Op-Ed Contributor: Labs, Washed Away





BEDPAN ALLEY is the affectionate name given to a stretch of First Avenue in Manhattan that is packed with more hospitals than many cities possess. This stretch also happened to be right in the flood zone during Hurricane Sandy. Water damage and power failures closed down all three of the New York University teaching hospitals — Bellevue Hospital, Tisch Hospital and the Manhattan V.A. Two months later, they are still not admitting patients, though two are on schedule to begin doing so shortly.




The harrowing evacuation of hundreds of patients made headlines nationwide. The disruption of regular medical care for tens of thousands of outpatients was a clinical nightmare that is finally easing. And the education of hundreds of medical students and residents is being patched back together.


All academic medical centers, however, rest on a tripod — patient care, education and research. The effect of the hurricane on the third leg of that tripod — research — has gotten the least attention, partly because rescuing cell cultures just isn’t as dramatic as carrying an I.C.U. patient on a ventilator down flights of stairs in the dark.


But, of course, there is an incontrovertible link between those cell cultures and that patient. For every medication that a patient takes, someone researched the basic chemistry of the drug, someone designed the clinical trial to test its efficacy, and of course a volunteer stepped forward to be the first to take the pill. Scientific research has engineered the impressive advancements of medical treatment, and every patient is a beneficiary.


When the hospitals were hit by Hurricane Sandy, hundreds of experiments were obliterated by the loss of power. Precious biological samples carefully frozen over years were destroyed. Temperature-sensitive reagents and equipment were ruined. Medications and records for patients in clinical trials were rendered inaccessible. And sadly, many laboratory mice and rats perished (though 600 cages of animals were rescued during the night by staff members who used crowbars on inaccessible doors and carried the cages out through holes cut in the ceiling).


On a slushy, rainy day earlier this month, I sat in on a meeting of N.Y.U.’s research community. Hundreds of scientists packed the chilly lecture hall to discuss what the future might hold. It was clear that the damage to laboratories and samples would not be amenable to easy repair. Some 400 researchers were being relocated to a patchwork of temporary sites so that they could restart their work.


But scientists can’t just walk in to a new space with a lab coat and a notebook; they need centrifuges, deep-freezes, lab animals, electron microscopes, incubators, autoclaves, gamma counters, PET scanners. They come with graduate students, lab techs, post-docs and collaborating investigators. For clinical researchers, there are also the patients enrolled in their clinical trials, with their medications and voluminous records.


Even beyond their eagerness to get back to work, researchers felt a sense of loss, not just in time, money, momentum, samples and grants, but of a part of their lives. Some senior scientists lost decades of archived samples. Others lost irreplaceable mice with genetic mutations for studying how coronary plaques resolve, the role of inflammation in lymphoma and the development of neural networks. At the other end of the spectrum were post-docs whose nascent careers were suddenly up in the air. Some were in tears.


Walking down First Avenue after the meeting, I passed a young researcher pushing a cart laden with cages, transporting lab rats to their new home. There was a blanket over the cages to protect them from the rain, but it kept slipping. She slogged up the wet avenue, one hand pushing the cart, the other struggling to keep the cover over her charges.


The logistical efforts to relocate and reignite such a vast research enterprise are staggeringly complicated. But the administration has cataloged each person’s research needs to match them with available space elsewhere, and hundreds of researchers have successfully rekindled their investigations despite the prodigious challenges.


Bellevue and Tisch are returning to their clinical operations and will be able to admit patients shortly. But even after the hospital wards and clinics are bustling at full capacity, the ribbon won’t feel ready to snip until the researchers are restored to their homes as well. For many patients, the thrum of research within a medical center is invisible. But it is an integral — and very human — part of a hospital. When a hurricane disrupts research, it is a loss that resonates well beyond the laboratories.


Danielle Ofri, an associate professor at New York University School of Medicine, is the editor of the Bellevue Literary Review and the author, most recently, of “Medicine in Translation: Journeys With My Patients.”



