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  • Voices from the Arab press: The new elite in Egypt

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    A weekly selection of opinions and analyses from the Arab media around the world.

    The new elite in Egypt

    Al-Masry Al-Youm, Egypt, August 14

    Until the early 1990s, the upper echelon of Egyptian society largely emerged from the public school system. Ministers, doctors, engineers, diplomats, and countless other professionals began their journeys in village and small-town schools before moving on to public universities.

    Today, however, the equation has shifted dramatically. Although precise studies and accurate statistics remain scarce, it is clear that graduates of private institutions – especially international schools – have risen to form Egypt’s new elite. The mere mention of such a school on a résumé can tip the balance in a young person’s favor, providing them with a decisive edge over their peers.

    Many jobs now demand proficiency in a foreign language, a requirement that leaves the majority of public school graduates – even those with advanced degrees from public universities – shut out from these opportunities. English, in particular, has become the gatekeeper of opportunity.

    If one’s English reflects the colloquial version taught in government schools, career prospects are stunted, no matter the strength of one’s university credentials. Conversely, fluency in polished English opens doors that remain closed to the majority.

    This phenomenon is not unique to Egypt. Across the globe, private schools have entrenched themselves in education systems. Roughly 17% of primary school students worldwide are enrolled in private schools, a figure that climbs to 26% at the secondary level.

    An illustrative image of private school students. (credit: SHUTTERSTOCK)

    Yet in Britain, the percentages tell a different story. As Alastair Campbell, former communications director under prime minister Tony Blair, recently noted, 93% of Britons attend state schools. Still, the 7% who receive private schooling disproportionately dominate positions of power across government, the judiciary, the media, finance, and beyond.

    Even though most ministers in the current Labour government hail from state schools, this does not automatically signal that Britain has achieved true meritocracy, or that social mobility ensures that anyone with talent, determination, and resilience can climb to the top.

    Campbell argues that private education confers an enduring advantage, positioning its graduates to occupy senior government offices and claim the lion’s share of society’s wealthiest and most prestigious roles. The so-called 7% club continues to wield vast political, cultural, and economic influence.

    Workplaces, by extension, favor private school graduates. While public school and university alumni strive to adapt, they often encounter a professional environment that feels alien, marked by subtle cues of exclusion. Accents, dress, hobbies, dining habits, and even conversational styles set them apart, reinforcing a sense of division between the world they come from and the world they now inhabit.

    Is this not precisely what we see in Egypt today? Increasingly, workplaces operate in English, even when serving a consumer base that is overwhelmingly Arabic-speaking.

    Sectors ranging from real estate to telecommunications, banking, and even hospitality package themselves as extensions of international firms, though their foundations remain deeply Egyptian. The cultural and social norms of these environments diverge sharply from those of the communities surrounding them.

    If Egypt is to achieve genuine social mobility, the graduates of its public schools – those scattered across its countless towns and villages – must be granted real access to elite positions. It should never be enough for someone to simply wave the credential of a private or foreign school as a passport to privilege. Equity demands more. The path to true mobility begins when opportunity is earned, not through background or accent but through merit, commitment, and ability.
    Abdullah Abdul Salam

    Where did Iran’s Arab masses disappear to?

    Asharq al-Awsat, London, August 15

    A grave-like silence hangs over the Arab public, untouched by the seismic events shaking the region. No demonstrations, no protests, no sit-ins can be found across Arab capitals – an unprecedented absence, perhaps for the first time in seven decades or more.

    Iran, meanwhile, has endured devastating blows. Its military setbacks and the damage to its nuclear infrastructure are immense, representing the loss of billions of dollars and countless lives, and years of labor. Beyond its ballistic and nuclear ambitions, Tehran has also seen the erosion of its vast network of influence – a popular movement painstakingly cultivated across the Arab world from Iraq toMorocco.

    When theLebanese government made the audacious decision to confiscate Hezbollah’s weapons, the reaction amounted to little more than a few dozen motorcycles roaming the streets of Beirut in protest. So where are the millions once summoned by the party’s leader or by Tehran itself?

    The collapse of Iranian influence across the Arab sphere echoes the unraveling of Nasserism after the crushing defeat of 1967. Stripped of its ability to ignite the street, Nasser’s regime fell back on choreographed displays – pressing Socialist Party loyalists and labor unions into filling venues – after spontaneous, fervent crowds that had once surged into public squares in response to the magnetic pull of radio broadcasts dwindled away.

