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Commissioner Sharon Meieran Newsletter - June 2018
Summer is finally here, and so is our Mental Health Care Report!
As an ER doctor, I regularly care for people who have fallen through the cracks in our mental health care system and ended up in crisis. As you likely know from reading prior Newsletters, mental health care is one of my top priorities, and as a County Commissioner, I’ve advocated for a deep systems analysis of how mental health services are provided and experienced throughout Multnomah County. The aim of this project has been to identify gaps and consider ways the system as a whole can work better to serve people.
I am excited that this six month project was recently completed, and that we are finally able to share results with the community. I will outline some of the main findings in this Newsletter, but you can access the full report online here, and you should have already received an invitation to join me at a community event this evening from 6 to 7:30 p.m. to hear directly from the lead researcher about the report findings and next steps.
One of the overarching findings that was particularly striking to me was the degree of disconnect between the aims of the mental health care system, and how the people actually using and working in the system experience it. Of course the “mental health system” is bigger than any single government or organization, and the County works with local, state and federal government partners, Health Share of Oregon, service providers, and many others. The research helps us all better understand the gaps and challenges that drive this mismatch, and provides a framework for beginning to address the disconnect.
The report outlines three priority recommendations. First, it recommends that a shared vision be adopted for the mental health system as a whole, so that we have a set of guiding principles and shared goals that we are working toward as an organization, and as a community. Second, it recommends elevating the value and role of lived experience in leadership at Multnomah County. And third, it calls for further evaluation of the complex funding streams that drive how services are provided, and integrating and sharing data to support system improvements and coordination of care.
In addition to the priority recommendations, the report provides an excellent overview of the feedback received through hundreds of individual interviews, through community listening sessions, and via online surveys. This feedback has resulted in a number of other recommendations which can be seen in the report. Among these other recommendations, there are a few major overarching themes that I’d like to highlight. Housing was identified as a key issue related to mental health by nearly every stakeholder who was interviewed for the study, and the findings of the study underscore the desperate need for affordable housing, as well as supportive housing for people with complex behavioral health, physical health, and other needs. It’s hard enough to navigate mental health treatment when a person has a stable place to live, and it’s virtually impossible to manage medications, get to and from appointments, and otherwise engage in treatment without a safe home. As we develop local plans to meet a goal of 2,000 new units of supportive housing over the next decade, this report confirms the importance and urgency of investing in supportive housing as a key strategy to improve mental health outcomes.
The report also points to hiring and retaining a qualified, culturally competent and stable mental health workforce as a critical element to improving the quality of care and providing better access to culturally specific care. Mental health providers of all types, including peers, navigators, case managers, and clinicians often struggle with low wages, limited benefits, intense caseloads, and few opportunities for professional development. As our region’s minimum wage increases over the next five years, and as we plan for new initiatives like supportive housing that will test the capacity of our existing service provider organizations, this need to better support the behavioral health workforce will only intensify. Our work in this area must include focused attention on diversity and cultural competence among all types of practitioners.
So what happens next? I am looking forward to partnering with people and organizations across our community to act on the report’s recommendations in a variety of ways. In the short term, I’ll be working with others to identify and advocate for key, shared state legislative priorities in the 2019 session. I also plan to convene a group to explore potential options to address workforce needs and work with County staff to discuss elevating the role of lived experience in leadership. Longer term, I am committed to working with a range of partners to develop and act on a shared vision of mental health care that is holistic, person-centered, and meets people where they are, with a full spectrum of services. This study has been grounded in the perspective of those experiencing the system -- whether as consumers, providers, family, friends and others -- which I think is absolutely essential to understanding the system as it exists today, and equally essential as we strive toward the next steps of implementation. With a shared vision, we can begin to take the steps needed to get us there.
I hope you’ll take time to review the report and let me know what you think. I always enjoy receiving email from you at firstname.lastname@example.org. Please know that we have released this report as a “draft” to allow time for people to review and provide corrections before the report is finalized in mid-July. If you see an inaccuracy and would like to suggest a correction, please share it here by July 18. And I hope to see you tonight at 6 p.m. in the Multnomah County Boardroom!
