Lehmann Audio Decade Manual Meat

Here at R Street we like to think of ourselves as red meat conservatives. The renewable electricity industry has grown rapidly in the past decade. R Street Senior Fellow R.J. Lehmann testifies before a June 7 hearing of the House Financial Services Committee on 'Flood Insurance Reform: A Taxpayer's Perspective.

Last week before our show on violent extremism, we were talking over a big week in media news. We don’t quite know what we’ll do without Jon Stewart and Stephen Colbert; we never had much use for Brian Williams or the latest iteration of The New Republic, but Bob Simon was the real deal. The dream guest to talk it through was David Carr, the New York Times legend and booster, who had come last fall to Boston University to teach budding journalists. Carr was honest but balanced, candid, self-conscious, and lively. And he managed to avoid the solipsism that comes with media on media. So we wrote David that afternoon, and of course discovered that night that we had lost him, too.

We spoke to some of Carr’s students this week, and discovered that he was almost utopian about the future of news media. The Carr line was that journalism is a joyful job — hardly ‘work’ —and that there were so many new ways to join the conversation. In the next century, he thought, more diverse groups of more people are going to tell more stories, and the New York Times will weather all the change. How could that be anything but good news? But there are warning signs all over that big-paper model, evident recently around the war in Iraq. So this week, we’re hacking journalism in the shadow of David Carr. We’re calling reporters and others from all over who want to build a better media establishment: more comprehensive and inclusive, more credible, and less the captive of power when it counts. (Our apologies for the audio problems on Chris Lehmann’s line — take it as proof that this journalism work is a kind of trapeze act, and that things, sometimes, go wrong.) That “New Media” Sound Venture capital flows into media startups, so we’re keeping our ears out for the sound of new journalism.

Call it a “new media mashup” of the storytellers behind #storytelling—Amy O’Leary of the Times’ Innovation Report, Alex Blumberg of Gimlet, Jonah Peretti of Buzzfeed, and others. The top photo of David Carr was taken by Nicholas Bilton in his own backyard.

Bilton was a close friend and colleague of Carr’s and on Medium. Podcast • March 27, 2013. The best fun of being president of the US, I often thought, would be appointing Anthony Lewis to the Supreme Court. He was a non-lawyer with a persuasive understanding of the gift and genius of the Constitution. He had a historian’s grasp on how the law evolved.

Justice Frankfurter said Tony knew the cases before the Court better than most of the sitting judges. And he could unfold the issues in lucid prose that grabbed me as a teen-age reader of the New York Times. It turns out now that lots of people, like my pal, had that fantasy – of putting Tony Lewis on the Court, as a sort of teaching judge, a people’s man with law and language. Here’s what he stood for and loved to recite – in the Lydons’ living room – for example: Oliver Wendell Holmes’ dissent in a free-speech case from World War I time, the Abrams case. The best test of truth, Holmes bellowed, is “free trade in ideas.” “That at any rate is the theory of our Constitution. It is an experiment, as all life is an experiment While that experiment is part of our system I think that we should be eternally vigilant against attempts to check the expression of opinions that we loathe and believe to be fraught with death, unless they so imminently threaten immediate interference with the lawful and pressing purposes of the law that an immediate check is required to save the country.” Justice Oliver Wendell Holmes, in dissent in Abrams vs. United States (1919), quoted in Anthony Lewis’ Make No Law: The Sullivan Case and the First Amendment, page 78.

Reading that stuff, as Tony liked to say, you felt the hair rise at the back of your neck. This was his meat: law, experiment, the rights of embattled South Africans, Palestinians and American outcasts, free expression, dissent, room for ideas we hate, and thundering prose. And of course Tony found he could thunder on his own, too. My favorite Tony Lewis columns – oddly unmentioned in the Times obit – might have been his answer to the, the Nixon-Kissinger “terror bombing” of Hanoi – with no measurable purpose or benefit.

Peace was at hand, they had said, the war all but over, but American B-52s poured it on: 2000 strikes over 11 days. “An episode that will live in infamy,” Tony Lewis wrote. And lest we forget he kept rewriting that column every Christmas for a decade. The lessons for Americans were still: “Beware obsession. Beware secrecy. Beware concentrated power.

Beware men untouched by concern for the moral consequences of their acts.” To my taste, Tony Lewis leaves the high-water mark in consequential newspaper work in our time – before snark and life-style and propaganda and the I-I-I voice in political columns came to seem standard. Wrote the other day that TV as a news medium began to die when MSNBC dismissed Phil Donahue ten years ago for his reservations about the war in Iraq. I would say newspapers started their descent to the grave right about the same time, when the Times sent Tony Lewis into retirement and retained William Safire who thought the war was a great idea. “Wait and see,” Safire ended a column. I wrote to him later: “Bill, we waited, and we saw.” Tony Lewis was my standard of excellence, though the “narcissism of small differences” kicked in, too.

I thought Tony was unfair to Ralph Nader. He knew the quality of Nader’s citizenship since their law school days in the 50s, but then Tony led the liberal chorus against Nader in that very stilted and stifling Bush-Gore campaign of 2000. I thought Ralph would have ventilated it, maybe brought Al Gore out of his own infamous lock-box, maybe scratched the veneer off George Bush.

I thought it was unlike Tony to be narrowing the field and the conversation that was stuck in a deep rut, going nowhere. So we disagreed, and made a radio program around the argument with both Tony Lewis and Ralph Nader. Tony indulged his friends, like me, in all manner of differences. But then I realized years ago: inside my own head the relationship went further, maybe deeper.

I found myself arguing all alone over small points of politics or taste with the mind of Tony Lewis. The oddest part was that as I sparred with my internal Tony, he often won the argument – with his patience, forbearance, and long view.

Over many years Tony was inexplicably generous to me as broadcast host. He’d begun with the granddaddy of public broadcast news, Louis M. Lyons on WGBH. He was an almost-regular on the MacNeil/Lehrer NewsHour and then on my Ten O’Clock News on WGBH-TV, where he could make a 4-minute interview sing – on anything. One night it was his idol Fred Astaire, and suddenly Tony broke into song with one of the Astaire classics — I think it was “A Foggy Day.” Margie Marshall, Tony’s new wife, said she would kill me, or him, if I ever let him sing again on TV, but he might have been happy to defy us.

There was more to Tony than law and politics. He wrote and talked wonderfully about his suit salesman in Filene’s Basement; about Frank Gehry’s Guggenheim Museum in Bilbao; about a fine revival of “Porgy and Bess;” about Boston’s Mayor Ray Flynn, who rated better than Ed Koch of New York, Tony judged. I loved to hear him on newspaper guys – on his sponsor, the incomparable team-builder James Reston; on the great independents and adventurers Harrison Salisbury, I. Stone and Sy Hersh; on the nonpareil columnist, the genius among the great craftsmen of the Times, Russell Baker. I saw Tony at home a month ago, not knowing the end was so close. His first words: “God, I miss Tom Winship at the Globe.” The last were: “Sure, let’s record our conversation the next time.” What we talked about most that February afternoon were song lyrics. He had a great book on the top of his pile:, compiled by Robert Gottlieb and Robert Kimball.