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Family, fans say goodbye to Jenni Rivera









Jenni Rivera was remembered in death the same way she was celebrated in life: on an illuminated stage, with thousands of fans chanting her name.


The singer, who was killed in a plane crash earlier this month, was honored Wednesday with what her family called a "celestial graduation," a musical memorial that packed the Gibson Amphitheatre with 6,100 people and drew hundreds more outside.


The more than two-hour farewell could have been mistaken for a concert, if not for the crowd's tears and the ruby-red casket on stage. In front of it was a cluster of white roses, the type of flower Rivera's family asked fans to bring. Behind it was a single microphone, left unused.





Family members — clad head-to-toe in white — praised Rivera as a "perfectly imperfect" mother and a guerrera, Spanish for "female warrior." Her father, Pedro Rivera, a noted singer of the Mexican ballads known as corridos, said goodbye by performing a song he wrote about her, "La Diva de la Banda."


Rivera's 11-year-old son, Johnny Lopez, addressed the sea of mourners in a white suit and red bow tie. His father died a few years ago.


"Mama, I've been crying so much these last few days. I miss you so much," he said, his voice breaking. "I hope you're taking care of my dad and I hope he's taking care of you, too."


He added: "I want to thank everyone for loving my mom."


Rivera, a Long Beach native, first gained fame via her banda music, a Mexican regional style heavy on machismo and brass instruments. A rare woman in the genre, Rivera often sang — in Spanish and English — about her chaotic personal life: three husbands, five children and struggles with her weight and domestic violence.


Rivera sold more than 20 million albums and, in recent years, had started to expand her business empire. She had a weekly radio program, clothing and cosmetics lines and a hand in several reality shows, including "I Love Jenni."


She and six others were killed Dec. 9 when a private jet that had departed Monterrey, Mexico, nose-dived 28,000 feet in 30 seconds and smashed into mountainous terrain. Rivera was 43.


"My sister, Jenni, died in a plane accident, but it was not an accident," Pedro Rivera Jr., a pastor and Rivera's brother, told the crowd in Spanish. "God has a purpose for all of us and God let us borrow her for 43 years and enjoy her."


It was clear how deeply Rivera had touched her legion of fans.


At the memorial, several well-known Latino singers performed, including Ana Gabriel, Olga Tanon and Joan Sebastian.


Outside, her fan base arrived early, blasting her music from cars decorated with tributes: "Jenni, we love you" and "We are going to miss you." They wore Jenni Rivera T-shirts and Jenni Rivera pins and waved handmade posters. One woman said Rivera was now performing "in a concert with God."


Lidia Farrias and her husband, Jose, drove three hours from Santa Maria. They didn't have tickets — the event sold out within minutes — so they shivered outside, eyes fixed on two jumbo screens streaming the memorial. Farrias said Rivera's frank lyrics had encouraged her to be a stronger woman.


"Whenever I listened to her songs, I felt like I could tackle anything," she said.


Denise Montalvo, 15, had left San Diego at 1 a.m. with her mother, aunt and two family friends. She admired Rivera for striving to obtain a better life, just like Denise's family. The teenager said Rivera wanted her funeral to be a celebration, reflecting her song "Cuando Muere una Dama" — "When a Lady Dies."


"We're trying not to be sad," she said.


That was hard for fans, particularly as the memorial wound down. One by one, each of Rivera's family members placed a white rose on her casket. Some whispered to it. Some kissed it. Then they walked away.


ruben.vives@latimes.com


adolfo.flores@latimes.com


Times staff writer Ashley Powers contributed to this report.





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A Google-a-Day Puzzle for Dec. 20











Our good friends at Google run a daily puzzle challenge and asked us to help get them out to the geeky masses. Each day’s puzzle will task your googling skills a little more, leading you to Google mastery. Each morning at 12:01 a.m. Eastern time you’ll see a new puzzle posted here.


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We leave the comments on so people can work together to find the answer. As such, if you want to figure it out all by yourself, DON’T READ THE COMMENTS!


