Milwaukee Health Department MAPP Project



Milwaukee Health Department MAPP Project

Community Themes and Strengths Assessment

Focus Group 1 – Becher Court

January 14, 2008

30 Resident Participants - (Most residents are elderly -60+)

1. What do you feel are the top concerns or issues for City of Milwaukee residents as a whole?

• Safety issues. Every time I try to cross the street there are people speeding. People come down the street to fast. At Forest Home and 19, people are always running that light.

• Pot holes and speed traps.

• Snow time is bad around here. The metro or whoever needs to have these corners cleaned up. People keep falling over getting onto the bus.

• Insurance, un-insured people. From what I understand, are they insuring younger children? A lot of elderly people can’t even get any insurance. They get sick, and then what do they do and where do they go? There has to be some place (for them to go), but where?

• I am from this neighborhood. I grew up six blocks away. It is not what is used to be. A lot of people get robbed and, like the other person said, getting across the streets can be tough because people are not using sidewalks. They don’t even shovel their sidewalks. I talked to the people across the street about it, and they were cool with it and they didn’t even speak English. We need more American food around here too.

• Gangs. They are just taking over children. They can get more money selling drugs than by going to school.

2. What do you feel are the top issues and concerns for your family and your community?

• We better clean up some of these streets. During the winter they are all sitting out there at 8 o’clock drinking already. It is degrading.

• I am concerned about these children on the buses. Those drivers need to check those seats and floors. Too many kids are getting left on the bus. The drivers are not doing their jobs. Mostly, it’s the school busses and daycare busses, but the city busses too (aren’t always doing their job).

3. How do these issues affect your community?

• People around here are barely mobile, but others are walking to school. They can’t run across the street like these young people can. I was coming across the street, and I had a walk signal and I got about half way across the street and the cars started coming through. There is a big red sign that says no right turn and they just went right around me. That was just one incidence. One time I was getting out of my car and people were just speeding past. I would see nobody coming, and all of a sudden people were there. This is just a broad concern. I would like to feel safe crossing the street. I was even in the cross-walk.

• I have a concern; the street lights don’t give enough time to cross the street. That is one concern; they do not give enough time, and this happens all over Milwaukee.

• On the corner of 20th street there is a 3-way walk. You have the walk sign going with you and the person who has the other go sign comes right through on you. One of these days, someone is going to get hurt. The two walk signs are showing, the car comes in and makes a turn right into the person. If you walk outside and you look on Forest Home on 20th street, you will see two walk signs and then a green light on the third light.

• Another thing is that there is a church near there and they are trying to cross the street too. They have a crossing guard for the school.

• These people, a lot of them are in lines of poverty and when you are in that line and you can’t manage your money and spend it on drugs and drinking, it’s bad and it is degrading.

4. Over the past three to five years, how have your community’s health needs and concerns changed?

• I have been here a little over a year. It is a bad neighborhood. Right here (in this building) it’s pretty cool because we have security, but otherwise it’s a bad neighborhood.

• It is worse as far as crime. It is not really safe out there. It is dangerous going out alone.

• These women need to stop walking with big purses. And they should walk with a buddy. Do not take anything to draw the attention of a thief.

• One thing is, I have had health insurance but they keep increasing the payments. It’s like I am almost afraid to go to the doctor. I have Medicare and a secondary insurance. The co-pay used to be $5, and now it is $25. They keep increasing the cost but the coverage is the same. Do I go to the grocery store or the doctor? It is a difficult decision.

• I have acid reflux and they put me on a generic drug. They did not have proper instructions/directions on my medicine. And I suffered a heart attack.

o (Who are they?)

o HMO’s and pharmacies.

• I like that nurses come and check our blood pressure.

• The nurses do not want to come here anymore. They come from Alverno and everybody wants the nurses here but they don’t show up for the meetings. They just do not want to come in. We have all of the information they want, but nobody will come in and listen. They don’t want to know anything about your health. This last year it has changed. I don’t blame them. They do not have time to sit down and listen. They check the blood pressure and then they go out the door.

• Some people take signs downs and then we do not know when stuff is going on.

• Very few people barely even know how to get to the internet.

• We need pamphlets about all of the above in English and Spanish.

5. How would you describe the quality of life in your community?

• Good. Relatively quiet in the building and surrounding area. It can get very loud in the summer.

• Personally, I am not concerned with the outer community. I am only concerned with around here. I do not care about the community. I am concerned with my immediate surroundings. This is a senior disability center. We do not care about a lot of things that have nothing to do with Becher Court. I have to live in the now. This is my world right now and that’s all I can get concerned with. When you get older, only certain things matter. Maybe if I were 15 years younger I would care.

• Actually, one neighborhood isn’t any better than the other. Because in wealthy neighborhoods there are still drug problems and homicides. Whether you are poor, rich or whatever, there are still problems. Our reputation is not too bad.

6. What do you think are our community’s greatest strengths and/or assets?

• It can’t be the police, because we are down 110 police, so where is our strength? We have to be our own strength.

• We do keep the streets clean. We do pick up the garbage in this neighborhood.

• We get stock boxes. But we need to get more volunteers of people who can speak and read English.

• We have strength in each other. We help each other in tough times and show love to each other. I would like to help each month and give back.

7. How would you define a healthy person? (What does it mean to you to be a healthy person?)

• Weight and health conditions, like a building all up to code. I feel that I am healthy.

• A person that exercises regularly and eats properly.

• There is not a healthy person around here. Everyone has something wrong with something.

• A person that eats well, sleeps well, exercises and keeps their weight.

8. Do you feel that you have a role or the ability to become involved in some of the solutions to these problems? How?

• I get along with everybody. I go with the flow. I try to be good and do things for people and that’s about it. And I try to be helpful.

9. What else do you think would be important for us to know related to the health of our community that we haven’t talked about?

• Lower the cost of health insurance. Co-payments went from $10 to $25. I went from $20 to $50 for doctors’ visits. That’s United Health Care.

• I think it would help a lot if we would learn to respect each other worldwide. People have to be taught that.

• None of the Spanish people participate with anything we do. We try to get them to get involved and they will not do it. They have their own meetings. The other groups are religious groups; regardless of how hard you try they will walk out because they are not interested.

Milwaukee Health Department MAPP Project

Community Themes and Strengths Assessment

Focus Group 2 – Arlington Court

January 22, 2008

43 Resident Participants – (Most residents are elderly - 60+)

1. What concerns you? What worries you? What do you feel are the top concerns or issues for City of Milwaukee residents as a whole?