Tony knew the words of Ira Gershwin, Lorenz Hart, Cole Porter, Oscar Hammerstein, Tom Lehrer, P. Wodehouse and Company the way he knew the law. And he worshipped above all, I think, Frank Loesser for the words and music of Guys and Dolls: “I Got the Horse Right Here” and Adelaide’s song: “A person can develop a cold,” which Tony loved to sing. The next time, I was going to bring him the Ray Charles / Betty Carter version of another Frank Loesser classic, “Baby, It’s Cold Outside.” Tony leaves us, I’d say, a memorable model for the best and broadest idea of a liberal at work. It wasn’t about dogma, much less radicalism. It was temperament as much as politics. It was about a modest optimism, a belief that institutions, even societies, could work on their flaws and get better.

He was the human embodiment of the Warren Court, in that sense. He made a pair with his friend, who stood also for civility, compromise, persistence on an upward course. They stood for that era of reform in civil rights, in one-man-one-vote political representation, in the protection of defendants’ rights and the expansion of free speech and expression. Tony goaded the country with columns and landmark books on those central subjects, and by gum, the country got better. It can sound almost quaint, but he knew for certain that there were remedies for real ills in patient, hard-working devotion to our ideals in the Constitution and the law.

So he never let up, and he never despaired. Podcast • April 13, 2012. – NYU journalism professor, social-media rock star and most thoughtful of – thinks the critical news stories of our time have grown “Too Big to Tell.” We’re pulling on a thread — “what are we going through?” essentially — that began with the late ‘s last book of sermons and continued with and.

It’s a wide-open inquiry that needs your nudges. Listen and comment, please! Here’s Jay Rosen on the media piece: It’s impossible to register in our public conversation an America in decline, a loss of confidence.

We also haven’t dealt with the huge crisis of accountability. Nobody’s accountable for anything in this country. Who’s accountable for a phony case for war, put forward in 2002 and 2003? Who’s accountable for a financial crash and corrupt financial practices that went on for years and made lots of people rich? Who’s responsible for failing to detect a phony case for war — in the press? Just to take an example: David Gregory [of NBC] to this day maintains that he and his colleagues reporting on the White House and the Bush Administration did a great job in the run-up to the war. He says this today.

His reward for that is not to be laughed out of the profession but to get Tim Russert’s chair on Meet the Press. He’s bigger than ever! To me just that little story tells the tale of accountability in the United States.

And it’s that group of people that still has a hold on the political conversation, even though fewer people believe them or pay attention or rely on them. And so the alternative to a reality-based politics, which we do not have, is just a huge increase in cynicism.

That idea of stories too big to tell, lies too big to take back, an audience hooked on placebos it doesn’t believe — it all makes sense about a malaise that the late was trying to pierce. Jay Rosen is putting his finger on one of the biggest mysteries in this troubled American moment. On one hand: what we call “media” has been transformed by the digital revolution. The tools of publishing and broadcasting have all been distributed, which is to say: democratized. Critically independent websites like,, and have taken root, and vast horizontal networks like Facebook thrive. Yet, on the other hand, in some strange way “the conversation” has not moved.

If anything, Jay Rosen says, the grip of reality has been weakened. As remarked in 1988 about the specialized and professionalized “process” around a presidential campaign: “What strikes one most vividly about such a campaign is precisely its remoteness from the actual life of the country.” I am asking Jay Rosen: are we looking at the end of something, or the beginning of something else?

I would say ‘the end’ in this sense: the only real program for change we have now is: Collapse! Because we have these institutions that don’t work. They are in many ways constructed on illusions or lies. They go go go go go until the day that they don’t.

Like the whole mortgage-fueled financial system, right? It worked it worked it worked it worked and then one day it collapsed, with a lot of destruction and almost a kind of violence. We’re now in a period where we can’t reform, so we’re waiting for various forms of collapse. Now in the aftermath, yeah, sometimes that can be the start of something. But I don’t see right now any alternative. The institutions that are supposed to be able to take account of reality — name it, frame it, allow for a contest of ideas, permit a choice of large directions to be made and therefore allow us to find some sort of imperfect remedy — just don’t work. And so the alternative is: Collapse.

But in the collapse there are new tools, there are new ideas, there’s another generation. Certainly it’s not going to be you and me! And so there’s where the case for optimism is. We still need people like Tony Judt.

We need writers just trying to make sense of their own experience, who can name and frame what they see. But the tools for ignoring those people roar. They are powerful, too. With Chris Lydon in Boston, April 5, 2012 This all calls to mind our last conversation with the late, who won two Pulitzer Prizes for his people-first coverage of the war in Iraq. What the most honored of reporters on the Middle East wanted to get off his chest with me two years ago was that “I find it almost painful to come home to the States” He was in grave distress wondering if anyone had read his stories in the Washington Post and the New York Times, about the war at the level of Iraqi villages and families.

“I think it’s just spectacular that we don’t appreciate the devastation that has been wrought in Iraq over the past 7 or 8 years. It’s just spectacular. There was an incredible amount of arrogance that went into this entire experience on the part of journalists, on the part of policy makers and the military. There wasn’t even a desire to learn. It does give you pause.” Podcast • April 11, 2012. Timothy Snyder, a rising-star historian at Yale (most recently of ), is turning up the heat on his friend Tony Judt’s parting sermons about “social democracy.” I’m taking Tony Judt’s last books as “a catalog of the malaise” in the land, and as a catalyst of an Open Source quest for an alternative narrative of the 2012 presidential campaign.

Grab a line, please! Tim Snyder drew almost literally the last words out of Tony Judt as he succumbed two years ago to Lou Gehrig’s disease.

Is their “talking book,” which they spoke and edited together. It’s Judt’s intellectual autobiography and a shared reflection on history at a dicey moment in the Western world. Tony Judt’s hope was in the “social democratic” compromises that keep alive dreams of equality, inclusion and fairness on a capitalist playing field.

Tim Snyder adds his own high notes of urgency. What’s ruinous today, he’s saying, is not the cost of “social democracy” in education, public health, and modern transport, which can be shown to pay for themselves. Rather it’s inequality and social isolation that exact a price in many measures of health and happiness — in crime, mental illness, life expectancy and social stability. The problem in Europe, Snyder says, is typified by Greece, which “like the United States has lots of wealth inequality and lots of rich people who avoid paying taxes.” This is another lesson of history: you can tell states are about to fall when the wealthy people who have been their bulwark are no longer contributing. They’re making bets elsewhere, and the state isn’t strong enough to make them pay taxes. And that’s kind of where we are now, which is why I worry. Not only do we have very rich people who don’t pay very many taxes, but we have this idea that it’s bad to make them pay taxes.

And Mitt Romney incorporates that argument. Timothy Snyder with Chris Lydon in the historians’ lounge at Yale, April 9, 2012 I hear a piercing cri de coeur in Tony Judt’s last several books, touching something much hotter and heavier than the campaign rancor so far, clearer and deeper than anything the Tea Party or Occupy have articulated, but not so distant from the general panic attack that many millions among us are facing: We have entered an age of fear. Insecurity is once again an active ingredient of political life in Western democracies. Insecurity born of terrorism, of course; but also, and more insidiously, fear of the uncontrollable speed of change, fear of the loss of employment, fear of losing ground to others in an increasingly unequal distribution of resources, fear of losing control of the circumstances and routines of our daily life. And, perhaps above all, fear that it is not just we who can no longer shape our lives but that those in authority have also lost control, to forces beyond their reach Tony Judt,, Penguin 2010.