In good health,
Multnomah County District 1 Commissioner
Commissioner Sharon Meieran Newsletter - May 2018
Today the Board of County Commissioners adopted the fiscal year 2019 budget for Multnomah County! Last month I shared some information about the budget process itself, along with some of the factors I consider in making tough budget decisions. I also provided a survey so I could hear about your priorities. I really appreciate your taking the time to fill out the survey - it was extremely helpful to have your input. You can review some general survey results here.
The budget that we unanimously adopted balances the County’s needs with limited resources. It prioritizes funds to address homelessness and the need for permanent stable housing, invests in health-related services, and supports public safety. Additional information about the County’s priorities is available from the County Budget Office. In this Newsletter, I wanted to highlight a few priorities for which I specifically advocated:
- I advocated for high-quality, accessible, affordable treatment for substance use and co-occurring mental health treatment in Multnomah County. Statewide data indicate that 1 in every 16 adults over age 25 needs addiction treatment, and one in every 15 youth needs treatment for alcohol abuse. Further, the opioid crisis in particular has devastated many of our families, friends, neighbors, and coworkers. On average, one opioid overdose death occurs every 30 minutes, with that tragic number just being the tip of the iceberg in terms of financial, social and emotional costs to our families and communities. I was able to secure $350,000 in funding toward the goal of improving the quality and capacity of County-supported treatment services, and better aligning residential and outpatient treatment for adults and youth.
- I worked with my colleagues to provide more comprehensive legal assistance to immigrants and refugees and their families. The funding we’ve invested will have ripple effects, not only protecting people’s basic foundational rights, but helping to stabilize families, push back locally against racist and xenophobic federal policies, decrease the need for mental health and other support services for the trauma caused by such devastating federal policies and practices, and more.
- I introduced and successfully advocated for an amendment to provide $50,000 for expanded mental health services in a safe and affirming primary care environment for lesbian, gay, bisexual, transgender, queer, and other sexual and gender minorities. LGBTQ+ youth and adults are far more likely than their heterosexual counterparts to suffer from mental illnesses such as depression and anxiety, and LGBTQ+ adults report nearly twice the rate of mental distress and more than double the rate of suicide ideation relative to heterosexuals. Oregon LGBTQ+ youth are 5 times more likely to attempt suicide as heterosexual youth, and transgender adults have 25 times the rate of suicide ideation as non-LGBTQ+ adults. I’m hopeful that this funding will leverage other investments to expand these much needed mental health resources in our community.
- I advocated for a study to evaluate the feasibility of bringing municipal broadband to Multnomah County. Municipal broadband refers to publicly owned high-speed internet infrastructure that would allow users to access these internet services at cost. Municipal broadband offers the opportunity to address one of our most foundational missions at the County: ensuring equity and inclusion, particularly for people who are most vulnerable and marginalized, and establish a level playing field so we all have the opportunity to thrive. As an added benefit, municipal broadband could be a great economic driver in our region. My amendment sets aside $150,000 for a feasibility study, which is the first step in potentially bringing municipal broadband to our community. For more information about municipal broadband, I encourage you to read this recent article in the Portland Mercury.
- Finally, as we wrap up the budget, I’m looking forward to release of our mental health system analysis report in the coming weeks. Please look for information soon about an event in late June to learn about the report’s findings and recommendations, as well as engage in a discussion about our next steps. I am very pleased that the budget includes funding to take the next steps toward implementation.
Though it is difficult to make some of the decisions about how to invest our County’s limited resources - there are so many fantastic programs and services, and so much need - budget season fills me awe for what Multnomah County is able to provide for those who are most vulnerable, and respect for the incredible dedication of so many people who work for and partner with the County. This is the heart of what I signed up for when I ran for County Commission, and I have been honored to represent my constituents during this process.
Multnomah County District 1 Commissioner
Commissioner Sharon Meieran Newsletter - April 2018
This week, the Board of County Commissioners kicks off our annual budget process when the Chair releases her proposed budget. The decisions we make in the budget reflect our values, and are at the core of what we do as county commissioners. I want to dedicate most of this month’s newsletter to describing what happens during the budget process, and what I will be considering. I’ve also included some information about May as Mental Health month and a link to my statement about the County’s sale of Wapato Jail.
Multnomah County Budget
The County’s budget supports critical services in the areas of housing and homelessness, health care, families and children, and public safety, as well as infrastructure like roads and bridges. The County’s total budget is about $2 billion. However, a large chunk of the total budget includes federal and state funds that the county receives in exchange for providing specific programs or services. About one-third of the total budget, or around $620 million, comprises the County’s General Fund budget.