• The Library is big issue. The library is rarely open so residents can’t get into it. The residents are very angry about this. They believe that the library is part of the cost of their rent. They want it open 24 hours so they can use it whenever they like – day or evening.

o It was explained that the reason the library is locked is because there is a computer and a TV in the space and they don’t want it to be stolen. Residents don’t feel this is an issue because there is a TV in the community room and that is not locked. The residents would prefer that the TV be taken out of the library so it can be open more.

• We would like a social Worker for advocacy on elderly issues.

• Crime – as you get older you can’t defend yourself as well.

• Access to transportation – snowy streets.

2. What do you feel are the top issues and concerns for your family and your community?

• Cost for drugs. There have been positive changes in lowering costs.

• We are concerned about insurance. We are often given generic medications that are not the right formulas. Pharmacies sometimes just do this without asking. Doctors are often surprised about these changes.

• Insurance. There have been so many changes. Insurance companies allow medications without a doctor’s approval. It is so confusing and we don’t know which is best for us. We need an advocate or to simplify the system.

• There are medications we need that we can’t afford. My doctor subscribed inhalers that my insurance won’t cover. These cost $400 per month.

3. Over the past three to five years, how have your community’s health needs and concerns changed?

• There are walk-in well clinics in the Walgreens stores. This really helps. It is right in our neighborhood and we can walk to it.

• Adding exercise equipment in our building helps elderly to stay fit in a simple way.

4. How would you describe the quality of life in your community?

• It depends on how you look at it. If you think of things in a positive way, we have much to be grateful about.

o We have many community shopping and retail choices.

o We have seating around the neighborhood.

o We have a beautiful lakefront and amenities in the city.

o We are lucky that we have such a nice neighborhood, and for a high rise building, we have a very nice facility.

• Volunteering is a part of the elderly person’s life, but we get stuck when the sidewalks aren’t shoveled and it inhibits transportation. We get stuck.

5. What do you think are our community’s greatest strengths and/or assets?

• Our people

• Our diversity in our communities

• Good transportation system

• People in this community extend a hand to help each other

• We are empathetic with each other and help others when they are down

• Our community is well-informed; we have many news and information sources available to us and many newspapers in the building

• Our close access to the lake

6. How would you define a healthy person? (What does it mean to you to be a healthy person?)

• An open mind and a positive attitude toward life

• Showing kindness

• Being generous

• Giving love

• Trust

• Having a companion

• Taking care of your body

• Following your diet and taking medications as prescribed with your doctor

• Eat right, exercise and don’t go to the doctor

7. Do you feel that you have a role or the ability to become involved in some of the solutions to these problems? How?

• We have a good volunteer system here in our building, but volunteering is not for everyone. Some of us are introverted and some extroverted so it works for some and not for others.

8. What else do you think would be important for us to know related to the health of our community that we haven’t talked about?

• Sex is great. People our age are afraid to talk about it, but it’s not taboo. We should be talking about sexual health in the elderly. Just because we’re over 50 years old doesn’t mean we can’t have sex. It’s a healthy thing.

• Handicap access; we need elevators to assist the elderly.

• The vans that help people get around are great and help the elderly.

• The speed in which the I-Team comes when we call. That helps.

• The various newsletters we get or the newspapers help to keep us informed.

Milwaukee Health Department MAPP Project

Community Themes and Strengths Assessment

Focus Group 3 – Riverwest Neighborhood Association

February 12, 2008

6 Participants (very poor weather/snow conditions on night of focus group)

1. What do you feel are the top concerns or issues for City of Milwaukee residents as a whole?

• Teen Pregnancy and access to healthcare

• Have a hard time getting people in through the GAMP system

• Elderly – no insurance, transportation issues

• Dental care – hard for poor to get access to dental healthcare. Also, people are traveling on a bus to get to a dentist that deals with people with no insurance.

• Lack of dental care and specialty services is huge. We are seeing that young doctors, dentists and other health professionals start in the city but when they get bigger, they move to the suburbs. Dermatology, psychology, and other specialists are extremely hard to get to.

• Also, food insecurity. The closing of all the grocery stores is compounding residents’ access to good food. And, the good stores are also moving out.

• The core area of the city has literally no grocery stores. Disadvantaged people can’t get to good quality foods.

• Safety is also an issue. People take advantage of the elderly. What are we doing to protect our elderly citizens?

• We keep hearing about more police but we are not seeing them or feeling safer.

• Coverage for undocumented citizens is big. GAMP now requires these people to have proof of citizenship or proper documentation.

• Community mental health – People are busy and don’t talk to each other these days. They don’t have dinner together or take time to talk to each other. The mental health issues and stress are huge, but they are not diagnosed or recognized to a great extent within the general population.

• Environmental health issues. There are 4 brown fields in this community. There are many times where things happen in town and hazmat teams need to come in. There are many contamination issues and the quality of air is getting worse. These need to be addressed also.

2. What do you feel are the top issues and concerns for your family and your community?

• Gun violence is big. Everyone in this neighborhood has been affected by gun violence.

• Chlamydia is much bigger.

• The community itself if getting better, beauty-wise and amenity-wise.

• The food pantry needs work.

3. How would you describe the quality of life in your community?

• Different areas have different affects

• Things have gotten worse for some and better for others. It depends on where in the neighborhood you are Different areas have different affects

4. What do you think are our community’s greatest strengths and/or assets?

• The diversity is great. It is a strength for some and not for others in this neighborhood.

• There is a lot of pride around here. People walk in the neighborhood at night and care about the neighborhood.

• We enjoy things being accessible with ample buses and close to many amenities.

5. How would you define a healthy person? (What does it mean to you to be a healthy person?)

• Body, soul and mind

• Feeling joy

• Not just a state wellness but involves the whole person – holistically

• If I can just get dinner on the table I feel good

6. Do you feel that you have a role or the ability to become involved in some of the solutions to these problems? How?

• Most definably. As a health professional we can be involved in clinics and help the community understand the options and where services are.

• I moved into the community recently so I don’t think I can. The issues are so big. How do you affect the insurance issue? All the problems seem so big. Even if you join a group, how do you really get your hands around the issues?

• If people like us don’t do something the issues won’t go away.

7. What else do you think would be important for us to know related to the health of our community that we haven’t talked about?

