Health
AP Investigation: Bungling by UN Agency Hurt Ebola Response
In this Monday, Aug. 10, 2015 photo, Juma Musa describes how he once opened a batch of ineffective chlorine powder that had expired a year earlier, during an interview at the government hospital in Kenema, eastern Sierra Leone. In the background is a yellow chlorine disinfectant sprayer. More than 40 health workers at the facility have died of Ebola. “We were in a war zone and the chlorine was the only thing that was giving us courage to come closer to patients,” Musa says. (AP Photo/Sunday Alamba)
MARIA CHENG, Associated Press
RAPHAEL SATTER, Associated Press
KRISTA LARSON, Associated Press
KENEMA, Sierra Leone (AP) — Something didn’t smell right.
As a worker at Kenema Government Hospital mixed a batch of chlorine on a broiling August day, he noticed it didn’t have its typically strong, bleach-like odor. Concerned, he turned to a consultant with the World Health Organization, who tested the disinfectant and found barely any active ingredient.
“I was deeply shocked,” the consultant, Jerome Souquet, wrote in an email to his boss in Freetown, Sierra Leone’s capital. Souquet said the consequences of using the ineffective chlorine “could be catastrophic, and cause immediate infection of all the staff.”
Questionable chlorine was just one of a toxic mix of avoidable problems faced by Ebola responders in Kenema last summer as the outbreak was spiking. Weak leadership, shoddy supplies and infighting exacerbated a chaotic situation at a critical front in the battle against the virus, an Associated Press investigation has found. More than 40 health workers died in Kenema — a devastating loss in the fight to control an epidemic that has claimed more than 11,000 lives.
In March, AP reported that senior officials at WHO’s Geneva headquarters resisted calls to declare Ebola an international health emergency — the equivalent of an SOS signal — on political and economic grounds. But newly obtained documents, recordings of conference calls and interviews with key players on the ground show that even after the alarm was raised, WHO and others struggled to put together a decisive response.
The World Health Organization’s Director-General Dr. Margaret Chan — whose U.N. agency is charged with leading the fight against global outbreaks — demanded the dispatch of vehicles and equipment, but penny-pinching meant only a trickle of cash made its way to frustrated responders. Supplies were so scarce that body bags — which protect aid workers from exposure to the highly contagious corpses — ran out. Confusion delayed the construction of a new treatment clinic.
Experts say the fumbling cost lives across West Africa.
“There’s no question that a better and earlier response from WHO could have resulted in thousands and thousands of fewer deaths than we saw,” said Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University in New York.
The situation at Kenema hospital last summer was horrific. Blood-drenched patients lay in agony in understaffed wards as the dead cluttered the hallways. Health workers sweltered through grueling shifts despite attacks from locals who threatened to burn the building down, convinced doctors and nurses were spreading the disease deliberately.
Meanwhile WHO was “paralyzed,” according to Joseph Fair, an American disease expert who was in Freetown advising the Sierra Leone government. In interviews with AP, he described “death by conference call” as health officials argued about things like whether to order more ambulances and the proper color of body bags.
Two months ago, a WHO-commissioned panel criticized the organization’s leadership but did not mention the logistical problems, infighting or other details uncovered by AP. The report called for accountability, but did not name a single person or department responsible for the failures. The evaluation concluded that “WHO was reported to be respected for its technical work in the three (Ebola-affected) countries.”
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“WE ARE AT RISK OF VERY POOR PERCEPTION”
Kenema, a diamond town whose potholed roads turn to red sludge in the rainy season, was a microcosm of the messy response across West Africa as Ebola raged out of control last year. Identified in the West African forest in early 2014, the virus appeared to abate in May before surging back, killing hundreds in Guinea, Sierra Leone and Liberia throughout June and July before belatedly triggering an international emergency in August. Officials estimate the outbreak won’t be stopped before the end of 2015.
One of Sierra Leone’s largest cities, Kenema’s proximity to Guinea’s forest region and its decent road link to Freetown made it a key seeding point as the virus spread across the region. It was identified as one of two priority areas in an urgent July 24 message sent by WHO’s Chan to her senior staff. “Transportation, PPE (personal protective equipment) and other equipment must (be) provided,” she wrote.
That did not quite happen.
Staffers were so strapped for safety gear that nurse Donnell Tholley said they sometimes resorted to ill-fitting gloves to protect their hands and stray plastic packaging instead of heavy-duty footwear.
And then there was the chlorine.
In Kenema, the disinfectant was made from powder kept in 10- or 25- kilogram (20- to 50-pound) drums in the hospital’s storeroom. The powder was mixed with water in several stages to make chlorine solution for washing hands and sterilizing surfaces. Many aid organizations in West Africa — like Doctors Without Borders, which had a facility in nearby Kailahun — imported the powder. WHO decided to use chlorine from the government’s own supplies in Freetown.
That proved to be a mistake.
By the time Souquet wrote his Aug. 20 email, it was the second time in several days the hospital had been left with defective chlorine.
Drums were repeatedly found with tags ripped off, expiration dates obscured or marked by evidence of tampering. Hospital porter Juma Musa described his horror at opening a batch of chlorine powder in July to find that it had expired more than a year earlier.
While in that case Musa said he stopped the spoiled chlorine from being used, other porters told AP they could not rule out that bad batches slipped through. The problem badly rattled staff at a time when many already were abandoning their posts.
“We were in a war zone and the chlorine was the only thing that was giving us courage to come closer to patients,” Musa said.
Kenema Government Hospital, an outdoor campus of aging buildings connected by gravel pathways, had enough problems as it was.
