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Jenn March, Special to the Post-Star 

Snowmobilers cross paths at the crosswalk near Million Dollar Beach on Feb. 11 during the second weekend of the 2018 Lake George Winter Carnival.

Putting a new lens on learning

QUEENSBURY — Medical student Sunit Misra knew he wanted to tie his medical education to his patients’ lives, believing it would expand his understanding of health care issues and help him become a better doctor.

Misra wanted to experience a side of medicine not found in textbooks.

“A lot of doctors are really smart, but there is more to gain from doctors being empathetic to patients’ needs,” he said, adding that understanding what life is like from the patient’s eyes is important.

So signing up for the innovative, year-long University of Vermont Larner College of Medicine’s Longitudinal Integrated Clerkship through Hudson Headwaters seemed to make sense, even though it was a new program and a new way for a third-year medical student to study medicine.

Last year, Misra — one of three third-year UVM medical students participating in the clerkship with Hudson Headwaters — moved to Glens Falls to live in the community, as did the other two students in the program.

And all three students — Misra, Kal Al-Tawil and Holly Bachilas — were guided by Hudson Headwaters’ physician preceptors while following a group of local patients over the past year.

“Physicians at Hudson Headwaters have been training Albany Medical Students for two decades, but more and more academic centers realize the value of doctors (going) into the community,” said Dr. Tucker Slingerland, Hudson Headwaters CEO and Misra’s preceptor.

According to Slingerland, they started talking with the University of Vermont about the program a few years ago. “It took a year of planning to support this kind of curriculum,” he said. “It has become a community project.”

Traditionally, third-year medical students spend the entire year in hospital rotations, spending about six weeks in a specialty and then moving on to the next. With the LIC, the students experience the various specialties while following their patients during the year.

“Instead of the traditional block format, where students complete rotations in seven different medical specialties, we choose a panel of patients that we follow to every doctor visit, to surgery, through labor and delivery and even navigating through health-related social services,” Misra said. “Their life becomes our life; their goals become our goals.”

Sunit was with Slingerland at West Mountain Center. “He accompanies the patient to CAT scan; he follows patients in the emergency room and reports back to me,” he said. “He becomes an expert on our patient.”

Slingerland continued.

“I think they really build a connection with the community, and they see their patients around town, at the grocery store,” he said. “They get to experience what it’s like to take care of families and neighbors.”

Misra tells the story of a patient who had to go to the emergency room and then was admitted into the hospital for five days.

“I wanted to know what does five days staying in the hospital do to you,” he said. “This is an opportunity we get while some of our classmates have to squeeze out (information) in six weeks.”

The students are required to take exams throughout the year, and Slingerland said they do very well because of their experiences working so closely with patients.

“They have done exceptional on their exams ... This is not a curriculum for someone who needs close supervision. This is one of those experiences that you get the most out of it by what you put into it,” he said. “This is a curriculum for students who have a strong sense of self.”

In addition to following patients, each of the three developed and implemented a community project.

Misra developed a healthy eating program with Warrensburg Elementary School and the after school “In the Zone” program.

“I would bring in snacks and help (the students) understand what they like and how to make choices,” he said, adding that each week he brought in different snacks for the students to explore.

One week they made fruit pizzas, a cracker topped with fruit. “One boy said, ‘this tastes like cotton candy,’” Misra said. “The students called me the ‘Snack Man.’”

Khaled Al Tawil’s project explored how much time is saved in a doctor’s office making a diagnosis by using the handheld ultrasound. And Holly Bachilas evaluated the effectiveness of a tobacco cessation support group, Slingerland said.

“Many of us have said, ‘if only programs like this existed when we were in medical school,’” he said.

According to Slingerland, the three will finish in March. Next year, the program will expand to four students.

“I really enjoy working with students,” said Slingerland. “They ask great questions and bring in a fresh perspective. And the information they bring back from following the patients is invaluable.”

Did the program give Misra what he wanted?

“It was everything I was hoping for and more,” he said.

South Korea's Moon may be on brink of legacy-defining moment

PYEONGCHANG, South Korea — Peace on the Korean Peninsula.

After decades of bloodshed and strife, including a runup to the Olympic Games that saw the rival Koreas lurching toward war amid a near-constant barrage of North Korean missile and nuke tests, it’s such a ludicrous concept at first glance that many refuse to even consider it.

Not South Korea’s liberal president, Moon Jae-in, a true believer in the power of Koreans talking to Koreans when it comes to solving the woes that have beset the Korean Peninsula since it was divided in 1945.

Moon has always harbored dreams of rapprochement, even as the missiles flew during his first months in office and he was forced to take a hard line during a deepening standoff featuring the South, his American ally and his northern neighbors.