• The lack of coordination on the many issues in our city. Who is handling violence – in our schools, in the community? We need to identify who is doing what and work together.

• At my church I discovered a service that gets eyeglasses for underserved kids. I had no idea this even existed.

• We need to understand what is happening in the city, who is doing what and then do a better job at coordinating these initiatives

• Partner with the colleges and get students involved earlier so we can volunteer earlier.

Milwaukee Health Department MAPP Project

Community Themes and Strengths Assessment

Focus Group 4 - House of Peace

February 20, 2008

27 Participants

1. What do you feel are the top concerns or issues for City of Milwaukee residents as a whole?

• Safety; we need to be able to go out of our homes in peace. Its not right when you work hard for what you earn, but then someone walks off with it.

• Gangs

• Drugs; what’s going on in neighborhoods? Young kids and people are getting killed in drive by shootings.

• Unemployment; I read an article about a kid who turned 18 and got a job, and when he went to cash his first paycheck, someone (presumably unemployed) robbed him. The person wouldn’t have done it if he had job. There just are not enough jobs.

• {Moderator} All of the above seem to be related to safety.

• [Agreement]

• Health insurance; People don’t have it, so they can’t get the help they need. Lots of people don’t go to the doctor because they don’t have insurance. Then the health problems get worse because they can’t get help.

• Jobs need to be created and employers need to go back to the old way where they train people on the job. Now, people aren’t hired if they don’t already have training; the old way would help people keep jobs.

• Companies won’t hire a person if they’ve had a problem with the law; those people should get a second chance if they have a misdemeanor. They need second chances so we don’t have people robbing and stealing. People need the opportunity to access health insurance, have a place to stay, and have a lifestyle where they can live comfortably.

• Abuse, especially with young people. There are not enough mentors or good parents for younger people. They need that support because they feel like that’s where they can go (for help).

• Child abuse and molesters in communities go unnoticed.

• When men go to jail, they can’t get a job when they come out. They should have to go to school (in jail) so they have an education, so that young men learn how to work and how to get jobs. In jail, they must go to school, because they get right back in trouble after they get out. They just have nothing to do, but if they knew how to work they would.

• Education; there are too many drive-bys, kids are out of school and sometimes even though they get a job, they don’t work long enough to get health insurance. Minimum wage isn’t enough to take care of yourself.

• More access to medication for elderly ; medications cost so much money, and elderly people don’t get medication they need even though they’ve worked all their lives, because they don’t have enough money

• Killings, of generally innocent people. There is a problem with mental health care. They might need support to take care of these issues

• Health issues take more than one thing to solve the problem. I look at things from several perspectives. If a person is financially disadvantaged, they are always going to have issues. If you don’t have insurance, you’re going to have problems. Fixing health insurance would help a lot. Let’s say I’m $1 over GAMP; I’m 53 years old, I get paid $9/hr, I don’t have health insurance, and I’m a single. I can’t pay the electric bills or gas bills. I can’t retire, and I don’t collect any other income. I’m sure that more than a third of city is in my shoes [General agreement – “more than that honey”]

• Corporations should provide health insurance and should pay enough money to cover bills. McDonalds is supposed to be this big money-maker, but the employees can’t make car payments.

• Our energy bill is more than our rent.

• When a corporation makes more money than the people working there, that is a problem; executives are driving Mercedes, and you’re catching the bus to make these people rich.

2. What do you feel are the top issues and concerns for your family and your community?

• It’s the same as above.

• Health insurance and jobs. If you work a job, and you retire, the co-pay on your medications are so high that you feel like you don’t have insurance.

• It feels like city is catering to people without jobs. I’ve been at the drug store, when I’ve paid 100 dollars, and have seen someone else get the same medication for one dollar.

• [In response to above comment about catering to unemployed] I’ve worked over 35 years, and now I’m on disability, and I need a surgery. I’ve been fighting for the last 3 years to find the money. Once my money and my insurance were gone, the doctors were gone. Even though I’ve been paying taxes, I don’t have the resources to help me. I’m not working anymore, but I don’t receive anything.

• You still have to pay for medication, even if you have insurance.

• Health insurance. Like Title 19, and the money we’re supposed to get; every time you get an increase in money, they take it back in rent, insurance, etc. Why would you work all your life just to have to pay a bunch of money – I’m not saying socialism or capitalism, I’m saying equalism.

• I’m concerned about the same things, jobs and healthcare and high prices of medication. I think it would be better to start problem-solving in the home.

3. Over the past three to five years, how have your community’s health needs and concerns changed?

• It has gotten worse. There are a lot of people without or who can’t pay for insurance. Premiums are so high, my son’s insurance (premium) keeps going up even though he works a good job – it’s just terrible.

• When I lost husband, we were left without insurance.

• I think situation has changed because people have lost jobs, and are losing insurance.

• I’d like to talk about senior citizens living in home. Your taxes are outrageous! It’s hard to stay in your home with these taxes because when they go sky-high, despite having a fixed income, how can you keep going? When you get behind, they take your house!

• When you’re young and work, you have the future to look to, but when you’re a senior citizen, you’re not eligible for anything! Like Title 19 – people get along scott-free, but when you are a dollar over, you’re not eligible.

• The system is set up so that people in authority can keep other people down (control). Two generations under me, I’m 77, have fallen into that rut where they say, “I’ll get this for nothing,” and there is a price associated with that. But no one can tell you to stay out of that (rut) because you (people) want something for nothing.

• In the last 5 years, more people are getting ill, more are diagnosed with diabetes, heart problems - a lot of health stuff changed.

{Moderator Follow-Up Question} Were there any positive changes?

[Several members of group] No!

• When you get old, it seems like you aren’t any good anymore, because you can’t work; America just forgets about you! [LOTS OF AGREEMENT]. Immigrants come in illegally and get help, without paying taxes, but I can’t even buy a loaf of bread!

• A lot of us are over 50, we were raised (to believe) “if you work hard, you’ll do well.” Lots of us worked for the county, and some of the jobs were hell, but we knew if we worked long enough, we believed we would have insurance. But now that we’ve arrived, and we’re getting it taken from us!

• I think people who have worked for a certain number of years, should be tax-exempt. I think we can institute some policies that give us relief. If you retire and your electric bill is 400 dollars, you should be partially exempt.

• [In response to the above statement] In Germany, taxes are by square foot, so you choose how much you’re going to owe.

