Mike DeGagné responds

January 9, 2010

Click here to find out more!The following letter was printed in the National Post today(www.nationalpost.com/todays-paper/story.html?id=2422478).  I have been invited to respond, and will be doing so shortly.  There was one error in my column (and original blog entry); I assumed that the executive director of the Aboriginal Healing Foundation was non-aboriginal, since his ancestry/identity was not stated in his bio.   Determining whether or not someone is “Aboriginal” is becoming increasingly difficult since in certain cases (hiring at Memorial University, for example) one only has to check a box “identifying” as such to be considered an indigenous person.  This means that many people who now identify as ”Aboriginal” have little in common with the isolated members of the native population who, because of their marginalization, are the focus of social policy. 

FW

***

Aboriginal healing group responds

Re: The Aboriginal Healing Boondoggle, Frances Widdowson, Jan. 4.

It is false that “the only ‘evaluation’ of Aboriginal Healing Foundation (AHF) programs has come from the organization itself.” The AHF and the programs it funds have been audited and evaluated by independent third parties in government and the private sector. These evaluations are available for public view on our website in their entirety. Only in this limited sense are they “from” the organization.

More important, Frances Widdowson’s dismissal of healing itself insults survivors of institutional physical and sexual abuses, mocking the front-line workers who dedicate themselves to battling root causes of poverty, violence, suicide and despair in aboriginal communities. It is these 950 front-line workers, hired by the aboriginal community, who Ms. Widdowson is certain are politically selected persons of privilege.

If she had made a two-minute phone call to the AHF, she would not have described the AHF’s executive director as “the most significant non-aboriginal player”). He is aboriginal.

Other points: healers, whether trained in aboriginal traditions or Western academic methods, have the appropriate credentials; AHF research in aboriginal health is more than a collection of press releases; the AHF operates entirely on interest earned from careful investment of the money entrusted to it and has committed more money to community projects than it has received; a focus on residential schools does not prevent, but rather promotes, understanding of why “many aboriginal people who did not attend residential schools are also suffering from the same symptoms.”

It is understandable that Ms. Widdowson denies the efficacy of aboriginal organizations; positive outcomes are inconsistent with the premise of her book. But the facts would reveal that the AHF is exactly what Ms. Widdowson espouses– a funder of high-quality services that are tailored to the special needs of the aboriginal population.

Mike DeGagne, executive director, Aboriginal Healing Foundation, Ottawa.

18 Responses to “Mike DeGagné responds”

  1.   balbulican said:

    For someone who claims to seek nothing but honest dialogue on these issues, Frances, you’re awfully reluctant to acknowledge your errors. Disparaging Mr. Degagné’s Aboriginal status is, I suppose, less damaging to the ego that admitting you were wrong and apologizing.

    I certainly look forward to your explanation of why you claimed in this blog that AHF initiatives had not been evaluated (a fib you wisely amended in your NatPo piece).

  2.   Frances Widdowson said:

    I am interested in honest dialogue. I will post any oppositional arguments and criticisms and respond to them as best as I can (as long as they are not libelous).

    I did acknowledge the error about DeGagne’s aboriginal status. I don’t really see how I am “disparaging” it, however. I am just trying to draw a distinction between marginalized members of the native population and those who are completely integrated, but choose to “identify” as aboriginal. This circumstance will need to be incorporated into a more nuanced understanding of the relationship between the native leadership and the Aboriginal Industry.

    The claim about the evaluations was not a “fib”. It was a flippant remark (which tends to happen on blogs) about the fact that these are not really “evaluations” in the scientific sense. As I will explain in a response to DeGagne in the National Post, these “evaluations” are funded, produced and copyrighted by the AHF and done by advocates intent on rubber stamping the organization’s cultural indoctrination.

  3.   Joe Lane said:

    Mr de Gagne writes: “It is understandable that Ms. Widdowson denies the efficacy of aboriginal organizations …” Perhaps, more accurately, ‘Widdowson QUERIES [or SEEKS EVIDENCE OF]the efficacy etc….’ Here in Australia, and perhaps in Canada too, any questioning of, or scepticism about, conventional wisdom is too often denigrated as ‘denial’, and treated as heretical. Shades of The Crucible ! Science and scientific investigation demand doubt, scepticism, evidence, validation of hypotheses, ‘proof’, ‘confirmation’, replicability of findings and thorough analysis. Unlike belief, truth and reality do not fear or despise doubt.

