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Interview with State Senator Jessica Ramos (D-NY); Interview with Former New York City Council Speaker and WIN Shelter CEO Christine Quinn; Interview with "Foreign Bodies" Author Simon Schama; Interview with "A Fitting Final Gift From Jimmy Carter" Writer and Pulmonary and Brigham and Women's Hospital Critical Care Physician Dr. Daniela J. Lamas. Aired 1:00- 2p ET

Aired September 13, 2023 - 13:00:00   ET



CHRISTIANE AMANPOUR, CNN CHIEF INTERNATIONAL ANCHOR: Hello, everyone, and welcome to "Amanpour." Here's what's coming up.

Utter devastation in Libya. Streets washed with the dead and thousands missing in the floods just days after a catastrophic earthquake in nearby

Morocco. Will Libya get the help it desperate needs now?

Plus --


ERIC ADAMS (D), MAYOR OF NEW YORK: This issue will destroy New York City.


AMANPOUR: New York's migrant crisis, we look at tackling this multibillion-dollar humanitarian calamity.

Then, pandemic, vaccines and the health of nation. With the new strain of COVID surging, I discuss lessons learned with historian Simon Schama.

And --



There's a real hesitation, fear to discuss this, particularly for people who are not, you know, in the final days of life.


AMANPOUR: Changing the conversation on hospice care. Dr. Daniela Lamas tells Michel Martin why Former President Jimmy Carter's choice of

healthcare is a fitting final gift.

Welcome to the program, everyone. I'm Christiane Amanpour in New York.

And we begin with the devastating natural disasters and human tragedy bedeviling North Africa. In Libya, harrowing stories of bodies piling and

filling up streets after massive floods when a torrential downpour smashed through two dams, washing away home and everything in water's way.

As that country starts to count the cost, more than 6,000 were presumed dead. And at last report, some 10,000 missing. Another 30,000 have been

displaced. These are huge numbers in a failing state which urgently needs help, as Correspondent Ben Wedeman now reports. And a warning, of course,

some scenes are difficult to watch.


BEN WEDEMAN, CNN CORRESPONDENT (voiceover): The bodies are everywhere. Dozens, dozens of the dead covered in blankets, awaiting identification and

burial. The dead number in the thousands. But so far, no one really knows how many were taken by Storm Daniel. Survivors are finding more and more


Rescue workers and volunteers have retrieved the body of a boy wrapped in a blanket and prepared to put him in a body bag. When his father arrives,

overcome with emotion.

Doctors fear so many dead left in the open could lead to an outbreak of disease.

We aren't able to identify all the bodies and bury them, says this woman identified as Dr. Ais (ph). We want to provide a humane place, freezers

where loved ones can then identify them.

Access to Derna remains difficult. The flood destroyed many roads and bridges leading to the city. This port of Eastern Libya has been

transformed into a waste land of mud, rubble and ruin. The raging waters that tore the city spared no one and nothing.


AMANPOUR: Correspondent Ben Wedeman reporting.

Now, this terrible disaster is sure to contribute to the steady flow of migrants leaving Libya and other African nations for Europe. And half a

world away here in the United States, the constant movement of migrants from the Mexican border is causing cities like New York an unprecedented


More than 100,000 migrants have arrived since last spring. City officials say it's straining resources, filling up shelters and putting pressure on

schools. And Mayor Eric Adams has resorted to highly charged rhetoric.


ERIC ADAMS (D), MAYOR OF NEW YORK: I don't see an ending to this. This issue will destroy New York City. Destroy New York City. We're getting

10,000 migrants a month. One time we were just getting Venezuela. Now, we're getting Ecuador. Now, we're getting Russia speaking coming through

Mexico. Now, we're getting Western Africa. Now, we're getting people from all over the globe have made their minds up that they're going to come

through the southern part of the border and come into New York City.



AMANPOUR: Joining me to discuss are two Democrats taking on their own party over this. New York State Senator Jessica Ramos and Christine Quinn,

CEO of WIN, formally known as Women in Need, New York's largest shelter in the city here. And she was speaker of the New York City Council. Welcome to

the program.

Can I start by asking each one of you whether you agree with your mayor's description that this will, as he said, destroy New York City? Senator

Ramos, firstly.

STATE SEN. JESSICA RAMOS (D-NY): Yes, thank you. I was tremendously disappointed to hear the mayor who is supposed to be our greatest

cheerleader here in New York City sound so defeatist. We know one of the values that truly characterizes New Yorkers is that we ban together when

there's a challenge at hand. And this should be no different.

This is a time where we ban together, where we make sure that we are utilizing our resources effectively, where we're vetting contracts

certainly, and making sure that we are investing in the system that is to support all New Yorks at this time.

AMANPOUR: Senator Ramos, have you spoken to the mayor about your concerns since he made those comments?

RAMOS: I have not. I have been in communication with many of my colleagues, trying to figure out how we can apply the appropriate pressure

to see the city and state, of course, respond in an appropriate way that creates opportunity and certainly, especially, takes care of our children

in our New York City public schools this year.

AMANPOUR: Let me turn to you, Christine Quinn, as former New York City officer, speaker of the council, what do you make of it? You're a Democrat.

