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Military Stress Clinics: Treating Troops At War

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Military Stress Clinics: Treating Troops At War

Health Care

Military Stress Clinics: Treating Troops At War

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NEAL CONAN, host:

This is TALK OF THE NATION. I'm Neal Conan in Washington.

On Monday, an American soldier on his third tour in Iraq allegedly opened fire at a stress clinic on a U.S. base in Baghdad and killed five fellow Americans.

This morning in testimony before Congress, the chairman of the Joint Chiefs of Staff, Admiral Mike Mullen, said the military must do a better job of caring for troops' mental health and spoke about the effects of traumatic brain injury and post-traumatic stress

Admiral MIKE MULLEN (Chairman, Join Chiefs of Staff): I remain deeply troubled by the long-term effects of these signature wounds of modern war and by the stigma that still surrounds them. Last month during a town-hall meeting with soldiers at Fort Hood, Sergeant Nicole Flockman(ph), an OIF veteran, told me they were not getting enough psychological help before and after deployments, and I told her I thought she was right, and we were working hard to meet that need.

She shot back: They're hiding it, sir, referring to the reluctance of soldiers and families to speak openly about mental-health problems. They she added: It's the cause of a lot of suicides, I would imagine, and I would imagine she is right.

CONAN: Admiral Mullen said that Monday's incident appeared to confirm his worries. We've talked before on this program about the mental-health services provided by the military before and after deployment. How do the issues change when soldiers and Marines are still in-country?

If you served, did you or someone you know go to a stress clinic in Iraq or Afghanistan? Are the services adequate? How did sergeants, officers and other troops react? Give us a call, 800-989-8255. Email us, talk@npr.org. You can also join the conversation at our Web site. Go to npr.org. Click on TALK OF THE NATION.

Later in the program, J.J. Abrams joins us to talk about his re-imagination of "Star Trek," but first, former Army Captain Tom Tarantino joins us here in Studio 3A. He served as both a cavalry and mortar platoon leader with the 11th Armored Cavalry Regiment and now works as legislative associate for the Iraq and Afghanistan Veterans of America. Nice to have you on the program today.

Mr. TOM TARANTINO (Iraq and Afghanistan Veterans of America): Hi, Neal, nice to be on.

CONAN: At this point, we can't say why Sergeant Russell may have opened fire on fellow Americans earlier this week. Obviously stress is different for everybody, but I was hoping you could give us some insight. How often did stress become an issue when you commanded platoons?

Mr. TARANTINO: Well, you know, no one comes to war and comes back unchanged. Various amounts of stress are always an issue. It's a very stressful environment. You know, soldiers and sailors and airmen and Marines - you're in an environment where you have to use 100 percent of your senses all the time, 365 days, the entire time you're there.

So it's very stressful. Even just being on a military post is a lot like being on a minimum-security prison. So the environment in itself is stressful. Add the conditions of combat, it creates a mix where stress can push someone, can push someone beyond what they would normally expect to do.

CONAN: Can you give us an example of a circumstance that you were involved with?

Mr. TARANTINO: Well yeah. I actually had a soldier very early on in the deployment, he was one of my best NCOs. He had just joined our unit a few months prior to us deploying, and while we were there, he started making mistakes. He was losing things. He was having some issues with decision-making, and when we realized that this was not who this guy was - fortunately we had been trained a little bit in how to recognize some of these symptoms. So we were able to say hey man, what's going on with you?

We come to find out that a few months prior, he was in Iraq. He was on his second tour in Iraq within six months, and he was having some combat stress issues from his first deployment.

CONAN: And what did you do at that moment?

Mr. TARANTINO: Well, I was a very fortunate that I had a command structure that was supportive and understood these things, and we had enough people that I could take him off the line for a month, and I could get him some help with a combat-stress team. I could, you know, take him out of the rotation on our patrols and let him decompress and work through his issues so he can get back into the fight. Because combat-stress issues are highly treatable if they're caught early, and that's something that the military really hasn't been doing a very good job at training their junior leaders.

We were lucky because I had outstanding NCOs and outstanding superior officers that understood these issues, but the military as a profession doesn't do a very good job of training our junior leaders.

CONAN: In part, we're told, because military culture. This is a time to have a stiff upper life. Suck it up; get on with it.

