because society makes it dif- my depressed-looking face”—she found that “it didn’t make me feel any better. I was still miserable, and I icult to be a girl and needing hormones to alleviate still hated myself.” From there, her distress gradually began to lift. “It was kind of sudden when I thought: dysphoria that otherwise won’t go away? How can You know, maybe this isn’t the right answer—maybe it’s something else,” Claire told me. “But it took a while to parents tell? How can they help their children gain actually set in that yes, I was deinitely a girl.” access to the support and medical help they might Claire believes that her feeling that she was a boy stemmed from rigid views of gender roles that she need, while also keeping in mind that adolescence is, had internalized. “I think I really had it set in stone what a guy was supposed to be like and what a girl by deinition, a time of fevered identity exploration? was supposed to be like. I thought that if you didn’t follow the stereotypes of a girl, you were a guy, and if There is no shortage of information available for you didn’t follow the stereotypes of a guy, you were a girl.” She hadn’t seen herself in the other girls in her parents trying to navigate this diicult terrain. If you middle-school class, who were breaking into cliques and growing more gossipy. As she got a bit older, she read the bible of medical and psychiatric care for found girls who shared her interests, and started to feel at home in her body. transgender people—the Standards of Care issued by Heather thinks that if she and Mike had heeded the World Professional Association for Transgender the information they found online, Claire would have started a physical transition and regretted it Health (WPATH)—you’ll find an 11-page section later. These days, Claire is a generally happy teenager whose mental-health issues have improved markedly. called “Assessment and Treatment of Children and She still admires people, like Miles McKenna, who beneited from transitioning. But she’s come to real- Adolescents With Gender Dysphoria.” It states that ize that’s just not who she happens to be. while some teenagers should go on hormones, that T H E N U M B E R O F self-identifying trans people in the United States is on the rise. In decision should be made with deliberation: “Before June 2016, the Williams Institute at the UCLA School of Law estimated that 1.4 million adults in any physical interventions are considered for adoles- the U.S. identify as transgender, a near-doubling of an estimate from about a decade earlier. As of cents, extensive exploration of psychological, family, 2017, according to the institute, about 150,000 teen- agers ages 13 to 17 identiied as trans. The number of and social issues should be undertaken.” The Ameri- young people seeking clinical services appears to be growing as well. A major clinic in the United King- can Psychological Association’s guidelines sound a dom saw a more than 300 percent increase in new referrals over the past three years. In the U.S., where similar note, explaining the youth gender clinics are somewhat newer—40 or so are scattered across the country—solid numbers are beneits of hormones but also harder to come by. Anecdotally, though, clinicians are reporting large upticks in new referrals, and wait- noting that “adolescents can ing lists can stretch to ive months or longer. become intensely focused on The current era of gender-identity awareness has undoubtedly made life easier for many young people their immediate desires.” It How can parents who feel constricted by the sometimes-oppressive goes on: “This intense focus nature of gender expectations. A rich new language has taken root, granting kids who might have felt on immediate needs may cre- get children alone or excluded the words they need to describe ate challenges in assuring that the support their experiences. And the advent of the internet has adolescents are cognitively allowed teenagers, even ones in parts of the country where acceptance of gender nonconformity contin- and emotionally able to make they might need ues to come far too slowly, to ind others like them. life-altering decisions.” while keeping The leading professional in mind that organizations ofer this guid- ance. But some clinicians adolescence is, are moving toward a faster by definition, process. And other resources, a time of identity including those produced by major LGBTQ organizations, exploration? place the emphasis on accep- tance rather than inquiry. The Human Rights Campaign’s “Transgender Children & Youth: Understanding the Basics” web page, for example, encourages parents to seek the guidance of a gender specialist. It also asserts that “being transgender is not a phase, and trying to dismiss it as such can be harmful during a time when your child most needs support and valida- tion.” Similarly, parents who consult the pages tagged “transgender youth” on GLAAD’s site will ind many articles about supporting young people who come out as trans but little about the complicated diagnostic and developmental questions faced by the parents of a gender-exploring child. HRC, GLAAD, and like-minded advocacy groups emphasize the acceptance of trans kids for under- standable reasons: For far too long, parents, as well as clinicians, denied the possibility that trans kids THE ATLANTIC JULY/AUGUST 2018 91