The mayor is Democrat. State Senator Ramos is a Democrat. The -- you know, the Senate in Congress is democratic. The White House is democratic. What

is going on here?

CHRISTINE QUINN, FORMER NEW YORK CITY COUNCIL SPEAKER AND CEO, WIN SHELTER: Well, look, I'm sympathetic to the mayor from the perspective of he could

never have seen this coming, right? This could never have been on his list of things he has -- would have to deal with as mayor. But it is now on that

list. And these individuals who are incredibly brave, who fled violence and poverty we can't even understand, literally walked through rivers to get to

safety in the United States. They're not going to break this city.

First of all, I don't think anything can break this city. But these brave individuals certainly are not. The senator is right. We need to come

together. We need to change policies that are making it harder for these individuals to work. Making it harder for these individuals to find

housing. We need to find a way to make them a full part of the City of New York. And that is doable.

Yes, it will cost money and yes, the federal government should give us a lot more, but it is doable.

AMANPOUR: Well, let's dig down into that then, because that is always the question. Is it, as you've said it is, and how is it? Just, you know,

Christine Quinn, you run the biggest shelter. What will it take? And is it state money? Is it federal money? Who has to vote on it? What are the

mechanics of trying to get the aid that's required that you're calling for?

QUINN: So, the federal government allocation could come from the president directly. It could go through Congress, but that is obviously, you know,

absurdly tricky. But that could come -- more could come right from the president. Senator Goldman -- Representative Goldman, excuse me, announced

a new allocation from the feds today that's good. It needs to keep coming, one.

Two, the federal government, and this will take both White House and congressional action, need to pass expedited working papers. Let me tell

you, we have 270 families that are asylum seekers in my shelter system, every single one of those people wants to work without question.

Three, the Adams administration needs to change the housing policy. Right now, it's housing most of these refugees in welfare hotels. That cost $383

a night. If we were to allow these individuals to get housing vouchers, like documented homeless people can, that only costs $72 a night.


QUINN: We did a study with the New York Immigration Coalition, we make that change, the city saves $3 billion in their services to these

individuals. That's a huge amount of money and certainly moves us away from the perspective of these individuals breaking the city.


AMANPOUR: Wow. I mean, that is such a stark explanation in dollars and cents of what could happen. Senator Ramos -- State Senator, you -- your

parents were refugees, right? They were migrants from south of the border, Colombia, I believe, if I'm not mistaken. From their experience --

RAMOS: That's correct

AMANPOUR: -- and what you experienced growing up, how do you think these migrants and who were, you know, for all intents and purposes, refugees in

New York City right now, how are they experiencing this? How are they living apart from what we've just heard from Christine Quinn that they're

housed in these expensive hotels, welfare hotels?

RAMOS: Yes. That's absolutely correct. You know, my mother crossed the Mexican border so that I could be born here. She was only 25 years old. And

because of her sacrifice, I'm able to represent my neighbors in the New York State Senate, and I just managed to raise the minimum wage in New York

State. So, we're definitely not here to destroy things but actually to make New York better.

And my district happens to have absorbed many of these fellow Colombian and, of course, Venezuelan migrants who are also seeking better

opportunities. And what we want is to see the city and, of course, the state and the federal government, every level, really band together to make

investments where they matter most.

There is no reason why, if from Albany we're sending every single nickel and dime that our public schools need in order to fully function that we

should be making cuts when we're actually welcoming 19,000 migrant children who will -- which means we will need more bilingual teachers, we will need

more mental health supports. This again is a moment where we invest in our people and build our infrastructure, not do the opposite.

I mean, we -- this mayor has now passed two budgets but has seen five different rounds of budget cuts. And we see that the actual price tag is

much bigger than it actually is based on the numbers. We could be using our resources much more efficiently and beat serving all of New Yorkers a lot


AMANPOUR: Can I ask you about a couple of contentious issues, and that is the work permit that you mentioned, Christine Quinn. On the face of it, it

obviously makes sense, but politicians and maybe, you know, demographers and others will say, well, hang on a second. If we made that a pledge on,

you know, touching ground in New York City, then that will increase the push factor from wherever they're coming from. So, how do you rationalize,

you know, offering, obviously, sensible work permits so they get into the economy and stop being a drag on any economy and any society versus the

criticism of that?

QUINN: Well, I think the forces that are driving individuals to come to the United States, to come to New York, to come to the border, I think they

are much more serious and really don't relate to people just coming for jobs. Oh, I'm going to go there because it's easier to get a job. I mean,

these are people who are fleeing sex trafficking, violence. You know, I don't think it's going to make that much of a difference.

We have seen these people will come because they have to find a better life for their families. So, the difference in my opinion would be negligible.

AMANPOUR: And meantime, what about the idea of -- as we've been reporting, and both of you can address this, you've seen governors in the southern

states, for instance, the border states, for instance, in Texas, essentially packing busses with migrants and sending them north,

particularly to places like New York which has, if I'm not mistaken, the right to shelter.

How much does that play into the crisis? Christine, you can go first, then I'll ask Jessica.

QUINN: OK. So, you know, look, I think what the governor of Texas done is horrendous. These individuals, like I've said, it's been harrowing

experiences. Then they get put on a bus, unceremoniously, with no sense really of where they are going. It's terrible.