As a Board, we are responsible for developing and approving a balanced budget each year. The General Fund, which is primarily local tax revenue, is the most flexible part of the budget. The Board has discretion to allocate the General Fund budget among the services we provide.
Our most recent General Fund forecast is fairly balanced for the upcoming fiscal year (July 1, 2018, through June 30, 2019). Assuming the County continues to provide all the same programs and services it currently provides, and based on projected economic growth, we have a small one-time surplus of about $3 million. However, the forecast also predicts that the County will face deficits in future years, and we will need to make difficult decisions about which programs will need to be cut, how program funding might be more effectively reallocated, or how to raise the additional revenue we would need to continue at current levels of programming.
Over the next 6 weeks I will work with the Chair and my colleagues on the Board to make budget decisions, focusing on using our limited resources to most effectively help the most people. When making some of the tough choices, the factors I consider include: (1) How closely the program or service is aligned with the County’s mission to serve people who are the most vulnerable in our community; (2) Whether the program or service (or something similar) is provided elsewhere; and (3) The balance of cost and benefit from the program or service, including the scale of the program’s impact.
I’d very much like to hear from you about your priorities during this year’s budget process, and there are several ways you can make your voice heard:
First, you can take this survey to share your thoughts about which County services should be our highest priorities.
You can also share your thoughts about the budget by attending and testifying at one of the three public budget forums we have scheduled in May:
You can also watch our budget work sessions starting next week by either joining in-person in the Boardroom at the Multnomah County Building (501 SE Hawthorne Blvd) or streaming live online. During budget work sessions, leaders from County departments present an overview about the services they provide, how effective those services are, and their major opportunities and challenges.
And of course, you can always contact my office directly to share your feedback, ideas, and thoughts by email at email@example.com, by phone at (503) 988-5220, or by mail at 501 SE Hawthorne Blvd, Suite 600, Portland OR 97214.
May is Mental Health Month!
May is recognized nationally as Mental Health month, and Multnomah County will join hundreds of other cities, counties, and states in raising awareness of mental health, fighting stigma, providing support, educating the public, and advocating for public policies that support recovery and promote mental health. There are lots of events happening across the County to observe this month of awareness and advocacy, and I’ve included a few key events below:
Tuesday, May 1: Mental Health Month Proclamation and Community Health and Wellness Resource Fair at the Rosewood Initiative (16126 SE Stark St, Portland, OR 97233). Proclamation at 2:30PM, Health Fair beginning at 3:00PM.
Monday, May 14 & Wednesday, May 16: Join us for the County's first “Hope Rocks” painting project! The County will provide rocks and painting supplies, and guests can paint their own symbol or message of hope. All visitors can keep their rock or donate one for the County to use at an upcoming community event.
Hope Rocks East County: May 14, 11AM-1PM. West Gresham Plaza (2951 NW Division St, Gresham, OR) in the Freshwater and Springwater Rooms.
Hope Rocks Downtown: May 16, 11AM-1PM. Lincoln Building (421 SW Oak St.) in the Oak Room.
Thursday, May 17: Multnomah County Proclaims May Mental Health Month! We will vote on a proclamation and hear from community members during our regularly scheduled board meeting.
Sunday, May 20: 2018 NAMIWalk! Join Multnomah County for the 16th-annual NAMIWalk on the Vera Katz Eastbank Esplanade. Local leaders, mental health providers and community members will come together in a walk to raise funds and awareness for mental health in Oregon. As a sponsor, Multnomah County will have a booth and a team of walkers. Check in begins at noon, and the walk starts at 1 pm.
Please consider joining me at one of these events, or look for other ways to get involved during Mental Health Month 2018!
Finally, I heard from a number of Multnomah County residents about the sale of Wapato Jail. As someone who cares deeply about the most vulnerable in our county, who works in the ER where we see the tragic downstream effects of homelessness, and who ran for office with a desire to improve coordination between and outcomes for our homeless, health care, and public safety systems, I wanted to share this statement to provide additional insight into my decision to vote to sell Wapato beyond what can be gleaned from the media coverage.
I love hearing from constituents and community members, so please don’t hesitate to reach out if you have a question to ask, a concern to voice, an idea to share, or anything else you’d like me to know about.