Also, with the knowledge that because others may publish their answers before you do, if you want to be able to search for information without accidentally seeing the answer somewhere, you can use the Google-a-Day site’s search tool, which will automatically filter out published answers, to give you a spoiler-free experience.


And now, without further ado, we give you…


TODAY’S PUZZLE:



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Ken is a husband and father from the San Francisco Bay Area, where he works as a civil engineer. He also wrote the NYT bestselling book "Geek Dad: Awesomely Geeky Projects for Dads and Kids to Share."

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Miss USA Olivia Culpo is crowned Miss Universe






LAS VEGAS (AP) — A 20-year-old Boston University sophomore and a self-described “cellist-nerd” brought the Miss Universe crown back to the United States for the first time in more than a decade when she won the televised contest Wednesday.


Olivia Culpo beat out 88 other beauty queens to take the title from Leila Lopes of Angola during the two-hour competition at the Planet Hollywood casino on the Las Vegas Strip.






Culpo wore a tight navy blue mini-dress with a sequined bodice as she walked on stage for the competition’s opening number. Later in the night, she strutted in a purple and blue bikini, and donned a wintery red velvet gown with a plunging neckline.


Culpo’s coronation ends a long losing spell for the U.S. in the competition co-owned by Donald Trump and NBC. An American had not won the right to be called Miss Universe since Brook Lee won the title in 1997.


Culpo was good enough during preliminary competitions to be chosen as one of 16 semifinalists who moved on to compete in the pageant’s finale. Her bid lasted through swimsuit, evening wear, and interview competitions that saw cuts after each round.


She won over the judges, even after tripping slightly during the evening gown competition. Telecasters pointed it out but also noted her poised recovery.


Minutes before the middle child of five was crowned, she was asked whether she had she had ever done something she regretted.


“I’d like to start off by saying that every experience no matter what it is, good or bad, you’ll learn from it. That’s just life,” she said. “But something I’ve done I’ve regretted is probably picking on my siblings growing up, because you appreciate them so much more as you grow older.”


Miss Philippines, Janine Tugonon, came in second, while Miss Venezuela, Irene Sofia Esser Quintero, placed third.


All the contestants spent the past two weeks in Sin City, where they posed in hardhats at a hotel groundbreaking, took a painting lesson, and pranked hotel guests by hiding in their rooms.


Culpo was the first Miss USA winner from Rhode Island when she took the national crown in Las Vegas in June.


She grew up in Cranston with two professional musicians for parents and has played the cello alongside world-renowned classical musician Yo-Yo Ma. On her Miss Universe page, she said she hopes to pursue a career in film or television, and cites Audrey Hepburn as a role model because of her “generosity, intelligence and grace.”


With Culpo’s promotion, Miss Maryland Nana Meriwether becomes the new Miss USA.


The Miss Universe pageant was back in Las Vegas this year after being held in Sao Paulo in 2011. It aired live on NBC and was streamed to more than 100 countries.


Organizers had considered holding the 61st annual Miss Universe in the popular Dominican Republic tourist city of Punta Cana, but Miss Universe Organization President Paula Shugart said that country’s financial crisis proved to be too much of an obstacle.


The panel of 10 judges included singer Cee Lo Green, “Iron Chef” star Masaharu Morimoto and Pablo Sandoval of the San Francisco Giants.


Asked on the red carpet whether he found playing in the World Series or judging the beauty pageant to be more difficult, Sandoval said both were hard.


Sharply dressed women and men, including a large contingent from South America, held banners and cheered on their favorite contestants.


The pageant started as a local revue in Long Beach, Calif., organized by Catalina Swimwear. It is not affiliated with the Miss America pageant and unlike that contest, does not include a talent section.


Contestants in the pageant cannot have been married or have children. They must be younger than 27 and older than 18 by Feb. 1 of the competition year.


As Miss Universe, Culpo will receive an undisclosed salary, a wardrobe fit for a queen, a limitless supply of beauty products, and a luxury apartment in New York City.


