The first drug purporting to slow the advance of Alzheimer’s disease is likely to cost the U.S. health care system billions annually even as it remains out of reach for many of the lower-income seniors most likely to suffer from dementia.

Medicare and Medicaid patients will make up 92% of the market for lecanemab, according to Eisai Co., which sells the drug under the brand name Leqembi. In addition to the company’s $26,500 annual price tag for the drug, treatment could cost U.S. taxpayers $82,500 per patient per year, on average, for genetic tests and frequent brain scans, safety monitoring, and other care, according to estimates from the Institute for Clinical and Economic Review, or ICER. The FDA gave the drug full approval July 6. About 1 million Alzheimer’s patients in the U.S. could qualify to use it.

Patients with early Alzheimer’s disease who took lecanemab in a major clinical trial declined an average of five months slower than other subjects over an 18-month period, but many suffered brain swelling and bleeding. Although those side effects usually resolved without obvious harm, they apparently caused three deaths. The great expense of the drug and its treatment raises questions about how it will be paid for, and who will benefit.

“In the history of science, it’s a significant achievement to slightly slow down progression of dementia,” said John Mafi, a researcher and associate professor of medicine at the David Geffen School of Medicine at UCLA. “But the actual practical benefits to patients are very marginal, and there is a real risk and a real cost.”

To qualify for Leqembi, patients must undergo a PET scan that looks for amyloid plaques, the protein clumps that clog the brains of many Alzheimer’s patients. About 1 in 5 patients who took Leqembi in the major clinical test of the drug developed brain hemorrhaging or swelling, a risk that requires those taking the drug to undergo frequent medical checkups and brain scans called MRIs.

In anticipation of additional costs from the Leqembi drug class, the Centers for Medicare & Medicaid Services in 2021 increased monthly premiums for Medicare patients by 15%, and premiums may rise again in 2024 after a slight decline this year.

Such increases can be a significant burden for many of the 62 million Medicare subscribers who live on fixed incomes. “Real people will be affected,” Mafi said. He contributed to a study that estimated lecanemab and related care would cost Medicare $2 billion to $5 billion a year, making it one of the most expensive taxpayer-funded treatments.

In its analysis, ICER suggested that Leqembi could be cost-effective at an annual price of $8,900 to $21,500. In an interview, David Rind, ICER’s chief medical officer, said $10,000 to $15,000 a year would be reasonable. “Above that range doesn’t seem like a good place,” he said.

Whatever its price, patients may be delayed getting access to Leqembi because of the relative shortage of specialists capable of managing the drug, which will require genetic and neuropsychological testing as well as the PET scan to confirm a patient’s eligibility. A similar drug, Eli Lilly’s donanemab, is likely to win FDA approval this year.

Already there are long waits for the testing needed to assess dementia, Mafi said, noting that one of his patients with mild cognitive impairment had to wait eight months for an evaluation.

Such testing is not readily at hand because of the paucity of effective treatment for Alzheimer’s, which has helped to make geriatrics a relatively unappealing specialty. The United States has about a third as many dementia specialists per capita as Germany, and about half as many as Italy.

“Time is of the essence” for the neuropsychological testing, Mafi said, because once a patient’s cognitive ability declines below a certain threshold, they become ineligible for treatment with the drug, which was tested only in patients in the earliest stages of the disease.

Mafi’s study estimates that patients without supplemental Medicare coverage will have to pay about $6,600 out-of-pocket for each year of treatment. That could put it out of reach for many of the 1 in 7 “dual eligible” Medicare beneficiaries whose income is low enough to simultaneously qualify them for state Medicaid programs. Those programs are responsible for about 20% of physician bills for drug infusions, but they don’t always cover the full amount.

Some practitioners, such as cancer centers, cover their Medicaid losses by receiving higher rates for privately insured patients. But since almost all lecanemab patients are likely to be on government insurance, that “cross-subsidization” is less of an option, said Soeren Mattke, director of the Center for Improving Chronic Illness Care at the University of Southern California.

This poses a serious health equity issue because “dual eligibles are low-income patients with limited opportunities and education, and at higher risk of chronic illnesses including dementia,” Mattke said in an interview. Yet many doctors may not be willing to treat them, he said. “The idea of denying access to this group is just appalling.”

