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Council’s Strategic Plan Misses The Mark

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Opinion Editorial submitted by Chad Krahn

It took a full year, but we finally have a glimpse into where Mayor and Council want to take Red Deer. This week they released their Strategic Plan … and it’s underwhelming. The plan is heavy on buzzwords and light on a concrete vision of where Council wants the city to be in four years.

Let’s start with the “vision” statement Innovative Thinking, Strategic Results, Vibrant Community. These six words do not tell us anything about where Council wants to take the city or anything specific Council would like to achieve in four years. Where is the inspiring vision with big goals to propel our city toward
greatness and make us proud to be Red Deerians?

There is also a complete lack of anything specific to Red Deer; this document could easily be the strategic plan for Medicine Hat or Lacombe. Every community should want to thrive and be healthy and connected, but what will Council’s focus be to ensure Red Deer grows into the great city we know it can be?

The focus areas of A Thriving City, Community Health and Well-being and An Engaged and Connected City are all wonderful, but they are tough to measure.

Many of the goals that Council hopes to achieve are minimalist and are not stretching the capabilities or the imagination of Red Deerians. Council wants to have a “vibrant downtown” and a “strong, respectful, and collaborative relationships” with citizens. That’s nice, but the indicators are so weak that one more event downtown and the goal was achieved. If the population grows by one person, another goal is achieved. Many of the indicators focus on the feelings of Red Deerians, which are virtually impossible to measure. Data-driven results are a great goal, but how does Council expect to get data on our collective feelings? Without numbers and benchmarks, this becomes a plan that is impossible to fail but also exceedingly difficult to make progress toward any difficult goal.

One of the top issues for Red Deer is crime. This does get mentioned in a roundabout way under Community Health and Wellbeing as a Safe and Secure City. It also comes with some indicators:

 feeling of safety
 number of calls for service (urban encampments)
 Reported crime statistics are within guidelines specified in the Annual Policing Plan

This seems passive for a huge issue. Feelings of safety are essential, but they are, by nature, hard to measure. My feelings of safety have a lot to do with how recently my garage was broken into. They also want to measure the number of calls for service, particularly around rough sleeper camps. Why not just measure the number of rough sleeper camps? Rather than specifying that crime statistics are within guidelines, where is the commitment to make sure our crime rate drops so Red Deer doesn’t appear on Canada’s most dangerous cities? What about committing to innovative ideas for our police officers to help get the crime rate down? Or even efforts to increase the number of RCMP members in the city. The Mayor has spoken several times about how community safety is a top priority, so one would have expected it to feature more prominently in the Strategic Plan.

The economy is another top issue in Red Deer, which is mentioned under Local Economy is Strong and Diverse. And there are some indicators:

 Net gain of businesses in Red Deer
 Business developer and local contractor satisfaction

Neither of these indicators speaks to the diversity of the economy. While a net gain is better than a net loss, it hardly represents an aspirational goal. Would council be satisfied if there was only a single more business in the city after four years? Where is a percent growth benchmark that the plan is striving to achieve? Where is the commitment to being a regional economic driver? What happened to Mayor Johnston’s push for hydrogen service hub development in Red Deer? Would that not be something that belongs in a Strategic Plan?

Red Deer’s biggest challenge is that it is a city that thinks like a small town. We are on the cusp of having the best of both worlds – a great community with a small-town feel. But I fear we won’t get there without a clear and distinct vision that will propel our city toward greatness. We can be so much more.

Chad Krahn is a former candidate for Red Deer City Council.

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Addictions

Alberta and opioids III: You can’t always just stop

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Monty Ghosh at Highlevel Diner, May 30.                                                                            Photo: Paul Wells

This is the concluding installment in a series on drugs in Alberta. Previously:

i. “Worse Than I’ve Ever Seen,” June 4

ii. “Alberta’s System Builder,” June 7


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A matter of expectations

Street family

My tour guide for much of my visit to Edmonton was Dr. Monty Ghosh, a clinician who’s on faculty at the University of Calgary and the University of Edmonton. He seems to talk to everybody who works with substance users in Alberta, from his own patients to front-line clinicians to the Alberta government. His relations with the latter go up and down, but he urged me to talk to Marshall Smith, the chief of staff to premier Danielle Smith.

