Obamacare: Running Out of Doctors?

Burning Question

Is America running out of doctors?

ObamaCare is set to expand the number of insured Americans, but an apparent shortage of doctors could make it difficult to treat them all

Published July 31, 2012, at 7:54 AM

The primary objective of President Obama's overhaul of the health-care system is to extend coverage to the tens of millions of Americans currently without insurance. "But coverage will not necessarily translate into care," because there may not be enough doctors to treat everyone, say Annie Lowrey and Robert Pear at The New York Times. The U.S. is already facing a severe shortage of doctors, particularly in rural areas of the country, and the problem is only expected to get worse as more Americans gain insurance. Here, a guide to America's dearth of doctors:

Why aren't there enough doctors?
The pool of new doctors hasn't kept pace with several factors boosting the number of people seeking care: Population growth, the ObamaCare expansion, and an aging Baby Boomer generation that requires additional medical attention. Enrollment in Medicare, the government-run insurance program for the elderly, is expected to swell to 73.2 million in 2025, up from 50.7 million in 2012. Furthermore, the U.S. is facing an acute shortage of primary-care physicians, leaving many patients without access to general practitioners, pediatricians, family doctors, and other providers of basic medical care.

How will the shortage affect patients?
"A shortage of primary-care and other physicians could mean more-limited access to health care and longer wait times for patients," say Suzanne Sataline and Shirley S. Wang at The Wall Street Journal. The shortage will likely most affect those on Medicaid, the insurance program for the poor and disabled, since Medicaid's rolls are expected to expand significantly under ObamaCare. The shortfall of doctors could reach 100,000 by 2025. (There are currently about 1 million doctors in America.)

Why do so few doctors choose to go into primary care?
The main reason is money. Medical school graduates can expect to make an average of $3.5 million more over the course of their careers if they choose to enter a specialized field, such as anesthesiology or radiology. The difference in pay is enough that primary-care physicians carry a stigma within the medical community of being less talented and intelligent. The trend has huge implications for ObamaCare: "It is no exaggeration to say that the success of the health-care law rests on young doctors choosing to do something that is not in their economic self-interest," says Sarah Kliff at The Washington Post.

What can we do about it?
ObamaCare contains modest provisions increasing Medicaid primary-care payments and incentives for medical students to become primary-care physicians. The number of primary-care residencies climbed 20 percent between 2009 and 2011, but it's still not enough. Communities have been encouraged to create more walk-in clinics, and to allow more nurses to provide primary care. In addition, the U.S. could alter its immigration policies to attract doctors from overseas, "which should be very easy to do since doctors in the U.S. earn on average about twice as much as their comparably trained counterparts in Western Europe and Canada," says Dean Baker at Business Insider.

Sources: Business Insider, The New York Times, The Wall Street Journal, The Washington Post

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Obamacare: Running Out of Doctors Before We Begin

The New York Times

July 28, 2012

DoctorShortage Likely to Worsen With Health Law

By ANNIE LOWREY and ROBERT PEAR

RIVERSIDE, Calif. — In the Inland Empire, an economically depressed region in Southern California, President Obama’s health care law is expected to extend insurance coverage to more than 300,000 people by 2014. But coverage will not necessarily translate into care: Local health experts doubt there will be enough doctors to meet the area’s needs. There are not enough now.

Other places around the country, including the Mississippi Delta, Detroit and suburban Phoenix, face similar problems. The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000.

Health experts, including many who support the law, say there is little that the government or the medical profession will be able to do to close the gap by 2014, when the law begins extending coverage to about 30 million Americans. It typically takes a decade to train a doctor.

“We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists,” said Dr. G. Richard Olds, the dean of the new medical school at the University of California, Riverside, founded in part to address the region’s doctor shortage. “We’ll have a 5,000-physician shortage in 10 years, no matter what anybody does.”

Experts describe a doctor shortage as an “invisible problem.” Patients still get care, but the process is often slow and difficult. In Riverside, it has left residents driving long distances to doctors, languishing on waiting lists, overusing emergency rooms and even forgoing care.

“It results in delayed care and higher levels of acuity,” said Dustin Corcoran, the chief executive of the California Medical Association, which represents 35,000 physicians. People “access the health care system through the emergency department, rather than establishing a relationship with a primary care physician who might keep them from getting sicker.”

In the Inland Empire, encompassing the counties of Riverside and San Bernardino, the shortage of doctors is already severe. The population of Riverside County swelled 42 percent in the 2000s, gaining more than 644,000 people. It has continued to grow despite the collapse of one of the country’s biggest property bubbles and a jobless rate of 11.8 percent in the Riverside-San Bernardino-Ontario metro area.

But the growth in the number of physicians has lagged, in no small part because the area has trouble attracting doctors, who might make more money and prefer living in nearby Orange County or Los Angeles.

A government council has recommended that a given region have 60 to 80 primary care doctors per 100,000 residents, and 85 to 105 specialists. The Inland Empire has about 40 primary care doctors and 70 specialists per 100,000 residents — the worst shortage in California, in both cases.