Eisai spokesperson Libby Holman said the company was reaching out to specialists and primary care physicians to make them aware of the drug, and that reimbursement options were improving. Eisai will provide the drug at no cost to patients in financial need, she said, and its “patient navigators” can help lock down insurance coverage.

“A lot of clinicians are excited about the drug, and patients are hearing about it,” said David Moss, chief financial officer of INmune Bio, a company that has another Alzheimer’s drug in development. “It’s a money center for infusion centers and MRI operators. It provides reasons for patients to come into the office, which is a billing thing.”

Outstanding doubts about Leqembi and related drug s have given urgency to efforts to monitor patient experiences. CMS is requiring Leqembi patients to be entered into a registry that tracks their outcomes. The agency has established a registry, but the Alzheimer’s Association, the leading advocacy group for dementia patients, is funding its own database to track those being treated, offering physician practices $2,500 to join it and up to $300 per patient visit.

In a letter to CMS on July 27, a group of policy experts said CMS should ensure that any and all Leqembi registries create and share data detailed enough for researchers and FDA safety teams to obtain a clear picture of the drug’s real-world profile.

The anti-amyloid drugs like lecanemab have created a polarized environment in medicine between those who think the drugs are a dangerous waste of money and those who believe they are a brilliant first step to a cure, said ICER’s Rind, who thinks lecanemab has modest benefits.

“People are as dug in on this as almost anything I’ve ever seen in medicine,” he said. “I don’t think it’s healthy.”

NORFOLK — It takes a village to keep neighborhoods safe, city leadership said at the Tuesday’s National Night Out event.

Residents from across Norfolk gathered on the city’s southside at Berkley Park to learn and promote violence prevention and public safety. In the neighborhood and surrounding the park, dance music echoed from the park’s stage ascommunity members bopped together.

National Night Out is a movement that began in the western suburbs of Philadelphia in 1984 and aims to build police-community partnerships and neighborhood camaraderie. Through a network of police departments, the first annual National Night Out involved 2.5 million neighbors across 400 communities in 23 states. The event, scheduled for the first Tuesday in August (or October, in select communities), is now hosted in all fifty states, U.S. territories and military bases across the world.

“National Night Out is all about how we treat each other when we come together,” Norfolk Police Chief Mark Talbot said. “The essence of this night is about building our connections with each other: first, resident-to-resident. A great city is created when residents are connected to each other and then are connected to police.”

This year, 162 communities pledged to hold National Night Out events in the commonwealth, including cities in Hampton Roads. According to the National Night Out official website, the events bring together an estimated 38 million people across 17,000 communities nationwide. At Berkley park, attendees were greeted by representatives from entities across the city and Hampton Roads — from the Commonwealth’s Attorney’s office and sheriff’s office to the Community Emergency Response Team and violence prevention organizations. The police department’s COPsicle truck passed out icy treats as children played basketball on the park’s court.

Danica Royster, representative of Superward 7, said that a “village mindset” is necessary for violence prevention.

“This is what community is about,” Royster said. “This is how we take back the block. We look out for one another. We express interest in one another.”

Bilal Muhammad, community activist and a leader of the Stop the Violence Team, said community members must also hold themselves responsible by working with investigations if they are to see anything suspicious or dangerous in their neighborhoods. Silence, he said, perpetuates violence.

“We just lost our son to gun violence, Ali Kareem Muhammad,” he said. “It’s been 31 days now, and it took a lot for us to be out here today, but my wife and I, we talked about it, and we decided to be here with the community and with family. We must be very vigilant. When you see something, say something. I found out that criminals, murderers, they plan their move and create friction, so that you may leave the scene. When you leave a scene, then they execute. We’ve got to learn how to stay on the scene. We have to learn how to dial 911. We’ve got to learn how to stay right there so the violence does not take place. I’m telling you what I know … It happens all the time. We’ve got to be the policemen for our brothers and our sisters.”

Eliza Noe, [email protected]

Jim Weaver has had two major surgeries in the past decade: one to remove cancerous tumors from his bladder and another to clear a blocked artery.

Weaver, 70, knew that after he emerged from surgery, he’d want privacy. But because he and his wife drove more than 150 miles from Bend, Oregon, to Oregon Health & Science University Hospital in Portland, immediately returning home was not an option.

So, the couple brought their Escape 19 camping trailer, a small but comfortable home on wheels, and parked it in one of the hospital’s 17 on-site RV parking spaces.