    These days, whenever I see the words ‘denial’ or ‘sceptic’ in relation to an issue, I know I am reading the words of a Believer, someone not amenable to discussion, who is searching for ideological agreement, not empirical investigation.

  4.   balbulican said:

    Interestingly, Joe, Ms. Widdowson has not actually discussed the methodology, scope, scale or conclusions reached by the formal evaluations. She has simply dismissed them as products of “the Aboriginal Industry”.

    Add to that Ms. Widdowson’s errors and misstatements – pardon me, “flippancies” – and one is forced to wonder – just who is searching for “ideological agreement, not empirical investigation”?

  5.   Frances Widdowson said:

    There are two things that should be kept in mind with respect to the AHF’s activities; the first is that “healing” and “jobs” are being linked, which means that the demands for healing constitute, in part, a form of rent seeking behaviour. The second is that the “evaluation” of the AHF takes place within an atmosphere of advocacy. To question the AHF is to be “anti-aboriginal”, racist, etc., and so this impedes critical analysis. As many have noted, the money earmarked for aboriginal policy is not going to where it is needed, resulting in no improvement of the living conditions in isolated native communities. Questions need to be asked if the billions of dollars that are going into various initiatives could be better spent elsewhere.

    I have analyzed the “evaluations” of the AFH, but both newspapers and blog posts are not places for in depth criticism. I agree that more work needs to be done in exposing this waste of funds. The “methodology” of the Foundation appears to be asking people if the healing process is working for them, and, as I stated in the National Post, “the designation of
    ‘healer’ is even defined as being ‘bestowed or created through the recognition and respect of others who believe in their healing ability.’ In other words, believing in the healing process will result, after many years, in being ‘healed’”.

    Much of this is very similar to the “evaluations” of “alternative medicine”. What is disturbing is that those who cast a critical eye on quackery in general, accept it in the case of aboriginal “traditional healing” initiatives because condescension is seen as a way of “empowering” and “raising the self-esteem” of the native population. Such a misguided approach keeps native people isolated and open to manipulation from the “healers” who are siphoning money away from evidence-based services.

  6.   balbulican said:

    I must say I have never seen parentheses deployed as a substitute for substantive argument with such creative vigour.

  7.   Informed Content said:

    Frances, this is why many people are confounded by your NP piece; while some of the work you’ve posted here is thorough and well sourced (biased and challenging though it may be), your opinion pieces are not. Above, you dismiss this as due to the nature of blogs. Rubbish. Be thorough and you’ll receive (some) thoughtful responses. In your original Full Comment piece you present an assumption as fact, in the absence of any evidence in the one source you appear to have checked. Then, in your “mea culpa” blog response, you deflect criticism and blame the nature of identity/identification in Canada and imply that Mr. Degagne might not really be aboriginal after all. That’s a cheap trick and hardly vindicates you. Later, you propose to look more closely at that subject. Free advice: Look more closely at that, develop an informed opinion, and share that; anything in the interim is half-assed. Same thing for the AHF or other research you reject. It’s awfully hard to believe you’re read it. My Google work seems to have uncovered far more detail than you included in your original piece, including the fact that you quote a decade-old criticism of the AHF from an aboriginal commentator. Yet you present it as if it is a contemporary criticism. That means you were either ill-informed or dishonest. Surely there are contemporary sources. If not, well then that’s a story. If so, then we are left to assume you were too lazy to find them.

  8.   Frances Widdowson said:

    Yes, it is true that the article could have been better researched and sourced. If I was undertaking a scholarly paper I would have done so, and I regret the unintentional error concerning DeGagne’s identity. A recognition of this will lead to a greater understanding of the Aboriginal Industry (defined as a non-aboriginal group of consultants and lawyers), and its relationship to the comprador aboriginal leadership. This seems to have changed over the last 40 years, but in the end what we still have are privileged people making $140,000/year encouraging marginalized people to retain cultural characteristics – tribalism, superstitutious beliefs and undisciplined habits – that result in their continuing dependency and isolation.