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS and teens even existed, let alone that they should be Claire’s parents, they may be convinced that their child is in pain, but also concerned that physical allowed to transition. Many such organizations are transition is not the solution, at least not for a young person still in the throes of adolescence. primarily concerned with raising awareness and cor- W E A R E S T I L L in the earliest stages of recting still-common misconceptions. understanding how physical transitioning afects dysphoric young people. While the A similar motive seems to animate much of the speciics depend on your child’s age, and can vary from case to case, the transition process for a persis- media coverage of transgender young people. Two tently dysphoric child typically looks something like the following. First, allow your child to transition genres of coverage have emerged. Dating back at socially: to adopt the pronouns and style of dress of their authentic gender, and to change their name if least to the 1993 murder of the Nebraska 21-year-old they wish. As your child approaches adolescence, get them puberty-blocking drugs, because developing Brandon Teena, which inspired a documentary as the secondary sex characteristics of their assigned sex could exacerbate their gender dysphoria. When well as the ilm Boys Don’t Cry, a steady stream of hor- they reach their teen years, help them gain access to the cross-sex hormones that will allow them to ror stories has centered on bullying, physical assault, develop secondary sex characteristics in line with their gender identity. (Until recently, hormones were and suicide—real risks that transgender and gender- typically not prescribed until age 16; it’s now more common for 15- and 14-year-olds, and sometimes nonconforming (TGNC) young people still face. even younger kids, to begin hormone therapy.) More recently, a wave of success stories has In the United States, avoiding puberty became an option only a little more than a decade ago, so appeared. In many of these accounts, kids are lost, researchers have just begun tracking the kids engaged in this process, and we don’t yet have confused, and frustrated right up until the moment comprehensive data about their long-term out- comes. Most of the data we do have involve kids they are allowed to grow their hair out and adopt a who socially transitioned at an early age, but who hadn’t yet physically transitioned. The information new name, at which point they inally become their comes from a University of Washington researcher named Kristina Olson. Olson is the founder of the true self. Take, for example, a Parents.com article TransYouth Project, which is following a cohort of about 300 children for 20 years—the longest such in which a mother, writing longitudinal study based in the U.S. The kids she is tracking appear to be doing well—they don’t seem pseudonymously, explains all that diferent, in terms of their mental health and general happiness, from a control group of cisgender that she struggled with kids (that is, kids who identify with the sex they were assigned at birth). her child’s gender-identity At the prestigious Center of Expertise on Gender For many issues for years, until inally Dysphoria, at Vrije Universiteit University Medical young people turning to a therapist, who, Center, in Amsterdam—often referred to simply in early studies, after a 20-minute evaluation, as “the Dutch clinic”—an older cohort of kids who pronounced the child trans. went through the puberty-blockers-and-cross-sex- hormones protocol was also found to be doing well: transitioning Suddenly, everything clicked “Gender dysphoria had resolved,” according to a appears to into place. The mother writes: study of the group published in 2014 in Pediatrics. “I looked at the child sitting “Psychological functioning had steadily improved, have greatly and well-being was comparable to same-age peers.” between my husband and These early results, while promising, can tell us alleviated their me, the child who was smil- only so much. Olson’s indings come from a group of dysphoria. ing, who appeared so happy, trans kids whose parents are relatively wealthy and who looked as if someone are active in trans-support communities; they volun- teered their children for the study. There are limits to But it’s not finally saw him or her the how much we can extrapolate from the Dutch study the answer way she or he saw him or as well: That group went through a comprehensive for everyone. herself.” In a National Geo- diagnostic process prior to transitioning, which graphic special issue on gen- included continuous access to mental-health care at der, the writer Robin Marantz Henig recounts the story of a mother who let her 4-year-old, assigned male at birth, choose a girl’s name, start using female pronouns, and attend preschool as a girl. “Almost instantly the gloom lifted,” Henig writes. Accounts of successful transitions can help fami- lies envision a happy outcome for a sufering child. And some young people clearly experience some- thing like what these caterpillar-to-butterly narra- tives depict. They have persistent, intense gender dysphoria from a very young age, and transitioning alleviates it. “Some kids don’t waver” in their gender identity, Nate Sharon, a psychiatrist who oversaw a gender clinic in New Mexico for two and a half years, and who is himself trans, told me when we spoke in 2016. “I’m seeing an 11-year-old who at age 2 went up to his mom and said, ‘When am I going to start growing my penis? Where’s my penis?’ At 2.” But these stories tend to elide the complexities of being a TGNC young person, or the parent of one. Some families will ind a series of forking paths, and won’t always know which direction is best. Like 92 JULY/AUGUST 2018 THE ATLANTIC