• There is too much technology in our system not to have solutions and answers to problems. I don’t have too much confidence in government because I wouldn’t let them run my household; they have deficit, they aren’t efficiently using money. Americans like to spend more money on feeling/looking good, but we should have more incentives to solve root problems.

4. How would you describe the quality of life in your community?

• Poor, terrible, rough.

• It’s even rougher in nursing homes, because they have people there who aren’t getting the proper care that you’ve put them in there for! [lots of agreement]. It seems like nursing homes charge what you have. Even if you have Social Security, or a raise, etc., if your parent has $2,000 - $3,000 (of income), that’s what they charge you, if you go up to $5,000, that’s what they charge you.

• [In response to above statement] It depends on the nursing home, I work at one and the service is good.

• They should raise the minimum wage to meet needs – people have needs like food, they should raise it to cover those needs

5. What do you think are our community’s greatest strengths and/or assets?

• We stick together, we survive.

• The churches, soup kitchens, community-based organizations.

• We should have more town meetings and work together to work out solutions – and we need volunteers.

{Moderator follow-up question}: Are people willing to engage in town meetings?

• If we explain to people about importance of volunteering they might see, but there is low volunteerism.

• Speaking of volunteers, our family was raised volunteering – when you volunteer, you’d be surprised about the skills you learn. You learn about resources – I know we need money, but we need education too!

• I just want to say that if we stick together, people won’t be afraid to speak out.

• We don’t have any assets!

6. How would you define a healthy person? (What does it mean to you to be a healthy person?)

• Health to me is when you eat properly, proper exercise; when you do those things you won’t have health problems like high blood pressure. But you have to work on it real hard – it’s not easy or cheap to eat properly! When I buy healthy, I get less food! Healthy is out of our price-range.

• Speaking of healthy, it’s a mindset [group agreement]. You keep focused on what you must do, not what someone else is doing – that’s where you go wrong.

• I think being health is also being willing to accept where you are – not saying you have to be stuck in your rut, but being happy with who you are.

• (Healthy is when) the emotional, physical, and mental are in balance. If you don’t have them in order, you will be out of balance.

7. Do you feel that you have a role or the ability to become involved in some of the solutions to these problems? How?

• Yes, absolutely [lots of agreement].

• I think all solution to all problems is owning WE Energies; number two, our children should be listened to, when they have talents and ideas, we should encourage them – we should sell their artwork on the internet.

• We should teach children to be balanced.

• We should own our insurance.

• In order for any solutions to happen, we need to have leaders, if community and elected officials would actually listen to the people and not their own agenda – like with healthcare. And stop building condos – build affordable housing!

• Volunteerism comes in again here – we need to realize service doesn’t always need to be paid for work. Don’t ask what I’m getting out of it; the product of your work is the reward.

• Well, like other problems, you have to start from the bottom and go up – one thing that happens to us is that we are at the bottom, and the bottom pays for the top (insurance, etc). We pay for the rich – they get rich from us. For example, my house got set on fire by another (adjacent) house fire. Now my insurance went up from $250 to $1000. In the inner city, we pay more insurance than people living in suburbs. We pay more light and gas bills.

• [In response to above] This lady brought up a good point – the pharmaceuticals should be the ones involved in the community. If that lady owns the house, why should she have to pay taxes on it if she owns it? When you take surveys, you take pieces out of it and them to other places. But nothing has changed since I was a kid. It can’t cause change, because – if I ask for higher wage, better medicate, etc. – what do you think the answer will be? They’ll just come up with another gimmick. On the other hand, this building is testament to the progress we’ve made.

• WE Energies doesn’t want to hear it – if you complain, they’ll turn off your energy. When you do surveys, you’ll take it to somewhere and it’ll go away. We need a kind of person like Jesus – he didn’t come to help governor, he came to help the bums and the thugs – he had a concept of love – you aren’t going to see WE Energies doing that. Those are the people you need.

• Why is it that if you own property, and pay high taxes, and you come in before 6pm where you’re supposed to park in front of your house, why do you get a ticket even though you’re parked where you’re supposed to?

• If enough people volunteer, you get something back – if you put 100% in, you’ll get 100% back. People can’t help us if we don’t do something about it. Everyone can take surveys, but if we don’t do anything about it, it won’t.

• We have to keep up with what’s going on in order to be effective in order to create change.

8. What else do you think would be important for us to know related to the health of our community that we haven’t talked about?

• One thing we need to talk about is drugs. We didn’t talk about the people who know how they get here. They aren’t coming from the city, they come from the suburbs. It’s not to their benefit to keep them out of the city – everyone knows they set up drugs to hurt black people, and then the drug problem rubbed off and caused more problems. They could stop drugs in the city – but they won’t. But in Wauwatosa, there was a drug dealer and everyone was surprised by the drug problem, and they still blame black people. When you give people food stamps, then take them away, what do you think they’ll do?

• We can do it if we come together – we sit and talk, but if we come together, we can do it. We can go to Madison, we can call officials. We’re letting it happen.

• I went to a town hall meeting, and there were only about 30 people and half were children. If people went, maybe there would be change. We can be effective.

• The will of the people is rarely what politicians end up actually doing – they should leave it up to the people.

Milwaukee Health Department MAPP Project

Community Themes and Strengths Assessment

Focus Group 5 - Northcott Neighborhood House – Headstart Parent Training

March 18, 2008

17 Participants

1. What do you feel are the top concerns or issues for City of Milwaukee residents as a whole?

• Crime

• No jobs

• Healthcare

• Food

• Education

• Poverty

• More transportation for kids

o City is going to stop transportation for the children to go to school and parents can’t afford bus fare: (note there was discussion about a change in policy from issuing bus passes to issuing individual bus tickets that are linked to attendance. This would limit students ability to attend after school programming, or other activities)

o Bad behavior on buses: Smoking, raping

• Lack of community departments for kids – recreation centers

• Asthma

• Lead poisoning put more brochures out about these issues. Also need to focus education of 13-14 year olds. They are future parents and also care for younger siblings.

• Rodent problems

o See the rats coming from the sewers and in the yards because people don’t care about the community and throw trash everywhere

o Ask the people to pick up the garbage they throw down but you never know who you are going to run into

o Landlords aren’t taking care of the rat issues

2. What do you feel are the top issues and concerns for your family and your community?

• Drinking water isn’t safe to drink, there are pills put down the sewer

• STD’s in young girls and boys

• AIDS increasing

• Corner stores – food is expired, canned goods are dented and expired, the store is dirty and has a lot of garbage, there is evidence of rat marks on food, the store workers don’t care, just take kids money

• Educate the community on what to look for, expiration dates, etc.