    However, this discussion is a distraction from examining the actual character of the AHF. As far as I can tell, the arguments that I have put forward, while crude, are still valid, and this should be the focus of further research. Oskaboose’s comments are dated, but they continue to be valid since the AHF is a leopard that has not changed its spots. Defining the problem as an absence of “healing” means that rigorous evaluation of the AHF is not possible. “Healing” is a nebulous term, which can mean almost anything. Its absence also has been linked to “cultural loss”, which is inevitable; this ensures that there will be a continuous need for “healing”. The focus of the AHF on cultural revitalization also has meant that “traditional healing” is a major part of its initiatives. The effectiveness of “traditional healing” is impossible because belief in the efficacy of “healers” is rooted in superstition.

    The AHF always has been seen as a way to distribute government funds to non-aboriginal consultants and aboriginal elites. The main concern is with the “loss of jobs” that will occur when its funding comes to an end, not the unlikely possibility that people will be unable to smudge, listen to elders or participate in “talking circles”. And by focusing on symptoms rather than the disease – geographic isolation, social marginalization, and economic dependency – the AHF has ensured that its “services” will be continously demanded.

  9.   To Frances Widdowson and Associates: An open letter « Wayne K. Spear said:

    [...] so perhaps there is only one kind of Aboriginal person. It’s a tough subject, on which she has publicly ruminated: Determining whether or not someone is “Aboriginal” is becoming increasingly difficult since in [...]

  10.   Frances Widdowson said:

    Dear Mr. Spear:

    I am very appreciative of your open letter. Although I disagree with a number of things that you say, I thank you for your thoughtful engagement with the arguments put forward by myself (often in conjunction with Albert Howard). This is very different than the mostly ad hominem comment that has plagued other commentaries about our work. From my experience, there is very little open and honest debate about aboriginal-non-aboriginal relations, and I see your letter as an important attempt to facilitate this process. In this way, we can all learn from one another.

    I was very happy to see your opposition to arguments characterizing my work as racist, but then you make the following statement: “instead [Widdowson] argues that Aboriginal people are inherently savage, but that with some help they can become good white people”. This results in the same flawed logic of the “racism” smear that you are trying to avoid: the conflation of race (ancestry) and culture (learned behaviour). It should be stressed that the developmental gap refers to those members of the aboriginal population who are still influenced by cultural features associated with hunting and gathering and horticultural modes of production. “Savagery” is a stage of development that existed in the context of hunting and gathering activities and technology such as the bow and arrow; all human beings were, at some point in history, at this stage of development and therefore it does not make sense to phrase our argument as the “inherently savage” can “become good white people”.

    I have never said that traditional knowledge “ought not to be considered in matters of science”. It is the spiritual component of traditional “knowledge” that I am opposed to the incorporation of. The empirical component – where animals migrate, ice conditions, etc. – should be (and often is) considered; it should, however, be systematically verified in scientific studies.

    I am not arguing for assimilation, but integration. Those characteristics that are helpful for aboriginal survival (and human survival more generally) should be retained – artistic sensibility, noncoercive forms of child rearing, etc. They should, in fact, be embraced by all people and part of the wider culture. The problem is when organizations like the Aboriginal Healing Foundation argue that public funds should be spent on the promotion of “traditional healing” (which is, at best, useless and, at worst, harmful).

    It is not my argument that there are “two kinds of Aboriginal subject positions”. What I am arguing is that a number of aboriginal people retain cultural characteristics associated with hunting and gathering/horticultural modes of production that are preventing them from making a full contribution to modern society – undisciplined work habits, tribalism, and superstitions, for example. Many aboriginal people no longer retain these characteristics and are completely integrated. Therefore, there is a spectrum within the aboriginal population of those continuing to be influenced by traditional cultural features and those who fully participate in modern society.

    My rumination about the question of “who is an aboriginal person” is due to the difficulties in trying to conceptualize the relationship between the native leadership and the Aboriginal Industry (defined as non-aboriginal lawyers and consultants), and the organizations that are maintaining aboriginal dependency. Much of the funding being dispersed to aboriginal organizations is justified on the basis that it will improve the terrible social conditions in isolated and undeveloped aboriginal communities. Today, however, an increasing number of people are identifying as “aboriginal” so as to access these funds. Even worse, these educated and completely integrated people often use their identity to head organizations promoting aboriginal traditions that are keeping marginalized members of the native population isolated and dependent. Therefore, it probably makes more sense to talk about “marginalized” versus “integrated”, rather than “aboriginal” versus “non-aboriginal”.