Tim Snyder is speaking also of something gone drastically wrong in the public conversation. We now have a 24-hour news cycle, as he puts it, and an ever narrower discourse. It annoyed Tony Judt, he says, that we call ourselves a nation of non-conformism and free speech, when in truth “our intellectual life is impoverished compared with many democracies in the world or with the U. 50 years ago.” Here’s the Tony Judt version in print: We cannot hope to reconstruct our dilapidated public conversation — no less than our crumbling infrastructure — unless we become sufficiently angry at our present condition. No democratic state should be able to make illegal war on the basis of a deliberate lie and get away with it.

The silence surrounding the contemptibly inadequate response of the Bush Administration to Hurricane Katrina bespeaks a depressing cynicism toward the responsibilities and capacities of the state: we expect Washington to under-perform Most people don’t feel as though they are part of any conversation of significance. They are told what to think and how to think it. They are made to feel inadequate as soon as issues of detail are engaged; and as for general objectives, they are encouraged to believe that these have long since been determined. Tony Judt,, Penguin 2010. 161, 172 Tony Judt acted out a rare conviction in the power of the word — and of his own words to the last breath. He believed it was the intellectuals’ job not only to broaden the public conversation but to change it. “If we do not talk differently,” he wrote, “we shall not think differently.” So a central part of this Tony Judt challenge we’re pursuing has to do with the mainstream American discourse we call “media” — how it works and what we make of it.

Our next conversation in this thread is with the ever provocative champion of “civic media,” and now a star of “social media,” of the dauntless and durable website, who chanced also to be Tony Judt’s colleague at New York University. By way of reintroducing Tony Judt, consider his passion for trains, and train stations — those “cathedrals of modern life,” collective projects for individual and common benefit, as he wrote.

In Mumbai and Milan, Paris and New York, trains and their stations remain both “perennially contemporary” and “aesthetically appealing” — quite unlike airports. And they work! — much as they were designed to work from the beginning. Tim Snyder makes trains a sort of lesson that Tony Judt learned in scholarship, in life, in politics — that “we don’t become individuals all by ourselves. We can’t become responsible, we can’t become interesting, we can’t become individuals of any sort without some sort of collectivity. And I think trains were all about that” When you’re on a train, you can be all alone — reading your book, you don’t have to be paying attention to anyone else. But you are with other people, even if the only thing you have in common with the others is that you’re going to the same place, in the same direction.

But the process of being on the train is one of looking around and noticing differences, right? Pongal Related Songs Free Download. So you can be alone together. Which is different from, on the one hand, the American practice of commuting in your car by yourself, staying up late playing a video game, where you’re alone alone. It’s also different from the kind of radical socialist or communist dream of being together together, where we’re all part of the same working class and we’re going to get rid of all those other people who aren’t It’s somewhere right in the middle. It’s alone together. Together alone.

Trains give us that, and in some sense I think that’s what modern society has to be like. The alone-alone is kind of a nightmare.

The together-together is kind of a nightmare. It’s the alone-together, you know, which is tenable and which we can make if we want to make it.

Timothy Snyder with Chris Lydon in the historians’ lounge at Yale, April 9, 2012 Comments, please! Or email to chris@radioopensource.org. Podcast • September 13, 2011. Saleem Shahzad on the cover of a report edited by Imtiaz Alam has the gruff manner of your classic, chain-smoking, get-to-the-point “Front Page” news editor.

He seems a Chicago sort of newspaper guy, except that he works and represents the profession in Pakistan, “the deadliest place in the world to be a journalist,” as all now agree. First point in our conversation is to register some constructive horror at the murder last May of Saleem Shahzad — a reporter of Sy Hersh’s or David Halberstam’s hyper-adrenal zeal for the ugly facts.

As Dexter Filkins details in this week’s (September 19, 2011), Saleem Shahzad had pushed his many cloaked sources in Al Qaeda, the Taliban and the Pakistan Army and the CIA to establish the working (but deniable) links among the official and opposition gangs. For telling the story in after he was warned off it by Army Intelligence, Shahzad was tortured, killed and dumped in a farm ditch. His was the 28th “target killing” of a Pakistani journalist in the last five years — the first to be investigated seriously. None has been prosecuted, and nobody’s betting that Shahzad’s killer will be. But it’s time, Imtiaz Alam is saying, to write a few groundrules of news reporting on the rough crossfire of Pakistan. For example: journalists should get risk and life insurance from their employers and the government; the Army and its media handlers should lay out its practice of “embedding” and often paying reporters; “all cases of the target killings of journalists should be investigated and the culprits brought to justice.” Imtiaz Alam is also giving us one rough-and-ready newspaper man’s take on Pakistan in general: “a horrifyingly difficult situation,” he says.

“We are sitting on a big bomb, and it’s ticking.” The extremists are not the majority or even the mainstream, but they are powerfully organized, and there’s been no leader around since Benazir Bhutto to say no to them. Imtiaz Alam admits a certain nostalgia for British rule, which he is not old enough to have experienced. “They learned about our culture, our ethos they are to blame for divide-and-rule — typical colonial methods. But they brought good things” — railroads, law, the liberal constitutional tradition. Even now, he says with a guffaw, “the Americans should hand over the job to the Britishers.” The problem with you Americans, he says, is not just inattention and tactlessness. It’s that the US armed the Taliban in the first place, to fight the Soviets in Afghanistan in the 1980s. “That was the original sin.

You made these people — so disappointing! — and compared them to the founders of your country So now when they turn their guns against Washington, you are saying they’re terrorists. I considered them terrorists then, and I consider them terrorists now.” The US handed Pakistan a bigger problem than Pakistan can handle, he is saying. My question: But can the US undo the damage. His answer: “The Urdu couplet says: “you gave the pain, you find the medicine.” Podcast • June 7, 2011.

If the Internet dream could take human form, it might look and sound a lot like cheerful, boyish, 44-year-old, the new director of the fantasy factory known as the. Like the Web, he’s everywhere and nowhere — often, in fact, 30,000 feet in the air, circumnavigating the planet every couple of weeks, but wrapped always in a digital and omnidirectional exploration. Draws on Japanese roots and American experience. Born and continually tutored by his grandmother in the old cultural capital, Kyoto, he was raised also by his parents in surburban Detroit.

But his air seems less East-West hybrid than a spirit of self-consciously detribalized human energy. His home airport now is Dubai, because he wanted to cultivate a Middle Eastern perspective on events, investments, social turmoil. Joi Ito is as complexly “global” a citizen as, the English-Indian writer who went to university in the States and now bases himself at TIME magazine and in Japan. But the effects, and the affect, are entirely different. Pico Iyer’s passions are literary; his oldest best friend is the Dalai Lama. Joi Ito’s issues — applied urgently to technology, culture, teaching and learning — are innovation, openness, connectedness. His passions — which seem to be engaged serially — have evolved from experimental “industrial” music, which he transported from Chicago to Tokyo, to start-up investments (early into Twitter, Kickstarter, Flickr).

Then came on-line games, and. In conversation, he might impel you to join his advanced guild; but then he might make others scream “Only disconnect!” and go home to a Victorian novel.

Like the Web, Joi Ito is a natural-born connector — cherished by fellow futurists for giving them courage., founder of the Media Lab 25 years ago and author of says of his heir: “Joi got the job because he is the most selfless young person I know who has made his short life-time one of enablement. This is so key. The Media Lab is now much broader than I ever knew it, where the ‘media’ du jour is the mind.” Joi’s job, Negroponte adds, “is to make the Lab crazy again.” We are talking about wrinkles in the Internet dream — about the self-cancelling possibility, for example, that digital tech has leveraged the surveillance state as much as it has linked up the social-justice crowds. I’m asking Joi Ito about ‘ dread, that “our commons is being enclosed” by phone companies, the entertainment industry and regulators who see the Net essentially as “a better way to get TV on your mobile device, delivered for subscription and usage fees.” And I’m venting some of my own latter-day anxiety about the damage the Internet has done to the old-media institutions we miss more and more, and maybe didn’t cherish enough — the late great New York Times, to name just one. Podcast • April 19, 2011.