On my first night in Edmonton Ghosh walked me around a neighbourhood that included the George Spady Society  supervised-consumption site, the Hope Mission’s Herb Jamieson Centre, and the Royal Alexandra Hospital, which has a supervised-consumption service on its premises.

A lot of people use the services these places provide. Other people don’t. Shelters in particular are tricky: they’re usually for single people who arrive alone. “The Hope, the Herb, the Navigation Centre, offering the world,” one Edmonton Police Service officer told me. “But all these places have one thing in common: rules.” If you have a spouse or a pet, you want to keep your drug supply or you want to stay close to your “street family” — the community spirit in neighbourhoods like this is striking, and might be surprising to people who prefer to stay away — a shelter’s probably not for you.

Several of the places we visited weren’t ready to welcome us when we showed up unannounced. To say the least, they’re busy. That was the case at Radius Community Health and Healing, an institutional building in a more residential part of the neighbourhood. Radius is a drop-in clinic and, as we’ll see, quite a bit more.

On a sunny weekday afternoon, more than a dozen people stood, sat or lay on the building’s front steps and truncated lawn. One lay on his back, shirtless, not moving visibly. Ghosh asked the man whether he was all right, asked again, finally nudged him. The man stirred, looked around. Ghosh apologized mildly for bothering him, then checked in on two other people who also weren’t moving. They turned out to be all right too.

Francesco Mosaico, Radius’s medical director, was on his way home for the day when we arrived, but we made plans to talk the next day. When I returned, I met Mosaico and Radius’s executive director, Tricia Smith, in her office.

I think it’s important to hear them out, because when drug use becomes the object of political debate, it’s natural to talk as though policy decisions are the main thing keeping people from getting well. This can lead to a lot of blame on one hand, and to excessive optimism on the other. In fact the biggest thing that keeps people from getting well is often the entire sum of their lives until now, compounded by the influence of drugs that are more potent than anything earlier generations had to deal with.


The most complex patients

Radius offers primary care to people “experiencing multiple barriers,” Smith said. That can include homelessness, addiction, severe mental health problems, criminal records. The centre’s team includes 12 family physicians and three psychiatrists. They currently see about 3,000 patients.

Radius has Western Canada’s only non-profit dental clinic. The centre runs a respite program for people who are not sick enough to be in acute care but are too sick to be managing independently on their own. It has a program for pregnant women experiencing homelessness. It runs on a harm-reduction model, so they don’t need to be drug-free to go into the program. It has an interdisciplinary Assertive Community Treatment team to help people with mental-health and substance problems find and stay in market apartments, with frequent assistance. There’s a supervised consumption site in the basement.

“In fact,” Smith said, “we actually have an exemption from the College of Physicians and Surgeons of Alberta to filter out and keep the most complex patients. The least complex, we refer elsewhere.” I couldn’t get care in Radius if I tried; they’d politely refer me elsewhere. They’re for the people who need the most help.

After my visit, Smith wrote to me to add another program to the list: Kindred House, which for more than 25 yearss has supported women and Trans women sex workers. “The women we see are from age 18 to 50, predominantly Indigenous, have intergenerational trauma, past/current trauma, substance use issues, often houseless or couch surfing,” Smith wrote.

Smith has been at Radius for three and a half years. While I was there, I asked her how work at Radius is going. “It’s going fabulously, honestly,” she said. She arrived early in the COVID pandemic, after eight years in Alberta government departments — which in turn followed 20 years as a Canadian Forces army nurse, including in combat zones. “I’m in the right place,” she said of Radius. “It felt like coming home.”

How come? “The staff, the team, the work, the dedication. It just feels like family. I missed that. Being in the military was a big thing. This work that this group does is just really amazing. The team is amazing and it’s hard, but it’s good work.”

And how’s the workload evolving? “Unfortunately, for this population, the struggles are only increasing, and the number of individuals that are experiencing those challenges is not getting less,” she said. “The workload isn’t going anywhere. It’s getting more difficult.”