Moreover, across the country, fewer than half of primary care clinicians were accepting new Medicaid patients as of 2008, making it hard for the poor to find care even when they are eligible for Medicaid. The expansion of Medicaid accounts for more than one-third of the overall growth in coverage in President Obama’s health care law.

Providers say they are bracing for the surge of the newly insured into an already strained system.

Temetry Lindsey, the chief executive of Inland Behavioral & Health Services, which provides medical care to about 12,000 area residents, many of them low income, said she was speeding patient-processing systems, packing doctors’ schedules tighter and seeking to hire more physicians.

“We know we are going to be overrun at some point,” Ms. Lindsey said, estimating that the clinics would see new demand from 10,000 to 25,000 residents by 2014. She added that hiring new doctors had proved a struggle, in part because of the “stigma” of working in this part of California.

Across the country, a factor increasing demand, along with expansion of coverage in the law and simple population growth, is the aging of the baby boom generation. Medicare officials predict that enrollment will surge to 73.2 million in 2025, up 44 percent from 50.7 million this year.

“Older Americans require significantly more health care,” said Dr. Darrell G. Kirch, the president of the Association of American Medical Colleges. “Older individuals are more likely to have multiple chronic conditions, requiring more intensive, coordinated care.”

The pool of doctors has not kept pace, and will not, health experts said. Medical school enrollment is increasing, but not as fast as the population. The number of training positions for medical school graduates is lagging. Younger doctors are on average working fewer hours than their predecessors. And about a third of the country’s doctors are 55 or older, and nearing retirement.

Physician compensation is also an issue. The proportion of medical students choosing to enter primary care has declined in the past 15 years, as average earnings for primary care doctors and specialists, like orthopedic surgeons and radiologists, have diverged. A study by the Medical Group Management Association found that in 2010, primary care doctors made about $200,000 a year. Specialists often made twice as much.

The Obama administration has sought to ease the shortage. The health care law increases Medicaid’s primary care payment rates in 2013 and 2014. It also includes money to train new primary care doctors, reward them for working in underserved communities and strengthen community health centers.

But the provisions within the law are expected to increase the number of primary care doctors by perhaps 3,000 in the coming decade. Communities around the country need about 45,000.

Many health experts in California said that while they welcomed the expansion of coverage, they expected that the state simply would not be ready for the new demand. “It’s going to be necessary to use the resources that we have smarter” in light of the doctor shortages, said Dr. Mark D. Smith, who heads the California HealthCare Foundation, a nonprofit group.

Dr. Smith said building more walk-in clinics, allowing nurses to provide more care and encouraging doctors to work in teams would all be part of the answer. Mr. Corcoran of the California Medical Association also said the state would need to stop cutting Medicaid payment rates; instead, it needed to increase them to make seeing those patients economically feasible for doctors.

More doctors might be part of the answer as well. The U.C. Riverside medical school is hoping to enroll its first students in August 2013, and is planning a number of policies to encourage its graduates to stay in the area and practice primary care.

But Dr. Olds said changing how doctors provided care would be more important than minting new doctors. “I’m only adding 22 new students to this equation,” he said. “That’s not enough to put a dent in a 5,000-doctor shortage.”

Annie Lowrey reported from Riverside, and Robert Pear from Washington.

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Obamacare: Prescription Rationing

It has begun already, but more details will become available more readily in greater numbers as the countdown to a cataclysmic failure begins.

Rationing Begins: States Limiting Drug Prescriptions for Medicaid Patients

By Melanie Hunter

July 30, 2012

(CNSNews.com) – Sixteen states have set a limit on the number of prescription drugs they will cover for Medicaid patients, according to Kaiser Health News.

Seven of those states, according to Kaiser Health News, have enacted or tightened those limits in just the last two years.

Medicaid is a federal program that is carried out in partnership with state governments. It forms an important element of President Barack Obama's health-care plan because under the Patient Protection and Affordable Care Act--AKA Obamcare--a larger number of people will be covered by Medicaid, as the income cap is raised for the program.

With both the expanded Medicaid program and the federal subsidy for health-care premiums that will be available to people earning up to 400 percent of the poverty level, a larger percentage of the population will be wholly or partially dependent on the government for their health care under Obamacare than are now.

In Alabama, Medicaid patients are now limited to one brand-name drug, and HIV and psychiatric drugs are excluded.

Illinois has limited Medicaid patients to just four prescription drugs as a cost-cutting move, and patients who need more than four must get permission from the state.

Speaking on C-SPAN’s Washington Journal on Monday, Phil Galewitz, staff writer for Kaiser Health News, said the move “only hurts a limited number of patients.”

“Drugs make up a fair amount of costs for Medicaid. A lot of states have said a lot of drugs are available in generics where they cost less, so they see this sort of another move to push patients to take generics instead of brand,” Galewitz said.