Is the newspaper columnist whose gruff prose has extended the whole human comedy of New York to the world, first in the pages of the New York Herald Tribune, and later the Daily News and Newsday. Breslin is telling us the story of, the owner of the old Brooklyn Dodgers who integrated baseball — and changed our country — when he hired Jackie Robinson back in 1947. Rickey, Breslin says, “decided that there was a great American sin, and a great America to be gained by putting a black into baseball. He could see things.” Jimmy Breslin can see things too. In our conversation, he’s musing far and wide about the great America that’s been gained, and the one that’s still in the offing. It’s all delivered in the unmistakeable style that he calls “a dirty shirt at night.” He’s sharing observations on everything from “Who?”; The thing in the air, where you don’t have to read. — Google, internet, this, that.

You’re gettin’ beat by the air. The air wins. To the future of The New York Times; The New York Times? 82 words in a lede sentence, I’m reading one day, and you expect it to last against the words that come whizzing through the air? It cannot be. Not for long. To Obama; Obama comes from Robinson.

There was a White House waiting for him because of Robinson. You put a black into the White House! Tell me that isn’t amazing. It makes the mouth drop open. Then the first thing he does is he’s in support of three wars. And I’m supposed to like him.

To the view from his apartment, 38 floors above Columbus Circle; The river is marvelous. I just look at the river; with the clouds, on prime days, it’s beautiful. It’s not going to help you — you better sit down and write! But it’s good to gaze once in a while. To the origins of the; BAR!

One hand on the wood of a bar while we expounded what we were going to do. It was a night at the bar and it spilled into too many. To the right wing today, Why do they waste their freaking time with those views in a country like this? What are you worried about saving money for so much? Spend the money!

Help people, be known for it and you’ll find there’s more money there than they believe is. And being called a “master. 3d Plants And Trees. ” It’s marvelous to be embarrassed. Jimmy Breslin with Chris Lydon, NYC, April 2011.

Podcast • January 25, 2011. What can Taliban captivity do to a man’s judgment, even to his soul?

It made root for the CIA’s drone missiles buzzing on the horizon, even when his captors assured him the drones were hunting for them and him, and were going to take his life with theirs: DR: At first you’re sort of afraid because you don’t know when the strike’s going to happen. There’s no warning. The missile comes down faster than the speed of sound, so you won’t hear the missile that kills you.

After a while you sort of get used to them and you don’t pay as much attention to them. But it’s a devastating weapon, and you have no idea when a strike will come. It sort of haunts you. CL: But what was your fundamental response to the sight and sound of these things in the sky? Was it, “Whew, help is on the way,” or, “Holy shit, this could take me out too”? DR: It changed with time and as my view of my captors changed.

I want to be honest: I came to just despise them. I hated them. I hated them for what they were doing to my family. I hated them for the fact that they were essentially making my wife and my parents and my siblings feel like they were just cheap people, and if they could somehow just come up with the millions of dollars they wanted, that my family could save my life. Kidnapping’s really an incredibly personal crime.

As time went by, if drones were killing Taliban it frankly made me happy. I saw them [my captors] as hypocritical criminals who were doing horrible things to my family. We tried to escape because we were basically ready to die.

And we wanted them to get nothing. We wanted our families to not have to suffer like this, and we just completely despised them.

So my view of the drones changed over time David Rohde, with Kristen Mulvihill, in conversation with Chris Lydon, January 25, 2011. New York Times reporter was a prisoner for seven months in 2008 and 2009 of the Haqqani network in the Taliban-run Tribal Areas of Pakistan. This is the same Haqqani network that a generation ago (pumped with Saudi money, Wahhabi theology, American Stinger missiles and CIA generalship) led the charge of the mujahedeen against the Soviet occupation of Afghanistan.

The late Texas Congressman Charlie Wilson (as in ) pronounced the Haqqani patriarch, Jalaluddin, “goodness personified.” What should it tell us that a generation later, the Haqqani sons, Badruddin and Sirajuddin, are the point of the Taliban lance against U. Forces in the region and both seem to have enjoyed overlordship of David Rohde’s kidnapping ordeal. In David’s account with his wife Kristen Mulvihill,, and in many other versions, I take the large arc of the story to be about the killer mix of fanaticism and firepower that came back to bite us on 9.11 and ever since, and how it is still tearing up the home grounds where the US helped plant the virus thirty years ago. David Rohde knows the details of that story — of our “Frankenstein’s monster,” as he puts it — far better than I do. And still I have to say his thematic question in this book strikes me as stunningly wrong.

First with smoke in his nose in Lower Manhattan in September, 2001 and on to the last strokes of this book, he is asking himself “how can religious extremism be contained?” He thinks those drones might actually be part of the answer. I am presuming in this conversation not just to differ on the drones, but to suggest he “buried the lede” of his own story. He lets me get away with it, perhaps because I’ve watched his work with affection, often with awe, since he interned as a Brown undergraduate with our Ten O’Clock News on WGBH, public television in Boston. Podcast • January 21, 2011. Fifty years almost to the day after the catastrophic assassination of in the Congo — a Cold War murder by Belgium with help from our CIA — the journalist is sketching an alternative path ahead for African development today.

China is the big investor in 21st Century Africa. China sees Africa as yet another “natural-resource play” but also as a partner in growth — not a basket-case but a billion customers who’ll be two billion by mid-century. With the West and Japan deep in a post-industrial funk, China is keeping its focus on manufacturing, exports and markets, “and we’ll have them largely to ourselves,” China calculates, “because the West doesn’t make the stuff middle-class Africans are buying — cars and houses and shopping malls and airports and all the things associated with a rise to affluence. Those are the things that China makes.” For the New York Times covered Africa and then China, where he learned Mandarin.

He returns to Africa now on a book project, observing and overhearing Chinese migrants to places like Ethiopia, Mozambique, South Africa, Namibia and Liberia. HF: I was struck every time I got on a plane: the Westerners tend to be rich American tourists on their way to seeing lions and giraffes; or aid workers and NGO people — coming with a mission to minister to Africans about capacity-building or democracy and what my father used to do: public health. I say none of this with scorn, but the Chinese have a very different mission. The Chinese that I saw on the planes — and by the way, ten years ago I saw no Chinese; now they’re maybe a fifth of all the passengers — are all, almost to a person, business people.

They’ve pulled up their stakes wherever they lived — in Szechuan province or Hunan province — and they have come to make it in Africa. And they’re not leaving until they do. Whatever it takes for them to make a breakthrough in farming or in small industry, they’re going to work 20 hours a day till they make it. They see Africa as a place of extraordinary growth opportunity, a place to make a fortune, to throw down some roots. These are not people who’re there for a couple of years. They’re thinking about building new lives for themselves in Africa. So you have this totally different perspective between the Westerners and the newcomers.

One sees Africa as a patient essentially, to be lectured to, to be ministered to, to be cared for. The other sees Africa and Africans as a place of doing business and as partners. There’s no looking down one’s nose or pretending to superiority. It’s all how I can make something work here.