Mr. TARANTINO: Right, right, and you know, this is - it really involves stigma, combat-stress stigma - and stigma with mental-health-care issues in our country as a whole. Military servicemen and women are asked to do extraordinary things with very little resources. So when faced with a problem that they can't solve by themselves, it's very difficult.

But what it takes is it takes a community. It takes a community of veterans and service-members within the service and outside of the service to come together and say you know what - you have been injured. It's as if you were shot. If you get a gunshot wound, you're not going to just put some tape over it and walk away. You're going to go see a medic. You're going to get the bullet taken out. You're going to get sewn up so you can go fight another day. We have to look at mental-health injuries as we would a wound: you go, you get your treatment, and then you come back into the fight.

CONAN: If you're been in Iraq or Afghanistan, if you served there, well, did you go to a stress clinic? Did someone in your unit? What happened? 800-989-8255. Email is talk@npr.org. And let's begin with Bill, and Bill's calling from Lansing, Michigan.

BILL (Caller): Good afternoon.

CONAN: Afternoon, Bill.

BILL: I just wanted to share with you that a few years ago, I was a company commander in Iraq, and you know, we had to send more than a few of our soldiers to combat stress at the time, and they did an excellent job of taking care of the soldier and equipping the soldier with the proper tools to deal with what they had to deal with on a daily basis, but a big part of that, and I think that was part of your conversation, is that we created a system where people weren't ostracized for going to combat stress.

And in all honesty, I had gone to combat stress myself, and I wasn't afraid to share that with my soldiers, and rather than having that become a weak point for any of us, it became a strength that people were willing to admit that maybe they needed to talk to someone. And I got experience with it, and the experience of my soldiers was a very positive experience.

CONAN: When you went yourself, was this something you noticed about yourself, and you self-reported, or was this somebody else said hey Bill, you've got a problem.

BILL: No, it was something that I had noticed myself. I was having some anxiety problems. You know, it's very, very stressful not only to be there but to get to the point where you're able to deploy and get your soldiers from the states to Kuwait to wherever you're going.

And so I had to deal with that, and I was realizing that this isn't something I could deal with myself, so I sought help, and I have to tell you, the people they put in that place to help you did an excellent job.

CONAN: Bill, thanks very much for the call, appreciate you sharing your story.

BILL: Thank you.

CONAN: Bye-bye. Two of the Army members shot on Monday were mental-health professionals working at the clinic. Joining us now by phone from Ogdensburg, New York, is Bryan Shea, who served three tours of duty in Iraq as a military psychologist and now works at St. Lawrence Psychiatric Center in New York, and it's nice to have you with us today.

Mr. BRYAN SHEA (Psychologist, St. Lawrence Psychiatric Center): Nice to be here.

CONAN: And as somebody who's been there, what is it like to work at a stress clinic in Iraq?

Mr. SHEA: It's a unique professional experience. We provided the full range of mental-health services. Obviously, we focus on combat-related issues but also home-front issues and adjustment to theater. It was a very challenging experience because like other soldiers doing other missions, our mission was around the clock, seven days a week for 365 days, and there's nothing like that professionally.

CONAN: Many people weren't even aware that these clinics existed in Iraq until Monday's incident, when it became really, really obvious. What is a stress clinic? What happens there?

Mr. SHEA: What is a stress clinic?

CONAN: Yeah.

Mr. SHEA: There is… Within the medical area, there's this thing called a Combat Stress Control Company or Detachment. My detachment had about 42 soldiers, and we were divided out into small teams. I was on a three-man team, and then we were sent to an area. We were located on one forward operating base, and then we were responsible for a couple of others. And we had a couple of offices in the bank of the troop medical clinic and made sure everybody in our area knew that we were there.

We did outreach, visiting the different company commanders, first sergeants, platoons, to say hey we're here, trying to make sure they know we exist before we're actually needed. And then we also saw soldiers voluntarily and with command involvement back in our clinic.

CONAN: Command involvement, the soldiers were told to go there or ordered to go there.

Mr. SHEA: Both. Basically I could see a soldier one of three ways: voluntary, where they say hey, I've got an issue, I'm going to seek help; with strong encouragement, which could be their buddies, their family from back home or their command; or there is this thing called the command referral where the commander orders a soldier that, for whatever reason, you need to go see mental health.