“Leaving that hospital with the bandage, the scar, and the rest of it, there’s no way I wanted to be in a hotel,” he said. “Being able to go down and stay in the trailer there, jeez, it was so huge.”

Weaver was fortunate. OHSU Hospital, one of two Level I trauma centers in the state, is one of several medical centers in the United States that maintain parking spaces specifically for RVs, electric hookups included. The hospital has offered the free amenity to patients since 2009.

Medical and RV industry professionals say hospitals that offer RV parking are easing access to health care for some patients who drive long distances for care, like many rural residents.

Monika Geraci, a spokesperson for the RV Industry Association, said she could understand the appeal to patients who travel with campers. “It’s your home away from home on wheels,” she said. “You’re able to bring all of your creature comforts. It’s your bed, it’s your sheets, it’s your bathroom, it’s your kitchen.”

Many patients drive eight to 10 hours to receive care at OHSU Hospital, said Brett Dodson, who oversees the facility’s parking and transportation services.

“They’ve seen the rural clinics and they need to come to that next level,” he said. “When they do, I think they’re more comfortable with an RV than they are trying to find a hotel.”

The average stay for a patient in the RV spaces is about seven days, and the limit is 30 days at a time. If a patient depends on the hospital for a recurring treatment like kidney dialysis, they’ll stay every few months. Recently, spots were occupied by transplant patients and a family with a baby in the intensive care unit, Dodson said.

The spots help patients keep close to their medical providers and avoid paying for hotels. If patients don’t have access to an RV or would rather stay in a hotel, Dodson’s team refers them to the on-site lodging that OHSU runs in partnership with the local chapter of Ronald McDonald House Charities or a nearby hotel that gives patients a discounted rate.

In addition to improving patient comfort, Dodson said, the RV spaces set the hospital up to provide better care. People who previously would have driven through the night to get to Portland for a morning surgery can now arrive the night before, he said. “They can get a good night’s sleep, they’d be ready for a surgery, and they’re there on time.”

Accommodations hospitals offer RV travelers vary widely and many aren’t part of an official policy. Among those that do offer overnight RV spaces, not all offer designated spaces or utility hookups like OHSU Hospital.

In Montana, patients have been parking their campers at Bozeman Health Deaconess Regional Medical Center for years. It started informally, when tourists got hurt while adventuring or sick while passing through the mountain city of 56,000 people. This spring, Bozeman Health created a short-term RV parking program at the hospital, which so far has largely been used by Montana patients traveling for care they couldn’t receive closer to home.

Bozeman Health worked for years to turn itself into a medical hub in southwestern Montana, expanding into specialty services such as intensive care for infants and cancer treatment. Simultaneously, hotel prices in the destination town, one of the gateways to Yellowstone National Park, have skyrocketed, and competition to find a place to stay in peak tourist season is high.

“There are towns in Montana that just don’t have hospitals,” said Kallie Kujawa, the chief operating officer at Bozeman Health. “We had a couple who came who could not find anywhere to stay in town. This was the only place they could find to stay. And that was critical for them.”

Patients can reserve a space for free for up to two weeks. Like at the hospital in Oregon, they need to bring their own water and lug their trash out. Bozeman Health has only two RV spaces; though, Kujawa said, the system could expand if demand increases.

Since it isn’t always clear whether a hospital will allow someone to park an RV on its property, publications and forums for RV owners have offered advice on the issue. An article in Family RVing, the Family Motor Coach Association’s magazine, encouraged readers to call ahead and ask for permission. The association does not, however, have specific guidelines for its members about RV parking at hospitals, said Robbin Gould, the magazine’s editor. Still, “from what various FMCA members have reported, hospital officials have granted permission for them to park their RVs on hospital property,” she said.

And it isn’t always patients who are looking to sort out a hospital’s RV parking situation. Staff also have an interest in on-site RV amenities.

In Salida, Colorado, an RV parking lot at Heart of the Rockies Regional Medical Center tends to get more use from hospital staff than from patients. Both patients and staff can stay at the six-spot, full-hookup lot for free.

One RV there recently was home to a new employee who was house hunting. Two nurses tend to use the lot while they work three straight days of 12-hour shifts, allowing them to avoid a commute over the mountains to their hometowns. A part-time general surgeon from Colorado Springs stays in the lot, too. A nurse comes down every week from Denver, a 2½-hour drive away.