Entertainment News Headlines – Yahoo! News





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U.N. Suspends Polio Campaign in Pakistan After Killings of Workers


B.K. Bangash/Associated Press


A Pakistani woman administered polio vaccine to an infant on Wednesday in the slums of Islamabad. Militants have killed eight polio workers over three days.







LAHORE, Pakistan — The front-line heroes of Pakistan’s war on polio are its volunteers: young women who tread fearlessly from door to door, in slums and highland villages, administering precious drops of vaccine to children in places where their immunization campaign is often viewed with suspicion.




Now, those workers have become quarry. After militants stalked and killed eight of them over the course of a three-day, nationwide vaccination drive, the United Nations suspended its anti-polio work in Pakistan on Wednesday, and one of Pakistan’s most crucial public health campaigns has been plunged into crisis.


The World Health Organization and Unicef ordered their staff members off the streets, while government officials reported that some polio volunteers — especially women — were afraid to show up for work.


At the ground level, it is those female health workers who are essential, allowed privileged entrance into private homes to meet and help children in situations denied to men because of conservative rural culture. “They are on the front line; they are the backbone,” said Imtiaz Ali Shah, a polio coordinator in Peshawar.


The killings started in the port city of Karachi on Monday, the first day of a vaccination drive aimed at the worst affected areas, with the shooting of a male health worker. On Tuesday four female polio workers were killed, all gunned down by men on motorcycles in what appeared to be closely coordinated attacks.


The hit jobs then moved to Peshawar, the capital of Khyber-Pakhtunkhwa Province, which, along with the adjoining tribal belt, constitutes Pakistan’s main reservoir of new polio infections. The first victim there was one of two sisters who had volunteered as polio vaccinators. Men on motorcycles shadowed them as they walked from house to house. Once the sisters entered a quiet street, the gunmen opened fire. One of the sisters, Farzana, died instantly; the other was uninjured.


On Wednesday, a man working on the polio campaign was shot dead as he made a chalk mark on the door of a house in a suburb of Peshawar. Later, a female health supervisor in Charsadda, 15 miles to the north, was shot dead in a car she shared with her cousin.


Yet again, Pakistani militants are making a point of attacking women who stand for something larger. In October, it was Malala Yousafzai, a schoolgirl advocate for education who was gunned down by a Pakistani Taliban attacker in the Swat Valley. She was grievously wounded, and the militants vowed they would try again until they had killed her. The result was a tidal wave of public anger that clearly unsettled the Pakistani Taliban.


In singling out the core workers in one of Pakistan’s most crucial public health initiatives, militants seem to have resolved to harden their stance against immunization drives, and declared anew that they consider women to be legitimate targets. Until this week, vaccinators had never been targeted with such violence in such numbers.


Government officials in Peshawar said that they believe a Taliban faction in Mohmand, a tribal area near Peshawar, was behind at least some of the shootings. Still, the Pakistani Taliban have been uncharacteristically silent about the attacks, with no official claims of responsibility. In staying quiet, the militants may be trying to blunt any public backlash like the huge demonstrations over the attack on Ms. Yousafzai.


Female polio workers here make for easy targets. They wear no uniform but are readily recognizable, with clipboards and refrigerated vaccine boxes, walking door to door. They work in pairs — including at least one woman — and are paid just over $2.50 a day. Most days one team can vaccinate 150 to 200 children.


Faced with suspicious or recalcitrant parents, their only weapon is reassurance: a gentle pat on the hand, a shared cup of tea, an offer to seek religious assurances from a pro-vaccine cleric. “The whole program is dependent on them,” said Mr. Shah, in Peshawar. “If they do good work, and talk well to the parents, then they will vaccinate the children.”


That has happened with increasing frequency in Pakistan over the past year. A concerted immunization drive, involving up to 225,000 vaccination workers, drove the number of newly infected polio victims down to 52. Several high-profile groups shouldered the program forward — at the global level, donors like the Bill and Melinda Gates Foundation, the United Nations and Rotary International; and at the national level, President Asif Ali Zardari and his daughter Aseefa, who have made polio eradication a “personal mission.”