CONAN: Tom Tarantino, did that come up in your situation? Did you advise people to go? Did you order people to go?

Mr. TARANTINO: We never had to command refer, at least the one soldiers I was talking about, but we were fortunate that we were able to identify these things. And I think, you know, some of the stuff that's been brought up during this conversation is very important.

The work of the combat-stress teams are really invaluable, there just simply isn't enough of them out there. And it's important that we understand that, as a military profession, it's those junior leaders, those sergeants, those lieutenants, those junior captains, where the rubber meets the road - that's really who's going to catch this stuff first. That's really who's going to see this, and that's really going to be the driving force behind taking the initiative and turning the tide on mental-health injuries.

CONAN: And Bryan Shea, I wanted to ask you. We've talked about the stigma that comes with mental health - not just in the military but maybe especially in the military - was that part of the treatment? Did you talk to soldiers about hey, some people may rag on you about this?

Mr. SHEA: Well, what we tried to do with the outreach is just to be part of the environment so that that reduced the stigma, so it wasn't so much you're going to mental health. It's you're going to see Captain Bass(ph), you're going to see Sergeant Freeland(ph), and that reduced the stigma somewhat.

CONAN: Because there was a face on it.

Mr. SHEA: Because there was a face, there was a person. We knew somebody in the unit before there was a mental-health need, and so that reduced the stigma. Then also just having that relationship with the various commanders where they could see, you know, looking at the mission, if mental health provides a payoff to them for the mission, then that reduces the stigma.

CONAN: We're talking about how the military handles mental health on the battlefield. If you served, did you or someone you know go to a stress clinic in Iraq or Afghanistan? Give us a call, 800-989-8255. Email us, talk@npr.org. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington.

We don't yet know why an American soldier allegedly shot and killed five of his fellow service-members in a U.S. stress clinic in Baghdad; we do know that it focused attention on how the military deals with mental health in-country.

If you served, did you or someone you know go to a stress clinic in Iraq or Afghanistan? Are the services adequate? How did non-coms, officers and other troops react? 800-989-8255 is the phone number, email talk@npr.org. You can also join the conversation on our Web site at npr.org. Just click on TALK OF THE NATION.

Our guests are Tom Tarantino, served as a platoon leader in Iraq, now legislative associate for Iraq and Afghanistan Veterans of America. Also with us, Bryan Shea, a psychologist at St. Lawrence Psychiatric Center in New York. He served three tours of duty in Iraq as a military psychologist, treating soldiers in the field, and let's get Luke(ph) on the line. Luke's calling from South Bend, Indiana.

LUKE (Caller): Hello.

CONAN: Hi, Luke.

LUKE: Hi. Yeah, I served in Iraq for a year, OIF3 is what it was called, third year of combat, and I came back with a brain injury and PTSD, and I was never made aware of stress clinics while we were there. They weren't something that we knew about. They might have been there, but we were never told about them, and really, in the unit I was in, we didn't have time to utilize them.

And I would say a lot of the failures that take place aren't failures of intent but failures of capacity. Just the need is so overwhelming, and just the resources available seem like they're so insignificant comparatively.

CONAN: Tom Tarantino?

Mr. TARANTINO: Yeah, I was actually there during OIF3 myself, and you're absolutely right. The capacity at that time, in 2005, early 2006 time frame, really wasn't there, not like it is now. I think it's been such a great achievement that they've been able to develop these combat-stress teams, that have been able to put more combat-mental-health-care professionals out in the field, but we're still looking at a very deficient population. We really don't have in the military. We don't have enough at the VA. We don't really have enough in this country.

CONAN: Bryan Shea, how did it change between your three tours?

Mr. SHEA: Well, I was in Kuwait for the buildup in '02, and there was three of us for all the U.S. service personnel in Kuwait for the four or five months before the buildup. Then I was in Iraq, '04, '05, and my medical detachment, we had 42 soldiers, and we were responsible for basically the northern third of the country.

CONAN: And that's a lot of American soldiers there.