“It only hurts a limited number of patients, ‘cause obviously it hurts patients who are taking multiple brand name drugs in the case of Alabama, Illinois. Some of the states are putting the limits on all drugs. It’s another place to cut. It doesn’t hurt everybody, but it could hurt some,” he added.

Galewitz said the move also puts doctors and patients in a “difficult position.”

“Some doctors I talked to would work with patients with asthma and diabetes, and sometimes it’s tricky to get the right drugs and the right dosage to figure out how to control some of this disease, and just when they get it right, now the state is telling them that, ‘Hey, you’re not going to get all this coverage. You may have to switch to a generic or find another way,’” he said.

Arkansas, California, Kansas, Kentucky, Louisiana, Maine, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Utah and West Virginia have all placed caps on the number of prescription drugs Medicaid patients can get.

“Some people say it’s a matter of you know states are throwing things up against the wall to see what might work, so states have tried, they’ve also tried formularies where they’ll pick certain brand name drugs over other drugs. So states try a whole lot of different things. They’re trying different ways of paying providers to try to maybe slow the costs down,” Galewitz said.

“So it seems like Medicaid’s sort of been one big experiment over the last number of years for states to try to control costs, and it’s an ongoing battle, and I think drugs is just now one of the … latest issues. And it’s a relatively recent thing, only in the last 10 years have we really seen states put these limits on monthly drugs,” he added.

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Syria and Foreign Policy Experience

The feckless wonder never ceases to amaze me.  Neither do those minions who lap at his feet, spewing mindless diarrhea on any number of subjects.

Syria is a good example of what can go wrong as is Egypt, when the idiots in the White House has absolutely no concept of world affairs and instead runs his administration like a textbook Marxist state - the people decide, governments simply make their lives easier, provide a cushion for their hard landings, and stay out of the way.  When government does intervene, it should do so only when the interests of the workers are affected, and not interests such as security or power.

Egypt is a fucking mess.  The Muslim Brotherhood is desiring of the destruction of the pyramids.  Never before in the history of man, has a group uttered that intent (19th century Ali does not count - England had control and exerted influence.  These men were not hardline Islamists as we know them today.)  Forget their ability to actually do it.  Not relevant.  It is the fact they want to.  They want to destroy the greatest accomplishments of man in the ancient world to fit their version of a religious doctrine.   They have openly threatened Israel, supported assistance to Hamas, fully cognizant of the effect it will have on Israel and Hamas.  The new leadership in Egypt does not care if the economy fails and Egypt returns to the dustbin - it will satisfy their religious doctrine - the Jews caused it, and will simply feed into war rhetoric devised by the leadership.  Did Mubarek have to fall?  No, but the vacillation in the White House, and lack of depth in understanding the potential fallout demonstrated their fecklessness in implementing a policy based upon an ideal of lunacy not reality.  

Tunisia - welcoming Tunisia as a part of an Arab Spring ... when the Islamists and Muslim Brotherhood have taken control.  

Morrocco -  Islamists have taken near control of that country.

Algeria - Islamists have coopted the former revolutionaries in their parliament and have begun a series of restructuring of the government.  Revolutionaries out, Islamists in.  In Libya something similar has occured.

North Africa has fallen to the hard line Islamists.  The United States plays catch-up.  We are in defensive mode, responding to actions, and our response hasn't done anything.  The Islamists who have taken control are not at all intimidated by a man who is always chasing to catch up or simply doesn't try.  Hillary must really hate Obama - she is having to go around the world plugging holes and just as she starts fixing a hole another one breaks and she never fixes anything.  Obama is the one with the hammer smashing the holes.

The US has allowed the Syrian issue to fall apart and we are still playing follow the mess.  Syria is a great example of the media and events creating the conditions that make collapse inevitable.  So was Libya and Egypt.  A bomb kills the defense minister and interior minister, the UN says a collapse is imminent, the EU says a humanitarian crisis is about to occur, no one is talking about Assad any more except how he is removed.  The end is decided, it is now a matter of when and how.  I will not shed a tear for the end of that regime BUT it did not need to occur as it did.  Neither in Tunisia or Libya or Egypt.  Instead, we allowed events to overtake the situation and we became a follower not a leader.

Naturally, you do not want the opposition to appear as if US stooges, but that is the funny part.  Any help we give them will be erased in the first weeks of an Islamist government in control - the people who toppled the former president of Tunisia did not take power.  The people who started the protests in Libya did not take power.  The people who began the protests and marched in Egypt, did not take power.  It was the Islamist movement behind those groups who walked in and took control.  Once they take control - ideas of freedom and democracy and toleration are forgotten and dismissed as western tools of imperialism. 

Obama will be on the sidelines wondering what happened to the promises made to the US.  Ha.  And he believed them.  Stupid man, feckless fool.  They lie and they do so to fulfil their religious belief system.  Whatever is necessary to do so, is fine - including begging the US for aid and then throwing us under the bus while they begin an Islamic purge of everything non-Islamic. 

My mailman had more federal experience than Obama when he was elected.  My mailman could probably do as well as Obama or better.