    What remained was a collective sense of shock and despair in a region that had long pinned its hopes on the liberation of Palestine.

    Iran, too, once commanded a similar popular reach. It defied attempts to ban its ideas, molding generations of Arabs through ideology and outreach. Tehran embraced Sunni extremists – including al-Qaeda figures – despite their anti-Shi’ite dogma, and threw support behind Sunni opposition movements challenging their regimes.

    It forged organic ties with the Muslim Brotherhood, held semiannual conferences for Arab nationalists and Communists, and invested heavily in cultivating intellectuals and artists. Poems, books, and speeches extolling the virtues of the imam’s regime poured forth, while Tehran’s reach extended across Shi’ite, Sunni, and Christian circles, drawing in voices from the Gulf, Egypt, the Levant, North Africa, Sudan, Yemen, and Western Arab diasporas. Many Arab media outlets echoed Khamenei’s messaging.

    Somehow, Tehran managed to reconcile contradictions that seemed irreconcilable. In Tripoli, a city marked by historic tension with the Shi’ites of Beirut, Sunni factions remained loyal to Tehran since the 1980s. In Jordan, elements of the Muslim Brotherhood pledged allegiance to Tehran’s leadership. Publications appeared across the region defending its policies, while conferences in the Gulf celebrated sectarian “rapprochement” under historical banners.

    Yet none of this was undertaken in the name of God or to genuinely heal sectarian rifts; it was always part of a calculated political project aimed at domination. For decades, Tehran orchestrated both elite circles and street movements across Arab cities, mobilizing protests not only against regimes but against films, novels, and peace negotiations.

    But since the wars following the October 7, 2023 attacks, that once-unshakable dynamism has evaporated. The reasons are clear: People turn away from the defeated, and the agencies that fueled these movements have seen their lines of communication severed and their resources dry up. The Arab street venerates victors and abandons them when they fall, only to embrace the next rising force.

    Iran’s followers have been stunned by repeated defeats, just as Nasser’s admirers were traumatized by the failures of the 1960s. Today, the central challenge is whether Tehran can retain even its Shi’ite base, which has borne the greatest burden and remains in shock.

    Sooner or later, Lebanon’s Shi’ites will confront a painful realization: They are victims of Hezbollah and Iran, not beneficiaries. For four decades, they have carried the weight of this alliance, suffering economic collapse, the destruction of their neighborhoods, and punitive sanctions targeting their livelihoods and remittances from Africa, Latin America, and North America. What they have endured is not the empowerment of a community, but the crushing cost of serving as Tehran’s front line. – Abdulrahman Al-Rashed

    Bombing civilians without a clear strategy

    Al-Ittihad, UAE, August 15

    On August 8, while commenting on the deaths of civilians in Gaza caused by Israeli airstrikes, US Ambassador to Israel Mike Huckabee sought to justify the attacks by invoking the Allied firebombing of Dresden in February 1945. His remarks, provocative as they are, raise a broader issue worth examining: the long and deeply contested history of aerial bombardment against civilians.

    The use of air power against noncombatants dates back to World War I, when German Zeppelins dropped bombs on British cities. Though casualties were relatively limited compared to the slaughter inflicted by artillery on the European front lines, the psychological impact was immense, signaling a new era of warfare.

    In the interwar period, air raids were deployed in colonial campaigns across the Middle East and North Africa. In Europe, the most notorious case was the German bombing of Guernica in 1937 during the Spanish Civil War. Though only a few hundred people were killed, the attack targeted a market day and became immortalized through Pablo Picasso’s iconic mural, which conveyed the horror of modern mechanized destruction.

    The Sino-Japanese War which erupted that same year marked an even more brutal expansion of this tactic. Japanese forces unleashed devastating air raids on Chinese cities, killing tens of thousands in Chongqing and contributing to mass civilian deaths in Nanjing.

    World War II cemented the role of air power in civilian carnage, with estimates of one to one and a half million people killed across multiple fronts. The German bombing of Warsaw in 1939, the flattening of Rotterdam, and the Blitz against Britain in 1940 foreshadowed the sheer scale of devastation yet to come.