CL: I just wonder: among those development geniuses who argue about Trade vs. Aid as America’s next gift to Africa, in the face of all the Chinese activity buying forests, or building railroads, or planning the sale of billions of cellphones, what is the West’s better bet? Do we have one, or are we still asleep? HF: I think we’re still asleep. Yes, Howard French observes a Chinese style of racism in Africa, both familiar and different. “There’s a certain discourse about Africans being lazy or lacking in intelligence or unready, variations on a theme.

One guy said to me just last week in Liberia essentially: ‘there’s a thousand-year gap between them and us,’ meaning culturally, educationally, just sort of temperamentally; the ability to save, to sacrifice, to commit to a long-term project. But there’s an important distinction to be made. Western racism was instrumentalized to justify the sale of black people and their enslavement across the ocean to work as animals of labor on other continents. Chinese racism is, comparatively speaking up until this point, a largely rhetorical phenomenon” And what are Africa’s chances of doing well in the new Chinese “deal”? Howard French sees “an incredible opportunity for Africa,” but no guarantees. States with a vigorous civil society, strong elites and an informed view of “how people’s daily and longer-term interests will be served” stand to get good results.

“In states that are stuck in the kleptocratic authoritarian mode, the Chinese will pay cash on the barrel for whatever they want and all of the contracts will go through the state house and none of the money or very little of it will enter the public budget. Twenty years from now, China will say: it’s not our fault if the money is frittered away on Mercedes and villas in France and Swiss bank accounts. We paid you exactly the amount we said we were going to pay you. Don’t blame us if you have twice as many people and all of your iron ore is finished.” Podcast • January 13, 2011. Somebody said: if you’re an intelligent Islamic militant and you had a choice: to take over either Afghanistan or Pakistan, what would you do? You would take over Pakistan, obviously., the Pakistani novelist, is observing from Karachi that “even the believers” don’t believe in the war in Afghanistan anymore. No statement of purpose passes the “you’ve got to be kidding” test — not the US professions about stabilizing the region, not the Pakistani Army’s mission to defend its country.

Pakistan’s tribal areas that were peaceful before the war have been devastated. The future is disappearing. Certain dark absurdities underlying Pakistan’s situation, underlying Mohammed Hanif’s “insanely brilliant” novel,, are chasing their own tails. On January 4 this year, the rich, connected governor of Pakistan’s Punjab province, was assassinated in broad daylight in a public market in Islamabad. The shooting eerily prefigured by four days our made-in-America madness in Tucson, but it was more horrifying by many measures. Taseer took 26 rounds of sub-machinegun fire from one of his own guards before the rest of his security detail intervened.

Prominent mullahs in Pakistan have celebrated the murder and promised vengeance on Taseer’s funeral goers. At issue, so to speak, was Taseer’s enthusiasm for repealing an Anti-Blasphemy law — an old statute that in today’s fervor has enabled religious prosecutions and deadly personal fatwas on farcical grounds. (You can be charged with blasphemy in Pakistan for discarding a salesman’s business card — if the salesman, like so many of his countrymen, bears the name Mohammed.) We are drawing again on a novelist’s gift for figure and ground, the big contexts of war and faith, news and nationhood, for tragic jokes.

MH: I think the basic kind of crisis that we are going through is that somehow a large majority of people are convinced that their faith is under attack. Now, how can their faith be under attack if 98 percent of people who live in this country are faithful?

What has happened is that this environment, these perpetual wars that we’ve been involved with, have somehow convinced our people. We’ve never even begun to deal with the reasons for which this country was created, which was that there should be some kind of economic and social justice for the Muslim minority in these parts. That’s what this was supposed to be about. But yesterday I was at this big religious gathering where all the kind of hot-shots of Pakistan’s religious parties were there. And they were saying that Pakistan was actually created to protect the honor of Prophet Mohammed.

Now I’ve lived here all my life. I haven’t grown up in some kind of sheltered community. But I haven’t heard that kind of discourse ever in my life CL: How does the Af-Pak war, ongoing, affect the day-to-day outlook of Pakistanis?

MH: Well, I think it has radicalized a section of Pakistani society. It has made a lot of people cynical and anti-American I think this is probably the first time in the history of the world that a so-called friendly country, the United States, is using robots to kill the citizens of its partner in war. Now whatever logic you might apply, that doesn’t come out nice.

It’s never, ever going to sound good to anyone. There’s an Urdu saying that when your neighbor’s house is on fire, the chances are that fire will get to you as well, [especially] if you as a nation, as a country, have been stoking that fire for 30 years. If you’ve had this attitude towards your neighbor, if you’ve never considered Afghans as human beings, if you only speak of them in military terms, as targets or allies or collateral damage then Pakistan is going the same route. You can’t create a monster, you can’t create a jihadi group, as the military has in the past, that will exclusively go and kill Indian soldiers in Kashmir, and not do anything else. You can’t create a faction of Taliban whose sole duty it is to go into Afghanistan and fight the Americans. They will do it for a while.

They’ve done it for a while. But after that, they will come back and they’ll find other targets. The jihadi groups that initially were supposed to fight in Afghanistan, and then fight in Kashmir and then go and liberate Sweden or whatever country, they’ve finally turned their guns on Pakistanis, sometimes on the Pakistani establishment CL: What is it about Pakistan — a dangerous place, a dangerous state of mind — that seems to invite broad satire? I’m thinking of your own Exploding Mangoes and also Salman Rushdie’s Shame and even the Tom Hanks movie, “Charlie Wilson’s War.” People seem to forget the unfunny truths here.

MH: I grew up in a small city in Punjab, and the traditional form of entertainment there was standing on a street corner, making jokes about current affairs, about political leaders, about the village elder, about the mullah in the mosque – anybody who carried, or thought that he carried, any authority. And it was quite accepted in our culture. So for me, the first insight into how the world is run, how a city is run, how a family works together, I got from the comedy clubs. But I don’t have it in me to be a standup comic. I’m a sit-down comic. I’ll sit down and struggle with myself and maybe compose a joke, or come up with a character that can reflect some of those absurdities Pakistan has lots of TV news stations, and suddenly I’ve seen that every single channel has got a political satire show, and those are the shows that are doing really well. Things are so bad that nobody actually wants any more analysis.

Nobody wants any more pundits telling them the future because they know it is all downhill. So we might as well sit here and laugh at ourselves. Mohammed Hanif in Karachi, in conversation with Chris Lydon in Providence, January 11, 2010 Posts navigation.

Migration to Europe - and in particular the UK - has risen dramatically in the past decades, with implications for public health services. Migrants have increased vulnerability to infectious diseases (70% of TB cases and 60% HIV cases are in migrants) and face multiple barriers to healthcare.

There is currently considerable debate as to the optimum approach to infectious disease screening in this often hard-to-reach group, and an urgent need for innovative approaches. Little research has focused on the specific experience of new migrants, nor sought their views on ways forward. We undertook a qualitative semi-structured interview study of migrant community health-care leads representing dominant new migrant groups in London, UK, to explore their views around barriers to screening, acceptability of screening, and innovative approaches to screening for four key diseases (HIV, TB, hepatitis B, and hepatitis C). Participants unanimously agreed that current screening models are not perceived to be widely accessible to new migrant communities. Dominant barriers that discourage uptake of screening include disease-related stigma present in their own communities and services being perceived as non-migrant friendly. New migrants are likely to be disproportionately affected by these barriers, with implications for health status.