    I am glad that you are opposed to the romanticism that currently exists with respect to aboriginal cultures. If so, you might want to investigate the basis of the “reverence” that you have for the “Great Law” and its supposed “appeal” to the authors of the American Constitution. This claim appears to be largely mythological – a deception being perpetrated to justify pre-contact aboriginal “sovereignty” and “democracy”.

    My concern is more with ending dependency and facilitating social contribution than “self-sufficiency” and “self-reliance”. I am not opposed to the “real-world effort of Aboriginal people to direct their affairs”; it is the manipulation of these processes by the integrated to enrich themselves at the expense of the isolated and marginalized that needs to be opposed.

    The “New Directions in Aboriginal Policy Forums” are an attempt to open up debate about aboriginal policy development. The Forum tries to bring in people of different perspectives to try to increase our understanding about aboriginal-non-aboriginal relations and policy development. We are hoping to have supporters of Mohawk sovereignty debate McHale and Vandermaas in a respectful manner. Other subjects will concern economic development and social policy. Perhaps you might know someone who would be interested in this?

    One area of debate concerns aboriginal peoples’ “unique legal-historical relationship with the British Crown and subsequently to Canada”. There are some who see recognizing this as the solution to aboriginal dependency and deprivation. Others argue that this is raising false hopes of marginalized members of native communities so that educated and integrated can be enriched with legal negotiations, consultations, and foundation and board appointments.

    Thanks, once again, for your thoughtful comments and attempts to open up debate on these important matters.

    Sincerely,

    Frances Widdowson

  11.   Informed Content said:

    I see AHF funding is in the news again.

    You never posted Mr. Degagne’s response in the NP to your response to his response. Given the glowing assessment AHF received in INAC’s evaluation I wonder how you’d respond to him now?

    AHF responds
    National Post
    Published: Monday, January 18, 2010

    Re: Native ‘Healing,’ letter to the editor, Jan. 12.

    It is clear from Frances Widdowson’s comments that her investigation of the Aboriginal Healing Foundation (AHF) consisted of a visit to our web-site and a perusal of the inside cover of one of our evaluation reports. She seems to think this justifies her dismissal of Kishk Anaquot’s expertise and integrity, on the grounds that it is an “Indigenous owned and operated consulting firm.”

    I encourage those interested to read our three volume Final Report, which establishes a clear definition of healing within the context of work carried out by AHF-funded projects. AHF research provides evidence of project successes and challenges. It is one thing to disagree. To dismiss research and researchers without engaging in careful analysis of methods, reasoning, and findings is foolish. What she calls nebulous can and has been qualified and quantified and is now better understood because many parties have put in the time and effort to think critically about these and related subjects.

    Further suggested reading includes Indian and Northern Affairs Canada’s forthcoming third-party evaluation of the AHF, which Ms. Widdowson’s Internet research must surely have uncovered. Real engagement makes for better science.

    Mike DeGagne, Aboriginal Healing Foundation, Ottawa.

  12.   Frances Widdowson said:

    I guess the response will depend upon the nature of the “evaluation” that provided the “glowing assessment”. I have not examined INAC’s evaluation in depth, but the important questions are as follows:

    How can “healing” be “quantified and qualified”?
    Does the “evaluation” just consist of asking the stakeholders if “healing” has occurred (or are more objective measures of performance documented – reduction in violence, substance abuse, unemployment, poverty, etc.)?
    What constitutes the “credentials” of a “traditional healer”? How does one determine if their “treatment” is effective (for example, practioners of alternative medicine have been known to argue that prayer improves health. In evaluating whether or not this is the case, one would have to ensure that the person who is being prayed for does not know that this is occurring. Otherwise, the placebo effect could be responsible for improved health or perceived improved health).

    It is quite common that the evaluation of aboriginal programs are concerned with ensuring that funding continues, not determining the actual effectiveness of the service. The major concern with the ending of funding for the AHF was that 1,000 “jobs” would be lost – an indication the major concern was perpetuating government transfers not improving aboriginal social conditions. The fact that the INAC report is “glowing” is not convincing. The methodology of the evaluation needs to be examined to determine if concrete objectives, and not feel good criteria such as “self-esteem”, are being analyzed. In the meantime, I encourage critical thinkers (as opposed to advocates) to examine the evaluation (www.ahf.ca/pages/download/28_13396).