In good health,
Multnomah County District 1 Commissioner
Commissioner Sharon Meieran Newsletter - March 2018
This month, I’m reflecting on the inspiring stories and images of students rallying and walking out of school to protest the school shooting in Parkland, Florida, and far too many other places. I wanted to attend the rally in Portland on Saturday but unfortunately I was traveling internationally and not able to attend in person. My heart was with everyone who gathered on Saturday, and even from across the world the impact of these young people’s voices is so clear.
My daughter, Ella, is a freshman at Wilson High School. She participated in the student protest and agreed to share some of her thoughts about the day. Here’s a little of what she had to say:
As a student, it’s deeply upsetting and scary that my older schoolmates can legally buy a gun and possibly sneak it into the school. And I think I speak for many of my classmates when I say I want something to be done, and I want to know how and when it is to be done, because I’m tired of hearing about school shootings on the news and thinking, “wow, that could’ve been me…” If we can make it a law that the legal age to buy tobacco is 21 instead of 18, why can’t we do the same for firearms?
I’m just a freshman wanting to be able to feel safe at school, but as a community, we can help make schools safer everywhere.
You can read the entirety of Ella’s insightful and thoughtful reflections here. My son, Ben, a 6th grader at Robert Gray Middle School, also participated in the protest last week.
Like many parents, I’m extremely proud of my kids for finding their voices on issues that matter to them. And seeing so many young people engage, agitate, organize, think critically, and hold us as adults accountable is truly amazing. As an emergency room doctor, I’ve seen the tragic effects of gun violence firsthand. I have had to inform parents that their child has been killed. I have seen young people rushed to the operating room, hoping they would survive. And as an elected official, I strongly support taking action to prevent gun violence at schools, in homes, in workplaces, and in public spaces.
I feel, as many others do, that the 2nd Amendment of the Constitution on its face does not convey the right for anyone, of any age, to purchase any weapon that exists, for any purpose they choose. I believe this right must be balanced with common sense and the safety of our communities, and I strongly support the advocacy of groups such as Moms Demand Action and Everytown For Gun Safety.
Here in Multnomah County and Oregon, we are fortunate to have strong leadership on this issue. Last year, the Board was briefed on the Multnomah County Sheriff’s Office’s comprehensive gun violence reduction strategy, and we formally adopted a legislative agenda that included addressing gun violence as a top tier priority. Chair Deborah Kafoury recently convened a roundtable discussion to get the word out about Oregon’s new extreme risk protection order (also known as a gun violence restraining order), a measure passed during the 2017 legislative session which allows the courts to temporarily prohibit someone from having guns if law enforcement or family members can show that the person is a danger to themselves or others. The Oregon Legislature closed the “boyfriend loophole” during the 2018 legislative session, giving courts the authority to remove guns from additional categories of abusers, prohibiting gun purchases by convicted stalkers, and improving notice to law enforcement of gun purchase attempts by prohibited persons. These laws aren’t perfect, but they move us in the right direction.
As Multnomah County’s representative on the Regional Disaster Preparedness Organization (RDPO), I also wanted to take the opportunity to share information about a new analysis about how an earthquake will affect our region from the Department of Oregon Geology and Mineral Industries (DOGAMI).
This new report provides updated and better information about the potential impact of the shaking from an earthquake. At the County, this analysis will guide how we plan our services over the long term. For example, the DOGAMI analysis supports the County’s current planning for major investments to ensure the Burnside Bridge can survive an earthquake and provide a lifeline over the Willamette River. The DOGAMI analysis also supports us in building the strong partnerships with other counties and cities in the region that will be essential in an emergency.
You can check out a city by city estimate of damage from a Cascadia Subduction Zone earthquake here, and the full report is available here. Every action you take to prepare for an earthquake helps. For help on how to start preparing, check out the resources here.
Finally, I hope you’ll save the date for my April constituent event the morning of Saturday, April 21. Stay tuned for details!
As always, I love to hear from you. I’m glad that many people have taken me at my word and reached out. Please don’t hesitate to send an email, call my office or keep in touch on social media.