Screening is certainly acceptable to new migrants, however, services need to be developed to become more community-based, proactive, and to work more closely with community organisations; findings that mirror the views of migrants and health-care providers in Europe and internationally. Awareness raising about the benefits of screening within new migrant communities is critical.

One innovative approach proposed by participants is a community-based package of health screening combining all key diseases into one general health check-up, to lessen the associated stigma. Further research is needed to develop evidence-based community-focused screening models - drawing on models of best practice from other countries receiving high numbers of migrants. Introduction With an estimated 72.6 million migrants now residing in Europe, the region is an increasingly important recipient of approximately one third of the international migrant population,. In the past decade the UK in particular has received a sizeable and increasing number of new migrants, which has had important implications for public health services,.

Infectious diseases are believed to be the key health issue for new migrants from high-prevalence countries, with asylum seekers and refugees considered to be particularly affected. Migrants bear the largest burden of infectious disease in the UK; approximately 70% of newly diagnosed UK tuberculosis (TB) and 60% of new HIV cases are in migrants, with comparable trends expected for hepatitis B and C, –. London now has the highest tuberculosis rate among all capital cities in western Europe. Numerous factors contribute to the vulnerability of new migrants to infectious diseases, with migrants - and ethnic minorities more broadly - known to face barriers to healthcare, which may result in delays to screening and diagnosis,.

Tackling infectious diseases may raise specific issues, including stigma and fear of discrimination –. New migrants may be particularly affected in terms of their ability to access and benefit from screening programmes for infectious disease as they attempt to navigate a new health system,. How best to screen new migrants, and what to screen for, remains an ongoing debate in the UK and Europe –, with approaches varying considerably,,. The UK Government, for example, has recently closed down its port of entry tuberculosis screening because of concerns that it was poorly run, discriminatory, and not cost-effective, opting instead for pre-entry screening. Evidence suggests that it is critical to engage new migrants from high-prevalence countries early on if they are planning to reside in the UK for a period of time. TB is known to surface 3–5 years after arrival and data suggests that HIV is often acquired in a migrants' home country with most unaware of their status on arrival to the UK. The issue of vaccination for infectious diseases may also be important for health-care providers to address.

There have been calls to strengthen primary-care-based screening programmes, and to place renewed focus on latent tuberculosis screening to tackle the rising tide of tuberculosis,. However, there remains a paucity of data on barriers to, and acceptability of, screening programmes for infectious diseases specifically in newly arrived migrants, and potential ways forward; addressing these shortfalls remains an important component in the strategy to tackle rising rates of infectious diseases. We did a qualitative semi-structured interview study of migrant community health-care leads, who represent dominant new migrant groups in London, UK.

The aim was to explore their views around barriers, accessibility, and acceptability of screening for HIV, tuberculosis, hepatitis B, and hepatitis C. Methods We did a series of semi-structured face-to-face interviews to explore migrant community health-care leads' perceptions about (i) the barriers to screening for HIV, TB, and hepatitis B and C faced by new migrants; (ii) acceptability of screening; and (iii) innovative approaches to improve screening uptake in new migrants. We defined new migrants as foreign-born individuals who had resided in the UK for less than 5 years, arriving from countries outside Western Europe, North America, Australia, and New Zealand. Therefore, we sought information about new migrant groups from high prevalence disease countries. We carried out and reported this study using COREQ guidelines as well as the quality guidelines of Mays and Pope (2000). The study was approved by the Imperial College Research Ethics Committee.

Participant selection and recruitment We approached migrant community health-care leads who encompassed dominant groups of new migrants in the study site – which was a high migrant area of West London (Hammersmith and Fulham) where 42.8% of residents defined as foreign born. The inclusion criteria were community leads who were expert professionals with a working knowledge of the health needs of new migrants within the communities and nationality groups they represented, who were >18 years of age, and capable of giving informed consent. This approach – of recruiting community leads rather than the new migrants themselves - is one used successfully elsewhere, and was repeated with the aim of acquiring an overview of the issues facing new migrants across a broad range of nationality groups. We recruited participants using purposive sampling to enable exploration of particular aspects of behaviours relevant to the research questions. We drew up a sampling frame for the target population by carrying out internet searches of London-based community groups around the study site. This list was used as a starting point to generate a list of relevant individuals working within these community groups who would meet study inclusion criteria.

Potential participants were then directly approached by telephone and invited to participate. Those who were interested in participating were emailed a Participant Information Leaflet about the study, and re-contacted to confirm participation and arrange the interview. Purposive sampling allowed us to then use our initial participants to establish subsequent contact with other relevant participants.

Purposive sampling also allowed us to recruit a mix of nationality groups to represent the major new migrant community groups. We developed a topic guide () of both structured and open questions based on previous work conducted by the authors in collaboration with community leaders in another London-base study site and pilot tested it on the first participant. Participant recruitment continued until data saturation was achieved for all categories.

Data collection and analysis In all but two cases, FS (female, British Asian) conducted interviews at participants' workplace in a private room where only the interviewer and participant were present. FS had previously been trained to conduct research interviews in the field of migrant health. After acquiring written informed consent, participants were reminded of the study aims and assured that all information they shared would be confidential and presented in an anonymous format, and the interview then commenced for 30–90 minutes. The interviews were audio-recorded with permission (Sony VOR Microcassette Recorder M-740V) and transcribed verbatim for analysis by independent transcribers (anonymously) after each interview. Case memos were made after every interview in addition to theoretical memos to assist in the formulation of theories. Data were analysed using the principles of grounded theory, which involved systematically collecting and analysing data simultaneously throughout the research process. Data were managed using QSR NVivo 10 software.

Data was first coded by open coding to generate concepts. After carrying out the first three interviews a list of all the codes elicited from the transcripts were grouped into a list of categories using axial coding. To guard against selectivity, two researchers (FS/SH) independently conducted these processes and discussed the initial interpretations of the data, the reliability of the codes, explanations of particular codes, and additional areas for exploration within the subsequent interviews. This discussion combined with the research questions that shaped the topic guide formed the basis of the coding framework thereon. Transparency in the method and regular checks and discussion about the codes and categories mitigated experimenter bias. A constant comparison approach was then used whereby transcripts were reviewed and codes were developed in an iterative process. By constantly comparing the codes and themes and using deviant case analysis to explore conflicting views, we were able to interpret the data with validity.

As interviews were completed, selective coding was conducted where the most common codes and those seen as most revealing about the data were emphasised and unified around a core framework. A final re-check of all transcripts was carried out to check whether all text had been accounted for and to ensure that all initial open-codes were incorporated into each theme where appropriate. Member checking was also adopted by sending the final report to all the participants in the study for feedback.

Sample characteristics 50 organisations working with migrants on health issues in the survey site were identified from the initial internet search, of which 34 were unable to support us in identifying participants within their own organisation (2 shut down; 5 contact details were out of date; 19 did not respond; 4 could not identify potential participants within their own organisation, 4 organisations declined). Of the four organisations that declined participation: one only dealt with more settled migrants who had been in the UK for long periods of time; two stated that they did not have a health-care lead for an interview; and one declined due to lack of experience in the field of health care specifically. From the initial contact with the remaining 16 organisations, 20 community health leads were identified and agreed to be interviewed. By interview 20, data saturation was achieved, no new or relevant material arose, and it was highly probably that additional interviews would not have influenced results.

There were an equal number of male and female participants (mean age 42.7 years). Nine participants worked in HIV & AIDS related organisations, one in a TB related organisation, and one in a hepatitis B related organisation; 16 of 20 were migrants themselves and of the remaining, 3 out of 4 were from ethnic minority groups in the UK.