The nurses’ station was perilously close to an area where Ebola patients were held, with only a flimsy barrier to separate them. Triage was virtually non-existent, and patients — many of them children — were shuffled to the Ebola ward bearing “slips of paper containing incomprehensible abbreviations or incomplete histories,” according to an Aug. 7 status report drafted by Tulane University’s John Schieffelin and Shevin Jacob of the University of Washington. Maxon Kobba, a nurse there, said that as many as 20 patients could die in one night.
“Some would cry, ‘I want to die! I want to die!’ because they were in so much pain,” he said.
Walking into the hospital made for “the shock of my life,” U.S. health official Austin Demby told Sierra Leone expatriates in an Aug. 16 conference call, a recording of which was obtained by AP. He described seeing dead bodies “just laying all over the place” and a “complete breakdown” in management.
“I’m not for blaming anybody for anything, but WHO could really spend a little bit more time on Kenema,” Demby said on the call.
Others complained about WHO leadership, too. When the Red Cross offered to build an Ebola treatment center to deal with the crush of patients in Kenema, it was held up because no one in Sierra Leone’s government or WHO could tell them where to build it.
“The instructions keep changing and nobody seems to take leadership,” Red Cross official Panu Saaristo said in an Aug. 4 email to WHO’s Ian Norton, who acknowledged that the issue was serious.
“We are at risk of very poor perception by the public when we send in IFRC (the Red Cross) then block their ability to care for patients,” Norton wrote in a follow-up message sent to colleagues.
The government in Freetown eventually insisted that the Red Cross set up 12 kilometers (8 miles) out of town. Amanda McClelland, a senior Red Cross Ebola advisor in Sierra Leone, argued against the decision.
“I was trying to hold my ground (until) the president of the country called me,” she told the AP. “And he said, ‘Well, you can build there or you can go home.'”
The Red Cross gave in and spent about a week fighting to clear the rural site with a single bulldozer in the driving rain before an expert said the land was unusable. The clinic was eventually built several miles away and opened in September 2014 — after the outbreak had peaked, McClelland said.
Outside the hospital’s main entrance, the health workers who died are memorialized in a large black marble monument etched with their names and the dates of their deaths. Fading fliers with photos and messages of love remain taped to the cement walls in each ward. The toll of the dead became so overwhelming a new cemetery was opened, behind the Red Cross clinic, the graves marked with numbers instead of names.
Sierra Leone has lost more health workers than any other country affected by the virus, recording 221 of 513 overall deaths.
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“EVEN BUYING BUCKETS WAS DIFFICULT”
Emails reviewed by AP put many of the complaints over WHO leadership at the feet of Jacob Mufunda, the WHO Representative in Sierra Leone. WHO Representatives, known as WRs, are supposed to reinforce poor nations’ health systems and prod local officials to action, but AP found little evidence Mufunda did either.
Meetings scheduled to last a single hour routinely stretched to three or even five hours with “lots of endless talk” and “no decision taken,” WHO Ebola coordinator Philippe Barboza complained in an Aug. 8 email to Mufunda.
Fair, who was with the U.S. epidemic research firm Metabiota Inc. before working as a government adviser, recalled an interminable conference call in which officials spent “a good 45 minutes discussing the cultural sensitivities of having a black body bag versus a blue or white one.” The cultural issues were real — black body bags were seen as sinister — but Fair said he was upset “that we were spending this much time discussing the color of body bags when we don’t have any.”
Requests to fix critical problems like the hospital’s shaky generator regularly went unfulfilled by Mufunda’s office, leaving WHO technicians to cover thousands of dollars’ worth of expenses out of their own pockets, according to two WHO employees on the ground at the time. They spoke on condition of anonymity because they were not authorized to talk without the U.N. agency’s permission.
Lionel Larcin, a Doctors Without Borders water and sanitation expert sent to Kenema in early August, described sitting on the plane to Africa “reading the newspaper about millions of dollars being sent to fight the virus.” But when he asked for protective boots, he was shocked to find WHO staffers dipping into their daily allowances to pay for them.
“Even buying buckets was difficult,” he said.
A missive from WHO chief Chan obtained by AP laid out the scale of the problem, not just in Kenema but across West Africa. The Aug. 3 email to Mufunda and other senior WHO staffers said logistics experts were receiving only a couple hundred dollars a week to cover $1,000 or even $10,000 worth of expenditures — a problem that had been festering for four months. Chan warned that WHO needed to respond efficiently if it was to retain its leadership.
“I expect all colleagues especially our WRs to facilitate experts and staff to do their field work and not to post barriers because business as usual does not work during crisis.”
Mufunda, who was reassigned to run WHO’s office in Mozambique shortly thereafter, did not return messages from AP seeking comment.
Dr. Bruce Aylward, WHO’s top Ebola official, disputed that the mistakes uncovered by AP worsened the epidemic. He said swapping posts was common in emergencies and that Mufunda and other WHO representatives in Guinea and Liberia “took the outbreak very, very seriously and were deeply concerned.”
“Now, their ability to scale the response and manage the response the way it needed to be done — they may not have had that experience or that expertise,” Aylward said.
In addition to struggles with the government, WHO also was wrestling over the reins with Metabiota, the epidemic research company. The San Francisco-based firm had been charged with reinforcing Sierra Leone’s response, but emails obtained by AP alleged that the company was instead undermining the U.N. agency’s authority by drawing up response plans without WHO’s knowledge.
“Since weeks now Metabiota staff are doing their level best to systematically bypass and marginalise (the) WHO role,” wrote Barboza, the Ebola coordinator.