  13.   Susan Koncan (Bruyere) said:

    As an Aboriginal – First Nations person, I must admit that I lost interest in the banter after the first couple of blogs. I just wanted to say “hello” to Mike and to compliment him on his good work. Mike and I went to elementary school together. I know Mike’s family and he is certainly Aboriginal. In fact, his grandmother Nellie and her family members, Big Ed, Jimmy and Margaret all attended Residential School.

  14.   Informed Content said:

    Frances, you are now encouraging people to do what Mr. Degagne asked of you. Compare: “The methodology of the evaluation needs to be examined to determine if concrete objectives, and not feel good criteria such as “self-esteem”, are being analyzed. In the meantime, I encourage critical thinkers (as opposed to advocates) to examine the evaluation” and “To dismiss research and researchers without engaging in careful analysis of methods, reasoning, and findings is foolish. What she calls nebulous can and has been qualified and quantified and is now better understood because many parties have put in the time and effort to think critically about these and related subjects.”

    Interesting development from your original opinion piece. I look forward to hearing a report (from someone) on a critical examination of AHF and AHF-related research. It would appear to my eyes and tired mind that the reports he mentions use both objective and subjective approaches.

    I also note that AHF-funded activities are rarely just the voodoo you make them out to be. It seems most of the ones highlighted in these reports mix Western talking therapies (for which there is a mountain of international literature) with elements of Aboriginal culture. Most of the key informants seem to say that those elements got them in the door and helped them stay on their path. Should that not be considered a success?

    The latest AHF report even includes the following definitions up front, seemingly in reponse to your dismissive questioning of “healing”:

    Healing Journey – engagement by Survivors or people affected intergenerationally by the legacy of residential schools in any of the healing approaches described [below].

    Alternative – approaches incorporating all those strategies outside of most regulated and provincially insured Western therapies including, but not limited to, homeopathy, naturopathy, aromatherapy, reflexology, massage therapy, acupuncture, acupressure, Reiki, neurolinguistic programming, and bioenergy work.

    Traditional – approaches incorporating all culturally-based healing strategies including, but not limited to, sharing, healing, and talking circles, sweats, ceremonies, fasts, feasts, celebrations, vision quests, traditional medicines, and any other spiritual exercises. Traditional approaches also incorporate cultural activities such as quilting, beading, drum-making, and so on. Others include on-the-land activities such as hunting, fishing, and gathering medicines.

    Western – approaches incorporating all strategies where the practitioner has been trained in Western institutions (i.e., post-secondary educational institutions) including, but not limited to, psychologists, psychiatrists, educators, medical doctors, and social workers. For the most part, Western practitioners are regulated by professional bodies, have liability insurance, and are staterecognized or their services are covered by provincial health care plans.

  15.   Frances Widdowson said:

    What is the definition of “healing”? There is reference to the “healing journey” and “healing approaches”, but how do we know if someone has been “healed”? Presumably, when the funds have been exhausted.

    There is no way of evaluating “alternative” and “traditional” approaches. If someone prays for someone, and the recipient of the prayers feels better, have they been “healed”? If so, the government should be funding Ernest Angley, Benny Hinn, etc. It is disgraceful that people who are critical of these charlatans would support the selling of snakeoil when aboriginal people are the victims.

    The “healing” foundation received hundreds of millions of dollars. This went to fund cultural indoctrination, board appointments and swank offices in Ottawa. At the same time, there is a shortage of doctors in aboriginal communities. Wouldn’t the 450 million have been better spent on 450 additional doctors for 10 years? But then, the lawyers, consultants, accountants, etc. would not be able to get their hands on this money.

    I have no quarrel with the “Western” (i.e. scientific) approaches used by the AHF. However, this could all be provided under the auspices of medicare, saving millions of dollars in consultations, legal fees and sweat lodge, “Reiki”(?!) and bioenergy quackery.

  16.   Informed Content said:

    Sigh. I see that if I am to play a lively game of devil’s advocate with you I will have to delve deeper into their materials. I shall return.

  17.   Informed Content said:

    I’m back.

    “According to the AHF, “Healing” can mean different things to different people. Healing occurs when an individual has meaningfully resolved the effects of trauma and has overcome patterns of destructive and self-destructive behaviour. The goal of healing is balance at all levels within persons and within their relationships. Healed individuals, families, and communities are able to create and sustain the conditions which promote their well being” (INAC evaluation).