On a global scale, setbacks are not unusual in polio vaccination campaigns, which, by dint of their massive scale and need to reach deep inside conservative societies, end up grappling with more than just medical challenges. In other campaigns in Africa and South Asia, vaccinators have grappled with natural disaster, virulent opposition from conservative clerics and sudden outbreaks of mysterious strains of the disease.


Declan Walsh reported from Lahore, and Donald G. McNeil Jr. from New York. Ismail Khan contributed reporting from Peshawar, Pakistan.



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BBC Inquiry Blames Rigid Management for Mishandling Sex Abuse Scandal



The 200-page report by Nick Pollard, a veteran British broadcast executive, strongly criticized the editorial and management decisions that prompted the BBC to cancel a broadcast last year that would have exposed decades of sexual abuse by Jimmy Savile, a BBC fixture who had been one of Britain’s best-known television personalities.


While the scandal led to the resignation and reassignment of several top executives — including George Entwistle, just two months into his tenure in the BBC’s top job as director general — Mr. Pollard absolved top management of applying “undue pressure” in the decision to stop the broadcast.


The report also did not challenge the assertions of Mark Thompson, then head of the BBC, that he had no role in killing the Savile investigation and was unaware of the sexual abuse accusations until he left the BBC this September. Mr. Thompson is now president and chief executive of The New York Times Company.


The report traced in detail what it described as “a chain of events that was to prove disastrous for the BBC.” Its central conclusion was that confusion and mismanagement, not a cover-up, lay at the heart of the decision to drop the Savile segment on “Newsnight,” an investigative program. Mr. Savile died at 84 in October 2011, weeks before the segment was scheduled to run.


“The efforts to get to the truth behind the Savile story proved beyond the combined efforts of the senior management, legal department, corporate communications team and anyone else for well over a month” after a rival channel, ITV, broadcast its own exposé in October 2012.


That segment presented the accounts of five women who said they had been sexually abused as teenagers by Mr. Savile, the report said. “Leadership and organization seemed to be in short supply.”


Mr. Pollard, a former head of the Sky News channel who began his broadcast career as a BBC reporter, dismissed a widely circulated theory that BBC News executives or their superiors pressured the “Newsnight” team to cancel the Savile segment to avoid embarrassing the BBC. Peter Rippon, the program’s editor, said that he canceled the report because he thought the team’s conclusions about Mr. Savile were inadequately substantiated.


“While there clearly were discussions about the Savile story between Mr. Rippon and his managers,” Mr. Pollard said, he does not believe that they went beyond journalistic considerations.


After publication of the report, Tim Davie, the BBC’s acting director general, said that Stephen Mitchell, the deputy director of news, would be taking early retirement and that Mr. Rippon would be moved to another job. Helen Boaden, director of the news division, who along with Mr. Rippon and Mr. Mitchell was suspended while the nine-week Pollard inquiry was in progress, will return to her job, overseeing new editorial leadership at “Newsnight.”


In a statement, the BBC Trust, which oversees the broadcaster, said the report made clear the need for major changes in the BBC’s operation. It said top executives must take initiative and responsibility, share information and embrace criticism, and persuade employees to rid the company of the “insularity and distrust” revealed in the report.


“The BBC portrayed by the Pollard review is not fundamentally flawed, but has been chaotic,” it said. “That now needs to change.”


The report was strongly critical of several news executives who were directly involved in the decision to cancel the Savile program, including Mr. Rippon and the top executives in the BBC’s news division to whom he reported, Ms. Boaden and Mr. Mitchell, saying they had reached a “flawed” conclusion in canceling the “Newsnight” segment that overrode the “cogent evidence” against Mr. Savile that the “Newsnight” team had gathered.


But it paid scant attention to the role of the former director general, Mr. Thompson, and did not fault him for missing opportunities to learn the details of the allegations against Mr. Savile.


After Mr. Thompson was told about the scuttled segment by a BBC reporter at a reception in late December 2011, he said, he asked his news executives about it. According to his testimony to the Pollard inquiry, he “received reassurances” that it had been killed for “editorial or journalistic reasons” and “crossed it off my list and went off to worry about something else.”