Airlines

I do not imply or suggest in any way, I know with any certainty anything but that which I do know - that until 2001 or about that time, American Airlines could sell out the 14 seats in First Class at regular rates and fly the rest of the aircraft empty to Europe and pay for all their costs.

Increases in fuel costs would be addressed by a small increase in all costs, perhaps adding on another $50 to First Class tickets and $20 to Business and $10 to Economy.  As long as the fuel increase did not rise over $3000 per tank of fuel, that would be enough.

What other costs are there?  Food?  But food was provided in 2000 just as it was in 2009.  Food costs did not jump THAT much.  Tack on $2 per meal and you should cover the cost.

What other costs?  Airport Fees?  Ok, so tack on $70 to First Class (diregard the food and fuel increase), $50 to Business and $30 to economy - and cover all increases.

Everything else is relative to the costs prior to 2001.  Baggage had always been on-board or carried on or under the plane or ... that never changed.

So why does the airline industry, in the person of John Heimlich, chief economist of U.S. aviation industry body, Airlines for America believe the airlines have no option but to charge for costs?

According to Heimlich, the increasse in costs allow airlines to "streamline their costs and offer customers greater value for money in an increasingly competitive marketplace."  

What did he say?

"Unlike a lot of other services, the airline industry was one of the last to unbundle its services," he says.  "The consumer is now getting a choice of what they pay for. It's in nobody's interest for airlines to charge customers for services (like in flight meals or entertainment) that they don't use."

We ALWAYS got a drink, peanuts and free movies but now you want to charge us for what you gave us free or included within the prices you charged. 

Amazing how you turned the language around and now we are supposed to feel we are getting a deal.

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All cultures are not equal #2

07/09/2012  TheWashington Post

Searching for the child bride: Story behind the story

By Sudarsan Raghavan

When I arrived in Maradi, a sleepy town in southern Niger, I knew immediately that it would be difficult to find victims of forced child marriages. This region has one of the highest rates of such unions in the world, but efforts by the government to curb them had driven the centuries-old practice underground. Parents had become reluctant to publicize child marriages, fearing they could face a jail sentence.

When I spoke with the head government child protection officer in Maradi, she informed me that she had heard of only one recent case: a 12-year-old girl who jumped inside a well and severely injured herself after learning that her parents was going to marry her to a much older man.

The family lived in a village about a two-hour drive away. But when we reached there, the girl said she was 17, and her parents and tribal elders claimed she jumped into the well because she was mentally ill. It was a dead end. So we drove back to Maradi.

But I knew that the practice was so widespread, that if I spoke with enough people, knocked on enough doors, I would find cases. I enlisted the help of local agencies working with abused children, the child protection officer of the United Nations Children’s Fund, and visited the regional hospital. Over the next four days, we managed to find the girls who are portrayed in today’s story.

Balki Souley is one of the 25,000 girls under the age of 18 who are married every day worldwide. According to the Thomson Reuters service TrustLaw, the top 10 worst countries for child marriage, by percentage of women 20-24 years old who are married before they reach 18, are:

1. Niger, 75 percent

2. Chad, 72 percent

3. Mali, 71 percent

4. Bangladesh, 66 percent

5. Guinea, 63 percent

6. Central African Republic, 61 percent

7. Mozambique, 52 percent

8. Nepal, 51 percent

9. Malawi, 50 percent

10. Ethi­o­pia, 49 percent

All cultures are not created equal.

Niger leads world in childhood marriage

Nearly three-quarters of Nigerian girls are married by age 18. Of the 10 countries with the highest rates of childhood marriage, eight are in Africa. Niger, with a population of more than 17 million, is one of the world's fastest growing nations. Read related article.

Sources: Population Reference Bureau; United Nations World Population Prospects, 2011. The Washington Post.Published on July 9, 2012, 8:32 p.m.

The Taliban

This administration (in the US) started off in December 2008, with an overture to the Taliban - make peace with us and let us leave your god-forsaken rock.  Obama wanted out very badly, still does.  Damn all the indications the Taliban has not reformed.  Just make the deal and let us escape from that hole.

Why should we remain.  I am not certain we should, but we should be quite sure what we leave in charge of that place and the people, and make no mistake we are not dealing with civilization or a civilized people.

19 June 2002

ZARMINA'S STORY

From Anton Antonowicz In Kabul

http://www.mirror.co.uk/news/allnews/page.cfm?objectid=11963136&method=full&siteid=50143

MILLIONS of people have watched this woman die. Yet none saw her face.

Only a handful of people know the real story which led to 35-year-old Zarmina being executed on the penalty spot in Kabul's Olympic Stadium in Afghanistan.

The image of this mother of five children being driven to her death in a Toyota pick-up for the crime of killing her husband shocked the world.

This anonymous woman being dragged across the pitch in front of 30,000 spectators and being made to kneel before the goalposts until the tall, thin Taliban rifleman blew out her brains.