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“Especially in the last couple years, I don’t think things have ever been worse for the vulnerable population,” Mosaico, Radius’s medical director, added. The same housing crunch that has made homes less affordable for everyone has put thousands of the most vulnerable on the street. Results: more frequent frostbite or burns from lamps lit to keep from freezing. Body lice. Trauma from watching friends die. And to Mosaico’s astonishment, frequent shigella outbreaks.

“Shigella’s a bacteria that causes torrential bloody diarrhea. It can be treated with a single dose of antibiotics. But if you’re homeless and you don’t have a place to take care of yourself… 70 percent of the cases have had to be hospitalized in the last two years…. I mean, they’re talking about potentially calling it an endemic disease, and it’s a disease of destitution. You see it in refugee camps in developing countries, not in the capital of Alberta, you know?”

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Ten thousand times deadlier

Radius also works closely with the Alberta government to integrate its services with the “recovery-oriented system of care” that I told you about last week. There are two Radius staffers working at the Integrated Care Centre the police set up to replace the old, passive holding cells for overnight detention. There are two more at the Navigation Centre, which steers people toward social and government services. If there’s an Alberta model, they’re part of it. So I was fascinated by the response when I asked my hosts the basic question that sent me to Alberta: Why are so many people dying?

“I think it’s the nature of the drugs,” Mosaico said. “You know, people used to overdose and die. But I’ve been here 17 years. I think in the first 10 or 11 years it wasn’t very common to hear about overdoses by opioids. Every once in a while you’d hear about it, but it wasn’t a daily thing. Whereas now with fentanyl and carfentanil, it’s really dangerous.”

Carfentanil is 10,000 times more potent than morphine, 100 times more than fentanyl. The Edmonton Police won’t return stolen cars they recover until they’ve scrubbed them thoroughly, because even trace amounts of these drugs are too dangerous. “We’re finding clients who use methamphetamines and swear up and down they’re not taking opioids,” Mosaico said. “And then we do urine tests and it’s there. We think their dealers are lacing methamphetamine with fentanyl because it increases the addiction.”

The other big thing on his mind, Mosaico said, is that any program to guide users into recovery will bump up against the fact that different people have often lived starkly different lives.


93% 4+

“I don’t know if you’re familiar with Adverse Childhood Experiences — the ACEs study,” Mosaico said. I was, barely, but I needed a refresher.

The original study began in 1985 in San Diego, under Vincent Felitti, who ran an obesity clinic, and Rob Anda from the Centres for Disease Control. (If you want to learn more about the study, this article and this speech on Youtube are good places to start.)

“They surveyed 17,000 people,” Mosaico said. “They found, you know, if people had developmental trauma — so, trauma between the ages of 0 and 18 — and there are 10 different forms of trauma that the study bore out as being detrimental. Things like physical, emotional, sexual abuse; physical, emotional neglect; substance use in the family; untreated mental illness in the family; separation from biological parents; maternal figure being treated violently; and a household member going to jail.

“If those things occurred, you would just tally up the number of types of trauma and you’d get a score out of 10. What they found was, if you scored four or greater, that there seem to be adverse health effects in adulthood. And it wasn’t just the presence of addictions or mental illness. It was lung disease, heart disease, liver disease, certain forms of cancer, diabetes, obesity.” This is almost folk wisdom today, but at the time, Felitti and Anda were amazed at the strength of the correlations between childhood trauma and adult physical and mental health.

The original test has been widely replicated, and it usually finds that the proportion of people in a sample who’ve had four or more adverse childhood experiences is about 12%. So something like every eighth person you meet had a really difficult childhood, and while you can’t predict for individuals from statistical trends, there’s a good chance they’re still living with the fallout.

The team at Radius surveyed a large sample of the population under their care. The prevalence of high-risk ACE scores was about 93 percent, compared to 12 in the general population,” Mosaico said.

“Harvard has a center on the developing child, which has pulled together a lot of the science that explains the neurobiological link between the adverse trauma and the adverse health effects. They talk about limitations in the development of executive function, of decision-making, emotional regulation. Impulse control is underdeveloped, neuroanatomically in the brain. And instead what over-develops is the fight-or-flight response.