    As the war intensified, the Allies responded with massive bombing campaigns across Germany, creating “firestorms” that consumed cities such as Hamburg, Kassel, and Dresden, while others – Cologne, Berlin, Hanover, Stuttgart, and Magdeburg – were left in ruins.

    In the Pacific theater, American raids on Japan culminated in the March 1945 firebombing of Tokyo, which incinerated more than 100,000 civilians, and later in the atomic annihilation of Hiroshima and Nagasaki.

    The use of air power against civilians did not end with World War II. In Southeast Asia during the 1960s and 1970s, hundreds of thousands perished in bombing campaigns, and the region suffered the ecological and human toll of Agent Orange, a chemical weapon aimed at destroying crops and forests.

    In later decades, wars in the Middle East and South Asia saw comparatively fewer deaths from airstrikes, yet the protracted bombing campaigns in Gaza have triggered some of the fiercest debates in recent memory.

    The ubiquity of raw, daily video footage – images of families digging through rubble, children starved and displaced, and entire neighborhoods flattened – has amplified global accusations that Israel is committing war crimes, even genocide.

    This moral quandary is not new. At the end of World War II, the destruction of Dresden was criticized by British officials, church leaders, and ordinary citizens alike, though it was not classified as a war crime, largely because the revelation of Nazi atrocities overshadowed such debates.

    Likewise, the moral reckoning over Hiroshima and Nagasaki was muted by the widespread belief that the atomic bombs spared millions of lives by forcing Japan’s surrender and avoiding a ground invasion.

    Today, Gaza presents its own moral labyrinth. While Hamas bears responsibility for embedding its operations among civilians, Israel faces mounting criticism for what increasingly appears to be a war without a clear exit strategy. The grim lesson of history is that aerial bombardment of civilians invariably raises doubts about both morality and strategy, doubts that reverberate long after the bombs have fallen. – Geoffrey Kemp

    Hezbollah’s weapons never intended to safeguard Lebanon

    An-Nahar, Lebanon, August 15

    The Islamic Republic says one thing and its opposite when it comes to Lebanon. Before Ali Larijani, secretary of the Supreme National Security Council of Iran, arrived in Beirut, Iranian officials – including Larijani himself – dismissed outright the Lebanese government’s stance on Hezbollah’s weapons. Iranian Foreign Minister Abbas Araghchi even proclaimed that the Lebanese government would “fail” in any attempt to disarm the party.

    Yet as Larijani’s visit approached, the rhetoric shifted. Suddenly, Iranian officials were speaking of “Iran’s support for the Lebanese people,” not merely for Hezbollah.

    This change in tone appears to have been one of the conditions set by the Lebanese side to grant Larijani meetings with President Joseph Aoun and Prime Minister Nawaf Salam, who insisted during a cabinet session on fixing a deadline – by year’s end – for dismantling Hezbollah’s arsenal. The president raised no objection, underscoring that the Lebanese authorities have but one option: to adopt a definitive position on the illegal weapons of a party that is Lebanese in name only.

    The difference between mounting a hostile campaign against the Lebanese government and claiming to “support the Lebanese people” is stark.

    Those who defend Hezbollah’s arms are, in truth, standing against the Lebanese themselves, given the devastation those weapons – extensions of Iran’s arsenal – have inflicted on the nation, including on its Shi’ite citizens. Hezbollah’s weapons have never been intended to safeguard Lebanon; their purpose has always been to transform it into a state orbiting within Tehran’s sphere of influence.

    Larijani could not maintain even a veneer of moderation. At a press conference following his meeting with Parliament Speaker Nabih Berri, he reverted to reiterating Iran’s opposition to any timetable for Hezbollah’s disarmament – in essence, resisting the dismantling of the Islamic Republic’s weapons stationed throughout Lebanon.

    He urged the Lebanese to “preserve the resistance,” ignoring that the primary cause of Lebanon’s misery is precisely this so-called resistance, which has impoverished the south and dragged the entire country into becoming little more than a battleground for Iran’s messages to Israel, and previously for the exchanges between the Assad regimes in Syria and Israel.

    There is a reality in Lebanon that Iranian officials like Larijani refuse to acknowledge: The “resistance” was never more than an Iranian instrument, advancing Tehran’s agenda under the guise of Lebanese struggle. Iran seized on the US-led war in Iraq in 2003 to push its expansionist project further across the region.