Barboza said the relationship with Metabiota was verging on “open conflict,” and recommended pulling all epidemiological staff from Kenema. He warned that the feud was holding up 1 million euros in funding from donors skeptical that WHO had control over the situation.
“That comes as a surprise to me,” said Metabiota CEO Nathan Wolfe in an interview Friday. “Most of the feedback has been that we worked very well with WHO.”
In follow-up emails Saturday, Metabiota said it had looked into the matter and said the conflict was an “individual disagreement between a Metabiota consultant and an individual at the WHO that we resolved.”
Reached by AP, Barboza declined to comment on the emails. Fair said he could not comment on the issue, which emerged after he left the company.
The response also was complicated by other problems.
Emails obtained by AP show a WHO data expert accusing Sierra Leonean officials of fiddling with her Ebola figures to make them match their government’s count, presumably to avoid having their numbers contradicted by the U.N. One Kenema government lab worker was even accused of accepting bribes in order to fake Ebola test results, a practice that risked sending infected people back into the community.
Then there was the matter of sheer indifference.
Amid a shortage of body bags, Fair said he spent about 12 hours calling numerous government officials in Freetown, in an attempt to guide a shipment of body bags through customs. By 11 p.m., after dozens of calls, he threatened to have the uncooperative airport customs officer fired unless the body bags were released.
Eventually, some 100 bags were piled into a car. In a 4 a.m. email to Barboza, Fair told AP, he begged the police superintendent to let the driver through a checkpoint so the bags could arrive overnight but said the superintendent slept through the driver’s calls. Stuck at the checkpoint, the driver napped in his car until he got authorization to leave the following morning.
“This was at a point when we had about 20 bodies lying outside,” Fair said. What are patients supposed to think, he asked, when they see “these bodies of people who were very recently next to them in the clinic, outside, with no dignity whatsoever, in the rain?”
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“DISORGANIZED AND LATE TO THE PARTY”
The problems that hamstrung the Ebola response have prompted soul-searching at WHO and across the public health community. The WHO-commissioned review was one of no fewer than five different inquiries set up to evaluate the world’s bungled response.
“WHO does not have a culture of rapid decision-making and tends to adopt a reactive, rather than a proactive, approach to emergencies,” WHO’s 28-page report said. It went on to say: “There seems to have been a hope that the crisis could be managed by good diplomacy rather than by scaling up emergency action.”
WHO has vowed to overhaul its emergency response system, but has not censured any senior officials who oversaw its Ebola efforts. They remain employed by the agency, except for its Africa director, who retired after serving out his term.
Aylward, the WHO official, said he believes fear and resistance from locals were more powerful drivers of the epidemic than any mistakes by WHO or anyone else.
Dr. Brima Kargbo, Sierra Leone’s chief medical officer, defended the government’s response to the crisis and said that the greatest setbacks were caused by community resistance.
“To me I don’t think there is anything different from what we are supposed to do as a government,” he said of any lessons learned from the outbreak.
Redlener, the disaster preparedness expert, said he doesn’t think things will be much different the next time a global health crisis strikes, namely because the top WHO leaders remain in place.
“We’ve already seen what the old leadership at WHO has been able to do, so I don’t know why we would expect them to be able to right themselves,” he said.
Redlener said that while nearly every response to a major emergency is flawed, WHO’s level of dysfunction during Ebola was exceptional, noting that the agency wasn’t just stretched for cash, as many have suggested.
“By the time WHO got in there, they were disorganized and late to the party,” he said. “When WHO failed to provide that leadership, it was demoralizing for the other agencies and for the rest of the world.”
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Cheng and Satter reported from London and Paris. Associated Press writers Jamey Keaten in Geneva and Lisa Leff in San Francisco contributed to this report.
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Online:
Maria Cheng can be reached at: https://twitter.com/mylcheng
Raphael Satter can be reached at: https://raphae.li
Krista Larson can be reached at: https://twitter.com/klarsonafrica
Lisa Leff can be reached at: https://twitter.com/scoopscout
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WHO’s Ebola emails: —https://apne.ws/1P9KpWt
Copyright 2015 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Black History
BOOK REVIEW — Curved Air: A Biography of Sickle Cell Anemia and the Quest to Cure the First Molecular Disease
OAKLAND POST — Over decades, researchers worked haphazardly. Papers were written, treatments were tried, used, or discarded. Doctors discovered that genetic testing could prevent new cases, a heartbreak for would-be parents. Researchers discovered that “a perfect storm” of confluence spread SCD: malaria, human population, and mosquitoes.
Copyright: c.2026, Publisher: The Belknap Press of Harvard University Press, SRP: $29.95, Page Count: 338 pages
Four weeks of testing, and you’re exhausted.
Two gallons of blood, maybe three, have been removed. No lie. You’ve laid on tables, slid through machines, been scanned so much you lost count and finally, your doctors have a diagnosis. As in the new book “Curved Air” by Kevin Davies, you have hope there’s a what next?
Though the disease was known in parts of Africa and likely existed here in the United States for hundreds of years, sickle cell disease (SCD) is a relative newcomer in disease research.
Says Davies, “Sickle cell was first identified more than 120 years ago” and it was considered as a “Black disease.” Because of that, discrimination followed “sickle cell warriors” and research was scant, though white people can and do get SCD.
With “agonizing” pain as a major symptom, “SCD is one of roughly seven thousand genetic diseases” currently known to science. When someone has SCD, a genetic mutation causes their red blood cells to curve and get stuck in blood vessels, rather than flowing freely as they should. This diminishes the oxygen supply “to various parts of the body… which causes inflammation and pain,” jaundice, stroke, and damaged organs. Anemia, Davies says, can leave a patient fatigued and short of breath. Anticipating pain crises causes anxiety and PTSD.