“It’s been very popular, to say the least,” said the medical center’s CEO, Bob Morasko. “I just know that it works. And it helps us staff the hospital.”

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KFF Health News Montana correspondent Katheryn Houghton and Colorado correspondent Rae Ellen Bichell contributed to this report.

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©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.

Things are really starting to heat up in Norfolk’s Railroad District.

District Apizza, featuring New Haven, Connecticut-style pizza, known for its crispy thin crust, will open in mid-August at 2411 Granby St. Pronounced “ah-beetz,” the business is affectionately called by the name Neapolitan immigrants dubbed the style of pizza before they brought it to the U.S.

The pizzas are baked at 600-700 degrees Fahrenheit in wood-fired ovens imported from Italy that were assembled piece by piece on-site by masons.

In addition to pizza, the menu will include salads and Italian bar food with a tapas twist featuring pasta made on-site, said Matt Albano, one of the owners. The restaurant will also sell beer, wine and cocktails.

“I think the quality of the food will speak for itself,” he said.

When the coronavirus pandemic hit, Albano, like many others, took stock of his professional life. Recruited in 2007 as the campus president for ECPI’s Medical Careers Institute in Virginia Beach, Albano had stayed on board there for seven years before taking a similar position at Fortis College in Norfolk.

“I noticed that regional pizza varieties were becoming more popular in their own right,” he said.

Albano, a Connecticut native, came up with the business idea and partnered with friends Mike Kreider and Rich Coleman in the business. All three live in Chic’s Beach.

Kreider, a Virginia Beach native who lived up north for two and a half years, said he only missed two things since returning south — the pizza and lobster.

“I missed it and I wanted it here,” Kreider said.

For Coleman, owner of HK on the Bay in Chic’s Beach, it was a trip last summer that sold him on the pizza.

“These guys took me up there and we spent a weekend eating pizza,” Coleman said. “You go to pretty much any big city and you can find New Haven-style pizza.”

Gaining popularity, primarily along the East Coast, Albano said he is excited to bring the pizza to the designated historical district that he and his partners see as an up and coming vibrant and energetic area in Hampton Roads.

District Apizza is housed in a former tractor supply building that dates back to circa 1920. It was most recently the site for the nonprofit organization ForKids’ thrift store, Good Mojo.

The trio signed the lease in late June 2022 for the 7,200-square-foot building and began the build-out following the landlord’s work on water lines, gas lines, heating and air conditioning and plumbing.

With an indoor seating capacity of 168, including tables, high tops and bar seating, the space boasts a traditional feel with a mix of original tiles covering its floor and white washed bricks poking through the walls.

John Williams, general manager, said he’s been busy with all different aspects of readying the restaurant for its opening, including hiring and training a team of roughly 50.

In time, the trio wants to invite local bands to bring their talents to the restaurant.

For now, Albano said the pizza will be the star of the show and he’s fired up to introduce it to Hampton Roads.

Sandra J. Pennecke, 757-652-5836, [email protected]

By ANDREW SELIGMAN (AP Sports Writer)

Northwestern has hired former U.S. Attorney General Loretta Lynch to lead an investigation into the culture of its athletic department and its anti-hazing procedures following allegations of abusive behavior and racism within the football program and other teams.

Lynch, who served as Attorney General from 2015 to 2017 under former President Barack Obama, will begin her review immediately, the school announced Tuesday. She will seek input from faculty, staff, students and alumni. The university announced no timetable for the investigation but said the results will be made public, unlike those of a previous investigation commissioned by the school.

“Hazing has absolutely no place at Northwestern. Period,” Northwestern President Michael Schill said in a statement. “I am determined that with the help of Attorney General Lynch, we will become a leader in combating the practice of hazing in intercollegiate athletics and a model for other universities. We will provide all of our students with the resources and support they need and do whatever is necessary to protect their safety and ensure that our athletics program remains one we can all be proud of.”

Athletic director Derrick Gragg said his department welcomes the investigation, calling it “a critical tool in identifying the additional steps Northwestern can take to eradicate hazing.”

“By making the results of her review public, we hope our entire community will be better informed and guided as we all work to address this critical issue in college athletics,” he said.