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РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS a top-tier gender clinic—a process unfortunately not much support so-called airming care, which entails available to every young person who transitions. accepting and exploring a child’s statements about their gender identity in a compassionate manner. But Among the issues yet to be addressed by long- they worry that, in an otherwise laudable efort to get term studies are the efects of medications on young TGNC young people the care they need, some mem- people. As Thomas Steensma, a psychologist and bers of their ield are ignoring the complexity, and researcher at the Dutch clinic and a co-author of luidity, of gender-identity development in young that study, explained to me, data about the potential people. These colleagues are approving teenagers risks of putting young people on puberty blockers for hormone therapy, or even top surgery, without are scarce. He would like to see further research into fully examining their mental health or the social and the possible efects of blockers on bone and brain family inluences that could be shaping their nascent development. (The potential long-term risks of cross- sense of their gender identity. sex hormones aren’t well known, but are likely mod- est, according to Joshua Safer, one of the authors of That’s too narrow a deinition of airming care, in the Endocrine Society’s “Clinical Practice Guideline” the view of many leading clinicians. “Airming care for treatment of gender dysphoria.) does not privilege any one outcome when it comes to gender identity, but instead aims to allow exploration Meanwhile, fundamental questions about gen- of gender without judgment and with a clear under- der dysphoria remain unanswered. Researchers still standing of the risks, beneits, and alternatives to any don’t know what causes it—gender identity is gen- choice along the way,” Aron Janssen, the clinical direc- erally viewed as a complicated weave of biological, tor of the Gender and Sexuality Service at Hassenfeld psychological, and sociocultural factors. In some Children’s Hospital, in New York, told me. “Many peo- cases, gender dysphoria may interact with mental- ple misinterpret airming care as proceeding to social health conditions such as depression and anxiety, but and medical transition in all cases without delay, but there’s little agreement about how or why. Trauma, the reality is much more complex.” particularly sexual trauma, can contribute to or exacerbate dysphoria in some patients, but again, no To make sense of this complex reality—and one yet knows exactly why. ensure the best outcome for all gender-exploring kids—parents need accurate, nuanced information To reiterate: For many of the young people in the about what gender dysphoria is and about the many early studies, transitioning—socially for children, blank spots in our current knowledge. They don’t physically for adolescents and young adults—appears always get it. to have greatly alleviated their dysphoria. But it’s not the answer for everyone. Some kids are dysphoric F OR GENDER-DYSPHORIC PEOPLE, physi- from a very young age, but in time become com- cal transition can be life enhancing, even fortable with their body. Some develop dysphoria lifesaving. While representative long-term around the same time they enter puberty, but their data on the well-being of trans adults have yet to sufering is temporary. Others end up identifying as emerge, the evidence that does exist—as well as the nonbinary—that is, neither male nor female. sheer heft of personal accounts from trans people and from the clinicians who help them transition—is Ignoring the diversity of these experiences and overwhelming. For many if not most unwaveringly focusing only on those who were efectively “born gender-dysphoric people, hormones work. Surgery in the wrong body” could cause harm. That is the works. That’s relected in studies that consistently argument of a small but vocal group of men and show low regret rates for the least-reversible physi- women who have transitioned, only to return to their cal procedures to address gender dysphoria. One assigned sex. Many of these so-called detransitioners 2012 review of past studies, for example, found that argue that their dysphoria was caused not by a deep- sex-reassignment surgery “is an efective treatment seated mismatch between their gender identity and for [gender dysphoria] and the only treatment that their body but rather by mental-health problems, has been evaluated empirically with large clinical trauma, societal misogyny, or some combination of case series.” A study on “bottom surgery,” or surgery these and other factors. They say they were nudged designed to construct a penis or vagina, found that toward the physical interventions of hormones or sur- from 1972 to 2015, “only 0.6 percent of transwomen gery by peer pressure or by clinicians who overlooked and 0.3 percent of transmen who underwent [these other potential explanations for their distress. procedures] were identiied as experiencing regret.” Some of these interventions are irreversible. Peo- Those of us who have never sufered from gender ple respond diferently to cross-sex hormones, but dysphoria can have a hard time appreciating what’s changes in vocal pitch, body hair, and other