The Somerville Health
Department had to postpone public flu clinics after vaccine shipments
fell short of expectations. Harvard Vanguard Medical Associates, in
Davis Square, told a similar story. This vaccine shortage comes to the
distress of parents with young children, who are particularly
susceptible to the H1N1.

There have been 1555 confirmed cases
of H1N1 in Massachusetts since April, when it was first detected in the
U.S. Of those cases, 13 people have died, according to a report by the
Massachusetts Department of Public Health (MDPH). According to the
Centers for Disease Control, H1N1 is now widespread in 48 states, which
has not been the case during typical flu seasons.

People lack
immunity to H1N1 flu, according to the Paulette Renault-Caragianes,
director of the Somerville Health Department, because H1N1 is a "novel"
virus.

"Part of that newness is there's a significant part of
our population that's probably never been exposed to this type of
influenza," she said, adding that the seasonal flu changes only
slightly each year.

H1N1 also differs from seasonal flu in the populations it hits hardest.

"90
percent of deaths you see from seasonal flu are from people over 65,"
Renault-Caragianes said. "In H1N1, 90 percent of the deaths we've seen
are people under 65, and more than half of the hospitalizations have
been people under 25-years-old."

'Vast majority'of flu cases will be H1N1

Dr.
Benjamin Kruskal, pediatrician and Director of Infection Control at
Harvard Vanguard Medical Associates, described the severity of H1N1 in
Somerville as being "similar to that with seasonal flu."

"Because
we're seeing more people sick, we are expecting to see more people who
are severely ill," Kruskal added. "We're now seeing levels of flu
illness that are typical of the very peak of a typical flu season
[February]. We normally see very little flu at this time of year."

The
Weekly Influenza Report released by MDPH showed the same trend, noting
that of the 75 influenza-positive specimens tested in Massachusetts
this October, 74 were H1N1, and the other was influenza B – not
seasonal flu. Kruskal says that based on that data, doctors could
assume the "the vast majority" of flu cases this fall are H1N1.

Along
with increased numbers of flu cases has been a vaccine shortage in
Somerville and across the country. According to Renault-Cariaganes, the
city originally planned to hold H1N1 clinics in the fall, but in
October it had received only "a very small amount" of the vaccine.

MDPH
and the CDC has advised the city that it "should wait until November
(and) until the supply that everyone has is sufficient for a
larger-scale offering of H1N1 vaccine clinics," she said.

Renault-Caragianes
blames the shortage on the fact that the same pharmaceutical companies
have contracted with the federal government to produce both seasonal
and H1N1 flu vaccines in the same year. As widely reported in the
media, manufacturers have also faced technical difficulties growing
virus for the H1N1 vaccine.

Even when the Somerville Health
Department does receive vaccine, it will not be immediately available
to everyone who wants it. Instead, the department will provide the
vaccine first to priority groups and even sub-groups outlined by the
CDC.

Renault-Caragianes said the priority groups include
pregnant women, caregivers of infants under six months, people 24 and
under, people 25 to 64 with underlying health conditions and healthcare
workers. After going through each group, the city may hold clinics.

'An Odd Loophole'

On
Nov. 2, the Somerville Health Department received a shipment of 400
doses of H1N1 vaccine and began inoculating children at Somerville
schools. Most of the vaccine they received is in a formulation called
FluMist, a nasal spray that contains a live virus which triggers the
body's immune system without causing an infection.

Renault-Caragianes
said that the vaccine is "limited in its use." Two high-priority
groups, pregnant women and those with underlying health problems,
cannot use the FluMist formulation, and the vaccine has only been
approved for people aged 2 through 49.

The school flu clinics
will start by vaccinating students only, and if vaccine supplies allow,
they will move on to teachers and staff. The clinics are not open to
the general public.

On Nov. 9, Renault-Caragianes said more
vaccines had been received by the city and that pregnant women would be
allowed to make an appointment to receive doses. She said there may be
enough vaccine for more general distribution in December.

The
shortage of vaccine and triage for available doses is a familiar
problem for Somerville parents Sue and Vince, who did not give their
last names. The couple has been struggling to get H1N1 vaccinations for
themselves in order to protect their daughter. At 3 months, she is too
young to receive the H1N1 vaccine.

In Sue's words, they "fall in an odd loophole in priority."

"We're
not young children, we're not infants, we're not pregnant, but we're in
that twilight zone where we care for a very young child," she said.

The couple tried to get vaccinated at Harvard Vanguard Medical Associates, but were told they could not get it.

"They
had some, which they gave out to children under 2 who already had
doctor's appointments and pregnant women," Sue explained. "But I wasn't
considered high priority in the first round."

Somerville
resident Liz Sylvan has had similar frustrations finding the H1N1
vaccine. Like Sue and Vince, Sylvan and her husband tried "a couple of
different ways" to find an H1Ni vaccine for their 2-year-old daughter,
Misha but have been unsuccessful.

"Nobody that we interact
with has it yet," Sylvan said. " Our pediatrician's office doesn't have
it, and I am worried about it, because she's little, she's 2."

Pointing
to her son, she continued, "And he's under 6 months, so he doesn't even
get to [receive the vaccine] yet, and so I am very concerned about it."

More information about H1N1 vaccine availability can be found at www.flu.gov.

But a closer look reveals a greater
variety of options: the small store attracts clientele from other areas
of the city, and beyond, for its selection of fresh produce and diverse
imports – from Indian and Irish tea to crumpets and mango chutney.

Romy
Sehli, who has owned the store for 18 years, said he started offering
international goods five years ago to satisfy the "huge demand of
international customers."

"Whoever doesn't change with the times loses out," Sehli said.