Says Davies, “More than forty million people carry” one copy of the genetic mutation that causes SCD, and “five hundred thousand affected” babies are born with the disease per year, worldwide.
Over decades, research was done haphazardly. Papers were written; treatments were tried, used, or discarded. Doctors discovered that genetic testing could prevent new cases, a heartbreak for would-be parents. Researchers discovered that “a perfect storm” of confluence spread SCD: malaria, human population, and mosquitoes.
There was always hope that someday, sickle cell disease might be cured.
Then, Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) gene-editing therapy was approved by the FDA, and a brave volunteer named Victoria Gray stepped forward…
So, you want to – need to – learn more about sickle cell disease? Is it imperative for you? Then, this is your book. But there are things you’ll want to know before you dive into “Curved Air.”
Because author Kevin Davies is the editor of The CRISPR Journal, you can expect up-to-date, cutting-edge information; but that’s a two-sided coin: the information is heavy-duty, not always easy to grasp, and it’s burdened by acronyms that can be overwhelming. Yes, that’ll inform you, but it may also send you elsewhere for further understanding, which really should’ve come from this book.
And yet, if you or someone you love has SCD, this is your book. It explains where the disease came from, why it hasn’t been completely cured yet, and what kind of hope you can hold. It’s a good start on a path to comprehension.
Also, be aware that the narrative here is sometimes padded with journalistic fluff that might annoy you if you’re eager to get to the science. Indeed, “Curved Air” will teach you. Then again, it also might test you.
Black Press
Prostate Cancer is Twice as Likely to Kill Black Men. Talking to Your Doctor Could Help Save Your Life
BLACKPRESSUSA NEWSWIRE — The American Cancer Society recommends that African American men speak with their doctor at age 45 about whether prostate cancer screening is right for them. Men at even higher risk should have that discussion at age 40, especially those with one or more close relatives who were diagnosed at an early age.
American Cancer Society board member Dr. Robert Winn discusses risk factors for the disease and why too many Black men still aren’t getting screened
September is Prostate Cancer Awareness Month, and as both a Black man and a cancer center director, I know many men in our community think it’s bad luck to talk about cancer. But I’m here to tell you it’s bad luck not to talk about it.
We, Black men in the U.S., are nearly 70% more likely than White men to be diagnosed with prostate cancer. We’re also twice as likely to die from the disease.
But I’m telling you, if you’re diagnosed early, you can still enjoy a long, happy life doing the things you love, whether that’s playing with grandkids or staying active in your community. That’s because although it can become a serious illness, most men diagnosed with prostate cancer won’t die from it.
In fact, more than 3.5 million U.S. men who’ve been diagnosed with prostate cancer are still alive today. And when it’s diagnosed early, you boost your odds of survival. It’s that simple.
Generally, prostate cancer is most likely to develop after age 50, but when it develops in Black men, they tend to be younger. That means we need to be on the ball about understanding our personal risk. The risk factors include a family history of prostate cancer and certain genetic health risks that come from a parent.
When it comes to family medical history, we need to get a lot better at talking. For me, it turned out I had uncles who’d died from prostate and other cancers, but I didn’t always know that, so I couldn’t use that information to help me make smarter screening choices.
The American Cancer Society recommends that African American men speak with their doctor at age 45 about whether prostate cancer screening is right for them. Men at even higher risk should have that discussion at age 40, especially those with one or more close relatives who were diagnosed at an early age.
Look, I get that no one looks forward to a screening, but it typically starts with just a simple blood test, called a prostate-specific antigen, or PSA.
Even if you end up needing a digital rectal exam, it takes less than a minute and could save your life. So, what I say to people is, what’s the price of your life? Isn’t it worth a minute of being uncomfortable?
Brothers, this is essential for you to know: just because you’re feeling good doesn’t mean you don’t have early-stage prostate cancer. By the time you start to actually experience symptoms, the disease could be at an advanced stage and might be harder to treat.”
Prostate cancer is significantly impacting our fathers, our brothers, and our sons. That’s why the American Cancer Society is working with health systems and professionals in your community to help remove barriers in the fight against the disease.
We can help you find low-cost or free screening locations. And for men who need cancer treatment, the American Cancer Society can reduce the financial burden of traveling to medical appointments by providing free rides and, if you live far away from where you receive treatment, a free place to stay.
When it comes to prostate cancer screening, one size doesn’t fit all. So, it’s important for all men – and especially Black men – to talk to their doctor about what’s best for them based on their age, risk, and health history. Please make that appointment, because we don’t want you to risk missing out on the best years of your life.
For more information, call the American Cancer Society’s 24/7 helpline at 1-800-227-2345 or visit cancer.org.
Dr. Robert Winn is a nationally recognized physician-scientist and researcher. He currently serves as cancer center director at Temple Health’s Fox Chase Cancer Center. Since 2021, he has served on the board of directors for the American Cancer Society, a leading cancer-fighting organization with a vision to end cancer as we know it, for everyone.
Black Press
Prostate Cancer is Twice as Likely to Kill Black Men. Talking to Your Doctor Could Help Save Your Life
BLACKPRESSUSA NEWSWIRE — The American Cancer Society recommends that African American men speak with their doctor at age 45 about whether prostate cancer screening is right for them. Men at even higher risk should have that discussion at age 40, especially those with one or more close relatives who were diagnosed at an early age.