Mr. SHEA: A lot of American soldiers. I don't recall the total number, but it was roughly the old Northern No-fly Zone, and so we were spread pretty thin. And the Army had just started going with brigade mental health, where they would have one licensed mental-health provider and one assistant for approximately 3,000 soldiers. So we worked hand-in-hand with the brigade mental health, but we were spread fairly thin.

One of the, you know, reoccurring issues we had was hooking up with our soldiers. You know, we would go from one base to another, and the platoon that we needed to see was out on a mission, and they wouldn't come back for four days, but we had to leave in three days. So there was those sorts of issues, but that was one reason why our door was always open, and we were constantly doing the outreach, was to try and catch soldiers whenever possible.

CONAN: Luke, how are you doing now?

LUKE: Well, I'm in what's called TDRO, and it's - I have to say it's probably one of the worst aspects. The Army considers me part of their retirement structure, but the VA does a great deal of my mental-health services, and so I kind of get thrown around, and I've needed to go for a psychological examination to confirm the TBI for three years now, and you know, had a hell of a time getting that scheduled. And I'm supposed to travel to Kentucky every 18 months to do that, and it's just accessible to me, and it's…

CONAN: So capacity is still a problem in this country, too.

LUKE: Yeah, and I have a local congressman, Joe Donnelly, and the people there have been extraordinarily helpful to me and have really gone out of their way to do everything they possibly can to help me. But I think it's really sad that I have to go to a congressman's office, you know, to deal with the Army and the VA occasionally.

CONAN: Luke, thanks and good luck.

LUKE: Thank you.

CONAN: Bye-bye. Here's an email we got from Nicholas(ph), who describes himself as an Iraq vet, 2004. When I was there, mental stress was a dirty word. I remember members of my unit jeering and looking down at a fellow soldier for taking Zoloft for a period in his life. My dark storm took place when I came home. Four years home, and I will never get myself right again. I finally understand what Plato meant when he wrote that only the dead know the end of war. To all those brothers and sisters still there, I salute you and await your return.

CONAN: Bryan Shea, we're going to let you go, but I wonder if you had just a thought about your two colleagues who were killed there earlier this week?

Mr. SHEA: My heart goes out to them and their families, where the decision they made, I can't tell you how many times I made that same decision, and I guess I got lucky.

CONAN: Bryan Shea, thanks very much, appreciate it.

Mr. SHEA: You have a good day now, thank you.

CONAN: Bye-bye. Bryan Shea did three tours of duty in Iraq as a military psychologist, seeing soldiers in the field. He joins us today from the St. Lawrence Psychiatric Center in New York where he now works.

Let's see if we can get another caller on the line. This is Steven(ph) in (Unintelligible) in Oregon.

STEVEN (Caller): Yeah, how are you guys doing?

CONAN: All right.

STEVEN: I'm actually the soldier that Tom Tarantino was talking about. How are you doing, LT?

Mr. TARANTINO: Oh wow. Hey, Steve, how's - wow. How's it going, man?

STEVEN: Oh, it's going pretty good. I just wanted to call in, since I heard you on the radio, and I wanted to say thanks for the great leadership over there. Since I've been back, I've been utilizing a lot of the VA benefits and a couple other local organizations to help me through some of those issues that you were talking about. And I don't know. I just wanted to say thanks for - it looks like you got out, so…

Mr. TARANTINO: Yeah. Well, I mean it was really you and the other guys who pulled me through the whole thing. So I mean, there was a team effort. Give me - jeez. Give me a call, man, or send me an email on IAVA.

STEVEN: All right, I've got you.

CONAN: All right. Steven, obviously you're doing a little bit better now. But tell us a little bit about coming back to the unit. Were you worried that you were going to be stigmatized?

STEVEN: Actually, I went back into the field. LT went on to the mortar platoon, and we got a new lieutenant. Everything was pretty good for a while. They changed our sector, and I ended up receiving fire and getting sent back home anyways.

I know that once I had got - taken the physical wounds, I got a lot more respect out of it as opposed to just somebody who had headaches all the time and was messing up a lot.

CONAN: A lot more respect because people understood that.

STEVEN: It was palpable; it was touchable. You know, people would say, well, why can't you do this? And I would show them the wounds, and they would say oh, okay. Bullets do that.