Attorneys representing athletes suing Northwestern blasted it as a publicity stunt and questioned whether the previous investigation that led to longtime football coach Pat Fitzgerald’s firing was thorough enough.

“We have to wonder if this is nothing more than an effort to counteract negative press, and more importantly, the growing number of former Northwestern football players filing lawsuits against the University,” attorneys Ben Crump, Steve Levin and Margaret Battersby Black said. “The University’s top priority should have been, and should be, doing right by the victims of these despicable acts and eradicating hazing from their campus. And they can start by being transparent and releasing the full report from the first investigation to the public.”

Lynch, who works for the law firm Paul, Weiss, Rifkind, Wharton & Garrison, was hired in November by the Boston Bruins to investigate the NHL team’s player-vetting process after it signed prospect Mitchell Miller and then rescinded his contract offer. Miller had his draft rights relinquished by Arizona for bullying a Black classmate with developmental disabilities in middle school.

Lynch is representing the NFL in Brian Flores’ race discrimination lawsuit. She also oversaw the sprawling investigation of international soccer that was unsealed in 2015 and led to the removal of a generation of soccer leaders in North and South America, and Switzerland-based FIFA and UEFA.

Northwestern is facing lawsuits from multiple former football players as well as one from a former volleyball player who says she was physically harmed during a hazing situation and mistreated by coach Shane Davis. Attorneys representing the former Northwestern athletes have said more lawsuits will be filed.

Fitzgerald — the program’s winningest coach and a star linebacker for the Wildcats in the 1990s — was fired by Schill on July 10 after initially being suspended two weeks following an investigation by attorney Maggie Hickey of law firm ArentFox Schiff that found hazing within the program and “significant opportunities” for the coaching staff to know about it. He was replaced an interim basis by David Braun, who was hired as defensive coordinator six months earlier.

Baseball coach Jim Foster was fired July 13 amid allegations of a toxic culture that included bullying and abusive behavior. Assistant Brian Anderson, a former major leaguer who won a World Series ring with the Chicago White Sox in 2005, took over on an interim basis.

Northwestern said following Hickey’s investigation the football team would no longer hold training camp in Kenosha, Wisconsin, as it did for years and would have someone not affiliated with the program monitor the locker room.

The school said at the time it would require annual anti-hazing training for coaches, staff members and athletes with an emphasis on reporting options and the responsibility to report as well as discipline. Other measures include creating an online tool for athletes to report hazing anonymously.

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AP college football: https://apnews.com/hub/college-football and https://apnews.com/hub/ap-top-25-college-football-poll

COLLEGE FOOTBALL

Old Dominion linebacker Jason Henderson continues to add to his list of preseason honors after a monster 2022 season.

On Tuesday, he was included on the Bronko Nagurski Trophy watch list, the Football Writers Association of America announced. The trophy has been given annually since 1993 to the top defensive player in the country.

Henderson, a 6-1, 225-pound junior from Dingmans Ferry, Pennsylvania, led the nation with 186 tackles last season. He broke the ODU and Sun Belt Conference single-season records for tackles. That led to five postseason All-America honors for him.

James Madison’s James Carpenter was among five other Sun Belt players to make the Nagurski watch list.

Also on Tuesday, Henderson made College Football Network’s All-Sun Belt preseason first team.

The Monarchs’ Ethan Duane was the Punter of the Year and made the specialists first team.

ODU defensive tackle Denzel Lowry made the second team, while cornerback LaMareon James and kicker Ethan Sanchez were on the third team and center Xavier Black and safety Terry Jones earned honorable mention.

James Madison’s Nick Kidwell was Offensive Lineman of the Year, while teammate Taurus Jones was Linebacker of the Year. They both made the first team along with defensive tackle James Carpenter.

• Linebacker John Pius was among five William & Mary players to be named to the Stats Perform FCS Preseason All-America Team. Pius was on the first team, while defensive lineman Nate Lynn and running back Bronson Yoder made the second team and cornerback Ryan Poole and long snapper Nick Levy made the third team.
• Hampton University linebacker Qwahsin Townsend has been named to the Bluebloods’ preseason All-CAA first team. He led the Pirates with 100 tackles last season. William & Mary had six players on the first team: running back Bronson Yoder, offensive lineman Charles Grant, defensive lineman Nate Lynn, linebacker John Pius and defensive backs Ryan Poole and Jalen Jones.
• James Madison offensive lineman Nick Kidwell and defensive lineman James Carpenter have both been named to the watch list for the Outland Trophy. The award  is presented to college football’s best interior lineman. They are the first JMU players in program history to be named to the award’s watch list.
• Norfolk State is offering gameday cabanas for home football games this season. It will include game tickets, heavy hors d’oeuvres, beverage tickets, pre-game snacks and an unparalleled atmosphere. They can be purchased by contacting the NSU athletics office at 757-823-8152.