physical at stake. Rebecca Kling, an educator at the National characteristics, such as the development of breast tis- Center for Transgender Equality, in Washington, D.C., sue, can become permanent. Kids who go on puberty told me that before she transitioned she felt as if she blockers and then on cross-sex hormones may not were constantly carrying around a backpack full of be able to have biological children. Surgical inter- rocks. “That is going to make everything in my life ventions can sometimes be reversed with further harder, and in many cases is going to make things surgeries, but often with disappointing results. impossible,” she said. “Of course being able to remove that heavy burden has added comfort and stability in The concerns of the detransitioners are echoed by a number of clinicians who work in this ield, most of whom are psychologists and psychiatrists. They very 94 JULY/AUGUST 2018 THE ATLANTIC

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РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS Max Robinson my sense of myself and my body.” Other went on cross-sex trans people have ofered similar descrip- tions of gender dysphoria—a weight, a hormones when buzzing, an unavoidable source of rumi- she was 16 and nation and worry. Hormones and surgery had a double grant transgender people profound relief. mastectomy Historically, they have been denied when she was 17. access to that relief. Christine Jorgensen, Now 22, she has the first American to become widely known for transitioning through hor- detransitioned mones and surgery, in the 1950s, had to go and identifies to Denmark for her care. The trans histo- as a woman. rian Genny Beemyn notes that Jorgensen’s doctor “received more than 1,100 letters from transsexual people, many of whom “informed consent” protocols, built on the philoso- sought to be his patients,” in the months phy that trans adults, once informed of the potential after Jorgensen was treated. As a result beneits and risks of medical procedures, have a right of the requests, “the Danish government to make their own decisions about their body and banned such procedures for non-citizens. shouldn’t have their need for services questioned by In the United States, many physicians sim- mental-health and medical professionals. ply dismissed the rapidly growing number of individuals seeking gender-affirming This shift is seen by many trans people and advo- surgeries as being mentally ill.” cates as an important course correction after decades of gatekeeping—aloof professionals telling trans peo- Today, the situation in the U.S. has ple they couldn’t get hormones or surgery, because improved, but the lack of access to tran- they weren’t really trans, or hadn’t been living as a sition services continues to be a problem. trans person long enough, or were too mentally ill. Whether trans people in this country can access treatments such as hormones and F OR GENDER-QUESTIONING CHILDREN surgery depends on a variety of factors, and teens, the landscape is diferent. A minor’s ranging from where they live to what legal guardian almost always has to provide their health insurance will cover (if they consent prior to a medical procedure, whether it’s have any) to their ability to navigate piles a tonsillectomy or top surgery. WPATH and other of paperwork. Erica Anderson, a trans organizations that provide guidance for transitioning woman and clinical psychologist who young people call for thorough assessments of patients works at the Child and Adolescent Gen- before they start taking blockers or hormones. der Center, at UC San Francisco’s Beniof Children’s Hospital, had no luck when This caution comes from the concerns inherent she tried to get hormones from an endocrinologist in in working with young people. Adolescents change Philadelphia just a decade ago. “Even I, with my edu- signiicantly and rapidly; they may view themselves cation and resources, was denied care and access,” and their place in the world differently at 15 than she told me. “The endocrinologist simply said, ‘I don’t do that.’ I ofered to provide her the guidelines from her own Endocrine Society,” Anderson said. “She refused and wouldn’t even look me in the eye. No referral or ofer to help. She sent me away with nothing, feeling like I was an undesirable.” Many trans people have stories like Anderson’s. For this reason, among others, trans communities can be skeptical of those who focus on negative tran- sition outcomes. They have long dealt with “profes- sionals who seem uncomfortable giving trans people the go-ahead to transition at all,” Zinnia Jones, a trans woman who runs the website GenderAnalysis, told me in an email. They have also faced “unneces- sarily protracted timelines for accessing care, a lack of understanding or excess skepticism of our identities from clinicians, and so on.” Groups like WPATH, the primary organization for psychologists, psychiatrists, endocrinologists, surgeons, and others who work with TGNC clients, have attempted to reverse this neglect in recent years. A growing number of adult gender clinics follow 96 JULY/AUGUST 2018 THE ATLANTIC PHOTOGRAPH BY CHLOE AFTEL