But one thing it does show is that, in some ways, New York is the new border. And we should be getting funded from the federal government at the

same level that the border states have been getting money so we can really help these individuals when they get off the bus. And, you know, they get

off that bus in port authority or wherever, they have the t-shirts on their back, the sneakers on their feet. They're not prepared for northeast


So, we really have a lot of work that we do. People have stepped forward but we should be getting the same level of support that Texas has been

getting, particularly since it's their governor who is sending these individuals to New York.

AMANPOUR: Senator Ramos, I'm going to play a little bit of the speech that Eric Adams made, and this is -- goes to the heart of the right to shelter



ADAMS: We are saying that you could come from anywhere on the globe, come to New York City, and we are to food, house, clothe for as long as you want

forever? That's not realistic. It's not sustainable.



AMANPOUR: So, that was obviously an interview. But, State Senator, what does your legislative think? What do the majority think in your state, in

the city about the right to shelter? He's saying it's not sustainable. What does that mean?

RAMOS: Well, to me, the right to shelter should actually mean transitioning New Yorkers into real permanent housing. We have done a

dismal job over the past few years of enacting a plan to build the amount of affordable housing that is so desperately needed in New York.

I think staying in a shelter should be always temporary and transitional while we help New Yorkers actually get on their feet and hopefully, fill

one of the many, many vacant apartments that exist here in New York State, whether they're stabilized apartments or even luxury apartment in Hudson

Yards that remain empty now for years.

So, this definitely compounds our affordable housing crisis that we've been seeing here in New York. But we -- I think we could have been quicker to

free up space in shelters and really help folks get back on their feet and bring some stability to their families.

AMANPOUR: And in general, then, where are these migrants -- I mean, we've heard about the hotels. But are they generally safe for migrants and their

families? Where are the kids going to school?

QUINN: Well, the kids are going to school mostly the school closest to the hotel or shelter that they are at. And I do have to say, although, clearly,

I have criticisms of some of the ways the Adams administration had responded to this crisis, I do want to give credit to the Department of

Education. Because this year on the first day of school, last year the first day of school, we saw no problems for our asylum-seeking families,

their children getting into school. That is one agency that has done a good job.

AMANPOUR: And can I ask you? You talked about absorbing them and giving them work permits et cetera, which would go a long way. Senator Ramos, is

there a need in New York for people to fill jobs? I mean, what is the employment situation?

RAMOS: Yes. Absolutely. I mean, we've seen labor shortages, particularly in Upstate New York, in all sorts of industry, including the construction

industry. We have a nurse shortage. And actually, this is why I've been so critical of the intake that has been done with these recent arrivals.

We have here in New York Executive Order 41, which protects the city from sharing personal information with the federal government. And therefore, I

believe that we should have known who these folks are, where they are staying, when their next immigration court date is, and certainly, what

skill set they bring so that we can utilize this time of waiting for work permits to better channel their talents into the appropriate places.

We know that our hospitals are understaffed. We know that we need more bilingual teachers in our schools to service these same -- the same group

of students. There's just so much more that we can be doing in order to create order and keep our efforts organized.

QUINN: And you know, one area where we do -- oh, I'm sorry -- we do need to do more that the senator referenced is the area of legal representation

for these individuals. And WIN, with law firms, we've created a pro bono clinic to help the clients figure out their legal path. But we now need

lawyers who can take them to court and represent them.

AMANPOUR: And as we know --

RAMOS: We have seven law schools.


RAMOS: We have seven law schools here in New York.

AMANPOUR: Immigration law is famously backed up as well. Yes, you do.

QUINN: Right.

AMANPOUR: You have seven great law schools. But the immigration process, as we all know, especially those of us who come from abroad, how difficult

it is. But I want to ask you, just finally, on the 2024 politics.

So, I alluded at the beginning, this appears to be a whole set of layers of Democrat on Democrat regarding this, eventually sort of really trying to

have the buck stop at the White House. Republicans are starting to use Mayor Adams' own words against him and against Democrats themselves. And,

you know, the idea of crime waves and this and that. How damaging, you know, Christine Quinn, do you think this is?

QUINN: You know, look, I don't think the mayor meant what he said, because he and his staff have been trying. I'd argue they haven't gotten it right

all the time, but they have been trying. I think, at some point, the mayor will go out and walk that back and it will go away. I think the question

that will be big in the 2024 election is, what did the president do? Did he help cities and localities enough? They need to get that right.

AMANPOUR: Got it. Well, that's laying down the gauntlet, if I ever heard it. Christine Quinn, Senator Jessica Ramos, thank you very much, indeed,

for discussing this really important topic.

QUINN: Thank you.


AMANPOUR: Now, another one, of course, is COVID, which is on the rise again in many countries. And here in the United States, the CDC is

recommending that if you are older than six months, get an updated COVID vaccine. The U.K. is bringing its vaccine drive forward as health agencies

around the world monitor a new variant.

My next guest is looking at lessons learned from past pandemics and the science that saves us. Historian Simon Schama's latest book is "Foreign

Bodies: Pandemics, Vaccines and the Health of Nations." So, we welcome you, Simon Schama, back to the program.