    What, after all, explains the assassination of Rafik Hariri and his companions, and the long chain of killings that followed – including the assassination of Lokman Slim – if not Iran’s determination to dominate Lebanon and suffocate any effort to revive its national life, especially in Beirut?

    Who can forget Hezbollah’s paralyzing sit-in in downtown Beirut, or the bloody events of May 7, 2008?

    Nor is there any need to revisit in detail the 2006 summer war, which preceded Hezbollah’s incursion into Beirut and Mount Lebanon. That conflict, with its devastating aftermath, exposed the depth of collusion between Iran and Israel, culminating years later in the election of Michel Aoun as president in 2016 and, before the close of his term, in the maritime border demarcation agreement with Israel that served Israeli interests.

    Iran acts solely for its own benefit. Every Lebanese child knows this.

    Every Lebanese child understands that the Islamic Republic has done nothing but dismantle Lebanon and displace its people. Iran has no allies in Lebanon – only tools it wields in the hope of striking a grand bargain with its “Great Satan,” the US, to cement its regional dominance.

    Larijani came to Beirut after first stopping in Baghdad, where he signed a security pact with Iraq aimed at salvaging what remains of Iran’s expansionist vision. At this moment, the Islamic Republic seeks nothing more than to prove it still has leverage in the region, Lebanon included.

    To that end, Larijani falls back on tired, hollow language that glorifies the “resistance” while deliberately ignoring the calamities it has unleashed, including the “Gaza Support War.”

    That war devastated Lebanese villages, most of them Shi’ite, and drove their people into displacement. It effectively reimposed the Israeli occupation, and Hezbollah’s insistence on clinging to its weapons now stands as the surest guarantee of its indefinite continuation.

    Larijani has no shortage of rhetoric and “advice” for the Lebanese, but he offers no answers to the obvious questions: Why did Hezbollah open a front in southern Lebanon? Who will bear the cost of the party’s crushing defeat? Who will rebuild the villages of the south? Who will return the displaced to their homes? Who will remove the Israeli occupation – an occupation Iran itself, through its proxy, has all but restored?

    Finally, the Iranian envoy, who claims to know the region well, seems to have forgotten Iran’s own most painful wound: the loss of Syria. Syria matters to Tehran as the indispensable corridor to Lebanon, and thus to Hezbollah.

    Until Iranian officials confront this new reality – that their wars can no longer be waged by proxy militias in Arab lands but must be faced within Iran itself – they will continue to repeat the same hollow script, even as the region around them moves on. – Khairallah Khairallah

    Translated by Asaf Zilberfarb/The Media Line. All assertions, opinions, facts, and information presented in these articles are the sole responsibility of their respective authors and not necessarily those of The Media Line, which assumes no responsibility for their content.

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  • Doctors Are Failing Patients With Disabilities

    Doctors Are Failing Patients With Disabilities

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    This piece was originally published by Undark Magazine.

    Ben Salentine, the associate director of health-sciences managed care at the University of Illinois Hospital and Health Sciences System, hasn’t been weighed in more than a decade. His doctors “just kind of guess” his weight, he says, because they don’t have a wheelchair-accessible scale.

    He’s far from alone. Many people with disabilities describe challenges in finding physicians prepared to care for them. “You would assume that medical spaces would be the most accessible places there are, and they’re not,” says Angel Miles, a rehabilitation-program specialist at the Administration for Community Living, part of the Department of Health and Human Services.

    Not only do many clinics lack the necessary equipment—such as scales that can accommodate people who use wheelchairs—but at least some physicians actively avoid patients with disabilities, using excuses like “I’m not taking new patients” or “You need a specialist,” according to a paper in the October 2022 issue of Health Affairs.

    The work, which analyzed focus-group discussions with 22 physicians, adds context to a larger study published in February 2021 (also in Health Affairs) that showed that only 56 percent of doctors “strongly” welcome patients with disabilities into their practice. Less than half were “very confident” that they could provide the same quality of care to people with disabilities as they could to other patients. The studies add to a larger body of research suggesting that patients with conditions that doctors may deem difficult to treat often struggle to find quality care. The Americans With Disabilities Act of 1990 (ADA) theoretically protects the one in four adults in the U.S. with a disability from discrimination in public and private medical practices—but enforcing it is a challenge.