American Cancer Society board member Dr. Robert Winn discusses risk factors for the disease and why too many Black men still aren’t getting screened
September is Prostate Cancer Awareness Month, and as both a Black man and a cancer center director, I know many men in our community think it’s bad luck to talk about cancer. But I’m here to tell you it’s bad luck not to talk about it.
We, Black men in the U.S., are nearly 70% more likely than White men to be diagnosed with prostate cancer. We’re also twice as likely to die from the disease.
But I’m telling you, if you’re diagnosed early, you can still enjoy a long, happy life doing the things you love, whether that’s playing with grandkids or staying active in your community. That’s because although it can become a serious illness, most men diagnosed with prostate cancer won’t die from it.
In fact, more than 3.5 million U.S. men who’ve been diagnosed with prostate cancer are still alive today. And when it’s diagnosed early, you boost your odds of survival. It’s that simple.
Generally, prostate cancer is most likely to develop after age 50, but when it develops in Black men, they tend to be younger. That means we need to be on the ball about understanding our personal risk. The risk factors include a family history of prostate cancer and certain genetic health risks that come from a parent.
When it comes to family medical history, we need to get a lot better at talking. For me, it turned out I had uncles who’d died from prostate and other cancers, but I didn’t always know that, so I couldn’t use that information to help me make smarter screening choices.
The American Cancer Society recommends that African American men speak with their doctor at age 45 about whether prostate cancer screening is right for them. Men at even higher risk should have that discussion at age 40, especially those with one or more close relatives who were diagnosed at an early age.
Look, I get that no one looks forward to a screening, but it typically starts with just a simple blood test, called a prostate-specific antigen, or PSA.
Even if you end up needing a digital rectal exam, it takes less than a minute and could save your life. So, what I say to people is, what’s the price of your life? Isn’t it worth a minute of being uncomfortable?
Brothers, this is essential for you to know: just because you’re feeling good doesn’t mean you don’t have early-stage prostate cancer. By the time you start to actually experience symptoms, the disease could be at an advanced stage and might be harder to treat.”
Prostate cancer is significantly impacting our fathers, our brothers, and our sons. That’s why the American Cancer Society is working with health systems and professionals in your community to help remove barriers in the fight against the disease.
We can help you find low-cost or free screening locations. And for men who need cancer treatment, the American Cancer Society can reduce the financial burden of traveling to medical appointments by providing free rides and, if you live far away from where you receive treatment, a free place to stay.
When it comes to prostate cancer screening, one size doesn’t fit all. So, it’s important for all men – and especially Black men – to talk to their doctor about what’s best for them based on their age, risk, and health history. Please make that appointment, because we don’t want you to risk missing out on the best years of your life.
For more information, call the American Cancer Society’s 24/7 helpline at 1-800-227-2345 or visit cancer.org.
Dr. Robert Winn is a nationally recognized physician-scientist and researcher. He currently serves as cancer center director at Temple Health’s Fox Chase Cancer Center. Since 2021, he has served on the board of directors for the American Cancer Society, a leading cancer-fighting organization with a vision to end cancer as we know it, for everyone.
Black Press
Texas Attorney General Race Tests Long-Running Party Loyalties
HOUSTON DEFENDER — The upcoming Texas Attorney General race features Republican State Senator Mayes Middleton, Democratic State Senator Nathan Johnson, Libertarian Tom Oxford, and independent Omer Khwaja. This election marks the first time in over a decade that a candidate other than Ken Paxton will be elected to the office, which Republicans have controlled for nearly three decades.
The upcoming race for the Texas Attorney General seat in the midterm elections will be slightly different from previous election cycles. For nearly three decades, Republicans have controlled the attorney general’s office. And for the first time in more than a decade, Texans will elect an attorney general who is not Ken Paxton.
The role comes with a salary of $153,750.
Paxton, who has held the office since 2015 and was impeached by the Texas House in 2023 on corruption-related charges before being acquitted in a Senate trial, is not seeking reelection, leaving an open seat that pits Republican State Senator Mayes Middleton against Democratic State Senator Nathan Johnson. Libertarian Tom Oxford and Omer Khwaja (independent) are also running.
In a sit-down interview with the Defender, Johnson explained his campaign priorities. Middleton’s campaign team did not respond to the Defender’s request for an interview for this article.
Q & A with Johnson
Middleton casts himself as the natural successor to a conservative office, while Johnson argues that the office itself has been eroded and needs to be restored, regardless of who wins in November.
“The office has lost the trust of the people,” Johnson said in an interview. “It’s partly due to recent scandals with Ken Paxton…it’s been a systematic loss of trust dating back probably before Ken Paxton… People expect the Attorney General’s office to be a productive place. It’s there to protect them from federal overreach, corruption in politics, and abuse in the commercial sector. All of those things have been sidelined.”
Johnson has represented Senate District 16 since 2019. A lawyer with a physics degree from the University of Arizona and a law degree from the University of Texas at Austin, he has worked as a litigator and mediator.
The Democratic nominee argues his legal background shapes how he views the attorney general’s job. His career choices have spanned the Texas Capitol and music studios. The lawmaker’s résumé also includes composing music for “Dragon Ball Z.”
What are his plans?
Stating plans for the office if elected, Johnson said he expects to sue federal government agencies if they violate the Administrative Procedure Act or overstep constitutional bounds, citing, as one example, the administration’s withholding of federal education funding appropriated for Texas schools, which other states’ Democratic attorneys general have already challenged in court.