Now, with an invitation to meet the North’s dictator in Pyongyang, personally delivered on the sidelines of the Pyeongchang Olympics by that dictator’s sister during the first-ever peacetime visit to the South by a member of the North Korean ruling family, Moon may be on the brink of a legacy-defining moment. If he’s not actually forging peace, he’s at least putting himself in a position to make a serious assault on the notion.

“Dizzying” is how one South Korean newspaper described the diplomatic typhoon swirling over the Korean Peninsula, with all the big players seemingly wanting different things and Moon, at times, the only calm in the storm.

The son of North Korean refugees and a leading advocate of a previous liberal government’s “Sunshine Policy” of engagement with the North, Moon has spent his career — a lifetime, really — waiting for this chance. The question now is whether he can persuade the North Koreans, his own people and Washington to back his play.

Of the three, the North Koreans might be the easiest sell.

Moon has not yet formally accepted the invite, and Washington would probably rather he not visit Pyongyang until the North puts its nukes on the negotiating table. Many South Koreans, meanwhile, who have been threatened with war for decades and saw 50 of their citizens killed in attacks blamed on North Korea in 2010, will be deeply wary of any deal that does not provide real security.

Moon knows the risks. He has taken a cautious approach to the invitation thus far, but the rivals’ lightning-quick swing from antagonism to seeming affection could be a chance too tempting to pass up.

The first liberal president in a decade, Moon has repeatedly said since his election in May that he’d be willing to visit Pyongyang and meet with Kim Jong Un if that would help solve the North’s headlong pursuit of a nuclear arsenal that can target the U.S. mainland.

It’s difficult to find an exact historical comparison to Moon’s situation outside of Korea. It’s not Nixon’s stunning visit to China; it’s not Reagan urging the Soviets to tear down the Berlin Wall. Perhaps the best comparison is to the man who Moon has called his “destiny,” and whose North Korean policy Moon is forever linked to: The late liberal president, Roh Moo-hyun.

Moon was raised in poverty in Busan by North Korean parents who’d fled during the war. He was imprisoned as a young man for working to topple South Korea’s military rulers and forced into the elite special forces as punishment. Stopped from becoming a judge because of his student activism, he became a human rights lawyer at a time where that work held real risk.

His boss was Roh Moo-hyun.

When Roh became president in 2003, Moon’s influence with his mentor got him the nicknames “King Secretary” and “Roh Moo-hyun’s shadow.”

Moon helped Roh on the “Sunshine Policy” begun by the country’s first liberal president, Kim Dae-jung, the Nobel Peace laureate and former political prisoner, in the late 1990s. Roh continued the efforts, which saw North and South Korea pursue now-stalled economic cooperation projects and reunions of families separated since the 1950-53 Korean War, which ended with an armistice, not a peace treaty.

Moon oversaw Seoul’s preparations for the 2007 inter-Korean summit talks, only the second-ever such leadership confab, between Roh and Kim Jong Il, the late father of Kim Jong Un.

A decade of conservative rule, beginning in 2008, overturned the policy. Now Moon, while not lobbying for its return, clearly wants to engage the North.

Among the hurdles to a deal in 2018 is the North’s steadfast claim that it is an already-established nuclear power and that its bombs are not open for negotiation.

Moon’s defenders point out that he has, for the most part, fallen in line with the international effort, led by Washington, to isolate and sanction the North for its ICBM launches and nuclear test over the last year. Many think he’ll take a cautious approach if a summit comes off, given the nuclear threat.

Moon has benefited from the rock star-like reception that Kim Jong Un’s sister, Kim Yo Jong, has received here. Her picture, often with a bemused half-smile, has been splashed across newspapers. Seemingly every aspect of her appearance and demeanor has been examined with microscopic detail on TV.

Her visit may “open the gates wide” for talks between the Koreas and contribute to regional peace, according to an editorial in the liberal Kyunghyang Sinmun newspaper.

The conservative Dong-A Ilbo warned that South Korea may lose the trust of the United States and Japan as it courts North Korea for talks, and that the North, knowing that Seoul and Washington plan to resume war games in March, “may deploy a strategy of using the Moon Jae-in government as a shield from the United States.”

“The current state of the Korean Peninsula is so dizzying because South Korea, North Korea and the United States are each thinking too differently,” the newspaper said.

It seems likely that those twin possibilities — the political opportunity of a lifetime coupled with intense distrust of North Korean intentions — played in Moon’s mind when he raised a toast at a lunch Saturday with Kim Yo Jong.