Matthew Purdy contributed reporting from New York.



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California parks officials improperly boosted pay, audit finds









SACRAMENTO — Managers at the California parks department circumvented payroll policies and boosted salaries improperly, the state controller said Tuesday.


Controller John Chiang said the payouts were made with "deliberate disregard for internal controls, along with little oversight and poorly trained staff. When security protocols and authorization requirements so easily can be overridden, it invites the abuse of public funds."


Chiang said that bad record keeping in the department made it impossible to determine a total for the amount of money improperly paid.





The payroll issues are coming to light months after revelations last summer that parks officials had a hidden $54-million surplus at a time when the department was cutting services and threatening to close parks. Disclosure of unused funds led to the ouster of department Director Ruth Coleman.


The payroll problems took many forms, the controller's office said. One involved "out of class" payments, which is extra money paid to employees for handling duties outside their regular responsibilities. Over a three-year period, 203 employees received a total of $520,000 for such work, but a lack of documentation prevented officials from determining how much of those payments were improper, the office said.


In another example, several temporary employees were allowed to exceed their annual ceiling of 1,500 hours of work.


The parks department conceded Tuesday that it had made errors.


"We acknowledge and it is widely known that some very unfortunate events occurred at the Department of Parks and Recreation, in particular with the mismanagement of payroll systems and data," spokesman Roy Stearns said. The department is using the controller's findings to "continue to improve and safeguard our payroll systems," he said.


Stearns said officials would try to have employees return any overpayments.


Last month, Gov. Jerry Brown appointed a retired Marine general, Anthony Jackson, to replace Coleman as director. Jackson is awaiting Senate approval.


"We see these audits and investigations as a catalyst for change," Jackson said in a statement. He said the department will "work diligently to earn back the trust of our fellow state agencies and the people of the state of California."


The state Department of Finance is conducting its own audit of the parks department. Spokesman H.D. Palmer said the findings could be released before the end of the year.


chris.megerian@latimes.com





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A Google-a-Day Puzzle for Dec. 19











Our good friends at Google run a daily puzzle challenge and asked us to help get them out to the geeky masses. Each day’s puzzle will task your googling skills a little more, leading you to Google mastery. Each morning at 12:01 a.m. Eastern time you’ll see a new puzzle posted here.


SPOILER WARNING:
We leave the comments on so people can work together to find the answer. As such, if you want to figure it out all by yourself, DON’T READ THE COMMENTS!


Also, with the knowledge that because others may publish their answers before you do, if you want to be able to search for information without accidentally seeing the answer somewhere, you can use the Google-a-Day site’s search tool, which will automatically filter out published answers, to give you a spoiler-free experience.


And now, without further ado, we give you…


TODAY’S PUZZLE:



Note: Ad-blocking software may prevent display of the puzzle widget.




Ken is a husband and father from the San Francisco Bay Area, where he works as a civil engineer. He also wrote the NYT bestselling book "Geek Dad: Awesomely Geeky Projects for Dads and Kids to Share."

Read more by Ken Denmead

Follow @fitzwillie and @wiredgeekdad on Twitter.



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Cassadee Pope wins Season 3 of ‘The Voice’






NEW YORK (AP) — Cassadee Pope, who was country singer Blake Shelton‘s protege on the third season of NBC‘s “The Voice,” has won the show’s competition.


The 23-year-old singer is stepping out into a solo career after performing with a band called Hey Monday. Her victory over Scottish native Terry McDermott and long-bearded Nicholas David was announced at the end of a two-hour show Tuesday.






“The Voice” has grown into a hit for NBC and was the key factor in the network’s surprising success this fall.


The show’s status was affirmed by the stream of hitmakers who performed on the finale. They included Rihanna, Bruno Mars, the Killers, Smokey Robinson and Peter Frampton.


Entertainment News Headlines – Yahoo! News





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Attackers in Pakistan Kill Anti-Polio Workers


Athar Hussain/Reuters


Relatives of Nasima Bibi, a worker in a polio vaccination drive, at a hospital morgue in Karachi.