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS they did at 12. “You’ve got the onset of acknowledging that feelings of gender dysphoria can puberty right around the age where they be exacerbated by mental-health diiculties, trauma, develop the concept of abstract thinking,” or a combination of the two? said Nate Sharon, the New Mexico psychi- atrist. “So they may start to conceptualize Clinicians are still wrestling with how to define gender concepts in a much richer, broader airming care, and how to balance airmation and manner than previously—and then maybe caution when treating adolescents. “I don’t want to puberty blockers or cross-sex hormones be a gatekeeper,” Dianne Berg, a co-director of the aren’t for them.” That was true for Claire: National Center for Gender Spectrum Health, at the A shift in her understanding of the nature University of Minnesota, told me. “But I also worry that of gender led her to realize that transition- in opening the gates, we’re going to have more adoles- ing was not the answer for her. cents that don’t engage in the relective work needed in order to make sound decisions, and there might For younger children, gender identity end up being more people when they are older that is an even trickier concept. In one experi- are like, Oh, hmm—now I am not sure about this.” ment, for example, many 3-to-5-year-olds thought that if a boy put on a dress, he W HEN MAX ROBINSON was 17, getting a became a girl. Gender clinicians some- double mastectomy made perfect sense to times encounter young children who her. In fact, it felt like her only option—like believe they are, or want to be, another gender because of their dress or play a miraculous, lifesaving proce- preferences—I like rough-and-tumble play, so I must be a boy—but who don’t meet the dure. Though she had a wom- criteria for gender dysphoria. an’s body, she was really a man. In the past, therapists and doctors interpreted the fluidity of gender iden- Surgery would inally ofer her tity among children as license to put gender-bending kids into the “right” box a chance to be herself. Affirming care by encouraging—or forcing—them to I met Max, now 22, in an is far more play with the “right” toys and dress in the “right” clothes. Until about ive years airy café in the quiet southern- ago, according to one clinician’s estimate, social transition was often frowned upon. Oregon town where she lives. humane For decades, trans-ness was sometimes She was wearing a T-shirt than older tolerated in adults as a last-ditch out- with a flannel button-down come, but in young people it was more philosophies. often seen as something to be drummed over it. On her head, a gray out rather than explored or accepted. So- called reparative therapy has harmed and humiliated winter cap; at her feet, a But it conflicts, trans and gender-nonconforming children. In her shaggy white service dog. By at least a little, book Gender Born, Gender Made, Diane Ehrensaft, the the time we met, we’d spoken director of mental health at UC San Francisco’s Child and Adolescent Gender Center, writes that victims of on the phone and exchanged a with what we these practices “become listless or agitated, long for number of emails, and she had know about their taken-away favorite toys and clothes, and even told me her story—one that gender-identity literally go into hiding in closets to continue play- suggests the complexity of ing with the verboten toys or wearing the forbidden clothes.” Such therapy is now viewed as unethical. gender-identity development. fluidity in These days, mainstream youth-gender clinicians Max recalled that as early young people. practice airming care instead. They listen to their young patients, take their statements about their gen- as age 5, she didn’t enjoy being der seriously, and often help facilitate social and physi- cal transition. Airming care has quickly become a treated like a girl. “I ques- professional imperative: Don’t question who your cli- ents are—let them tell you who they are, and accept tioned my teachers about why their identity in a nurturing, encouraging manner. The airming approach is far more humane than I had to make an angel instead older ones, but it conlicts, at least a little, with what we know about gender-identity fluidity in young of a Santa for a Christmas craft, people. What does it mean to be affirming while acknowledging that kids and teenagers can have or why the girls’ bathroom pass had ribbons instead an understanding of gender that changes over a short span? What does it mean to be airming while of soccer balls, when I played soccer and knew lots of other girls in our class who loved soccer,” she said. She grew up a happy tomboy—until puberty. “People expect you to grow out of it” at that age, she explained, “and people start getting uncomfortable when you don’t.” Worse, “the way people treated me started getting increasingly sexualized.” She remem- bered one boy who, when she was 12, kept asking her to pick up his pencil so he could look down her shirt. “I started dissociating from my body a lot more when I started going through puberty,” Max said. Her discomfort grew more internalized—less a frustration with how the world treated women and more a sense that the problem lay in her own body. She came to believe that being a woman was “something I had to control and ix.” She had tried various ways of making her discomfort abate—in seventh grade, she vacillated between “dressing like a 12-year-old boy” and wearing THE ATLANTIC JULY/AUGUST 2018 97