• The store workers aren’t following the WIC policies, let people use for diapers, sweet cereals, cigarettes: Maybe only large supermarkets should take WIC

• The city should come and check all the children that are exposed to lead get follow up checkup

3. How would you describe the quality of life in your community?

• Dismal

• Unemployment is increasing

• Poverty is rampant

• There are many vices-the only solution you have to feel better is temporary -so you

turn to alcohol and drugs to relieve the pain

• Increasing teen pregnancy

• Increased alcohol use

• Don’t just witness the fighting and crime, call the cops

• “It’s not about being a snitch, it’s about savoring your life” Can’t report crimes anonymously, the cops will come right to your house

• “It takes a village to raise a child, is not true anymore”

• You really can’t talk to anybody-just don’t confront anyone. Everyone is a dead man walking

• The community needs to stick together and report the crime

• The problems aren’t just the community; it stems from the parents

4. What do you think are our community’s greatest strengths and/or assets?

• Milwaukee has a lot of free days at the zoo, Betty Brinn Children’s Museum

• Milwaukee has a lot of kid oriented activities for families to bond

• “There is nothing here in Milwaukee. I want to have in Milwaukee someplace laid back where there’s no crime and I can leave my door unlocked”

• The different agencies – like New Concepts, Northcott, Safe and Sound – are great assets in helping the community, but people don’t take advantage of these agencies. Many people don’t know about the resources of small CBO’s because they can’t afford to advertise

• Need to advertise better to the public, but don’t have the money to take out ads or better advertise

• Good W-2 program

• Disagree about being a good W2: “You work your whole life and need help for just one month and you can’t get it. The case workers act like it’s their own money.”

• All of the doors are shut on the felons once they get out of jail, it makes them give up and commit again

5. How would you define a healthy person? (What does it mean to you to be a healthy person?)

• It’s hard to define or identify a healthy person because you can think you are healthy and then get the flu and it will take you down.

• Mentally and physically capable and able to function

• Not stressed out from all the worries

6. Do you feel that you have a role or the ability to become involved in some of the solutions to these problems? How?

• Yes, absolutely (lots of agreement)

• Take your self out of negative situations, stay away from negative people

• Many good programs have rigid geographical boundaries-lead example

• Get more funding for places like Northcott-used to be more for kids to do-Tae Kwan Do, Art classes, Basketball, trips

• Come to activities like this particular focus group, and become educated about the problems so when the time comes to stand up for it you can

• Take the knowledge you learn and tell it to the community and let them know where to find the resources

• Being a spokesperson to the community

• Educating your children at home so they can educate their friends

7. What else do you think would be important for us to know related to the health of our community that we haven’t talked about?

• Being around negative people, having negative people around you and in the community, ultimately affects you

• If you are a working its sometimes hard to qualify for the different problems, have more citywide programs that don’t leave certain people out

• More funding to advertise the programs that help children and fund the programs they have for the children so they can have better programs

• Labels for Education

• Need something that will get the community active and involved and excited about doing something

• Wisconsin started requiring you to have a co-pay for prescriptions

Milwaukee Health Department MAPP Project

Community Themes and Strengths Assessment

Focus Group 6 – Neighborhood House

15 Participants – 10 youth ranging in age from 13-17, 5 supervising staff

1. What do you feel are the top concerns or issues for City of Milwaukee residents as a whole?

• There are too many fast food restaurants that aren’t healthy

• Venereal disease. There are many prostitutes in this area. We need more information on causes and prevention of STD’s.

• The city is dirty and polluted

• Taking jobs away if Miller leaves

• Drugs – there is a big amount of drug usage among young people

• Lack of healthcare for community members. It is not affordable to many people. People have way too many hospital bills. They can’t get eye and dental care.

• Depression. If they get depressed they eat too much.

• Emotional and behavioral issues. This is because of lack of family unity. Kids have behavior problems and never learn, so they can be a threat to behavior.

• Genetics – Disease can be passed among the community

• Water pollution

• Antibiotics in milk

2. What do you feel are the top issues and concerns for your family and your community?

• Drugs. They are very close to this neighborhood

• Crack heads, dope

• Litter and trash around the community

• Smell of Miller Beer / smell of yeast in the area

• Even the police that come over here, they dismiss many things that go on

• Public safety

3. Over the past three to five years, how have your community’s health needs and concerns changed?

• The crack issue has gotten much worse. Large increase in drug use here.

• There are drunk people all over

• There are huge rats around here and lots of them

• There is less trash on the streets than 5 years ago, but there still needs to be more trash cans

• Healthcare is disappointing because the general public health is declining. There is a lack of access to healthcare and no preventative measures

• Prostitution of the young girls in the area

• Peer pressure – people challenge people to sell drugs and do drugs

4. What do you think are our community’s greatest strengths and/or assets?

• After school programs, non profits – Neighborhood House

• I don’t think that we have anything that is good for the community

• The kids stick together to help each other, tutor each other, and invite

• Grand Avenue CLC – they are strict enough there, but it is a good place

• There are many basketball courts around

• There are sports programs available throughout the program, the CLC, Neighborhood House and community put these on

5. How would you define a healthy person? (What does it mean to you to be a healthy person?)

• Eating right and keeping things that don’t belong out of your body

• Eat in moderation

• Exercise

6. Do you feel that you have a role or the ability to become involved in some of the solutions to these problems? How?

• No – you can’t tell crack heads anything

• I could help when I am grown by creating programs. I could be the president like Obama.

• We need to start with our age people so that there will be change.

• Crack, week and cocaine needs to be found and eliminated.

• Better education so we know about crime prevention.

• Police need to be strict on the streets. They need to take the crack heads off the street and lock them up.

• I think the government should invest in some of the things that we need.

• Need more schools and security guards in our schools.

7. What else do you think would be important for us to know related to the health of our community that we haven’t talked about?

• Teen pregnancy – young girls have kids and the dads don’t take care of them

o It doesn’t seem that just talking to women about getting pregnant is going to solve the problem

o Maybe it would help if they talk to younger kids (11-18) not just 14-18.

o Maybe they should also talk to the boys about using condoms and responsibility

• Anorexia seems to be a problem because people just need their crack and they don’t care about getting any nutrients

• Many of these people cant vote, but it is important for young people to understand what is going on

• Clean up the streets. It is very trashy here.