First glance, pandemics is not necessarily what I would associate with you and your grand explorations of history. But maybe, absolutely, we need to

learn these lessons from history. What's the most important one you would say to start off?

SIMON SCHAMA, AUTHOR "FOREIGN BODIES": Trust science. Don't trust it absolutely uncritically. But it was very shocking to me, actually, I think

last week or maybe it was this week, to hear the surgeon general of Florida, appointed by the governor of Florida, Ron DeSantis, who's making

skepticism about containing the possibility of rising COVID at the heart of his campaign and criticizing what was done during the first stages of COVID


The surgeon general of Florida said, do not take this new vaccine, especially if you're a young man. This is on the basis of extremely dubious

data associating the possibility of myocarditis, a kind of inflation of heart muscles among young males.

And, Christiane, this is, to me -- since you asked the most important thing, this is sort of part of a general attack on the authority of

knowledge. A lot of the people I talk about in the book, it goes way back to the 1700s when we had no understanding -- we didn't really know about

what an immune system was. And it was, of course, counterintuitive to actually take a bit of toxic material, in this case, small pox pus, and

stick in it your body because you thought that would actually bring on a mild case of small pox and protect you from actually dying or being

horribly disfigured about it.

But people in the 1700s, a little on, including the philosopher, Voltaire, who was the first person to write about inoculation as an effective

mitigation of the severity of disease, they all felt the following, that once the empire of knowledge spread its benevolent -- you know, its

benevolent web of understanding, then, really, once people actually read a little of the science they could understand, they would accept that there

just was a benevolent, not a dangerous thing. And we get rid of conspiracy theories.

But what in so many parts of contemporary life of experiences, on the one hand, humans are capable of the utmost ingenuity, producing vaccines at a

record rate, including the monovalent new vaccine for the variants of XPB, the decedents of Omicron.

At the same time, rebundle (ph) of crazy paranoias. You know, our antenna are out there thinking, OK, it's a sort of conspiracy to rob of us of our

liberty. God and God only should be the arbiter of who shall live and who shall die. And, you know, if your -- basically common sense, common sense

will tell you what to do rather than hard-earned scientific knowledge.

AMANPOUR: So, going back to that -- you know, that central point and the small pox one, for instance. We have a fabulous picture of the very first

illustration of the very first, you know, small pox injection. You graphically describe it as people having to accept some -- I don't know

what you called it, small pox pus being injected into their bodies.

So, this is scary stuff, particularly way back when. And then we went on to polio and Jonas Salk and all of that. And you had important people

modelling. How much relative -- and let's face it, you know, relative to the knowledge then and the knowledge now, were people, you know, swept up

in the fear and conspiracies about vaccines then compared to now?

SCHAMA: Well, they were. And it's understandable. What was really -- you know, it was an extraordinary. It felt like why would you take something

which you knew to be toxic and put it in the healthy body, particularly of your children? That the great pioneer of small pox inoculation, 100 years

before (INAUDIBLE), was a woman called Mary Wortley Montagu. She was the wife of the British ambassador and Constantinople. And she inoculated her

six-year-old son, Edward, in Turkey. And then, when she got back to England, the inoculation to her three-year-old daughter, both very, very



She had barely survived an attack of small pox herself. But it was instantly said, what kind of mother is it that would actually take a bit of

poison and actually stick it in the body of their children? She was doing the right thing. What is astonishing and really resonates now, it's all to

do with persuasion. She was a literary celebrity. She knew the princess of Wales who became Queen Caroline to King George II.

She -- and women are very, very important part of this. She kind of stormed into a public promotion campaign for inoculation. That happened with color

in the 19th century and with the return of bubonic plague in the late 19th century as well. It is all about the arts of persuasion and assurance.

AMANPOUR: So, I wanted to ask you, because you talked about cholera and in India, particularly. The BBC did a documentary about a certainly person who

you profiled, calling him the vaccine pioneer the world forgot. A Jewish man from Odessa who worked against cholera.


AMANPOUR: And for his trouble, viceroy apparently said he should be hanged, which he was.

SCHAMA: Right.

AMANPOUR: Tell us about that.

SCHAMA: Yes. He was an astonishing man called Waldemar Haffkine. He came from Ukraine. He grew up in Odessa. He went to the only university Jews

could in 1881. He was the first person -- he's is part of a group of students to arm the Jewish community against the programs occurred in 1881.

He was thrown into the slammer three times for being caught with a gun.

The person who got him out of the slammer was his science adviser, the father of immunology, Elie Metchnikoff. He goes to the early institute --

Pasteur Institute in Paris. And there, he does what had thought to be impossible. He creates a vaccine against cholera. But he knew that the

place actually to carry out randomized clinical trials would have to be somewhere where cholera is very dangerous. So, he goes to India.

And the extraordinary thing is he runs into fierce opposition from the powers that be, and also, from the medical profession in India, the

imperial British medical profession, who did not want to know about new microbiology at all. Haffkine did not have a medical degree. Had a

scientific degree. But the astounding thing is that very much on his own (INAUDIBLE), with a little help and the little money, and the extraordinary

allies in Mumbai, what was then Bombay, and the Jewish community and the Ismaili, he undertakes these odysseys (ph) of vaccination throughout the

country. And traveling hundreds and thousands of miles among very, very poor people.