    Laura VanPuymbrouck, an assistant professor in the Department of Occupational Therapy at Rush University, calls the 2021 survey “groundbreaking—it was the crack that broke the dam a little bit.” Now researchers are hoping that medical schools, payers, and the Joint Commission (a group that accredits hospitals) will push health-care providers for more equitable care.


    Due in part to scant data, information about health care for people with disabilities is limited, according to Tara Lagu, a co-author of both the 2021 and 2022 papers and the director of the Institute for Public Health and Medicine’s Center for Health Services & Outcomes Research at Northwestern University Feinberg School of Medicine. The few studies that have been done suggest that people with disabilities get preventive care less frequently and have worse outcomes than their nondisabled counterparts.

    About a decade ago, Lagu was discharging a patient who was partially paralyzed and used a wheelchair. The patient’s discharge notes repeatedly recommended an appointment with a specialist, but it hadn’t happened. Lagu asked why. Eventually, the patient’s adult daughter told Lagu that she hadn’t been able to find a specialist who would see a patient in a wheelchair. Incredulous, Lagu started making calls. “I could not find that kind of doctor within 100 miles of her house who would see her,” she says, “unless she came in an ambulance and was transferred to an exam table by EMS—which would have cost her family more than $1,000 out of pocket.”

    In recent years, studies have shown that even when patients with disabilities can see physicians, their doctors’ biases toward conditions such as obesity, intellectual disabilities, and substance-use disorders can have profound impacts on the care they receive. Physicians may assume that an individual’s symptoms are caused by obesity and tell them to lose weight before considering tests.

    For one patient, this meant a seriously delayed diagnosis of lung cancer. Patients with mobility or intellectual challenges are often assumed to be celibate, so their providers skip any discussion of sexual health. Those in wheelchairs may not get weighed even if they’re pregnant—a time when tracking one’s weight is especially important, because gaining too little or too much is associated with the baby being at risk for developmental delays or the mother being at risk for complications during delivery.

    These issues are well known to Lisa Iezzoni, a health-policy researcher at Massachusetts General Hospital and a professor of medicine at Harvard Medical School. Over the past 25 years, Iezzoni has interviewed about 300 people with disabilities for her research into their health-care experiences and outcomes, and she realized that “every single person with a disability tells me their doctors don’t respect them, has erroneous assumptions about them, or is clueless about how to provide care.” In 2016, she decided it was time to talk to doctors. Once the National Institutes of Health funded the work, she and Lagu recruited the 714 physicians that took the survey for the study published in 2021 in Health Affairs.

    Not only did many doctors report feeling incapable of properly caring for people with disabilities, but a large majority held the false belief that those patients have a worse quality of life, which could prompt them to offer fewer treatment options.

    During the 2021 study, Iezzoni’s team recorded three focus-group discussions with 22 anonymous physicians. Although the open-ended discussions weren’t included in the initial publication, Lagu says she was “completely shocked” by some of the comments. Some doctors in the focus groups welcomed the idea of additional education to help them better care for patients with disabilities, but others said that they were overburdened and that the 15 minutes typically allotted for office visits aren’t enough to provide these patients with proper care. Still others “started to describe that they felt these patients were a burden and that they would discharge patients with disability from their practice,” Lagu says. “We had to write it up.”

    The American Medical Association, the largest professional organization representing doctors, declined an interview request and would not comment on the most recent Health Affairs study. When asked about the organization’s policies on caring for patients with disabilities, a representative pointed to the AMA’s strategic plan, which includes a commitment to equity.


    Patients with disabilities are supposed to be protected by law. Nearly 50 years ago, Congress passed Section 504 of the Rehabilitation Act of 1973, which prohibited any programs that receive federal funding, such as Medicare and Medicaid, from excluding or discriminating against individuals with disabilities. In 1990, the ADA mandated that public and private institutions also provide these protections.

    The ADA offers some guidelines for accessible buildings, including requiring ramps, but it does not specify details about medical equipment, such as adjustable exam tables and wheelchair-accessible scales. Although these items are necessary to provide adequate care for many people with disabilities, many facilities lack them: In a recent California survey, for instance, only 19.1 percent of doctor’s offices had adjustable exam tables, and only 10.9 percent had wheelchair-accessible scales.