“So you’re dealing with a population that, because of their experiences, isn’t the same as the general population . And then that’s compounded by the fact that a high percentage of those clients who have high ACE scores also have traumatic brain injuries from living rough on the street. They also have adult trauma that compounds the childhood trauma. They have [fetal alcohol spectrum disorder], which impairs executive function even further.

“I hear these success stories and I think they’re wonderful, when you hear about people who have a difficult life and then they straighten up. And then, you know, they go back to their jobs and their families and they become leaders in their communities. But this is a population which is over-represented in every aspect of society, negatively as it were. In the prisons and child family welfare services. In the health system, you know, prevalence of HIV, tuberculosis, Hepatitis C, STIs, all that.

“And you look at them and you think, even if they managed to wait, you know, six months to get into an addiction recovery bed, after waiting for weeks to get into detox and they go through the program, what do they go back to? Most of them had to drop out of school. They have criminal records, which makes it hard to get a job. They’re disconnected and estranged from their families. They haven’t learned social skills.

“I had a client who lived in dumpsters for two and a half years. The fact that he just stayed housed — on income support — for the rest of his life was a huge win, right? It was important for his dignity, his quality of life. It’s just a matter of adjusting your expectations of what might actually be realistic.”

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Dr. Larson writes

The idea for these stories goes back to February, when it first became clear to me that 2023 would be Alberta’s worst year for overdose fatalities. I asked the communications team at the University of Calgary for names of people to talk to. Many weeks went by, because sometimes it’s ridiculous how hard it is to extract myself from Ottawa routine. After I published the second article in this series, the one where Marshall Smith showed me all the stuff Alberta is building, I received an email from Dr. Bonnie R. Larson, who’s on faculty at the University of Calgary. She thought I should have talked to her, and she thought I was too credulous in reporting the Alberta government’s side. I asked if I could publish part of her email. Here it is.

What cannot be taken for granted is Mr. Smith’s view that his goals are different, somehow nobler, than those of us on the front line.  Smith paints a picture that front line providers’ priorities are at odds with his own.  His perspective is at once undemocratic, insulting, and arrogant, belittling those who are doing the hard work of keeping people alive every day.  

I will not have Smith speak for me in his suggestion that front liners lack system knowledge and that is why we support harm reduction. This ignores the excellent evidence supporting harm reduction interventions at the population level.  Smith seems to think he knows from whence I “enter this conversation”.  If so, why does he not engage me and my expert colleagues?  Where I “enter this conversation” is at 20 years of working with the affected community and 13 years of post-secondary education.  The only reason I am what Smith likes to dismiss as a “radical harm reduction activist”, is because the UCP, immediately upon taking office, set out to destroy harm reduction in Alberta.  Nobody would have ever needed to fight this soul-destroying battle in the first place if Smith hadn’t put Alberta squarely on its current path of destruction. Yes, we should hope for a better tomorrow but that doesn’t excuse ignoring the past and present.  

I would ask you to think about several additional factors that your analysis appears to ignore, including who actually benefits, in power and wealth, from Smiths’ system of so-called care?  DId you consider the other ways that the UCP policy direction is moving the entire publicly-funded system steadily towards profit?  Gunn (McCullough Centre) was a wonderful non-profit facility that helped many of my patients find their way to recovery from substance use disorders. While I agree that people should not have to pay for treatment, the question remains:  in whose pockets do those tax dollars ultimately land?

You report that Smith indicates that they are “monitoring” the entire system.  Where is the data from that monitoring?  They have had five years now to show some outcomes, but who am I, just a lowly street doctor, to ask for population data?  What I do know is that if deaths begin to decline, it is because so many are already gone.  You should ask to see the data about which Smith so proudly boasts.    

Smith’s entire premise that he is fixing the ‘addiction crisis’ is a fallacy.  Addictions are not increasing.  Deaths by drug poisonings are, however, and Smith’s circus is only making that worse.  Allow me to spell it out for you:  harm reduction addresses the drug poisoning crisis that is, no question, taking a horrific toll in Alberta and nationally.  Smith’s ROSC, in contrast, addresses a figmentary addictions crisis.    