COLLEGE SOCCER

UVA women ranked fifth in poll

The University of Virginia women’s soccer team is ranked fifth in the United Soccer Coaches Associated preseason poll, which was released Tuesday.

The Cavaliers went 16-4-3 and advanced to an NCAA region final last season.

Meanwhile, the UVA men are ranked 15th in the USCA poll. They finished 10-4-5 last season.

In the Division III women’s poll, Virginia Wesleyan is ranked fourth and Christopher Newport is sixth.

CNU is ranked 21st in the Division III men’s poll.

Briefly

• Pitcher DL Hall is returning to the Norfolk Tides after spending a month in Florida trying to regain his strength after a back injury, according to multiple reports. The left-hander is expected to take a reliever role initially.
• Kyle Pope has joined the William & Mary men’s basketball staff as director of basketball operations. The former two-sport athlete at Saint Vincent College in Latrobe, Pennsylvania, comes to Williamsburg with coaching experience at the Division II and Division III levels.
• University of Virginia women’s lacrosse coach Sonia LaMonica has announced the addition of Caylee Waters as an assistant coach. Waters is a U.S. national team member and competes professionally with Athletes Unlimited. She has been a volunteer assistant for UNC and Army.

By EVENS SANON and MEGAN JANETSKY (Associated Press)

PORT-AU-PRINCE, Haiti (AP) — Aid efforts for Haitians enduring the gang violence ravaging their nation suffered a new blow with the kidnapping of an American nurse from New Hampshire and her young daughter, who were still missing Tuesday.

Gang warfare has increasingly plagued Haiti since the 2021 assassination of President Jovenel Moïse. The killing worsened criminal control of Haiti and today the innocent are regularly killed, raped and held for ransom. A local nonprofit has documented 539 kidnappings since January, a significant rise over previous years.

That number is almost certainly underreported in Haiti, where many people fear authorities in addition to the gangs. Hospitals and other aid organizations — often the only institutions in the country’s many lawless areas — have increasingly been criminals’ targets. Many service providers have been forced to close, leaving a growing number of people in this country of 11.45 million without access to healthcare, food, education and other basics.

Haitians, aid providers and outside observers worry that the kidnapping of New Hampshire native Alix Dorsainvil and her daughter will turn more of the nation into a no-go zone for anyone besides gangs and the populations they torment. The Christian organization Dorsainvil works for, El Roi Haiti, has offered medical care, education and other basic services. The organization released a photo of Dorsainvil smiling happily with her arm around her husband but provided no details about the mother and their daughter.

Dorsainvil was providing medical care in El Roi Haiti’s small brick clinic late last week in a gang stronghold of the country’s capital, Port-au-Prince, when armed men burst in and seized her, witnesses told The Associated Press. The captors have demanded $1 million in ransom, a standard practice by the gangs to get money to fund operations.

“(The kidnapping) is definitely going to have a chilling impact on the work that particularly smaller aid groups do in the country,” said Renata Segura, International Crisis Group’s deputy director for Latin America and Caribbean. “People are going to be thinking about it twice before returning to those communities.”

Smaller grassroots organizations like Dorsainvil’s are particularly affected, Segura said, because they have fewer resources to deal with the violence. People in Cite Soleil protested the kidnapping, carrying signs that read, “She is doing good work in the community. free her.” Protesters marched to the medical facility where Dorsainvil was kidnapped. It had closed doors.

Doctors Without Borders last month announced that it was suspending services in one of its hospitals because some 20 armed men had burst into an operating room and snatched a patient.

“There is such contempt for human life among the conflicting parties, and such violence in Port-au-Prince, that even the vulnerable, sick and wounded are not spared,” Mahaman Bachard Iro, the organization’s head of programmes in Haiti, wrote in a statement. “How are we supposed to be able to continue providing care in this environment?