    Miles says she’s noticed an improvement in care since the ADA went into effect, but she still frequently experiences challenges in health care as a Black woman who uses a wheelchair. “We need to keep in mind the ADA is not a building code. It’s a civil-rights law,” says Heidi Johnson-Wright, an ADA coordinator for Miami-Dade County in Florida, who was not speaking on behalf of the county. “If I don’t have access to a wellness check at a doctor’s office or treatment at a hospital, then you’re basically denying me my civil rights.”

    The ADA isn’t easy to enforce. There are no “ADA police,” Johnson-Wright says, to check if doctor’s offices and hospitals are accessible. In many cases, a private citizen or the Department of Justice has to sue a business or an institution believed to be in violation of the ADA. Lawyers have filed more than 10,000 ADA Title III lawsuits each year since 2018. Some people, sympathizing with businesses and doctors, accuse the plaintiffs of profiteering.

    And it’s not just about accessible equipment. In 2018, the Justice Department sued a skilled nursing facility for violating the ADA, after the facility refused to treat a patient with a substance-use disorder who needed medication to help maintain sobriety. Since then, the department settled with eight other skilled nursing facilities for similar discrimination. “It is a violation of the ADA” to deny someone care based on the medications they need, Sarah Wakeman, an addiction-medicine specialist at Massachusetts General Hospital, wrote in an email, “and yet continues to happen.”

    Indeed, in the focus groups led by Lagu and Iezzoni, some of the doctors revealed that they view the ADA and the people it protects with contempt. One called people with disabilities “an entitled population.” Another said that the ADA works “against physicians.”

    The Department of Health and Human Services is aware of the issue. In a response to emailed questions, an HHS spokesperson wrote, “While we recognize the progress of the ADA, important work remains to uphold the rights of people with disabilities.” The Office of Civil Rights, the spokesperson continued, “has taken a number of important actions to ensure that health care providers do not deny health care to individuals on the basis of disability and to guarantee that people with disabilities have full access to reasonable accommodations when receiving health care and human services, free of discriminatory barriers and bias.”


    Researchers and advocates told me that the key to improving health care for those with disabilities is addressing it directly in medical education and training. “People with disabilities are probably one of the larger populations” that physicians serve, Salentine said.

    Ryan McGraw, a community organizer with Access Living, helps provide education about treating patients with disabilities to medical schools in the Chicago area. He regularly receives positive feedback from medical students but says the information needs to be embedded in the medical-school curriculum, so it’s not “one and done.”

    In one effort to address the issue, the Alliance for Disabilities in Health Care Education, a coalition of professionals and educators of which McGraw is a member, put together a list of 10 core competencies that should be included in a doctor’s education, including considerations for accessibility, effective communication, and patient-centered decision making.

    One of the simplest solutions might be hanging signs or providing accessible information in exam rooms on patients’ rights. “It’d be there for patients, but it’d be also there as a reminder to the providers. I think that’s a super easy thing to do,” Laura VanPuymbrouck says. Miles says this could be a good start, but “it’s not enough to just give people a little pamphlet that tells you about your rights as a patient.” Although all doctors should be willing and able to care for patients with disabilities, she thinks a registry that shows which providers take certain types of insurance, such as Medicaid, and also have disability accommodations, such as wheelchair-accessible equipment, would go a long way.

    Some advocates have called on the Joint Commission for more than 10 years to require disability accommodations for hospitals that want accreditation. The step could be effective, because accreditation “is extremely important” to hospitals, Lagu says.

    On January 1, 2023, new Joint Commission guidelines will require that hospitals create plans to identify and reduce at least one health-care disparity among their patients. Improving outcomes for people with disabilities could be one such goal. However, Maureen Lyons, a spokesperson for the Joint Commission, adds, “if individuals circumvent the law, standards won’t be any more effective.”

    Finally, Lagu says, “we have to pay more when you are providing accommodations that take time or cost money. There’s got to be some accounting for that in the way we pay physicians.”

    One of the most basic things people with disabilities are asking for is respect. The biggest finding of the 2021 survey, Iezzoni says, is that doctors don’t realize that the proper way to determine what accommodations a facility needs for patients with disabilities is to just ask the patients.

    “I can’t tell you how many times I go to a doctor’s office and I’m talking, but they’re not hearing anything,” Salentine says. “They’re ready to speak over me.”

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    Emma Yasinski

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