The scene was recorded with a hidden video camera and smuggled into Pakistan by the brave women of RAWA, the Revolutionary Association of Women from Afghanistan.

Later, it marked the opening scenes of Beneath the Veil, Channel 4's award-winning documentary of life inside Afghanistan under the fanatical Taliban.

Here was the truth of life in a nation wracked by 23 years of war yet largely ignored until that day.

When the Mirror first published photographs of Zarmina's death in June last year we were inundated by calls and letters from readers.

Few knew of real life under the regime which came to power in 1996. September 11 changed all that.

But one, simple question remained unanswered. One which obsessed me from the moment I first saw that secret footage in spring last year.

If the claim that Zarmina had murdered her husband was true, what was the desperation, knowing the Taliban's brutality, which ultimately led her to her death?

And what, if anything, did it tell us about the life of women under the fanatics' yoke?

These were the questions which took me to Afghanistan. To a secret rendezvous. To a filthy prison. To a cemetery. To houses where doors slammed in my face. Where men with guns threatened to kill me if I continued asking questions.

FINALLY, last Friday, a thin airmail letter arrived on my desk, post-marked April 6.

It contained three pages of green biro notes ripped from a school exercise book, confirming details which myself and colleague Tom Newton Dunn discovered during two separate Afghan assignments.

It also held a tiny photograph, the size of a thumbnail, from a police file - the face of Zarmina, the woman beneath the veil.

The letter came from a young "fixer" I hired in Kabul. It followed a meeting I had arranged with a woman police inspector who had promised that somehow she would ensure Zarmina's real story was told. Rana Sayeed works at the central police station in Kabul. It was sheer chance that we first found her on a rain-lashed day in late February standing at the entrance to the women's jail.

Rana, a mother in her late 40s, appeared different from most Afghan women. She did not wear a burka. Her manner was loud and confident.

She spoke of her training as a detective and told how she was sent to Moscow by Afghanistan's former Soviet puppet regime.

Rana said she had been a police officer for some 20 years. "Even the Taliban needed some women to apply law and order," she said, suddenly lowering and shaking her head. "Even the Taliban..."

She took us across the mud-caked compound into the charred basement of the police HQ.

The room held two desks and one old typewriter. The air was still heavy with the stench of smoke from hundreds of fires the Taliban started in Kabul before they fled.

She asked us to wait until her boss gave her clearance. When eventually the newly-appointed chief of Kabul's police told her to give us every assistance, she began.

"At last Zarmina's story can be told," she said. "It is the story of one woman. But it is also the story of Afghan women under the Taliban, under brutes who turned our country into a zoo and our women into dogs.

"I thought Zarmina would die when they brought her here. They beat her for two days with steel cables until she confessed.

"But she was a tough one. As she lay on the floor of the cell, she pointed to her one-year-old twins - the girl Silsila and the boy Jawad - and said she would fight for life, fight as the mother of these babies.

"There were other children. Zarmina had a son Hawad, who was 11, and two beautiful daughters Shaista, 14, and Najeba just 16.

"It was her love for all of them which drove her to do what she did. The tragedy is that it made life a thousand times worse for them."

Zarmina, from northern Kabul, was married at 16. It was an arranged union but blossomed into love.

She was an attractive, feisty woman. Her Pashtun husband, Alauddin Khwazak, from the village of Paghman an hour's drive away, was a policeman who also owned a small general store.

It was a marriage which flowered in the face of war and seemed at first to survive the violence in Kabul.

But almost imperceptibly, perhaps inevitably, the relationship began to fall apart. Relentless bloodshed changed everyone. And it destroyed Zarmina's husband.

The bombings, mass rapes, and murders brutalised Khwazak's mind, infecting it with an insidious poison.

A NEIGHBOUR told me: "He had been a mild man but slowly he turned into a monster. Perhaps, as a policeman, he had seen too much.

"He'd rage. He became violent. He was mad with jealousy, convinced that Zarmina was seeing other men. It was rubbish. But his head was wrapped in madness."

When the Taliban took control of Kabul in September, 1996, they effectively handed Khwazak a licence for that madness.

For these fundamentalist "students" from the south, Kabul was Satan's playground. A place where women were allowed to wear miniskirts and attend high school and university. A world of sin.

Women had no rights in Taliban Afghanistan. They existed only to obey.

They were drones to bear children, cook and satisfy men. They were lashed for their high heels, had their fingertips amputated for revealing varnish and and were stoned to death for prostitution.

Two women charged with adultery were hanged from a crane. A boy of 10 was given a gun to shoot his father's killer and a girl of seven whipped for wearing white shoes.

Girls were forbidden to attend school and summary justice wrapped in a medieval robe was the creed. Ruthless in pursuit of purity and perfect proof that no crime is too awful if justified by religious belief.

Khwazak's moods matched the new doctrine. His brother, a dour and unforgiving man, hailed the Taliban's fundamentalism and fed his sibling's fevered brain.