CONAN: Well Steven, again thanks very much, and I've never served, but I'm a student of military history, and everything I've read suggests that former Captain Tarantino is right. You and the other guys pulled your LT through, so…

(Soundbite of laughter)

STEVEN: I don't know about that, but hey LT, Second Platoon Vipers.

(Soundbite of grunt)

CONAN: Thanks very much Steven (Unintelligible). As you listen to him now, you must wonder how he and all the other guys that you commanded in Iraq are doing.

Mr. TARANTINO: Yeah, you know, it's great to hear his voice, and it's great to hear him sounding good. I'm in touch with a few of my guys, but mostly, you know, we keep intermittent contact through the MySpaces and the Facebooks out there. But you know, once - the transitory existence that you have in the military, you get really close with people, and then you move away, and reconnecting is difficult.

I mean, that's one of the reasons that I have, IAVA, created this Web site called communityofveterans.org. We did this so that Iraq and Afghanistan veterans can connect with each other and recreate their units, recreate their communities and talk about things that you otherwise wouldn't talk about with your family and your friends who weren't in the military.

CONAN: But people might not understand how people you may have known for just a couple of days, but those were incredibly intense days, and you know them in ways…

Mr. TARANTINO: That no one would ever know, right. You spend so much time together, hours in Humvees, in the most intense stress you could possibly imagine. You get to know these men and women more than you'd ever know anyone else in your life, and then a few years later, you might lose touch. It's - I think actually that compounds the problem because, you know, less than one percent of the American population are veterans of Iraq and Afghanistan, and we tend to feel very isolated when we're out there.

CONAN: Let's get Ben(ph) on the line, Ben calling us from Rhode Island.

BEN (Caller): Hi, thanks for taking my call. I just wanted to give a comment. I'm a Marine reservist. I was in Fallujah in 2006, and the level of mental-health care that I've seen from when we came home in 2007 has just really, has seemed to really spike.

You know, we've been getting classes and things like that in our drill weekends, and I hadn't even heard of, you know, mental health clinics in-country when I was over there.

But now, you know, it's just the crazy the amount of education that we're receiving as reservists compared to when I was over there.

CONAN: It's like when you do a big project. By the time it's over, then you know how to do it. It's lessons learned.

Mr. TARANTINO: Right, exactly.

CONAN: Yeah. Ben, are you scheduled to go back?

BEN: I'm currently - I - I have two years left on my contract. I'm currently seeing a therapist and a psychiatrist, so it's a - it's kind of pending. It's up in the air. I'm service-connected, so…

CONAN: Well, we wish you the best of luck.

BEN: All right, thanks so much.

CONAN: Thank you.

Mr. TARANTINO: It's also really important to note that the DOD has gotten much better at this in the last few years. They've set up the Center of Excellence for Mental Health and Brain Injury, is doing outstanding work. The Center for Deployment Psychology out in Bethesda is doing amazing work. I think we're going to see a huge leap ahead in the next few years. One of the things the DOD can do immediately is do mandatory face to face mental health screening for everyone coming back from Iraq or Afghanistan.

We have a health assessment and reassessment process. What we need is a trained mental health care professional sitting across the table from that young man or woman asking them these questions, looking them in the eye and seeing where they are at redeployment 30, 60, 90, 180 days.

CONAN: Back in 2006 in December, an NPR investigation found that officers at Colorado's Fort Carson were punishing soldiers who needed help with mental health issues. Do you think that has changed?

Mr. TARANTINO: I think that's changed as the awareness of mental health injuries has changed. I think a lot of that that's happening is also due to the extreme stress placed on units and leaders with multiple deployments. I mean, if I'm in high op tempo unit or high operational tempo unit, I come back from Iraq or Afghanistan and I know that in 18 months I'm going to be back in country. I have to refit my unit. I have retrain my guys. I have to decompress myself. I have to reset all my equipment.

It makes leadership very challenging when you have a significant number of your force are having issues. And I think a lot of the exasperation that's being felt by a worn out, tired force is manifesting in poor leadership decisions.

CONAN: When you have to submit readiness reports saying I have X number of troops on sick leave, some going for mental services, do your superiors look at that and say that reflects badly on you?