“The occasion today is watched closely by the world, and there’s a lot of hope placed on the South and North,” he said. “I feel that weight on my shoulders.”

By the beaming smile Moon gave his rival’s sister, you could hardly tell.

Trump support vital as Congress tackles immigration issue

WASHINGTON — The Senate begins a rare, open-ended debate on immigration and the fate of the “Dreamer” immigrants today, and Republican senators say they’ll introduce President Donald Trump’s plan. Though his proposal has no chance of passage, Trump may be the most influential voice in the conversation.

If the aim is to pass a legislative solution, Trump will be a crucial and, at times, complicating player. His day-to-day turnabouts on the issues have confounded Democrats and Republicans and led some to urge the White House to minimize his role in the debate for fear he’ll say something that undermines the effort.

Yet his ultimate support will be vital if Congress is to overcome election-year pressures against compromise. No Senate deal is likely to see the light of day in the more conservative House without the president’s blessing and promise to sell compromise to his hard-line base.

Trump, thus far, has balked on that front.

“The Tuesday Trump versus the Thursday Trump, after the base gets to him,” is how Sen. Jeff Flake, R-Ariz., a proponent of compromise, describes the president and the impact conservative voters and his hard-right advisers have on him. “I don’t know how far he’ll go, but I do think he’d like to fix it.”

Senate Majority Leader Mitch McConnell, R-Ky., scheduled an initial procedural vote for this evening to commence debate. It is expected to succeed easily, and then the Senate will sort through proposals, perhaps for weeks.

Democrats and some Republicans say they want to help the “Dreamers,” young immigrants who have lived in the U.S. illegally since they were children and have only temporarily been protected from deportation by an Obama-era program. Trump has said he wants to aid them and has even proposed a path to citizenship for 1.8 million, but in exchange wants $25 billion for his proposed U.S.-Mexico border wall plus significant curbs to legal immigration.

McConnell agreed to the open-ended debate, a Senate rarity in recent years, after Democrats agreed to vote to end a three-day government shutdown they’d forced over the issue. They’d initially demanded a deal toward helping Dreamers, not a simple promise of votes.

To prevail, any plan will need 60 votes, meaning substantial support from both parties is mandatory. Republicans control the chamber 51-49 but GOP Sen. John McCain of Arizona has been home for weeks battling brain cancer.

Seven GOP senators said late Sunday that they will introduce Trump’s framework, which they called a reasonable compromise that has White House backing. The group includes Sens. Tom Cotton of Arkansas, John Cornyn of Texas and Iowa’s Charles Grassley.

Democrats adamantly oppose Trump’s plan, particularly its barring of legal immigrants from sponsoring their parents or siblings to live in the U.S. It has no chance of getting the 60 votes needed to survive. The plan will give GOP lawmakers a chance to stake out a position, but it could prove an embarrassment to the White House if some Republicans join Democrats and it’s rejected by a substantial margin.

Another proposal likely to surface, backed by some Republicans and many Democrats, would give Dreamers a chance at citizenship but provide no border security money or legal immigration restrictions. It too would be certain to fail.

Votes are also possible on a compromise by a small bipartisan group led by Sens. Dick Durbin, D-Ill., and Lindsey Graham, R-S.C. It would provide possible citizenship for hundreds of thousands of Dreamers, $2.7 billion for border security and some changes in legal immigration rules. McCain and Sen. Chris Coons, D-Del., would offer legal status but not necessarily citizenship, and require tougher border security without promising wall money.

Trump has rejected both proposals.

Some senators have discussed a bare-bones plan to protect Dreamers for a year in exchange for a year’s worth of security money. Flake has said he’s working on a three-year version of that.

“I still think that if we put a good bill to the president, that has the support of 65, 70 members of the Senate, that the president will accept it and the House will like it as well,” Flake told NBC’s “Meet the Press” on Sunday.

Underscoring how hard it’s been for lawmakers to find an immigration compromise, around two dozen moderates from both parties have met for weeks to seek common ground. So have the No. 2 Democratic and GOP House and Senate leaders. Neither group has come forward with a deal.

In January, Trump invited two dozen lawmakers from both parties to the White House in what became a nearly hour-long immigration negotiating session. He asked them to craft a “bill of love” and said he’d sign a solution they’d send him.

At another White House session days later, he told Durbin and Graham he was rejecting their bipartisan offer. He used a profanity to describe African nations and said he’d prefer immigrants from Norway, comments that have soured many Democrats about Trump’s intentions.

Trump made a clamp-down on immigration a staple of his 2016 presidential campaign. As president he has mixed expressions of sympathy for Dreamers with rhetoric that equate immigration with crime and drugs.