Rana said: "Khwazak beat his wife every night. He abused her and her elder daughters. I don't know if there was sexual abuse, but it was something Zarmina could no longer bear. So she plotted with Najeba to kill him. And finally they did it."

The murder was carried out early one summer night five years ago.

Some say Zarmina put opium in Khwazak's food. Rana says she laced his meal with sleeping pills. As he fell into a drugged sleep Zarmina woke her daughter.

Rana said: "She told me that there, at the final moment, she couldn't do it."

It was Najeba who took the 10lb mason's hammer and killed her father with one blow to the head.

Rana said: "They ran from the house screaming that robbers had broken in and attacked Khwazak. They said the men were 'shadows in the night'.

"Some believed them, others weren't so sure. Zarmina's brother-in-law was the first to accuse and called the Taliban.

"They never found the hammer, but they got their confession. That was all that mattered.

"Zarmina said she was the murderer. That she acted alone. She stuck to that story all the time she was tortured. It was only two years later when she knew me well that she admitted the truth. And I wasn't going to tell anyone."

ZARMINA was taken to the central jail and held there with her twins for nearly three years.

Sometimes her mother would come with food. But she condemned her daughter for bringing shame on all of them and said she hated her.

She told Zarmina other women in jail would kill her. Yet it was those prisoners who helped keep her and her children alive.

Rana went on: "They'd give them scraps. I gave her a few blankets. Somehow she stayed alive.

"She was a brave woman and fought desperately against her fears. She told the Taliban she was a mother and that what she'd done was for her children."

Rana said: "She asked what would happen to her children without a mother? She pleaded with them to lash her and let her go to tend her precious kids.

"She had dreams in which her husband appeared. Then she said she knew she would die."

Zarmina's elder girls and son were given to her brother-in-law, according to tradition.

He was Taliban and demanded blood law refusing to let her escape death. Then, two months before the execution, he told Zarmina's mother he had sold Najeba and Shaista into sex slavery.

"That nearly killed Zarmina," said Rana. "Everything she'd done was for her children. Now it had taken her girls to a living hell.

"The brother-in-law even made sure she knew the price, 600,000 Pakistani rupees for Najeba and 300,000 for Shaista. Sold to a man from Khost."

Khost, seven hours south east of Kabul on the Pakistani border, is a name which echoes loud.

The city was a Taliban stronghold. The place where al-Qaeda had its main training camp and the tunnels from which Osama bin Laden issued his fatwa to kill Americans and their allies.

"Zarmina beat herself, smashed her head against the jail wall," said Rana. "Of course her daughters were sold to Taliban, but who? To Afghans? To fanatics? To bin Laden? She knew she'd never see them again."

Then, on November 15, 1999, the radio announced there would be an execution in two days time.

Zarmina knew nothing of this. She had spent nearly three years in jail and knew there would be punishment. But still she convinced herself they would not kill a mother.

EVEN when the guards came for her she said she expected to face 100 lashes, but no more.

She put on three dresses - two borrowed - underneath her burka, hoping they would soften the blows.

Rana said: "I was ordered to accompany her with two women police officers.

"We climbed into the pick-up with her and prayed together. I couldn't stand it. I left before the truck entered the stadium.

'And I'll tell you that after what happened next, those two colleagues never worked again. One had a nervous breakdown. The other is plagued by nightmares to this day." As the stadium crowd settled, an announcer described what was to happen: "Zarmina, daughter of Ghulam Hasnat, is to be executed for killing her husband with a hammer."

He falsely said the murder happened "five months ago". But the truth would not have fitted the Taliban creed of swift justice.

The reality was that her execution was delayed until a premium price was haggled and paid for her virgin daughters.

The video takes over. It first shows the Toyota twice circling the pitch, the driver parading his passenger before the spectators.

Zarmina, flanked by her two female escorts, sees little. Surgeons in masks stand to one side, ready for amputations which will follow the main event.

The next clip shows the two women guards escorting Zarmina to the goal area. She is told to sit. For the first time, the crowd of men, women and children falls silent. Slowly a tall Taliban steps forward. Zarmina tries to crawl away. What is not shown is the first shot.

The executioner's hands are shaking. The cries from the crowd to spare Zarmina unnerve him. Officials refuse all pleas for clemency. They claimed there were too many in the crowd who wanted to see death.

The first shot creases Zarmina's hair telling her at last what her fate would be. Her precious children brought for the spectacle can only stand and stare.

Zarmina cries out. She says she cannot sit or kneel without falling. "Someone take my arms," she pleads.

Her last request went unanswered. The gunman aimed his Kalashnikov again. And Zarmina was dead from a single 7.62mm bullet. The executioner turned away, blood law sated. He was Zarmina's brother-in-law. The man who sold her precious girls. The man who, Rana is sure, escaped to Pakistan with so many others. A man with money in his pocket.

ZARMINA'S body was taken to the Wazir Akbar Khan hospital.

Her body lay unclaimed in the mortuary for 20 days. Her mother, Shah Sultan, refused any responsibility, telling Rana: "She brought shame. She deserved what she got. She is not even a memory to me."