One last tip. Medications used for opioid agonist treatment are not harm reduction, they are treatment.  Nobody here is against treatment or recovery.  But Marshall Smith is against harm reduction.  Why can’t we just have the full spectrum of care???  Polarization is created by politicians to benefit politicians.   

I don’t endorse everything Dr. Larson writes here. The data, or a lot of it, seems to me to be publicly available on the province’s impressive dashboard website. Use the tabs at the top of the page to navigate. And indeed, the story the dashboard tells is alarming, which, as I explained in this series’ first instalment, is why I flew west. But Larson’s years of front-line work has earned her, at the very least, a right of rebuttal.


Synthesis

On my last day in Edmonton, I met Monty Ghosh at Highlevel Diner, at the outer edge of the hip Strathcona neighbourhood on the south of the North Saskatchewan River. Highlevel is famous for its cinnamon buns, which, if I’m going to be honest, are noteworthy mostly for being large.

If the Alberta government and its most vociferous critics are thesis and antithesis, Ghosh tries to provide synthesis. He helped design the National Overdose Response Service, or NORS, which provides some of the emergency-response capability supervised consumption sites offer to people who aren’t near such a site or can’t use it for other reasons. He’s been critical of the Alberta government, but both sides keep lines of communication open.

I asked him about diverted safe supply — the idea that pharmaceutical opioids used in safe-supply programs in BC, principally hydromorphone tablets, are being sold or distributed away from their intended use. “I know it happens,” Ghosh said. “We sometimes get clients from British Columbia who come to Alberta to try to escape BC, because they’re looking for a fresh start. They’re looking for support and they’ll tell me themselves that they’ve diverted their safe supply.”

But what are the quantities? Trivial so far, Ghosh maintains. “Have I seen hydromorphone come into our province? Not at all, not yet.” This is the same thing I heard from Warren Driechel, the Edmonton deputy police chief.

Why do people divert their prescribed safe supply anyway? The answer Ghosh gave me was the answer I heard from everyone I asked. “They never used it. It just was not effective. The potency of the hydromorphone that they’re getting was nowhere near touching the fentanyl that they were using. It wasn’t dealing with the cravings, it wasn’t dealing with withdrawals, they felt it was useless. So what did they do? They sold it. They’re incredibly poor, they cannot afford their substance-use concerns and so therefore they supplement with revenue from hydromorphone.”

Before I flew to Edmonton, when Ghosh and I were trying to gauge on the phone what each of us thought of this infernal crisis, he figured out that I was interested in the differences between government policy in British Columbia and Alberta. “I’m not sure you want to hear this,” he said, “but I think it’s going to be bad everywhere.” I said that’s what I think too. Perhaps I surprised him.

I don’t know what happens next. Maybe things just stop getting worse everywhere on their own, for big complex reasons that resist easy analysis. Overdose deaths were lower last year in the United States, the capital of this hellscape, than the year before.

If not… well, we shall see. I wonder what happens in year six or seven of the effort the Alberta government is building. Is there resentment among people in ordinary hospitals and correctional facilities, who don’t have access to bespoke programs and personal attention? Does the ROSC system become bureaucratized after the first generation of administrators moves on?

Or does it start to win converts? David Eby, the NDP premier of British Columbia, has started putting distance between himself and his public-health advisors on legalization and safe supply. A new appointment in BC is being closely watched in Edmonton.

Or, conversely, does the Alberta recovery effort bump up against the limits imposed by the substances involved and by human nature? Reported recovery rates from addiction vary widely, depending in part on how you measure them. This paper puts the rate at less than 30%. If you even manage to double it, that still leaves a large cohort who aren’t getting better. Would their neighbours see them as people who “failed recovery” or “blew their chance?”

I won’t claim to know. I do hope that in the year ahead, more Canadians check their assumptions and stow their cheap certainties. Especially those who aspire to positions of leadership.

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illegal immigration

US can stop border-crossing terrorists with – Obama administration policies?

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Uzbek “special interest aliens” in Tapachula, Mexico after crossing from Guatemala on their way to the U.S. Southwest Border. January 2022 photo by Todd Bensman

By Todd Bensman as published June 12, 2024 by The New York Post

Near-misses from the worst mass migration border crisis in American history keep coming at us like machine-gun fire.