ISLAMABAD, Pakistan — Gunmen shot dead five female health workers who were immunizing children against polio on Tuesday, causing the Pakistani government to suspend vaccinations in two cities and dealing a fresh setback to an eradication campaign dogged by Taliban resistance in a country that is one of the disease’s last global strongholds.




“It is a blow, no doubt,” said Shahnaz Wazir Ali, an adviser on polio to Prime Minister Raja Pervez Ashraf. “Never before have female health workers been targeted like this in Pakistan. Clearly there will have to be more and better arrangements for security.”


No group claimed responsibility for the attacks, but most suspicion focused on the Pakistani Taliban, which has previously blocked polio vaccinators and complained that the United States is using the program as a cover for espionage.


The killings were a serious reversal for the multibillion-dollar global polio immunization effort, which over the past quarter century has reduced the number of endemic countries from 120 to just three: Pakistan, Afghanistan and Nigeria.


Nonetheless, United Nations officials insisted that the drive would be revived after a period for investigation and regrouping, as it had been after previous attacks on vaccinators here, in Afghanistan and elsewhere.


Pakistan has made solid gains against polio, with 56 new recorded cases of the diseases in 2012, compared with 192 at the same point last year, according to the government. Worldwide, cases of death and paralysis from polio have been reduced to less than 1,000 last year, from 350,000 worldwide in 1988.


But the campaign here has been deeply shaken by Taliban threats and intimidation, though several officials said Tuesday that they had never seen such a focused and deadly attack before.


Insurgents have long been suspicious of polio vaccinators, seeing them as potential spies. But that greatly intensified after the C.I.A. used a vaccination team headed by a local doctor, Shakil Afridi, to visit Osama bin Laden’s compound in Abbottabad, reportedly in an attempt to obtain DNA proof that the Bin Laden family was there before an American commando raid on it in May 2011.


In North Waziristan, one prominent warlord has banned polio vaccinations until the United States ceases drone strikes in the area.


Most new infections in Pakistan occur in the tribal belt and adjoining Khyber-Pakhtunkhwa Province — some of the most remote areas of the country, and also those with the strongest militant presence. People fleeing fighting in those areas have also spread the disease to Karachi, the country’s largest city, where the disease has been making a worrisome comeback in recent years.


After Tuesday’s attacks, witnesses described violence that was both disciplined and well coordinated. Five attacks occurred within an hour in different Karachi neighborhoods. In several cases, the killers traveled in pairs on motorcycle, opening fire on female health workers as they administered polio drops or moved between houses in crowded neighborhoods.


Of the five victims, three were teenagers, and some had been shot in the head, a senior government official said. Two male health workers were also wounded by gunfire; early reports incorrectly stated that one of them had died, the official said.


In Peshawar, the capital of Khyber-Pakhtunkhwa Province, gunmen opened fire on two sisters participating in the polio vaccination program, killing one of them. It was unclear whether that shooting was directly linked to the Karachi attacks.


In remote parts of the northwest, the Taliban threat is exacerbated by the government’s crumbling writ. In Bannu, on the edge of the tribal belt, one polio worker, Noor Khan, said he quit work on Tuesday once news of the attacks in Karachi and Peshawar filtered in.


“We were told to stop immediately,” he said by phone.


Still, the Pakistani government has engaged considerable political and financial capital in fighting polio. President Asif Ali Zardari and his daughter Aseefa have been at the forefront of immunization drives. With the help of international donors, including the Bill and Melinda Gates Foundation, they have mounted a huge vaccination campaign aimed at up to 35 million children younger than 5, usually in three-day bursts that can involve 225,000 health workers.


The plan seeks to have every child in Pakistan immunized at least four times per year, although in the hardest-hit areas one child could be reached as many as 12 times in a year.


Declan Walsh reported from Islamabad, and Donald G. McNeil Jr. from New York. Salman Masood contributed reporting from Islamabad, and Zia ur-Rehman from Karachi, Pakistan.



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