Asked to back up his campaign priorities in healthcare and the electric grid, Johnson pointed to Senate Bill 1296, a 2021 measure Johnson authored. It asked for a review of the insurance plans offered to Texans through the Affordable Care Act (ACA) Marketplace to reduce net premiums and make health insurance more affordable for uninsured residents.
Having served on the Business and Commerce Committee, which has jurisdiction over the Electric Reliability Council of Texas (ERCOT) and the Public Utility Commission of Texas (PUC), Johnson has filed legislation on the electrical grid load growth. Pointing to the grid, he noted a dearth of steel and transformers needed to keep it running.
He also plans to review the Texas consumer-protection law for gaps related to AI-driven scams and data privacy, if elected.
Johnson’s stated priorities include suing sanctuary cities, aggressively enforcing federal deportation orders, defending the state’s abortion restrictions, opposing transgender participation in women’s sports, cracking down on what he calls “rogue” district attorneys, enforcing Texas voter ID laws, and pursuing a “DOGE Texas” initiative aimed at rooting out government waste. Notably, Middleton voted to acquit Paxton during his 2023 impeachment trial in the Senate.
Election history in Texas points to a trend that favors Middleton.
The #1 law my Democrat opponent says he will not enforce is the Women’s Privacy Act I passed.
It’s common sense that men should not be in girl’s restrooms and locker rooms. As Attorney General, I will fight to enforce this law and make sure Texas is the best and safest state… https://t.co/tSWGu0AGqw
— Mayes Middleton (@mayes_middleton) August 27, 2026
An uphill statewide race
No Democrat has won a statewide contest in Texas since 1994, and the attorney general’s office in particular has been in Republican hands since Democrat Dan Morales left office in the late 1990s. John Cornyn flipped the seat for the GOP in 1998, defeating Democrat Jim Mattox, and it has stayed red through Greg Abbott’s tenure and Paxton’s three terms. Both campaigns are treating the election history as something to either defend or break.
The 2026 election will test whether the streak of Republican candidate wins continues.
Johnson, however, said in the interview that he has heard similar arguments about political odds before.
“The office has lost the trust of the people.”
Nathan Johnson, Democratic State Senator and nominee for the Texas Attorney General race
When he first ran for the Texas Senate in 2018, Johnson challenged Republican incumbent Don Huffines in a district Johnson said was expected to favor Republicans by 12 points.
“I had no connections. I didn’t have money, name ID, wasn’t famous,” Johnson said. “But I felt like I could beat him.”
The race was “written off until very, very late in the cycle” before he won by eight points, he added, “And I aim to pull off a similar result this time around on a statewide basis.”
What do Black voters think of Johnson?
A new poll by Texas Southern University’s Barbara Jordan Mickey Leland School of Public Affairs, which surveyed more than 500 Black Texans, 20% of those surveyed favor Johnson, and 8% do not, while an overwhelming majority of 72% do not know enough about him.
Johnson says he is looking to change that by visiting historic Black communities in Houston.
“I’m visiting and engaging with communities right now, particularly in the Black community, where there’s no one on the statewide system,” Johnson told the Defender. “It’s very important for Black voters to feel like there’s someone who listens to them, who talks to them, and who understands what’s happening, who directs their interest.”
Based on reporting by Houston Defender.
Black Press
Peer Support Brings Faith and Counseling to NC Prisons
THE CAROLINIAN — Incarcerated individuals in North Carolina prisons are increasingly finding guidance and support from “field ministers.” These are prisoners who earn a four-year bachelor’s degree in pastoral ministry while also receiving counseling training.
NC HEALTH NEWS – Inside North Carolina prisons, incarcerated people have long turned to fellow prisoners for guidance about faith, conflict, grief, addiction, and simply how to navigate life behind bars.
An increasing number of those people are “field ministers” — incarcerated men who have earned a four-year bachelor’s degree in pastoral ministry and received training in counseling and other skills.
After graduation, the field ministers — many serving life sentences — are deployed to prisons across the state in teams of three to six, where they work alongside prison chaplains and other staff.
The role comes with an unusual degree of trust and access. Field ministers can walk into a housing block and make rounds to check on people. They can sit with men struggling with grief, addiction, mental illness or the challenges of being separated from loved ones. They can visit men in solitary confinement, counsel peers, provide hospice care and teach classes.
Their work has made a difference, said Alpha Herring, an employee at Nash Correctional Institution who oversees programs there.
Ten years ago, when someone came to him with an issue, he might spend 30 minutes talking with them. Now, he doesn’t always have to be the one responding.
“We trust them enough that when a field minister just shows up at a block, no one questions them as to why they were there,” Herring said. “We trust them enough to know that they’re going to go forth, fulfill the vision and do the work that’s been assigned to their hands.
“They help us go home daily because they intervene in situations that we would never know about,” Herring continued.
The program launched at Nash Correctional in August 2017 in partnership with Judson College, a Wake Forest-based seminary, and the nonprofit Game Plan for Life, which describes itself as training men “to be influential leaders within their own faith tradition.” It’s modeled after a similar prison ministry program at Louisiana State Penitentiary, known as Angola.
Since then, more than 80 men have graduated — more than 60 of whom now are serving as field ministers at 16 prisons. Another 87 men are completing their education at Nash Correctional. The first cohort of 19 female field ministers is also earning degrees; the program launched at North Carolina Correctional Institution for Women in January 2024.
Nash Correctional Warden Talena Lee told NC Health News that she has seen the field ministers change prison culture, and they have challenged her and other prison officials to reconsider “what they can be and what they can do.”