Last September he said he was ending the Deferred Action for Childhood Arrivals program, or DACA, which lets Dreamers temporarily live and work in the U.S. Trump said President Barack Obama had lacked the legal power to create DACA.

Trump gave Congress until March 5 to somehow replace it, though a federal court has forced him to continue its protections.

The court’s blunting of the deadline has made congressional action even less likely. Lawmakers rarely take difficult votes without a forcing mechanism — particularly in an election year. That has raised the prospect that the Senate debate launching Monday will largely serve to frame a larger fight over the issue on the campaign trail.

White House grappling with fallout from aide's resignation

WASHINGTON — Reeling from the downfall of a senior aide, the White House was on the defensive Sunday, attempting to soften President Donald Trump’s comments about the mistreatment of women while rallying around the embattled chief of staff.

Several senior aides fanned out on the morning talk shows to explain how the White House handled the departure of staff secretary Rob Porter, a rising West Wing star who exited after two ex-wives came forward with allegations of spousal abuse. And they tried to clarify the reaction from Trump, who has yet to offer a sympathetic word to the women who said they had been abused.

“The president believes, as he said the other day, you have to consider all sides,” senior counselor Kellyanne Conway said. “He has said this in the past about incidents that relate to him as well. At the same time, you have to look at the results. The result is that Rob Porter is no longer the staff secretary.”

On Saturday, Trump tweeted that “lives are being shattered and destroyed by a mere allegation. Some are true and some are false.” And the day before, he pointed to Porter’s assertions of innocence and wished him a great future.

Conway also delivered what she said was a vote of confidence from Trump for chief of staff John Kelly, who has come under fire for his handling of the Porter matter. Kelly initially defended his right-hand man before later offering a version of the week’s events that puzzled aides said did not line up with the White House’s earlier timeline.

Budget director Mick Mulvaney, among those mentioned as a possible Kelly successor if Trump were to make a change, also downplayed the speculation about Kelly’s standing, suggesting those stories “are mostly being fed by people who are unhappy that they have lost access to the president.” He said talk of Kelly’s departure is “much ado about nothing.”

But Trump has grown frustrated with Kelly, who was once commended for bringing discipline to the West Wing but recently has been at the center of his own controversies.

Trump has begun floating possible names for a future chief of staff in conversations with outside advisers, according to three people with knowledge of the conversations but not authorized to discuss them. In addition to Mulvaney, the others are House Majority Leader Kevin McCarthy, Rep. Mark Meadows and CIA Director Mike Pompeo.

Mulvaney said no one has talked to him about replacing Kelly and “I don’t want that job.”

There was no sign that a move was imminent, according to the people with knowledge of the conversations. Trump is known to frequently poll his advisers about the performance of senior staff and is often reluctant to actually fire aides.

Kelly has indicated he would step aside if he lost the faith of the president. But he has not offered to resign, according to a White House official who spoke on condition of anonymity.

A number of West Wing aides were shaken by Kelly’s handling of the Porter accusations. At a senior staff meeting on Friday, Kelly tried to push his own timeline concerning Porter. Some aides in that meeting privately questioned Kelly’s account, thinking his version of events was self-serving, according to one official with knowledge of the meeting.

Kelly has said he found out only Tuesday night that the accusations against Porter were true, but that same evening the White House released a statement of support for Porter from Kelly. The chief of staff, who has said he only learned of irregularities with Porter’s background check in November, insisted that the decision for the staff secretary was made before photos of one of his ex-wives with a black eye were published.

Mulvaney, however, said Porter was “not entirely forthcoming” when asked about the allegations and, once the photos came out, “we dismissed that person immediately.”

The week also cast a harsh spotlight on Hope Hicks, the White House communications director, who was dating Porter. She helped craft the White House’s initial supportive response and has clashed with Kelly. But several aides, including Conway, delivered ringing support for Hicks and said the president still valued her.

As the aftershocks of the accusations against Porter reverberated for a sixth day, Trump stayed out of sight on a rainy Sunday in Washington. Showing little regard for the #MeToo movement, he has followed a pattern of giving the benefit of the doubt to powerful men and insisting upon his own innocence in the face of allegations of sexual misconduct from more than a dozen women.

“I think the president’s shaped by a lot of false accusations against him in the past,” said legislative director Marc Short, who added that Trump was “very disappointed” by the charges against Porter. “And I think that he believes that the resignation was appropriate.”

Conway spoke on ABC’s “This Week” and CNN’s State of the Union,” Mulvaney on “Fox News Sunday” and CBS’s “Face the Nation,” and Short on NBC’s “Meet the Press.”