Residents of an adjoining neighborhood, Tabarre, were wondering Tuesday if aid groups’ temporary closures will become permanent.

“People are probably dying without basic services because they cannot afford to go to a private hospital,” 39-year-old bus driver Donald Saintilus said.

Hospitals have told the AP that they now see patients arriving in dire condition due to lack of medical care. The United Nations said in February that violence had “severely hampered” access to health services.

Segura, of the International Crisis Group, said fewer women have given birth in hospitals, which could boosting infant and maternal deaths. She also said that gangs have been trying to provide aid services to the communities they terrorize in an effort to project a sort of Robin Hood image.

The international community has attempted to address Haitian disorder in the past, with some success, and Kenya’s Foreign Ministry said Saturday that it had offered 1,000 police to help train and assist the Haitian National Police “restore normalcy in the country and protect strategic installations.”

State Department spokesman Matthew Miller wouldn’t provide details Monday on what was being done to locate and recover Dorsainvil and her daughter. Haitian authorities have not responded to multiple called and messages from the AP.

“Obviously, the safety and security of American citizens overseas is our highest priority. We are in regular contact with the Haitian authorities. We’ll continue to work with them and our US government interagency partners, but because it’s an ongoing law enforcement investigation, there’s not more detail I can offer,” Miller wrote in a statement Monday.

In a video for the El Roi Haiti website, Alix Dorsainvil describes Haitians as “full of joy, and life and love” and people she was blessed to know.

Dorsainvil graduated from Regis College in Weston, Massachusetts, which has a program to support nursing education in Haiti. Dorsainvil’s father, Steven Comeau, reached in New Hampshire, said he could not talk.

In a blog post Monday, El Roi Haiti said Alix Dorsainvil fell in love with Haiti’s people on a visit after the devastating 2010 earthquake in the Caribbean. It said the organization was working with authorities in both countries to free her and her daughter.

“Please continue to pray with us for the protection and freedom of Alix and her daughter. As our hearts break for this situation, we also continue to pray for the country and people of Haiti and for freedom from the suffering they endure daily.”

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Janetsky reported from Mexico City. Michael Casey in Boston contributed to this report.

LOS ANGELES (AP) — Lizzo has been sued by three former dancers who accuse the Grammy winner of sexual harassment and allege the singer and her production company created a hostile work environment.

The civil lawsuit filed Tuesday in Los Angeles County Superior Court claims Lizzo pressured the dancers to engage with nude performers at a club in Amsterdam and shamed one of them for her weight gain before firing her.

Plaintiffs Arianna Davis, Crystal Williams and Noelle Rodriguez make numerous charges including sexual, religious and racial harassment, disability discrimination, assault and false imprisonment.

The legal complaint seeks unspecified damages and names Melissa Viviane Jefferson, known professionally as Lizzo, her production company Big Grrrl Big Touring, Inc., and Shirlene Quigley, captain of the performer’s dance team.

Representatives for Lizzo didn’t immediately respond to emails seeking comment on the lawsuit.

The court filing claims that after performing a concert in Amsterdam, Lizzo and her crew attended a sexually themed show at a club in the city’s notorious Red Light District where “Lizzo began inviting cast members to take turns touching the nude performers.” During the show, Lizzo led a chant pressuring Davis to touch the breasts of one of the nude women performing at the club, the filing states.

“Finally, the chorus became overwhelming, and a mortified Ms. Davis acquiesced in an attempt to bring an end to the chants,” the complaint states. “Plaintiffs were aghast with how little regard Lizzo showed for the bodily autonomy of her employees and those around her, especially in the presence of many people whom she employed.”

Lizzo, who routinely champions body positivity, is also accused of calling out Davis for her weight gain after accusing the dancer of not being committed to her role. Davis was fired in May for recording a meeting during which Lizzo had given out notes to dancers about their performances, according to the complaint.

Quigley, who served as a judge on the singer’s reality show “Lizzo’s Watch Out for the Big Grrrls,” is accused in the lawsuit of pushing her Christian beliefs onto dancers. The court filing claims Quigley referred to Davis as a “non-believer” and told co-workers that “No job and no one will stop me from talking about the Lord.”

Earlier this year, Lizzo won the Grammy for record of the year for her hit “About Damn Time.” A global tour supporting her fourth studio album, 2022’s “Special,” wrapped up last month.