• We need to vote a different government of people who can help our community rather than messing it up.

• I say the health of our city is very bad because it is poorly funded. If we can get more funding and information for healthcare, we could improve our city’s healthcare.

• Government is not giving enough funding. It is hard to improve anything if we don’t have any money.

• They should make pollution commercials/billboards about cleaning up the city, like the ones they have about quitting smoking

• Like that we asked the teens their opinions

Milwaukee Health Department MAPP Project

Community Themes and Strengths Assessment

Focus Group 7 - Core/El Centro – Hispanic Focus Group

March 20, 2008

30 Participants

1. What do you feel are the top concerns or issues for City of Milwaukee residents as a whole?

• La salud y la communicacion entre los provedores y las personas que no puedan hablar espanol (educacion)

• Health and communication between health care providers and those who do not speak English. It is also an issue of education.

• Tiene que esperar por mucho tiempo por un interpreter, especialmente por un emergencia Aveces son problemas grandes y no puede obtener atencion en su lenguaje.

• In most cases, you have to wait a long time for an interpreter. This is especially true in the emergency room. Sometimes there is a serious problem and you are not able to get medical care in your language.

• Access is a huge issue – for the whole city- children with special health care needs who are not documented properly- I have seen many cases where families have to cancel appointments because of miscommunications

• Le cortan la tarjeta no lo sabe antes del cita

• There have been many problems with people’s access to care being cut and not realizing it until the appointment

• Tema de negacion – la licensias/immigracion- no pueda ir a la escuela, a la salud- ir a la depression y resulta en problemas de la salud

• There is a theme of being denied because of immigration status. We can not gain licenses, can not go to universities/further education, we do not have access to healthcare. All of these obstacles can lead us to depression and result in further health problems.

• No tenemos aceso a la cosa mas basico- la salud aunque paga los ingresos

• We don’t have access to the most basic right - health, even though we pay taxes

• No tenemos dinero para el medicamientos o cuando mandan uno al hospital o para una especialista – no da la informacion cuanto va a tener pagar…. 3 mil dolares- como voy a pagar – y porque no tengo papel, ni licensia

• We can’t afford prescriptions… or when they send you to the hospital or to a specialist, no one tells you what to expect or how much you will have to pay…. 3 thousand dollars- how am I going to pay for that, especially when I don’t have documentation or a license?

• Mis padres son ligales pero, porque no son redsidentes por 5 anos – le corta seguro medico – no lo entendieron-

• My parents are legal immigrants but recently they changed the requirement for receiving benefits to having to be a resident for five years. My parent’s medical insurance was cut, but it wasn’t explained to them why… they didn’t understand.

• La comunicacion y educacion – las familias tienen que hacer un decision entre dinero para la casa y la salud- las personas piensan que hay tantas cuentas y no entienden que hay maneras para pagar un parte o hay un programa o discuento- estan tan preocupadas – otros no les ofrecen esta informacion- tenemos que luchar tanto para esta informacion

• I think our biggest health problem is the lack of communication and education. Families have to make a decision between spending money on providing a home and money for healthcare. People are faced with so many bills and don’t realize that there are discounted programs. They are so worried, but they are not aware, no one tells them what to expect. We literally have to fight for this information.

• Nos da miedo preguntar algo, es muy importante que uno aboge por su mismo y lo que ellos necesitan

• We are scared to ask for things. It is important that one is able to navigate the system and advocate for themselves and what they need.

• Somos residents perminentes pero no hay un sentidio de ser miembro- no nos aceptan porque tenemos una casa que realamente no es un casa- hay demasiado personas – no hay recursos suficientes

• We are permanent residents but we don’t feel like “members.” We are not accepted because we have a house- that realistically does not qualify as a house. There are too many people and not enough resources- we are constantly struggling.

• Se cayen a enferma a las 10 de la noche- no se si debe ir al hospital porque voy a esperar por 10 horas y tengo que trabajar (no hay suficiente recursos y la calidad es diferente, nos traten diferente)

• My child fell ill at 10 o’clock at night and I didn’t know if I should take them to the hospital. I knew that if I went, I would have to wait 10 hours to see a doctor and then have to work in the morning. When trying to seek medical care, there are not enough resources and the quality of care that we receive as Latinos is different. Healthcare professionals treat us differently.

• En children’s la calidad de servicio es diferente entre los personas que hablen ingles y los que hablen espanol

• At Children’s Hospital for example, the quality of service is different for those who speak English and those who speak Spanish.

• El medicamento- es demasiado caro

• The medicine- it is too expensive

• Es lo mismo para todos- latino, Moreno, Americano

• It’s the same for all (the high price of medicine)- Latinos, African Americans, Americans

• De los enfermedades sexuales, los embarazos de los jovenes- Milwaukee es uno del los ciudades que tiene lo mas embarazos y enfermedades sexuales

• Sexually transmitted diseases, teen pregnancy- Milwaukee has one of the highest number of teen pregnancies and sexually transmitted diseases

2. Over the past three to five years, how have your community’s health needs and concerns changed?

• la calidad es peor- la asistencia es menos y hay mas poblacion

• The quality of care is worse. There is less assistance and more people.

• Como se manejan el nivel de calidad de la hospital- quien decide – estamos trabajando y pagando impuestos pero el dinero- como regresan este dinero.

• How do they manage the level of quality at the hospital? Who decides? We are working and paying taxes, but the money- how do they return this money?

• Las cosas se han puesto peor- trabajo en el area de la salud sexual reproductiva- hay mucha pobreza de problemas de imigracion padres estan sienten menos control por sus hijos- no se sienten por la informacion adecuadas de la informacion para educar a los hijos- hay menos esperanza.

• Things have worsened. I work in the sexual and reproductive health arena. There is much poverty and problems resulting from the complexities of immigration. Parents feel like they have less control over their children. They don’t feel like they have enough information to educate their children about health- there is less hope.

• Las personas que hablan espanol – que son professional son trabajando mucho – una mayestra en una escuela esta trabajando como un social worker- estan preocupados- hay mucho trabajo – y no hay personas para hacerlo.

• The people who speak Spanish, those that are professionals, are overworked. For example, a binlingual teacher is often forced to work as a social worker because they are the only ones with a grasp on the language. This creates stressed and overworked bilingual professionals. There is so much demand, and not enough qualified people to do the work.