    There are objective and subjective measures for what is described in the second sentence, particularly the latter part (behaviour). And the last sentence defines “healed.” Nothing there about the money being exhausted (which is, apparently, the case post-Budget 2010; however, no one from the communities is saying healing has been completed). Further, even western medicine concerns itself with indicators of “well-being.” There is a rich international body of literature.

    You reject “prayer,” largely because its effectiveness can’t be measured and can’t be proven to be anything more than a placebo effect. I’m actually with you there, although I have found an exhausting list of publications in scholarly journals which seem to argue otherwise (no, I have not read them all).

    But petting dogs is said to have medical benefit. It’s not about the dogs at all; rather, it is about the activity promoting some element of well-being. So I don’t see how allowing communities to choose sweat lodges, for example, as part of one’s efforts to achieve “well-being,” can be called “cultural indoctrination” (and sweat lodges are not “prayer” in the Judeo-Christian sense; although the English word prayer is often used the experience is also often described as meditation).

    I know the indoctrination by Industry members angle is central to the argument you make in your book and in the opinion piece but the argument is a bit like a dog chasing its tail:

    If I say that the whole point of the recommendations in Gathering Strength was to empower Aboriginal people and communities by allowing them to choose how they wanted to address issues in their communities, you argue that they didn’t really ask for that or want that; they were bamboozled by lawyers and activist charlatans (or comprador leadership, a concept I look forward to seeing you develop) who wanted a model like the AHF in place because it would be a perpetual motion machine of gravy for them. Those who oppose you on this will never be able to see eye-to-eye with you because you reject the possibility of any decision made being a decision that actually reflects the interests of the “aboriginal people [who] are the victims.” And once they are leaders, you have argued in the case of Degagne, they are not longer regular aboriginal people.

    Thus, I cannot, in your eyes, argue that communities wanted programs that were not government run and, thus, could not “all be provided under the auspices of medicare” because you don’t accept this premise at all. And keep in mind that for approximately 50% of First Nations and most Inuit this medicare suggestion is either unworkable due to the non-insured health benefits program or because it would create a dizzying labyrinth of inter-jurisdictional wrangling if 10 years of funding for doctors, nurses, or even other para-professionals was managed by the feds but spent in provinces and territories.

    Finally, while I know this is essential to your Aboriginal Industry argument, I cannot accept, based on what I’ve read from several different sources, that the “hundreds of millions of dollars … went to fund … board appointments and swank offices in Ottawa.” The argument in INAC’s own evaluation is that AHF is cost effective to a degree that government simply cannot compete with.

    From a recent update from the AHF: The AHF has received $515 million from the government of Canada (that’s a lot of money, indeed). The total interest generated was $106,022,405 making the total fund $621,022,405. The total committed to project funding was $522,970,336. Therefore, AHF funding commitments exceed, by over $7 million, amounts received from Government; administrative costs, at 12%, are well below the industry standard of 15%. Government is another story.

    While you and I can argue that the administration costs of $72,376,738 are an awful lot of money, it is being argued that the costs of similar programs run by Canada would be exponentially higher – and not run on interest alone! So it’s really not fair to say that the fund went to board members and swank offices; that’s a pot shot at supposed “fat cats.” What you’re really arguing then, is your Aboriginal Industry argument – that the programs are “cultural indoctrination.” You don’t approve of the way the program dollars are spent. We should stick to arguing that because your initial outrage was painted as having to do with the jobs lost argument. Well jobs have been lost and many were western-trained professionals, the kind you approve of. But that misses the point; the points should be 1) Is healing (or mental health and well-being work) required? If so, 2) Is that work complete? 3) Should it continue? 4)Who should pay and how should this work be carried out? 5) What’s the accountability?

    I still don’t think you know this program delivery mechanism very well and have attempted to shoehorn it into your Industry argument (some of which should be championed). My reading of this initiative does not fit your argument.

  18.   Informed Content said:

    Please ignore the “50% of First Nations” and NIHB remark above. In my haste and haze I mispoke. I conflated NIHB partcipation with urban First Nations numbers (approximately 50%). My apologies. Of course, many urban FN access services paid for by NIHB.

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