“You cannot pour all the time and energy into every single person,” Lee explained, noting that the 654-bed prison has fewer than 12 case managers, including supervisors. “They come alongside and help us in our jobs. We consider [the field ministers] a tool in our toolbox — one that we use quite frequently, and it’s made the population here better.”
Creating a pipeline
Rocky Wright, director of prison programs at Judson College, said the North Carolina Field Minister Program is in high demand. Each year, he said more than 100 people apply for up to 30 slots.
Participants must have already earned a high school diploma or GED, completed at least one year without any infractions and have at least 10 years left to serve on their sentence. Wright said the program looks for people who demonstrate humility, compassion, and a willingness to serve.
“We’re looking for guys who have servant hearts, who want to serve others,” Wright said.
Students take a full college course load year-round, including coursework in liberal arts, biblical studies, and counseling.
After earning their degrees, field ministers are asked to serve for at least four years, though Wright said participation is voluntary.
How field ministers work can vary from prison to prison. Despite being unordained, some work alongside prison chaplains. Others work more closely with program staff. At intake facilities, field ministers help newly incarcerated people acclimate to the prison environment, and they serve as mentors during their first weeks. Many also teach classes, such as Thinking for a Change, a therapeutic approach to changing negative behaviors, and Father Accountability, which teaches positive parenting. They also lead Bible studies.
Wright said one field minister team at Harnett Correctional Institution even came up with a nonviolence initiative that lessened violence and fights at the facility.
Finding new purpose
Barry Mintz, 21 years into serving a life sentence without parole, was part of the field minister program’s first cohort. He said he originally joined for selfish reasons, thinking it would look good and help his chances of release.
But as he studied, Mintz said, his understanding of his faith changed, along with his understanding of himself and his purpose.
“My journey to this moment right now is a testament to the transformative power of faith and education,” he said during an Aug. 19 event at Nash Correctional that celebrated 10 years of the program.
Mintz said he’s helped countless people. Some days, that means lending an ear to someone who is in a mental health crisis or going through a wrenching life event.
He recalled one encounter that has stuck with him: an incarcerated man whose father died the day before he was released from prison. Based on his training, Mintz said he felt equipped to offer theological answers, grief counseling and simply a warm embrace.
“In that moment, I realized that we weren’t just equipped to think well, to read well, to write well and speak well — but we had been equipped to love well,” Mintz said.
‘Part of the community’
Field ministers lean into their own transformations and shared experiences to reach other incarcerated men.
“Our real effectiveness comes from being a part of the community,” said Timothy Johnson, another member of the first cohort of field ministers. “They know they can trust us with their problems because we’re living with the same problems. We don’t talk to them about how hard it is to be locked up and go home at the end of the day.”
Field ministers told NC Health News they often encounter men who want to change but don’t know how — and they can step in with guidance and support.
Jimmy Smith, a field minister at Caswell Correctional Center who graduated in the program’s second cohort, said he uses his own testimony to show how much change is possible.
“I’ve been incarcerated 31 years, so a lot of guys knew me when I was in my craziness, and they knew the transitions that I had made over the years and became the preacher,” Smith said. “I had to explain to them that I thought like a child, but then I became a man, and there are qualifications of being a man, and it’s responsibility, accountability, and reliability. Walking in that, it gives you parameters and things you won’t do anymore.”
William Singletary described getting support and mentorship from field ministers at Granville Correctional Institution.
“Their presence was not only uplifting but instrumental in my growth and development as an individual and a man of faith,” Singletary said. “Exposure to these ministers opened my eyes to the profound impact we can have on one another’s lives, even in the most unlikely of places. I watched as they poured their energy into helping others find peace, joy and purpose amidst their struggles.”
Singletary wanted to do the same. He’s studying to become a field minister himself.
Matthew Grant, a field minister student in his junior year, was sent to prison in 2004. He said he’s ready to draw on his own experiences to counsel others.
“I’ve lost family too,” he said. “I’ve been in the hole too. I’ve been depressed. I’ve been suicidal. I’ve been angry before. I’ve been in fights before. I’ve been to some of the most violent prisons in the state. I’ve done that. I’ve seen what that gets you, and I’ve been able to come out on the other side.”
Filling critical needs
The field ministers aren’t intended to replace prison chaplains or other staff, but to extend their reach.
Sarah Jobe, director of Chaplaincy Services at the N.C. Department of Adult Correction, said the department has about 47 chaplains serving across the state — about one-third of whom are community-funded through churches and other grants. That leaves some prisons without a chaplain.
“People’s critical needs for conversations around hard topics do not always happen when a chaplain is on site,” Jobe said. “The field ministers are right there to be called at any time, and can really step in and be a witness and a presence inside of the dorms in a way that the chaplain cannot.”
The N.C. Department of Adult Correction funded eight new chaplain positions last year, Jobe said. Prison leaders have been working toward having at least one chaplain in each state prison, she said, in recognition that spiritual care and religious accommodations can shape prison environments and culture.
Jobe helps determine which facilities get field ministers. The biggest factor, she said, is staff buy-in and their willingness to provide field ministers with the support and autonomy they need to best serve. She said she’s got more facilities that want field ministers than there are available graduates.
“They can be radical change agents for good and serve in caregiving professions well and under incredibly difficult circumstances,” Jobe said.
N.C. Department of Adult Correction Secretary Leslie Cooley Dismukes said she “hands down, without a doubt” views the field minister program as the program with the greatest impact on the department’s population of nearly 33,000.
“This program allows us to bring in partners from the outside to reach you, and then it allows you, when you earn your yellow shirt, to reach everyone,” she said. “You are credible messengers. You are the people who can change lives.”