So, he's an astonishing kind of evangelist for the proven efficacy of vaccine. And he cultivates religious leaders in order that they may

persuade those who are understandably fearful or suspicious. It's when there's a kind of contamination scandal and 19 people die of a contaminated

package, a contaminated batch in the Punjab in 1902, he instantly gets the blame for it. Although, it had happened in the village, not at his -- the

first mass production facility for vaccines in the world.

But that's the point. When the Jew, the Ukrainian Jew, the vaccination becomes an embarrassment to the British empire. And the viceroy says, well,

Haffkine has brought discredit on the whole empire, he ought to be tried and hanged for this abomination. It's sort of a medical Dreyfus (ph),


AMANPOUR: But he wasn't. Was he?

SCHAMA: He's eventually vindicated --


SCHAMA: -- after five years. But his career and his life is really broken by this tragedy.

AMANPOUR: You know, as you say that, I just -- I'm fast forwarding so many, you know, generations and decades and centuries, to actually Dr.

Fauci --


AMANPOUR: -- who was practically -- not broken, but they attempted to, the Trump administration, break his reputation and his unbelievable, you know,

saving of people with the advice and with his vaccine, you know, status really.

SCHAMA: Yes. The hunt for scapegoats, the suspicion that actually, you know, there is some skullduggery involved in vaccination campaigns is a

constant -- depressing constant of what happens when we're faced with pandemics. And it is an extraordinary depressing fact to me that actually

real political traction can be gained, actually, by demonizing people who - - at a time when everybody is sort of out for their promotion or their own self-interest, who genuinely have acted disinterestedly and neutrally and,

you know, spent decades of their career trying to prevent catastrophic deaths suddenly are in the firing line and finding themselves accused of

being some sort of villain. Some sort of conspirator to rob people of their individual liberty, autonomy over their own bodies.


You heard that on, you know, not just in the crazier wild, wild shores of social media but on, dare I say it, cable news. Not this one. Of course.

But on other cable news stations. The sense in which you could actually -- you know, you can actually make a reputation by, first of all, flogging

Ivermectin and hydroxychloroquine, which were shown to have no effect therapeutically or prophylactically against COVID-19 and then find someone

sort of hunt down, really, and turn into some sort of social villain is one of the most distressing things that's happened in public life in the many

years, I believe.

AMANPOUR: Well, Simon Schama, it's starting again.

SCHAMA: It is. It is.

AMANPOUR: I mean, the 2024 campaign, already you have Donald Trump talking about the -- I think -- what did he call them, the radical Democrats trying

to raise the COVID hysteria. You've got the governor of Florida, Ron DeSantis, who apparently has failed on the culture wars is now touting his

own, what he calls, brilliant COVID strategy.

Here's a soundbite. And you mentioned, of course, you know, the Florida surgeon general saying, don't take them. Well, here's what the governor is



GOV. RON DESANTIS (R-FL), REPUBLICAN PRESIDENTIAL CANDIDATE: That was what we did in Florida, cutting against the grain of the elites, it was cutting

against what a lot of "experts" were saying, the bureaucrats, the White -- both White Houses of the last two administrations, the media, and we stood

for people's children and businesses and ability to earn a living, the ability to decline taking a COVID vacs if you don't want to do that. And

so, all these things were very, very important.


AMANPOUR: So, you know, you're a political scientist as well. How do you think that's going to play?

SCHAMA: I will tell you, Christiane, never was applause less well earned than that one we just heard. It's doubly disingenuous. First of all, Ron

DeSantis was quite rightly, good for him, a champion of vaccines before he suddenly changed his mind. Secondly, the most disingenuous thing is that,

as he started to not only cool, but become hostile to booster vaccination and hostile to masks and vaccination mandates, so Florida suffered

measurably from excess mortality compared to states that did not take the same view.

So, for him to boast really about the fact that Florida did so well, particularly its economic record, which was, you know, it didn't do badly,

but it didn't do well either, is just really shocking because he is essentially playing with matters of life and death. And you want to say to

him what was said to Senator McCarthy, have you no decency?

AMANPOUR: Since I have you here, and we've talked in the past about strong man, authoritarianism, et cetera, which actually played into the anti-vacs

conspiracies over the last couple years, whether it was in Brazil, in Russia, in North Korea and elsewhere. Comment on the images of the day,

which everybody are talking about, Kim Jong Un and Vladimir Putin.

It doesn't appear that there's any major military deal, you know, sealed. But, of course, remember, the Putin vaccination wasn't terribly successful,

the Sinovac or rather the Sputnik. And even Kim Jong Un didn't have a vaccination strategy.

SCHAMA: Right.

AMANPOUR: Comments?

SCHAMA: Well, you know, I mean, the distressing thing about that actually is the way, you know, vaccine gaming competition. I mean, that's what it --

facetiously and trivially, Christiane. But really, one would have really hoped actually that the procurement and the testing and trials of vaccines

would have been something that would have happened under the WHO.

I know this is to be naive about it, really. Everybody understandably wants to secure the health of their own populations first. But issues like

vaccine and also, the still extremely contentious debate over the origins of COVID then became part of international power games.