Zarmina was buried in an unmarked grave 300 yards from her unforgiving mother's home.

Rana took me to the cemetery in Khair Khana, in District 11, north Kabul. She stayed in the car while I tried to find the grave.

She said it was safer that way. That locals might object to her being in the company of foreign men. The gravediggers denied any knowledge of the executed woman. One man produced a gun and told myself and photographer Phil Spencer we had no business there.

Then a young fellow, perhaps 20 and dressed in a red blazer, drew up on his bike. "I know what you are looking for," he said.

"Everyone knows about Zarmina. They don't want trouble. They don't want reminding. But they are ashamed of what happened to that woman and her girls."

People know when a wrong has been done. But there was palpable fear that Afghanistan's turmoil would once again overwhelm them.

That the Taliban were all around. That they would return and exact vengeance upon anyone who might now question their actions.

The cyclist ignored those fears. He led us through the cemetery. A stark moonscape of a place. So little colour. So much misery. So many newly dead. Just scores of the thousands who died young in an incessant war.

My guide pointed out a mound with two stones facing each other flat on. The positioning meant it was a woman's grave.

But there was nothing else to determine whose it was. Just the anger of the gunman and other armed men nearby, the embarrassed faces of the gravediggers and the cyclist pointing and saying "This is Zarmina".

He refused my offer of money, saying "It is time Zarmina's story was told." And of course there are so many of these stories to be told.

"There were so many nightmares here," Rana said as we drove to The Herat, Kabul's best restaurant. The place is little better than a greasy spoon. But Rana would not enter.

"It's OK. You go, you sit. Just ask them to bring me some food in the car." That is how it still is in Afghanistan. The Taliban and their al-Qaeda allies may be put to rout but still women's rights are hardly a footnote on the agenda.

WE speak to a beggar woman by the restaurant door. She has three children all under five. Her husband is dead.

She tells me life should be better now. She receives about 50p a day.

She says all this through her burka. A Pushtun barges through the crowd, bends over her and strikes her head. "Get lost, you whore-bitch!" he shouts. And the woman scrambles away with her children.

I ask Bashir, our "fixer", why he did that. Was he related to the woman? "No. He's just a Taliban type. Any woman is ripe for a beating. They don't need an excuse."

We ate with Rana in the car. She said: "I remember another stadium execution where the man had 10 bullets in his body. His victim's family took turns to shoot him.

"I remember a woman the Taliban accused of having a walkie-talkie. There were 16 of them beating her with cable wires until she pissed blood. All the time they made sure her head and face were covered so they should not be tempted by her looks.

"I tell you I thank God for September 11. Not for the innocent deaths. But, without that day, we'd still be treated like animals.

"The whole place was run by Pakistanis and Arabs. No one dared say anything against them.

"It was the same the day Zarmina died. Everyone knew she did not deserve to die. But nobody said anything. Nobody dared."

Now some do dare to speak. Rana and Zarmina's neighbours tell me the twins, now six, and their brother Hawad,16, have been cast adrift.

Unwanted by their fleeing uncle. Unacknowledged by their grandmother. They beg, they rag-pick at the local dumps. But nothing has been seen of Najeba and Shaista.

Five children all lost because of a mother's desperation to give them a better life. "Yes," Rana repeated, "Zarmina's story must be told."

So, with that photograph arriving on my desk last week, it has been told. It cannot be the whole truth but from what we have found and checked, it is nothing but the truth.

The story of a woman beneath veils of violence, madness and terrible sadness. A woman so many saw die. But never knew how she had lived.

Voice of the Mirror

Nigerian Attacks on Christian Villages

Deny all you want.  The reality is still the reality and while you may convince the UN you aren't raiding Christian villages, the truth is something the UN has never been particularly interested in.

8 July 2012 Last updated at 10:24 ET

Nigeria violence:Raids on Christian villages near Jos

Armed gangs attacked Christian villages in northern Nigeria on Saturday, sparking a day of violence in which 37 people died, the military says.

Dozens of men launched attacks on the villages near the city of Jos in the early hours of Saturday.

A military task force deployed and got the situation under control after hours of heavy fighting, officials said.

Muslim herdsmen were blamed for the raids, but their community leaders denied any wrongdoing.

The area around Jos has seen much ethnic violence as well as clashes between Christians and Muslims in recent years.

Mustapha Salisu, of the special task force, said "hundreds" of assailants had launched "sophisticated attacks".

"Some had [police] uniforms and some even had bulletproof vests," he said.

The dead included 14 civilians, 21 attackers and two policemen, Mr Salisu said.

He declined to lay blame for the attacks, but another military spokesman had earlier told Reuters news agency that Muslim Fulani herdsmen were the likely culprits.

Fulani community leaders denied their people had done anything wrong.

The Miyetti Allah cattle group dismissed the accounts as propaganda and said the military had attacked the herdsmen.

Jos is in Plateau state, which lies on the fault line between Nigeria's mainly Muslim north and Christian and animist south.