This month, FBI counterterrorism agents arrested six Tajikistani nationals on terrorism charges after they illegally crossed the southwest border from Mexico, apparently foiling a terror plot linked to the ISIS-K terror group in Pakistan and Afghanistan.

The arrests came soon after a Russian who illegally crossed the border was convicted and sentenced in California on terrorism charges for buying weaponry for an al Qaeda group in Syria, as the FBI said he would have gone kinetic had he not been charged.

In May, a Jordanian national who illegally crossed the border from Mexico staged a vehicle ramming attack on Marine Corps Base Quantico that all involved federal agencies refuse to publicly rule out as a terror incident.

This year, Border Patrol agents overrun by the mass migration crisis have accidentally released at least seven immigrants  who were on the FBI’s terrorism watch list when they illegally crossed the southern border, according to multiple reports, sparking frantic manhunts to capture them.

That’s just a fractional few of many disturbing cases.

For years prior to the historic mass migration crisis that President Biden kicked off on his inauguration day in 2021, the US media laughed off the threat of terrorist border infiltration as the stuff of baseless right-wing fear-mongering — such as when then-President Donald Trump said in 2018 that Middle Easterners were moving with US-bound caravans through Central America and Mexico.

Much good company has joined the once-ridiculed Paul Reveres, including FBI Director Christopher Wray and the apparently spooked authors of a surprisingly anxious Foreign Affairs magazine essay published this week.

But while many are sounding border infiltration alarms, few have offered solutions.

Perhaps Republican border hawks should turn to an unexpected ally: Democratic Party stalwart Jeh Johnson, President Barack Obama’s secretary of homeland security.

In 2016, during his final months in office, Johnson became a true believer in the threat posed by “special interest aliens,” or SIAs: border-crossing migrants from 35 to 40 nations where Islamic terrorist groups are active.

After 9/11, one of the most important counterterrorism protocols implemented on the border required agents to detain all SIAs until they could undergo face-to-face interviews to determine if these total strangers harbored potential terror connections or intent.

In June 2016, Johnson was so fearful about SIA border crossers that he sent a memorandum to his top deputies demanding their “immediate attention” to “the increased global movement of SIAs.”

He ordered the formation of a “multi-DHS Component SIA Joint Action Group” that would assess the entire program and create a tightly coordinated international action plan to “counter the threats posed by the smuggling of SIAs.”

“I want to ensure we are bringing the full resources of the Department to bear in a coordinated manner on the issue of SIAs,” he wrote, to build on existing counter-SIA programs.

Johnson’s completely prudent plan to intensify the vetting of SIAs at the border and to take down terrorist smugglers in other countries got lost in the chaos of the transition to Donald Trump’s presidency.

His intended revamp never happened — and the catastrophic Biden-engineered mass migration crisis vaporized whatever was left of it.

While SIA traffic over the border had previously amounted to 3,000 to 4,000 individuals annually, SIA traffic since 2021 has reached an unimaginable 70,000 to 80,000 per year.

Federal intelligence and law enforcement officials could no longer interview even a smidgeon of those SIAs, who are mostly waved into the country with no interviews.

“Due to massive numbers of illegal aliens overwhelming CBP, in-depth face-to-face interviews are nonexistent,” former Chief Border Patrol Agent Rodney Scott testified before the House Judiciary Committee last September on the subject of terrorist border infiltration.

The first fix is, of course, almost too obvious to mention: Reduce the total numbers of illegal aliens pouring over the southwest border.

But the far less obvious fix is this one, regardless of how many are crossing: We must resurrect Johnson’s 2016 initiative to interview SIAs before they are released on asylum, and target their smugglers for prosecution and prison.

As importantly, we must adequately fund and equip this massive effort — no matter how many SIAs arrive.

If Johnson’s 2016 plan was nonpartisan enough for the Obama administration, it should be good enough for the Biden DHS, or a Trump one. And, we can hope, not too late to stop the next terrorism attempt within the United States.

Todd Bensman, a senior national security fellow at the Center for Immigration Studies, is the author of “America’s Covert Border War” (2021).

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