And I don't know. I think we either think we're all on life boat earth together and when the next round of something extremely serious happens, we

have to, at least --


SCHAMA: -- you know, look on cooperation rather than zero-sum game competition --



SCHAMA: -- as part of our collective safety.

AMANPOUR: Really good point to end on. Because, as you say, there wasn't a collective reach out to the rest of the world. Certainly, to Africa and

elsewhere, and that will be definitely under the microscope if there's another one. Simon Schama, thank you so much, indeed.

SCHAMA: Thank you.

AMANPOUR: Now, so many people learned during COVID providing care for someone at the end-of-life is a difficult and demanding task. The countless

options and decisions that need to be made while navigating the emotions of losing a loved one.

Now, an unlikely candidate is breaking some of the misconceptions around hospice care. Earlier this year, the former U.S. president, Jimmy Carter,

announced he would enter hospice care. And while many took that to mean he was on the verge of death, he is now just weeks away from celebrating his

99th birthday. So, congratulation to him.

And Dr. Daniela Lamas is a critical care physician and says hospice does not automatically mean death. She joins Michel Martin to explore what she

calls President Carter's final gift.


MICHEL MARTIN, CONTRIBUTOR: Thanks, Christiane. Dr. Daniela Lamas, thank you so much for talking with us.



MARTIN: You recently published a piece in "The New York Times" titled "A Fitting Final Gift From Jimmy Carter." And you talk about the former

president's decision not just to enter hospice care, but to talk about the fact that he had entered hospice care. What made this important to you to

write about?

DR. LAMAS: Well, as a critical care doctor, I mean, I work in the intensive care unit, I see patients often or not infrequently at the ends

of their lives or facing the ends of their lives and in the intensive care unit for whatever reason.

And often, that's entirely an appropriate choice. But at the same time, the questions of hospice often come up. And there is a real hesitation, fear,

to discuss this. Particularly for people who are not, you know, in the final days of life.

And so, the fact that Jimmy Carter was very public with his decision to enter hospice when there were months of his life to go, whether or not he

knew it at that time, he wasn't in the final days of life, I felt like that was a very kind of important and powerful model to give to an American


MARTIN: For people who are not familiar with the term or the practice or what it is, what is hospice?

DR. LAMAS: Yes. So, hospice is -- I mean, ultimately, it's a benefit. It's an insurance benefit that people get, which means that if a doctor

determined that they're within, the best that we can tell, last six months of life, they can receive care that is targeted to their comfort rather

than life prolonging measures.

Meaning, often, that people don't return to the hospital or to the emergency department in those last months of life. They are cared for

either at their home or at a hospice facility. So, it's really care that is targeted toward comfort rather than life extension for people who are in

the last six months of their life.

MARTIN: You point out in your piece that half of patients in hospice are enrolled for only 18 days or less. That a tenth are in hospice for only one

or two days before they die. So, what's your take on that? Is that that people don't know about it or you think that maybe people are afraid of it

or they think that it means you really are in last couple of days?

DR. LAMAS: Yes. I think probably the latter. I'm sure that there are some people who don't know about it. But I think in the past decade or so, the

sort of prominence of hospice and palliative care as a discipline has become more prevalent in terms of discussion. But I think at the same time,

there's a real fear and challenge with acknowledging that somebody is there. That your loved one is there. And as a result, hesitation to

acknowledge it until it is impossible to ignore until somebody is really in the last couple days, couple of weeks of life.

And I think that -- you know, I'm saying that in a way that suggests that that comes just from the patient or family member, but that's not fair or

true, that's also coming from us, from doctors, from their caregivers who have very similar human reactions to say, no, no, no, there's something

more I can do. There's something more I can do, instead of really opening up this other avenue of care.

MARTIN: That's interesting. Are you saying that doctors as patient are reluctant to embrace hospice care or are you saying that doctors don't

necessarily introduce the idea to their patients, you know, as an option?


DR. LAMAS: The latter, that doctors don't necessarily introduce that idea to their patients, which I think makes sense. I think it is hard for us as

doctors to -- who are, you know, trained with the idea of sort of avoiding death, of prolonging life, to acknowledge, to say, we are there, there's

nothing more that we can't or perhaps should do to the intent only to prolong life. Now, it's time for us to talk about maximizing quality of

life and to talk about something like hospice, and that's hard to do. That's hard for doctors who have known their patient as long time

particularly to do.

MARTIN: So, why do you think it's so important that Former President Carter not only availed himself of these services but made a point of

talking about it? Because we well know that, you know, people have a right to some sort of medical privacy, especially when they're no longer in

office. He didn't have to tell people, you know, what he was doing and where he was, but he chose to. Why do you think it's so important that he


DR. LAMAS: Yes. I mean, exactly to your point, he didn't have to and yet, he did. And I think he offered a model of a way to face the end of one's

life that doesn't feel like defeat, that doesn't feel like giving up.

There was the announcement that he was announcing hospice care and then, there are articles about how he was spending time with his family, you

know, details like eating ice cream, these sorts of things, that, you know, suggested that it's not that hospice correlates directly with death, it's

that this is a way to meet the final months of one of life.