Jobe agrees and said their impact will only grow as more field ministers are deployed to prisons across the state in the coming years.
The impact has been tremendous on Timothy Johnson, one of the prison system’s first graduates.
He went to prison in 2005, sentenced to life without the possibility of parole. For many years, he said, that sentence defined his life story. But his work as a field minister changed his perspective.
“I feel like my story changed from life without parole, and that’s what defined me, to a life of purpose,” Johnson said. “Every day I wake up knowing I’m going to have some conversation with somebody that needs a little bit of hope, some inspiration that can feed off my story.”
Based on reporting by The Carolinian.
Black History
COMMENTARY: Young Black Men Suffering in Silence a Curse That Can Be Broken
JACKSONVILLE FREE PRESS — Young Black men often face societal expectations of strength and toughness, leading to a culture where expressing emotions is discouraged and seen as a weakness. Many are taught from an early age to suppress feelings, creating a burden that can impact mental health.
As a young Black man, I find this topic personal. When people discuss mental health, they usually don’t picture someone who looks like me. Instead, Black men are often seen as strong, tough, or able to handle anything life throws at us.
Growing up, I was taught exactly that.
My elders always told me to be strong. If I got hurt, I was told to get back up. If I was upset, I was told not to cry. Showing emotion wasn’t encouraged. It was seen as a weakness.
Looking back now, I realize I wasn’t just being taught how to be a man. I was being conditioned to hide my emotions. I was taught to believe that strength meant staying silent, no matter how much pain I was carrying.
I know my family wasn’t trying to hurt me. They wanted me to survive in a world that has never been easy for Black men. They wanted me to be prepared for life’s challenges.
When people discuss mental health, they usually don’t picture someone who looks like me. Instead, Black men are often seen as strong, tough, or able to handle anything life throws at us.
Growing up, I was taught exactly that.
My elders always told me to be strong. If I got hurt, I was told to get back up. If I was upset, I was told not to cry. Showing emotion wasn’t encouraged. It was seen as a weakness.
Looking back now, I realize I wasn’t just being taught how to be a man. I was being conditioned to hide my emotions. I was taught to believe that strength meant staying silent, no matter how much pain I was carrying.
I know my family wasn’t trying to hurt me. They wanted me to survive in a world that has never been easy for Black men. They wanted me to be prepared for life’s challenges.
But somewhere along the way, being strong became confused with pretending everything was okay.
Instead of talking about our feelings, we learned how to bury them. Instead of asking for help, we learned how to deal with everything on our own.
The problem is that emotions don’t disappear just because you ignore them. They stay with you, and eventually, they find another way to come out.
I believe that is the reality for many young Black men today.
We’re expected to carry the weight of our families, our communities, our schools, our work, and our lives without ever breaking down. People admire our strength, but they rarely ask how much it costs to always be strong.
The truth is, many of us are hurting in silence because we’ve spent our entire lives believing that is what real men are supposed to do.
For many Black boys, those lessons start early.
Some grow up in neighborhoods where hearing gunshots or seeing police lights is normal. Others lose friends or family members before they are even old enough to understand why. Some are raised in communities where violence, poverty, and limited opportunities are part of everyday life.
When you’re constantly worried about making it home safely or helping your family make ends meet, you don’t always have time to process your emotions.
You focus on surviving.
Then there is the way society sees us.
Before some people even hear us speak, they have already made assumptions. Many Black men know what it feels like to be watched while shopping, stereotyped because of the clothes they wear, or judged simply because they are Black.
On top of that, many of us grow up having conversations with our parents about how to act if we are ever stopped by the police.
We aren’t taught those lessons because our parents don’t trust us. We are taught them because our parents are afraid of what could happen if someone else doesn’t see our humanity.
Living with that kind of pressure affects your mental health, whether people realize it or not.
Constantly feeling like you have to prove you are not a threat is exhausting. Always feeling like you have to be perfect just to be treated fairly takes a toll.
Those experiences create anxiety, fear, and stress that many young Black men carry every single day, even if they never talk about it.
I also think these experiences help explain why some young Black men feel disconnected from politics and voting.
If you have spent your whole life watching your community struggle no matter who is in office, it is easy to believe that your vote won’t change anything.
You see schools that need more resources, neighborhoods that deserve more investment, and communities asking for change year after year. After a while, some people stop believing anyone is listening.
But I also believe that is exactly why voting matters.
The people we elect make decisions about education, mental health funding, affordable housing, community programs, healthcare, and criminal justice. Those decisions directly affect neighborhoods like mine and families like mine.
If we want things to change, we can’t sit back and expect someone else to make those choices for us.
Our voices matter, and our votes do too.
One of the biggest changes that needs to happen is the way we talk about mental health.
We have to stop teaching young Black boys that crying makes them weak. We have to stop acting like asking for help is something to be embarrassed about.
Real strength isn’t pretending you’re okay when you’re not.
Real strength is being honest enough to say you’re struggling and courageous enough to ask for help.
As I continue to grow into the man I want to become, I’m learning that strength and vulnerability can coexist.
I can be determined, hardworking and resilient while still being honest about my emotions. I don’t have to carry everything by myself, and neither does the next generation of young Black men.
It’s time we change the conversation.
Instead of only telling young Black boys to be strong, we should also tell them it’s okay to cry.
It’s okay to talk.
It’s okay to heal.
Because when we create a generation of men who feel safe expressing themselves, we aren’t making them weaker. We are giving them a better chance to live healthier, happier lives.
And that is the kind of strength our communities have needed all along.
Based on reporting by Jacksonville Free Press.
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