РЕЛИЗ ПОДГОТОВИЛА ГРУППА \"What's News\" VK.COM/WSNWS revealing, low-cut outits, attempts to defy and accede be performed only on adults who have been living in their gender role for at least one year.) Max went to the demands the world was making of her body. But into the surgery optimistic. “I was convinced it would solve a lot of my problems,” she said, “and I hadn’t nothing could banish her feeling that womanhood accurately named a lot of those problems yet.” wasn’t for her. She had more bad experiences with Max was initially happy with the results of her physical transformation. Before surgery, she wasn’t men, too: When she was 13, she had sex with an older able to fully pass as male. After surgery, between her newly masculinized chest and the facial hair she was man she was seeing; at the time, it felt consensual, but able to grow thanks to the hormones, she felt like she had left behind the sex she had been assigned at birth. she has since realized that a 13-year-old can’t consent “It felt like an accomplishment to be seen the way I wanted to be seen,” she told me. to sex with an 18-year-old. At 14, she witnessed a But that feeling didn’t last. After her surgery, Max friend get molested by an adult man at a church slum- moved from her native California to Portland and threw herself into the trans scene there. It wasn’t a ber party. Around this time, Max was diagnosed with happy home. The clarity of identity she was seeking— and that she’d felt, temporarily, after starting hor- depression and generalized anxiety disorder. mones and undergoing surgery—never fully set in. Her discomfort didn’t go away. In ninth grade, Max irst encountered the concept Today, Max identiies as a woman. She believes of being transgender when she watched an episode that she misinterpreted her sexual orientation, as well as the efects of the misogyny and trauma she of The Tyra Banks Show in which Buck Angel, a trans had experienced as a young person, as being about gender identity. Because of the hormone therapy, porn star, talked about his transition. It opened up a she still has facial hair and is frequently mistaken for male as a result, but she has learned to live with this: new world of online gender-identity exploration. She “My sense of self isn’t entirely dependent on how other people see me.” gradually decided that she needed to transition. M AX IS ONE of what appears to be a growing Max’s parents were skeptical at irst but eventually number of people who believe they were failed by the therapists and physicians they came around, signing her up for sessions with a thera- went to for help with their gender dysphoria. While their individual stories difer, they tend to touch on pist who specialized in gender-identity issues. She similar themes. Most began transitioning during ado- lescence or early adulthood. Many were on hormones recalled that the specialist was very open to putting for extended periods of time, causing permanent changes to their voice, appearance, or both. Some, her on a track toward transition, though he suggested like Max, also had surgery. that her discomfort could have other sources as well. Many detransitioners feel that during the process leading up to their transition, well-meaning clini- Max, however, was certain cians left unexplored their overlapping mental-health troubles or past traumas. Though Max’s therapist that transitioning was the had tried to work on other issues with her, Max now believes she was encouraged to rush into physical answer. She told me that she transition by clinicians operating within a framework that saw it as the only way someone like her could “I’m a real-live “refused to talk about anything experience relief. Despite the fact that she was a other than transition.” minor for much of the process, she says, her doctors more or less did as she told them. 22-year-old When Max was 16, her woman with a therapist wrote her a referral Over the past couple of years, the detransitioner scarred chest and to see an endocrinologist who movement has become more visible. Last fall, Max could help her begin the pro- told her story to The Economist’s magazine of cul- ture and ideas, 1843. Detransitioners who previously a broken voice cess of physical transition by blogged pseudonymously, largely on Tumblr, have and a 5 o’clock prescribing male hormones. begun writing under their real names, as well as The endocrinologist was speaking on camera in YouTube videos. shadow because skeptical, Max said. “I think Cari Stella is the author of a blog called Guide on I couldn’t face what she was seeing was a Raging Stars. Stella, now 24, socially transitioned the idea of lesbian teenager,” not a trans at 15, started hormones at 17, got a double mastec- one. At the time, though, Max tomy at 20, and detransitioned at 22. “I’m a real-live growing up to be interpreted the doctor’s reluc- a woman,” said tance as her “being ignor- Cari Stella, a ant, as her trying to hurt me.” Armed with the referral from detransitioner. her therapist, Max got the endocrinologist to prescribe the treatment she sought. Max started taking tes- tosterone. She experienced some side efects—hot lashes, memory issues—but the hormones also provided real relief. Her plan all along had been to get top surgery, too, and the ini- tially promising efects of the hormones helped per- suade her to continue on this path. When she was 17, Max, who was still dealing with major mental-health issues, was scheduled for surgery. Because Max had parental approval, the surgeon she saw agreed to operate on her despite the fact that she was still a minor. (It’s become more com- mon for surgeons to perform top surgeries on teen- agers as young as 16 if they have parental approval. The medical norms are more conservative when it comes to bottom surgeries; WPATH says they should 98 JULY/AUGUST 2018 THE ATLANTIC