We don't even know how long it will be, really, on one's own terms. And for him to say that, for him to acknowledge, this is the way that I am choosing

to end, I think is a powerful model to say, this is the way one can do it. This is the way you can do it and it can still be graceful, it can still be


MARTIN: I have to say that, you know, as we are speaking now, it's been about six months, and I think that --


MARTIN: -- that's kind of its own message in a way. People who have seen him say that he's in a very joyful, peaceful state of mind. That he is, in

fact, enjoying the time, you know, with his family. So, can you just talk a little bit more about, like, what are some of the kinds of things that take

place when one is in hospice care?

DR. LAMAS: Yes. So, just to kind of make a differentiation, some people can be in hospice at home and others, because of their own personal

preferences, because of their needs, because there isn't a setup at home to make this possible, which we can talk about, choose to be in hospice, in a

hospice home or a facility. And both of those are the right choice for people based on their circumstances.

At home, one is at home. There are hospice providers who come a certain amount of times a week, sort of shifts based on your need. And you exist.

You live your life. You can still be treated for an infection with antibiotics, it doesn't mean that all care that is intended to avoid

infections or sickness, that all care stops. But if you're in pain, ideally, you don't go to an emergency room. Ideally, there actually are

medicines at home that you can receive or medicines at hospice facility that you can receive.

There are -- you know, there are issues surrounding, you know, what counts as life prolonging that's not allowed in hospice and what might actually be

tailored to people's comfort. There's, you know, debates about whether or not people on hospice should be able to continue to undergo dialysis, for

instance. So, there's some complexities there. But the sort of big picture is that people can continue to do the things that are important to them and

live their life while being aware that what they're trying to do is maximize the quality of their time that is remaining rather than maximizing


MARTIN: Is there anything you could point to to demonstrate that hospice care can be an effective way to address this time in one's life?

DR. LAMAS: Sure. I mean, you know, studies sort of looking at patients who have enrolled in hospice, you know, people have -- that are pain control,

you know, there are people who are -- even after having conversations about how to sort of have their care, at the end of their life, conversations

about realistic prognosis. People are less anxious, less depressed sometimes.

You know, being able to really -- I think for a lot of people, uncertainty is the worst thing. And so, being able to say, OK, I'm looking ahead. This

is a decision I have made. This is where we're at, is kind of -- even if that decision is terrifying, that allows people to take back power and to

determine, you know, what this period of time looks like. And that in and of itself, I think, has sort of great psychological and ultimately, pain

relief in the setting of hospice benefits.

MARTIN: Kind of reaction have you gotten to your piece?


DR. LAMAS: I would say the reaction has been, you know, mostly positive to say, yes, you know, that this was a powerful message, that Former President

Carter chose to make by sort of announcing this.

But also, you know, sort of reading through the comments on "The Times" website and in conversation, I think something that came up a lot is, yes,

he has been able to be -- and for all we know, will continue to be in hospice in his home. But for a lot of people, that's not possible. The

hospice benefit itself doesn't guarantee 24/7 care giving. That really does fall on family members, who, if you look at sort of the stats of who cares

for people who end up in home hospice, are predominantly women and sort of the demographics of caregiving that one would expect. And not everybody has

that. That's not possible for everybody's family. People sometimes need to work and aren't going to be able to be home and taking care of somebody's.

And so, a lot of these comments were yes, when this is possible, this can be beautiful for people and a meaningful and important way to be able to

meet the final months of one's life, but it's not possible for everybody.

MARTIN: In response to your piece, one reader wrote, the idealized fantasy of at-home hospice care is just that, a fantasy. My husband's death was

traumatic for the whole family. Based on my experience, I urge families faced with the heart-wrenching decisions around end-of-life care to

consider the family's needs and the patient's leads, not the false advertising of a hospice agencies or naive recommendations of doctors who

don't live with the consequences.

And clearly, this was a painful experience for the person who wrote this. What's your response to that?

DR. LAMAS: My response is that we need to do better. You know, I think and I say this in the intensive care unit where we see families whose loved one

was on hospice, pain became excruciating. The family became scared because they're not trained physicians or nurses. And they call 911. And then, end

up back in an intensive care unit. And that happens. That happens too commonly.

And that's a failure not of the family, to be sure, not of the patient, but of the hospice system where -- and of this -- exactly as that letter said,

this is sort of gauzy (ph) fantasy that we give people where we say, people want to die at home, if that's -- you know, if you love -- your loved one,

that's what's going to happen. But then, we don't have a healthcare system that is set up to offer that in a way that doesn't rely on family


It works when it works. When there are enough people there who feel comfortable enough with things like giving morphine. You know, in certain

families and circumstances, it does work. But it doesn't work for everyone. And we -- if we pretend that it does, we definitely do people a disservice

in the hospital. And that's -- I mean, I think, you know, that letter, I -- my heart breaks for that person because that is not the end that anybody

would want or want for the person that they loved.

MARTIN: And I also wonder how you would address, you know, the equity issues. I mean, part of the suspicion around, you know, the healthcare

system speaks to the fact that some people have been and remain very badly treated by the healthcare system in this country, that they are made to

feel that they don't matter, that their lives are not as important. And I just wonder how you deal with that, because that is so fundamental to

people's question about, are you doing enough for my loved one? And is it because of who they are as opposed to because they're human being? You know

what I mean? How do you -- how would you fix that?