Five participants were Chief Executives/Directors of the organisations they represented, 5 were programme coordinators, 2 were project leaders, 3 were project managers, 2 were community development officers, 1 was a project officer, 1 was a volunteer, and 1 was a faith engager. Participants represented new migrant communities from 39 diverse nationalities across Africa, Americas, Asia and Europe (age range in these communities 20–85 years). The majority of new migrants represented were refugees and asylum seekers, followed by migrants claiming citizenship, and those on student visas; most of the population under discussion, therefore, were considered by participants to be of low socioeconomic status (). Screening is certainly acceptable to new migrants. Participants stressed the need for service providers to bring accessible and migrant-friendly screening into the community, strengthening collaborations with community-based organisations, and proposed a community-based package of health screening combining all of the diseases into one general health check-up with the aim of reducing stigma.

The barriers and facilitators described were points most commonly recommended or strongly recommended by participants. Screening is inaccessible to the new migrant community Participants identified a range of barriers to screening for infectious diseases at the health system, community, and individual level (). There was strong agreement among participants that screening for infectious diseases was not accessible to the new migrant community in the UK.

Most participants felt that although screening services do exist, they are not adequately reaching people in the community, stating that “people don't even know that these [screening services] exist” (Participant 11, age 31, male, Latin American community) and that new migrants specifically “do not easily take them up” (Participant 1, age 52, male, African community). Some participants added that the services are not well-publicised as information on them is not given to new migrants who are attempting to navigate a new health system, while one participant believed that services at present are “not pro-active” in encouraging new migrants to come forward for testing, and focus remains too much on the “treatment angle” rather than a preventative approach (Participant 13, age 32, male, migrant communities). Barriers to screening reported. The most cited barrier, highlighted by 19 of 20 participants, was the stigma and misconceptions that new migrant communities' hold about the key diseases. Participants identified that stigma within their own communities is the “biggest barrier to date” and the “biggest dilemma” they face when considering going for screening.

Each disease has more than one different type of stigma in the different communities. According to participants, we found that TB, HIV, and hepatitis B and C can be perceived by new migrant communities as being “fatal” and/or “highly infectious”, which generates fear of testing. As a result of stigma, new migrants may “run-away” from the infected individuals, not inviting infected individuals to their houses, eating with them, or wanting to be near them. Participants said this discourages people from attending screening, because they may have to face such disease-related social consequences if people know they have attended screening and an infection is found.

TB specifically is perceived in the Somali and Asian community as a “disease of the poor” and in the Asian community also as “hereditary”. Participants unanimously considered HIV to still be the most stigmatised disease of the four. Issues around stigma for HIV are complex and deeply interlinked with a migrant's culture and faith.

Stemming from cultural and religious beliefs, HIV is perceived as a result of a “sinful” and “immoral” lifestyle including “pre-marital sex”, “drug use”, “promiscuity”, or “being gay”. Participants said that new migrant communities see HIV as being self-inflicted, a “punishment from God” and a “well-deserved disease”. This prevents people from attending screening “as nobody wants to be seen in that way” (Participant 5, age 59, male, Somali community). Two participants also indicated that in the African migrant community, HIV is strongly associated with TB. Therefore, people often misconceive patients who have TB as having HIV or vice versa. Little was known about hepatitis stigma and only three participants indicated that the stigma could be similar to the way in which HIV is perceived, “filled with things about a lifestyle, moral behaviour and stereotypical things” (Participant 2, age 44, male, Ukrainian community).

The second most important barrier reported by participants was that the screening services are not “migrant friendly”. Twelve participants expressed concerns about the cultural insensitivity experienced by new migrants within services, where sometimes assumptions are made about the patients.

In addition to cultural insensitivity, eight participants indicated that new migrants were frustrated with the inhospitable and unfriendly experiences when they accessed services. Many of these participants were concerned with the inhospitality of receptionist staff in particular; one participant said that this was the case even where receptionists were from an ethnic minority or migrant background themselves.

In addition, seven participants identified discrimination from health-care professionals as an important barrier. Some participants mentioned that the discrimination was against the new migrants' country of origin, for example one participant who went to ask for results was asked by a nurse, “Is this the way you guys behave in Africa?” (Participant 13, male, age 32, all migrant communities), while another participant reported patients being asked: “why don't you speak English, how long have you been here?” (Participant 20, age 36, female, all migrant communities). Language barriers may be a particular issue for new migrants on arrival; most new migrants represented in this study spoke little English (). Another participant identified that it was a combination of their migrant status, as well as their infectious disease, that lead to discrimination. Four participants, however, felt that services were culturally sensitive and had not come across any cases or complaints from within their communities.

Participants also mentioned a number of barriers that may be unique to new migrants, including the issue of a lack of entitlement to free health care and confidentiality issues (). Participants commented that new migrants “have to find their own way” (Participant 5, age59, male, Somali community), that “they don't know what existsthat they have the right, that it's free” (Participant 11, age 31, male, Latin American community). New migrants “may not think they're entitled to help here and they may not think they could just go and get it” (participant 15, age 48, male, African community). New migrants may also have confidentiality issues “concerns around immigration” and whether their “disease status will be shared with immigration services” (Participant 12, age 27, male, Afro-Caribbean community).

Participants report that new migrants are concerned that clinical services, especially in hospital settings, are “government bodies and attached to the governmenttherefore somehow linked to immigration” (Participant 10, male, age 29, Asian community). In particular, some new migrants perhaps “don't have a visa” and are scared of “exposing themselves” by attending screening as “they will be deported because of their status” (Participant 18, age 59, female, African community).

Barriers to care have implications for health status Participants highlighted a number of consequences that barriers can have for a new migrant patient and the wider community. Directly, the barriers stopped migrants from attending screening services as they “wait until their situation has got a little bit worse, when it's actually disabling them and they can't do any other activities” (Participant 14, age 40, male, African community) before they get tested for the diseases.

“When they are screened later then the medication is not given the optimum chance to work for themthen obviously they have got a very narrow chance of recovery” (Participant 1, age 52, male, African community). Four participants mentioned that this “late diagnosis” has led to cases of death in their communities; a case study from one participant is presented in. Case study on the consequences of the barriers to screening. Two participants mentioned that in the Eastern European community new migrants may turn to alternative forms of medication, for example, getting “herbs sent back from home” (Participant 2, age 44, male, Ukrainian community), “return back home” (Participant 7, age 31, female, Eastern European community) to do the screening or may also use services from individuals in the community “who they knew practiced medicine back in their own country” but who are not yet licensed in the UK (Participant 2, age 44, male, Ukrainian community). At the community level, participants raised concerns that by presenting late and not knowing ones status, new migrants with infections may be “putting others at risk” and increasing “the number of people being exposed to that risk” (Participant 6, age 34, female, Arabic speaking community). How do we improve access to screening? Despite this lack of accessibility there was consensus among participants that screening is acceptable to new migrants, if services are promoted and offered in a tailored and sensitive manner, and uptake would be high if barriers were broken down.

Participants collectively reported that between 50% and 100% of new migrants they represented would consider screening if it was more accessible to them. One participant mentioned that “in relation to their health they [the community] wouldn't hesitate to take part in the screening.because it's for their benefit.” (Participant 6, age 34, female, Arabic speaking community). Key factors to consider when making screening more accessible included ensuring better collaboration between service providers and community organisations, as well as combining the screening of diseases into one appointment (). Whether with faith-based or nationality based organisations, all participants strongly conveyed the message that screening services need to be taken out into the community and that the health service must work in partnership with community organisations. Community organisations are a key “asset” because they have the link to the migrant communities and hard-to-reach individuals (Participant 13, age 32, male, migrant communities).