• estan cortando la medicinas.

• They are cutting medicines.

3. How would you describe the quality of life in your community?

• Es mala por el nivel de estres- para mantener mi casa, de mis hijos estan hacienda en la escuela, cuando la gente estan hacienda 2 o 3 turnos como van a tener energia para hacer cosas alredador de la salud

• Quality of life in the community is bad due to the level of stress. To maintain my house, to provide for my children and their education. How are people going to have the energy to focus on bettering their health when they are working 2 or 3 jobs?

• Conflicto con la cultura- con la diferencia de la cultura- que no hay mucho comuncacion sobre esto

• There is a conflict between differing cultures and there is little discussion of cultural understanding/competency.

• La calidad es mala- aumenta tremenda- la gente se siente much estres- es como un ciclo que afecta la gente- no hay mucho esperanza

• The quality of life is poor. The quality is tremendously affected by the high levels of stress felt by community members that results in a vicious cycle with very little hope.

• No tienen un lugar bueno para vivir- estan pagando un gran cantidad de rent pero no tienen un calidad adecuadada- hay muchas familias que viven juntos por falta de dinero

• Many people do not have a good place to live. They are paying large sums of money for rent for disproportionately poor quality of housing. There are many families that live together for lack of money.

4. What do you think are our community’s greatest strengths and/or assets?

• La familia- muchos trabajamos – antes de ir al divorcio tratamos de mejorar la calidad

• The family- many of us work hard to maintain our families. Before arriving at divorce, we try to resolve our problems and strengthen the relationship

• Una guante fuerte- somos muy Fuertes- sigan luchando aunque tenemos

• We are a strong group of united people. We will continue fighting if we have to.

• La passion- hacemos todo con passion –trabajamos, - como podemos tener confianza y hacer cosas para otras entre nosotros

• Passion- we do everything with passion, including work. We trust each other and take care of one another within our community.

• La cultura que tenemos no es tan islada- necistamos- tenemos mas recursos

• Our culture is not as isolated (as mainstream American culture). We need each other and have many resources.

• Ver la confianza

• It is easy to see the trust within our community.

• Tenemos que mesclar con otros razas- tenemos que tener informacion

• We need to work on reaching out and “mixing” with other racial and ethnic groups. We need to learn from each other.

• Trabajan duro y fuerte

• Our community is tough and strong.

• La fuerza- yo empiezo ser un voluntario por todos lados- me da la oportunidad me da cuenta que yo soy capaz de hacer muchas cosas buenas- necesitamos otro ambiente para hacer cosas afuera de la casas- podemos salir de este sentido

• There is a strong force within the community- I started as primarily a volunteer in different capacities- it gave me the opportunity to realize that I am capable to do many things well. We need other outlets to do things outside the home and have faith in ourselves and our abilities.

• Podemos unir para hacer algo cuando hay problemas y lograr una meta

• We can unite to address a problem and achieve our goals

• Toman riesgos para lograr algo major (de la salud o mas)

• A strength is that we are willing to take risks to achieve something better- whether that be for health or something more

• Los lideres latinos- le explicamos porque es importante- lideres are supporting eachother in what we do. Los lideres de antes empezaron como secretaries pero, los lideres de hoy le dan cuenta que tengamos la capaz.

• Another strength is we have an increasing group of Latino leaders. The importance of being a leader in the Latino community has been explained to us and we are supporting each other in what we do. The first Latino leaders began as secretaries and worked their way up, where as today’s young leaders realize that they already have capacity.

5. How would you define a healthy person? (What does it mean to you to be a healthy person?)

• La salud es fisical y emocional no puede tener salud fisica sin mental- si queramos mejorar problemas de la Guerra o problemas de la sociedad y la salud- tenemos que empezar con ambos

• Health is both physical and emotional- one can not have physical health without mental health. If we want to address problems caused by the war or problems here at home and related to health we need to take a comprehensive approach and address both physical and mental health.

• Poder disfrutar la vida- trabajamos por horas y horas y no tenemos la oportunidad hacer otras cosas

• To be able to enjoy life. We work for hours and hours and do not have the opportunity to do anything else.

• Alguien equilibrado como dijo…. Con su familia y en aspectos diferentes, emocionalmente, spiritualmente, saludable

• A healthy person is someone who is balanced- like I said earlier- healthy within the context of their family and healthy in all aspects of life: healthy emotionally, spiritually, and physically.

• Cuando una persona tiene una enferemedad chronica puede disfruta la vida- como puede motivarme y moverme

• When a person has a chronic disease but can still enjoy life. Learning how to motivate and get oneself moving.

• Cuando la gente esta tranquila- bien de salud- economicamente- no esta pensando en los lideres- el precio de azuca… que los mativa – la vida como quiera tiene problemas- mas que nos afecta es la salud- es mal atencion por los hispanos- todo el dia estamos aca

• When people are calm, economically healthy- they are not focusing on politics or the price of sugar and allowing that to motivate them. Life, in all forms, has problems; but what affects us the most is health. There is little attention paid to Hispanics, even though we have always had a presence.

6. Do you feel that you have a role or the ability to become involved in some of the solutions to these problems? How?

• Todos tenemos la habilidad en todo que hacemos- estamos motivados hechamos ganas (porque tenemos una persona que nos motiva- que habla espanol)

• We all have the ability, the opportunity in all that we do. We are motivated and have an interest in bettering our health. This is because we have access to a healthcare provider who motivates us and speaks our language.

• Podemos animar a los jovenes y ninos- hay una falta grande de gente hispana en el papel de medico o promotores de la salud- podemos poner mas programas en las escuelas

• We can motivate the young. There is a large lack of Hispanics in the role of doctor and health promoter. We should put more programs in the schools.

• La prevencion en las escuelas- como podemos prevenir las enfermedads- tenemos que educarnos- cosas simples- los ninos no quieren tener las enfermedades de sus padres- tenemos que hablar

• Through prevention in schools, we can prevent illnesses. We need to educate ourselves- learning and doing simple things that can make a difference. Kids do not want to end up with the illnesses their parents are dealing with – we need to communicate.

• Pero los sistemas americanos tienen que involuncarnos y dar nos la oprtunidad de estar escuchados y ser la solucion – tienen que escucharnos, si las pidan tienen que usarlos- por ejemplo- las clinicas de 16 nos pidan como ayudarnos y dijimos que tienen que tener horas mas tardes- trabajamos durante el dia y no podems ir a la clinica hasta la noche… pero muchas veces nada pasa.