DR. LAMAS: Yes. I mean -- so, I think there's sort of systematic or systemic ways to fix that and then also just doctor/patient ways. And I

think, you know, it boils down to trust and how do you get somebody to trust you. You have to earn that trust.

And so, you know, I think our system has to be better at making sure that we sort of meet people where they are and actually give them the care that

they want and need. You know, working in the hospital, I should say, we err on the side of doing more, far more than we err on the side of doing less.

The ways that we harm people are, I would say, almost always offering that final line of chemotherapy, offering that final stay in the intensive care

unit. We are very hesitant to pull back.


And if you look at how that boils down, you know, black patients and patients and minoritized groups, they are less like to receive palliative

care, perhaps that is because they're less likely to sort of trust those recommendations, but also, we're likely less likely to offer it.

I think that, you know, that sort of the opposite side, where that too is an inequitable. And I think if you look at who is able to do hospice at

home who has family members who can take time out of work to be there, you know, you see equity issues with that as well, and sort of the system and

Medicare of reimbursement has to be better at that.

MARTIN: I know you didn't write about this in your piece, but it does make me wonder whether our kind of media images of what great care looks like

is, in part, too irresponsible for our kind of mindset. And I do wonder whether it's because, you know, we've seen all these TV shows where people

rush in and they're pounding on the people and people are yelling and sweating. And so, people have it in their minds that that's what good care

looks like, there's a lot of activity and motion and yelling and machines.

And I think I hear what you're saying, as a hospital-based physician, that no, that that's actually brutal, and that perhaps there are other things.

You know, I just wonder if maybe it's a mindset shift?

DR. LAMAS: I think it is entirely. I think -- you know, I think our -- you know, if you look at the outcomes of cardiac arrests on medical television

shows, they are far superior to the outcomes in real-life, right?

MARTIN: And you would know. Do I have this right, that you would know because you've actually written for some medical TV shows, presumable

hoping to try to get more reality to it, I hope?

DR. LAMAS: Entirely. Yes, yes. That was the hope. So, yes. Entirely. You know, and if you look at what images the media gives though, they are

inaccurate. I think the images of, you know, peacefully floating away in one's slumber at home are also not always true. Even in home hospice, you

know, death can be hard and it can messy.

And if somebody -- if a family is not prepared for that, that's not -- if that's not something that people can -- are willing to sort of sit with and

are able to carry with them without real trauma, you know, then that option is not actually right for everyone. And, you know, just because this was

Jimmy Carter's choice, and I think it was an important thing to publicize, it also doesn't mean that everyone has the family structure and the life

that would allow this.

For some, it would never be right. And for some, it's not right because our healthcare system doesn't offer appropriate reimbursements.

MARTIN: So, before we let you go, Dr. Lamas, what do you think would make this better?

DR. LAMAS: You know, I think on many levels, there are different ways to make this better. I think, you know, up from downstream, I do think that

having conversations with patients about realistic prognostication and about what is important to them in the setting of those realities.

You know, there are things that are important to people more than living as long as possible. And sort of understanding those and understanding the way

those change overtime and really targeting our care to get to what's important to the individual is essential. And we can do better at that.

I also think on a broader level, if we're looking at, you know, Jimmy Carter's, what we assume his death will be at home, and that's something

that should be achievable to others, I do think that Medicare reimbursements for in-home care giving at the end-of-life have to be

better. And to make that possible to people, particularly as we are at the same time selling a notion to people that a death at home is something that

they should want and should be able to achieve.

And so, I think we can do better both downstream and sort of at those final months of life.

MARTIN: Dr. Daniela Lamas, thank you so much for talking with us.

DR. LAMAS: Thank you for the time. I really appreciate it.


AMANPOUR: And real food for thought there. That's it for now. Tune in tomorrow for my interview with Walter Isaacson, our colleague, on his new

biography of Elon Musk. We discuss Musk's controversial personality and business practices, the extent of his power, his savior complex and more.

Here's an excerpt.


AMANPOUR: Kara Swisher, of course, renowned tech journalist, interviewed you in March about this. And she wrote on Twitter, X, whatever that means,

the review of the biography. She says, my mini review of the Musk bio, sad and smart son slowly morphs into mentally abusive father he abhors except

with rockets, cars and more money. Often right, sometimes wrong, petty jerk always. Might be crazy in a good way but also a bad way. Pile o' babies.

Not Steve Jobs. You're welcome.

Your response? Accurate.

WALTER ISAACSON, CNN HOST AND AUTHOR, "ELON MUSK": Yes. Yes. I think almost all those things are accurate. You know, when I first started this

book, Elon Musk's mother, Maye, says to me, the danger for Elon is that he becomes his father. And indeed, he had this psychologically rough father

who would make Elon stand in front of him as he berated him for more than an hour, would go from light to dark moods. Well, that happens too with

Elon Musk, and that's sometimes the way he treats people. You know, he gets stuff done, but that doesn't excuse the behavior sometimes.



AMANPOUR: The complicated Elon Musk tomorrow. Thank you for watching and goodbye from New York.