In good health,
Multnomah County District 1 Commissioner
Commissioner Sharon Meieran Newsletter - February 2018
Last week, we were reminded that winter isn’t done with Multnomah County yet... Although the snow was beautiful, it was also a stark reminder for me of what people without homes endure, especially when the weather is severe. A little over a year ago, we had a snow storm that truly pushed our resources, planning, and preparedness to the limit. This time around and with a year as county commissioner under my belt, I’ve been really proud to see how Multnomah County has learned from and improved our response to severe weather to help ensure that people are safe, warm, and sheltered.
During the recent snow storm and cold spell, Multnomah County declared severe weather over five days, almost doubling the number of severe weather days active this season. We started the week providing more than 300 beds working with our partner Transition Projects, and added 125 beds at a Multnomah County Department of Community Justice building that we'd readied in advance, as those initial beds filled. Overall, we provided a safe, warm place for 300 to 350 people, on average, to sleep each night, and community-led sites served a few hundred more people every night. Nearly 50 county employees stepped up and volunteered to work shifts at our warming shelters, and countless partners joined them around the clock to keep doors open for those who needed shelter. More than a dozen trained medical resource volunteers, including my husband, offered their time helping guests at the shelters. Dozens of community members also stepped up to volunteer their time. Meanwhile, providers said community members responded to our calls for essential winter gear with a surge in donations. We coordinated with 211 to connect people with transportation, and worked hard to hold to our values by ensuring that nobody would be turned away from shelter during severe weather.
As always, there is a lot happening at the county. This month, I want to share some things that really stuck with me as this month has flown by.
- On the first day of February, I cosponsored a resolution passed by the Board encouraging the Legislature to continue to work towards universal access to health care for Oregon. We heard from people about their personal experiences with the health care system - as patients, as business owners, and as health care providers. As I discussed in my last newsletter, we need to ensure that everyone has real, meaningful access to health care.
- I traveled to Salem during the opening days of the 2018 legislative session to testify in support of House Bill 4143, legislation brought forward by the Governor’s Opioid Epidemic Task Force. In Multnomah County, there are very few services and programs that have not been touched by the opioid epidemic. Our health clinics, public safety services, housing resources, and even our libraries are affected, as we’ve had to devote a larger and larger share of public resources to deal with the effects of opioid addiction, and as the demand for substance abuse treatment across the board -- from detox to residential -- far exceeds the availability of these services.
- I hosted a community listening session that included showing a documentary focused on youth mental health. After the screening, members of our community engaged in discussions about their experiences and perceptions of our mental health system, and reported back on their vision for a better system. I’m grateful for everyone who attended and told their personal stories, especially the youth who participated. The feedback from this listening session will inform the mental health system analysis Human Services Research Institute (HSRI) is conducting for Multnomah County.
- The county made a tough decision to indefinitely suspend services at our largest shelter serving families while we work to assess the condition of the facility. Last year, the number of people served by the shelter more than tripled, and despite the County’s efforts to mitigate challenging conditions and capacity needs -- by increasing motel vouchers, limiting the number of people who could stay at the facility each night, and by opening the Mitzvah House family shelter at Congregation Beth Israel -- we could no longer ensure that the facility was safe for the families staying there. Closing the family center was a heartbreaking decision because we know the need is so great. Fortunately, we were able to move families into motel rooms, so kids can stay connected to their schools and parents connected to services until they are able to move into homes of their own.
- We proclaimed February as Black History and Black Future Month in Multnomah County, and the Multnomah County Employees of Color Employee Resource Group hosted speakers, performers, and community members with a celebration: Black History Month and 365 Days a Year: A Celebration of African American Achievement Everyday. We also proclaimed February 7th as National Black HIV/AIDS Awareness Day, and heard from an amazing panel about the progress we’ve made, and the health disparities African Americans still face.
- I toured the Mid County Health Center, which does much of the county’s immigrant and refugee health work. It was incredible. The clinic serves about 11,000 people, who can receive medical, dental, pharmacy, and behavioral health care all in one place. Patients speak 81 distinct languages, and the clinic seeks to coordinate appointments with translators so everyone receives high quality health care. The number of immigrants and refugees seeking care at the clinic has fallen significantly in the current political climate, reinforcing my commitment to continuing to fight to ensure that immigrants and refugees have safe access to medical care and support.
- The Board was briefed on the Native American Rehabilitation Association of the Northwest's (NARA) latest efforts, as well as how County funding has made an impact in the Native community and Multnomah County. Afterwards, we were honored with NARA blankets -- it was a special and moving experience.