• But the “American” systems need to involve us and give us the opportunity to be heard and be a part of the solution. They need to listen to us- and if they ask for our input- they need to use it. For example- 16th street clinic asked community members how to better help and we said that they would need to have later hours- that people work during the day and can only go to the clinic in the evenings- but many times nothing happens.

• Ahora somos de los estados unidos y hacemos cosas en esta manera- es el tiempo

• Now we are united and working together- this is the time.

• Cuando alguien encuentra informacion- tiene que compartir esta informacion con lo mas personas como possible-

• When someone learns or comes across new information we need to share this with as many people as possible.

• Crear redes mas estables- donde los lideres puede hacer cosas con mas comunicacion con la comunidad

• We need to create strong, established networks, where leaders can work to accomplish things with more communication with the community.

• La coalicion de la salud latina – queremos involucar mas personas de la comundidad

• There is a Milwaukee Latino Health Coalition currently working to involve the community in addressing these issues

• Podemos educarnos pero necesitamos los recursos- listas, tenemos que realizar que tenemos poder

• We can educate ourselves but we need resources- even lists of what is available. We need to realize that we have power.

7. What else do you think would be important for us to know related to the health of our community that we haven’t talked about?

• Tener mas aceso a la comida saludable- la gente no tiene tiempo para viajar lejos para comida saludable, la estructura tiene que ver con la salud

• We have to have more access to healthy food- community members do not have time to travel far for healthy food- our structures need to provide for healthy lifestyles.

• Aceso de recursos- mas que va a la clinica- necesitamos mas aceso a especialistas

• Access to resources- more than being able to go to a clinic- we need access to specialists.

• Los que Mandan a ellos- haga mas responsibilidad que le hagan bien, traten bien- no hay reprecusion-

• They send us to specialists and turn over the responsibility of caring for our health to them (the specialist) but there is no follow- there is no repercussion if we are not treated well.

• Mas educacion de culturas diferentes en la Universidad- no lo conocen las otras culturas y como trabajar con culturas diferentes

• There needs to be more education about different cultures at the university level. The majority of providers does not understand other cultures or know how to work with/serve people of other cultures.

• Las personas de gran poder como tratan de los empleados

• Also the leaders- ones with the most power- don’t understand how to treat their employees.

• Las salud mental- no hay suficientes provedores- la gente latina ha crecida mucho con la stigma de salud mental- personas have died of mental health problems- personas han aceptados que tienen problemas pero cuando llaman no hay recursos – y los terapistas no conocen la cultura

• Mental health is a major issue. There are not sufficient providers. The Latino community has grown up with a stigma surrounding mental health. People have died of mental health problems. People have begun to accept that they have mental health problems but when they ask for help, there are no resources. The therapists do not understand the culture.

• Reconocer a los otros culturas- para que no hay tanta islamiento- es como un miedo – en vez de comunicar mas- no hay- hay una falta de comunicacion y temor

• We, as a Latino community, also need to recognize other cultures so that we are not as isolated. Right now there is a fear. Instead of communicating with each other there is a lack of communication mixed with fear.

Milwaukee Health Department MAPP Project

Community Themes and Strengths Assessment

Focus Group 8 – Hmong American Women’s Association (HAWA)

March 29, 2008

10 Hmong Women Participants

(Maymao Lee, the association’s director, served as the translator for the group and was able to translate a majority of responses. Responses are summarized below.)

1. What do you feel are the top concerns or issues for City of Milwaukee residents as a whole?

• Equal opportunities for people of different races

• Diabetes

• High blood pressure

• As people get older they have more health issues

• Strokes

• Depression

• Husbands are overseas at war

• Death in family

• Husbands having affairs – this effects about 30% of community

• Husbands absent from household because they are working or having affairs

• Pressure to have money and support our families

• People don’t care about people

• Increase of losing jobs and lack of jobs in community causes the families to suffer

• Lack of education

• Many people cannot speak English which causes them to not be able to get a job

• Most have no money and this causes stress and illnesses in families

2. What do you feel are the top issues and concerns for your family and your community?

• We don’t feel too safe living in community

• High pressure to provide money to support family

• Diabetes

• Flu

• Money, money, money

3. Over the past three to five years, how have your community’s health needs and concerns changed?

• There are more illnesses now than in the last five years

• The elderly don’t know how to protect themselves

• Women keep having children making it hard for families to make enough money

• Increase in pregnancy in all ages

• Less jobs than before

• I have been here for only 2 years so it’s hard to compare

4. How would you describe the quality of life in your community?

• Everyone in the community helps one another

• Life is hard right now

• There is a lot more divorce - age 35 and up

5. What do you think are our community’s greatest strengths and/or assets?

• We are helping each other

• We need more jobs to support families

• We need more education

• When our kids have their own jobs they can help support the family

• I’ve been here for 2 months and have 6 children. My husband passed away that’s why we came to the United States. We need to have more education before we can get a job, but overall I am happy here.

6. How would you define a healthy person? (What does it mean to you to be a healthy person?)

• You have a job

• Able to support your family

• Your children are well educated and well behaved

• Education

• Smiling

• No depression

• No worries

• Having fun

• Good nutrition

• Normal weight

• Have parents for a role model

• Have money

• Have the medicine you need

• Communication with community, friends, families, co-workers, employees

• Helpful husband to benefit family

• Happiness

• Hmong medicine

• You have a family

• You help each other

• Have children

• You shave

• You have/can give love and be understanding

• Housewives are responsible for finding medicine for the family

• No need to check with doctor; we go to the doctor only when we are in pain

• Having money and not having as much pressure to get by in life

7. Do you feel that you have a role or the ability to become involved in some of the solutions to these problems? How?

• We have to support each other and women have to help each other more

• We have to help each other in the community

• I would like to see more education offered

• A lot of people don’t have a job so they can’t afford daycare to get the education

• Couples don’t trust each other when they go to work. They think they are having an affair. If there was more education we would be able to know better and trust each other.

• Education, education, education

8. What else do you think would be important for us to know related to the health of our community that we haven’t talked about?

• A lot of people don’t have education and they need it

• If someone would come here and set up workshops and come teach, the people would come

• If we have a job and can support our family there would not be a problem

• It’s really hard to find a job because:

o Education - first

o English - second

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