Islam

Protecting Christianity

·        3 Jul 2012

·        National Post - (National Edition)

·        BY RUKMINI CALLIMACHI

·        The Associated Press

Ransacking of timbuktu by ‘divine order’

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DAKAR , SENEGAL • Muslim extremists razed tombs and attacked the gate of a 600-yearold Timbuktu mosque on Monday, triggering an international outcry over the destruction of the ancient Malian city.

The International Criminal Court has described the demolition of the city’s patrimony as a possible war crime, while UNESCO’S committee on world heritage was holding a special session this week to address the pillaging of the site, one of the few cultural sites in sub-saharan Africa that is listed by the agency.

The Islamic faction, known as Ansar Dine, or “Protectors of the Faith,” seized control of Timbuktu last week after ousting the Tuareg rebel faction that had invaded northern Mali alongside Ansar Dine’s soldiers three months ago. Over the weekend, fighters screaming “Allah Akbar” descended on the cemeteries holding the remains of Timbuktu’s Sufi saints, and systematically began destroying the six most famous tombs.

Reached by telephone in an undisclosed location in northern Mali, a spokesman for the faction said they do not recognize either the United Nations or the world court. “The only tribunal we recognize is the divine court of Sharia,” said Ansar Dine spokesman Oumar Ould Hamaha.

“The destruction is a divine order,” he said. “It’s our Prophet who said that each time that someone builds something on top of a grave, it needs to be pulled back to the ground. We need to do this so that future generations don’t get confused, and start venerating the saints as if they are God.”

Among the tombs they destroyed is that of Sidi Mahmoudou, a saint who died in 955, according to the UNESCO website. In addition, on Monday they set upon one of the doors of the Sidi Yahya, a mosque built about 1400. Local legend held that the gate leading to the cemetery would only open on the final day at the end of time.

Local radio host Kader Kalil said the members of Ansar Dine arrived at the mosque with shovels and pickaxes and yanked off the door, revealing a wall behind it. Mr. Kalil said that they explained they were doing so in order to disabuse people of the local legend and to teach them to put their whole faith in the Koran.

“Since my childhood, I have never seen the door on the western side of the mosque open. And I was born in 1947,” said Mr. Kader, a longtime resident of the city. “When we were children, we were told that the door would only open at the end of time. These religious people want to go to the source, to show us that this is not true ... Of course our population is not happy. The women, especially, are crying a lot.”

Shamil Jeppie, who heads the Tombouctou Manuscripts Project at the University of Cape Town in South Africa, says the destruction in Mali is analogous to the demolition of the Bamiyan Buddha in Afghanistan. The Wahabi interpretation of Islam that Ansar Dine — like the Taliban — espouses is a narrow version of the faith, and stands in contrast to what he says is the history of Islamic learning.

“Timbuktu was a centre of Islamic learning, a very significant centre — there is lots of internal and external evidence of this. But Ansar Dine is ignorant of this,” Mr. Jeppie said. “For them, there is only one book and it’s the Koran. All this other [Islamic] learning is inconsequential to them,” he said.

The UN cultural agency has called for an immediate halt to the destruction of the sacred tombs. Irina Bokova, who heads the UN Educational, Scientific and Cultural Organization, reported in a statement issued Saturday that the centuries-old mausoleums of Sidi Mahmoud, Sidi Moctar and Alpha Moya had been destroyed. Meeting in St. Petersburg in Russia, UNESCO’s World Heritage Committee, last week placed the mausoleums on its list of sites in danger due to earlier attacks by the Islamists, said UNESCO spokesman Rony Amelan.

On Sunday during a stop in Senegal, Fatou Bensouda, prosecutor for the International Criminal Court, said the destruction of the city’s patrimony constitutes “a possible war crime,” according to private radio station RFM. And on Monday, State Department spokeswoman Victoria Nuland condemned the destruction, telling reporters in Washington that the United States calls on all groups to enter into a ceasefire.

For years before the north of Mali became a base for an offshoot of al-Qaeda, Timbuktu was a must-see for backpackers and package tour groups. Much of the city thrived on tourism.

Scholars held out hope that the Islamists would not also attack the city’s 20,000-catalogued manuscripts, some dating as far back as the 12th century. Beyond the tombs, the manuscripts are considered to be the real treasure of the region and library owners have succeeded in spiriting some of the manuscripts out of the city, or else buried them in secure locations.

“We’re talking about generations and generations of culture being destroyed,” said New York-based Michael Covitt, chairman of the Malian Manuscript Foundation . “It’s an outrage for the entire world.”

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Of course, these people are not acting in an Islamic way, they are no different than cultish sorts in Christianity who burn Bibles and wave placards saying God loves dead fags.  of course.  Except with Christianity, they tend not to get violent and death engaged killing as they go.  Oh, yes, maybe 500 years ago, but Christianity has evolved.  That, and the fact Christians exclude the extreme and embrace toleration versus these individuals who run amok with no regulation killing and destroying in the name of their religion.