- The ordinance Commissioner Vega Pederson and I introduced to address pollution from wood fires took effect this month. The winter burning season ends March 1, but starting October 1 and beyond look here for information about air quality and burning restrictions. Under our ordinance, wood fires that aren’t for cooking are prohibited on the worst air quality days in the wintertime. There are exceptions if a wood fire is your only source of heat, if you are low income, or if there is an emergency, such as a power outage.
There is even more I could say, but this is a potpourri of the types of things I’ve been working on at the County. As always, please don’t hesitate to contact my office with questions or ideas. You can reach me by email at firstname.lastname@example.org or by phone at (503)988-5220. I always look forward to hearing from you!
In good health,
Commissioner Sharon Meieran Newsletter - January 2018
Last week, Oregon voters protected access to healthcare for thousands of Oregonians by adopting Measure 101. I strongly supported the measure, canvassed, rallied and am so glad voters passed it.
Since the election, I’ve been reflecting on how important it is to ensure that everyone has health insurance and real, meaningful access to healthcare. If Measure 101 had failed last week, hundreds of thousands of Oregonians, including thousands of kids, would have faced uncertainty about whether they would have coverage if they became sick. They would be grappling with the reality that they might not be able to access potentially life-saving preventive care. They would have had to face impossible decisions about whether to pay for food, rent, or medications.
As an emergency physician, I cared for many newly insured patients after the Affordable Care Act took effect. The fact that newly insured patients were still coming to the ER first for routine care seemed to surprise many people, but as an ER doctor, I and many of my emergency medicine colleagues expected to see this from a systems standpoint - despite having insurance, this influx of patients coming to the ER still did not actually have connections with primary care providers or know how to use other resources available in a health care system. For example, I vividly recall seeing a woman with severe emphysema the day she received insurance. She did not need to be hospitalized, but she was chronically ill, her breathing troubles had been worsening for years, and she was finally was covered. As a result, she knew she could go somewhere to seek the kind of care she had needed for a long time. I was able to connect her with primary care and a pulmonologist, and just wish our system could have allowed this to happen sooner, and without her having had to suffer for years and ultimately come to the ER.
Expansions in Medicaid eligibility have moved us closer to universal coverage, but there are still people in our community who are not connected to the coverage and care they need. In Multnomah County, about 16% of people seeking care at the county’s health clinics are uninsured. These individuals are still able to get care and help enrolling in coverage, and this percentage is much lower than it was before the Affordable Care Act (when about 31% of clients at County clinics were uninsured). But clearly, 16% of people uninsured walking through the door is unacceptable from a humanitarian standpoint, and unsustainable from a financial standpoint.
That is why I’m championing a resolution for Board consideration this week supporting universal health care. Our Oregon Legislature has a history of working to improve healthcare access, including their work in 2014 to expand Medicaid eligibility, their work over several years to investigate financing options to improve coverage and access, and passage of two strong measures in 2017 to ensure comprehensive coverage for kids and reproductive health coverage regardless of immigration status. Currently, the Legislature’s Universal Access to Health Care Work Group is meeting with a directive to develop a set of recommendations to the Legislature to guide consideration of approaches that would achieve “universal access to an adequate level of high quality health care at an affordable cost.”
The resolution before the Board this week supports this progress by thanking the Oregon Legislature for its work toward universal health care and urging the Governor and Legislature to continue working to develop a comprehensive, equitable, and high quality system of health care that is accessible to all. If you’re interested in hearing more about this topic, you can join the Board meeting tomorrow, Thursday, February 1, at 9:30 a.m.at the Multnomah County Building at 501 SE Hawthorne Blvd., or watch live or recorded here.
Finally, please remember to RSVP if you’re interested in attending the second community mental health listening session coming up on Tuesday, February 6, at 6 p.m.! At this event, we will screen the documentary film Not Broken, which is a powerful film focusing on the stories of youth with lived experience of mental illness, as well as listen to community members’ experiences of the current mental health system and their vision for a better system. Seating is limited, so please RSVP by tomorrow, Thursday, February 1, to reserve your seat.
Whether it’s at the community listening session, at our board meeting supporting universal access to health care, or in the community, I hope to see or hear from you soon!
In good health,
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