Interventions should be “co-owned” and based on the “principles of partnership about coexistence, collaboration, and cooperation” (Participant 13, age 32, male, all migrant communities) if screening services are to be made more accessible. Statutory service providers should focus on raising awareness of diseases, promotion of screening services, language and psycho-social support, as well as designing services that are migrant friendly and culturally sensitive with input from community organisations. Approaches identified to make screening more accessible. Most of the participants argued that screening services need to be taken out of the hospital and into the community to make access easy, ”not sticking into one building or geographical location” (Participant 13, age 32, male, all migrant communities) and “delivering the service to the people where they are” (Participant 15, age 48, male, African community).

Participants identified community settings such as places of worship, football games, community centre events, and carnivals as good opportunities to run screening interventions. As one participant explained, there is a bus outside the local market where - with the assistance of community health workers - individuals can “go in there, get fully screened, come back to the market and buy your goat meat and your plantain and go home knowing your status” (Participant 15, age 48, male, African community). Another participant made the point that people would prefer screening at the site of a community organisation, compared to a hospital, as they would feel more “comfortable” having attended the organisation before, and that these organisations have “staff employed from the community itself, when people come they may have a worker on hand who can talk them through the process in a culturally sensitive manner, or in a linguistically sensitive manner” (Participant 10, male, age 29, Asian community). By bringing screening into communities screening programmes will “work better and be far more effective” (Participant 15, age 48, male, African community). 15 of 20 participants considered that the best approach is to offer new migrants a package of care to include screening for TB, HIV, and hepatitis B and C at one appointment; the majority supported the idea of this being within a community setting.

Participants suggested that screening be advertised as a general “health check” which would make migrants more receptive and considerably lessen the stigma of infectious diseases. Most importantly, participants felt that offering screening for multiple diseases at one appointment would lessen the dominant barrier of stigma that can prevent migrants from attending screening. This approach could be “immensely convenient for the person as well as the service” (Participant 15, age 48, male, African community).

Participants suggested that packaging screening in this integrated way will reduce stigma, or “push stigma down” (Participant 13, age 32, male, all migrant communities) and participants would say yes to screening as it “is enough for people to take a minute and think okay, I know for a fact that I might not have HIV but I might well have the others” (Participant 6, age 34, female, Arabic speaking community). Discussion This research highlighted strong agreement among health-care leads that screening for infectious diseases is currently inaccessible to the new migrant community in the UK. Interestingly, a key factor in poor uptake rate among the new migrant community was stigma and misconceptions that new migrant communities' themselves hold about the key diseases, deeply interlinked with a migrants' culture and faith, as well as perceived fears around the social implications of attending screening and receiving a positive diagnosis. Participants identified numerous barriers to accessing screening services at the current time - which were considered to be non-migrant friendly and culturally insensitive. New migrants are likely to be disproportionally affected by these barriers, and delays to diagnosis and treatment may have health consequences. However, there was strong consensus that acceptability of screening of the four key diseases is high among new migrants.

Participants stressed the need to bring accessible and proactive screening into the community, strengthening collaborations with community-based organisations. They supported the idea of a community-based package of health screening combining all of the diseases into a general health check-up, with the aim of lessening the associated stigma.

We are aware that the views expressed by participants will reflect their own experiences of working with the health system around West London. While this may impact on the responses they provided, as community leads, their primary role is to represent their communities. We encouraged interviewees to talk about the wider communities around them; nevertheless, it is a challenge to have one group of people speak for another, and a separate study exploring the specific views of different groups of new migrants will be of interest. In addition, we are aware that a considerable number of participants were working in HIV as oppose to other infectious diseases under discussion, which will mean there may be an inevitable focus on barriers as they relate to HIV services. Data are limited on the issue of infectious disease screening specifically in the new migrant community; however, numerous studies exist on the use of general health services by the wider migrant community and ethnic minority groups which confirm a myriad of potential barriers to access that confer with our findings –. Studies specifically exploring HIV testing barriers in migrants, including a systematic review overlap with our findings in new migrants across all four diseases – including migrants having insufficient information about diseases and their prevention, lack of knowledge about health service provision, a perceived discriminatory attitude of health-care providers (including reception staff), fear of a lack of confidentiality and deportation, and confusion over entitlement to free health care –.

Furthermore, studies on tuberculosis in “vulnerable groups” report that a key barrier to screening was to do with concerns around stigma within their own communities, and a fear of death –. For hepatitis B and C, previous studies in migrants and ethnic-minority groups report barriers related to language and culture, discrimination and stigma, low confidence in health services, lack of knowledge of available services, association of hepatitis testing with sexual health, and a low perception of disease risk,,. What is clear is that the data themes we have documented are not unique to new migrants, but common experiences of migrant and ethnic minority groups affected by these diseases. However, it is our view that new migrants who are attempting to navigate a new health system and settle in a new community are likely to be disproportionally affected. That barriers to health care among new migrants may impact on health status has been previously reported,.

That acceptability for screening of HIV, TB, and hepatitis B and C is high among migrants has also been reported elsewhere, with migrants considered to be proactive about their health and screening “valued highly”,. We found that there was a unanimous view among participants that to facilitate greater uptake of testing screening must be brought into the community, with service providers strengthening collaborations with community-based organisations. In the UK and elsewhere there are interesting examples of successful community outreach screening initiatives that target migrants for TB, HIV, or hepatitis (); however literature on community-based approaches are scarce with few high quality or controlled studies evaluating community models. We have found that data from innovative locally tested screening initiatives are often not published so the benefits of these approaches remain unclear. Conversely, international studies have reported unsuccessful community-based collaborations, in terms of uptake and cost-effectiveness. The Migrant-Friendly Hospitals Initiative, which resulted in The Amsterdam Declaration (Towards Migrant-Friendly Hospitals in an Ethno-culturally diverse Europe) in 2004, specifically calls for service providers to focus on developing partnerships with local community-based organisations with a view to improving service delivery to migrant groups. Screening high risk groups for TB in General Practice/primary care has been formally assessed in a randomised controlled trial and found to be successful in terms of increased yield.

The optimum approach in high-migrant receiving countries is most likely to offer screening in a range of settings,, incorporating a strong focus on community engagement and partnership with migrant organisations in both the design and implementation of screening approaches. Examples of international models of community-based migrant screening collaborations for TB, HIV or hepatitis B and C.

The idea raised by participants of combining these diseases into some kind of general health check-up, with the aim of reducing the considerable stigma associated with infectious diseases, merits further exploration. Such an approach will need to be combined with awareness raising about the benefits of screening within new migrant communities, and attempts to facilitate high uptake to services, in an attempt to tackle misconceptions and reduce stigma. The UK's Health Protection Agency previously recommended that consideration be given to the idea of an extended New Patient Health Check for certain groups of migrants in primary care. To what extent such an approach can be adopted in other high-migrant receiving countries is unknown, with countries taking a wide variety of approaches to screening for infectious diseases in this patient group. Further research is now urgently needed to develop evidence-based community-focussed screening models - drawing on models of best practice and lessons learned from UK and internationally – as well as exploring how healthcare professionals can work more effectively with the new migrant community to facilitate improved access to screening.