Mr. TARANTINO: I wouldn't say that as a general statement. I'm sure there's a couple people that - that do that. I mean responsible leaders understand that, you know, soldiers are your first, soldiers are absolutely your first line of defense. Soldiers are your first considerations. But there is a point where you have to start making decisions based on your capacity of the mission. And I think that the mental health stigma isn't just among the lower ranks. It goes all the way up. And you see that happening when, you know, you look at a soldier that you have to make a leadership decision about and, you know, a good leader is going to be educated and is going to understand what they're going through and is going to understand that if I can get that soldier better, he's going to be a more effective fighter later on. But the force is so exasperated and so tired, you really are seeing poor leadership decisions being made.

CONAN: We are talking with Tom Tarantino, who served as a junior officer. He commanded cavalry and mortar platoons with the 11th Armored Cavalry Regiment in Iraq. You're listening to TALK OF THE NATION from NPR News. And let's get Raymond on the line. Raymond with us from Waterford in Michigan.

RAYMOND (Caller): Good afternoon. As I told your screener, my name is Raymond. I did two tours in Iraq from '03 to '04 and all of '05 up in Mosul. I had to go see one of those mental health clinics and literally I got the Baghdad cocktail - and what - I mean it helped, but just the looks you get from people going, he's getting help why? Oh, there's - he's just trying to get, you know, whatever.

CONAN: What's the Baghdad cocktail?

RAYMOND: I got a Risperdal and Lamictal as well as some sleep medicine to help me sleep. I was just having really, really bad thoughts towards the enemy. I had had a friend of mine killed and had not gotten over it my first tour. So my second tour I was medicated for about half the time.

CONAN: And that can't make you a very efficient soldier.

RAYMOND: It made me cheerful, but I just lost my mental edge. I just, a little after I got out, a friend of mine got assigned to go back for a third tour. Instead of going he blew his head off. This was a guy that I spent a year with and called a brother. So people outside don't understand this.

CONAN: That goes back to the clip of tape that we played earlier from Admiral Mullen, the chairman of the Joint Chiefs of Staff, confronted by a sergeant who said this is causing people to commit suicide. Not just there but when they come back too. And Raymond, we're sorry to hear - sorry about your loss.

RAYMOND: Thank you.

CONAN: Thanks very much for the call. Let's see if we can go to Katie. Katie is with us from Baton Rouge.

KATIE (Caller): Hey, I noticed the earlier caller seemed to be up from North. And I really congratulate all the soldiers that are brave enough to call in. But I'm a spouse. My husband was in the Louisiana National Guard, still is. Went in, he went to Iraq when the - around the elections in '05, he was there, he was there for 18 months. And they weren't trained for that. You know, we did the hurricane thing down here.

CONAN: Right.

KATIE: He was in two individual IED explosions, treated. They had mandatory just little grief counseling. And not much - there was no services. There wasn't a clinic there, where he was located. And I never really knew where he was. He just told me he was he wasn't - there wasn't anything really available at the time. He was gone every - and you know, right after the accident, four days later he was gone for another 72 hour mission. When he came home it took him about a year, but then he started having really bad suicidal thoughts and along with other soldiers he started going to a VA clinic in New Orleans. And now they've classified him, you know, as not suited for duty. They don't want him to go, you know, the psychiatrist had said that.

But they still have him as a reservist and he's scheduled to go back and the psychiatrist - the VA psychiatrist has told them he cannot go back overseas, and they still have not discharged him.

CONAN: Yeah. Tom quickly.

Mr. TARANTINO: Yeah, on a weird side note, I was actually attached to your husband's brigade in the same sector. My squadron was working briefly for the 256. But this is actually a hole. This is a pretty serious hole in Veterans Affairs where for the first time we have the National Guard and Reserves deploying so much that they come home, they leave active duty, and these mental health injuries don't come on for a few months. They realize their suffering, they go to the VA for health care, and then they get pulled out (unintelligible) and redeployed, because they're not going through the DOD system, they're going through the VA system. And this is something that there's legislation pending to fix that.

CONAN: Katie, thanks for the call. We wish you and your husband the best.

KATIE: Thanks.

CONAN: And Tom Tarantino, thank you for your time.

Mr. TARANTINO: Thank you very much.

CONAN: Coming up, J.J. Abrams will join us to talk about "Star Trek." TALK OF THE NATION, NPR News.

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