After
turning away up to ten people looking to buy alcohol each day, Sehli
decided to apply for a liquor license transfer from a business that had
stopped using it, hoping to offer Indian wine and Irish beer for the
"convenience of my customers."

Within days, Sehli said close
to 400 people signed a petition in favor of the license. Yet almost
four months later, Sehli and his customers are still waiting. The
decision rests with the Licensing Commission, a three-person panel
which administers all liquor licenses in Somerville.

'Common Good'

The
number of available licenses is capped by the state according to
population. Somerville currently holds 84 restaurant and club licenses,
and 20 package store licenses, said Jenneen Pagliaro, who works for the
Licensing Commission from City Hall.

The Commission must weigh a
myriad of factors in approving an application and deciding which store,
restaurant, or area deserves a license, and which one does not.

All
factors can be grouped into two main categories: the character and
fitness of the applicant, and the "public need" or "common good," said
Andrew Upton, the chairman of the Licensing Commission.

The
first category is relatively straightforward: the Commission looks at
the applicant's experience with the business and makes sure he does not
have a criminal record.

Alderman-at-Large Dennis Sullivan, who
testified in favor of Farmer's Bounty's application at one of the
Commission's monthly meetings, called Sehli a responsible business
owner with a "proven track record."

Yet it is the second category, that of "the common good," that poses more difficulty.

Commissioners
must consider everything: the number of other liquor licenses in the
area, noise and traffic levels, population density, proximity to
churches or schools, as well as testimonies from the community ¬- from
aldermen, customers, neighbors, and city officials.

In listening
to "the public," each voice must be weighed against every other,
business needs considered along with complaints of neighbors.

The
Commission must factor in the eight Farmer's Bounty customers who came
to the commission's last hearing in support of the store's application.

But
they must also consider the testimony of Ward 6 Alderman Rebekah
Gewirtz, who argued earlier that Farmer's Bounty patrons could simply
buy their liquor across the street, from Downtown Wine and Spirits.

"I represent the residents and the neighborhood," Gewirtz said. "And I maintain that this license is not necessary."

Commissioner Vito Vaccaro said that "economic development" is the Commission's number one priority.

"Has
it enhanced, or will it enhance, the dining experience in the city of
Somerville? Will it help the city of Somerville?" Vaccaro asks for each
license application. "That's the bottom line."

Liquor licenses
can be used by the city to bring greater business to underdeveloped
areas, such as Winter Hill. The Commission has also set aside ten
licenses for Assembly Square, anticipating a proliferation of
restaurants and hotels in the area over the next few years.

Somerville has become a "dining destination" in recent years, said Upton, the Commission's chairman.

However, until recently, there were not enough liquor licenses available for new restaurants.

"It's
hard to have a successful restaurant without at least serving beer and
wine," Upton said. "Sometimes people won't even come to your place for
food unless they can also order a glass of wine."

No New Licenses?

To
boost the appeal of the city's dining scene, Somerville submitted a
home rule petition to the state legislature through the office of State
Senator Pat Jehlen, asking for more liquor licenses for restaurants.
Twenty full liquor licenses were granted in 2008, said Robert
FitzPatrick, Jehlen's chief of staff.

Full liquor licenses can
be used for package stores, restaurants, or bars and clubs, but
FitzPatrick said he expects the city to use most of the licenses for
restaurants, not for liquor stores.

"Somerville's done a good
job of attracting really nice restaurants," FitzPatrick said. "Now it's
up to the city to use these [new] full liquor licenses in the right
way."

While the city plans to use the new liquor licenses to
attract people to Somerville's restaurants and clubs, there are no new
licenses available for liquor stores or "packies," Vaccaro said. Stores
that want to obtain a liquor license must buy a transfer license from
someone else, and the city must approve the transaction.

"We
have only 4.2 square miles in Somerville," he said. "Everything you do
affects the neighbors. We have to think, how are we going to affect the
neighborhood?

"I personally don't want to walk down the street and see a bunch of liquor stores."

Upton
agreed, stating that while restaurants draw people from all over the
Boston area, "people don't come from all over the place to buy a
six-pack of Buds."

"I don't believe the city, the commission, or anyone, think Somerville should have more liquor stores."

Rob
May, from the Mayor's Office of Strategic Planning and Community
Development (OSPCD), represented the city's position on the Farmer's
Bounty case at the last hearing.

May suggested a compromise:
Farmer's Bounty should submit a floor plan on where it plans to place
its beer and wine, in order to ensure that it does not become a full
liquor store.

As of August, May and the OSPCD have been working
with the Commission to create a set of guidelines and criteria for the
city's liquor licenses.

The OSPCD wants to formalize a licensing
process that has long relied more on consensus and Commissioner
experience than on the new technology, and statistical and mapping
tools now favored by city governments across the country.

Somerville's
existing guidelines for liquor licenses are simply taken from those
used state-wide. However, May said that it is important to consider
local needs.

By December, May said he hopes to present the
Commission with several options for possible changes to licensing
guidelines ¬- which may require liquor stores to limit the number of
signs on the storefront, or install exterior lighting or live-feed TV.

However, eschewing the high-tech, Farmer's Bounty may do well to follow the example of David Jick, owner of Dave's Fresh Pasta.

When
Jick decided to apply for a liquor license to supplement the other
options in his specialy food store, he took the time to talk to
neighbors and fellow businessowners "to make sure people were okay with
the idea."

Although the process took over a year, Jick said he has had his current license for three years without any problems.

Jick's
neighborly approach was much appreciated by Dan Parsons, the general
manager of Downtown Wine and Spirits, which lies across the street from
Farmer's Bounty.

An estimated 140,000 children in
Massachusetts are in need of mental healthcare, with 100,000 unable or
too afraid of stigmatization to receive help.

The Nov. 5 event
served as a collaboration between the city's Making Connections mental
health campaign and the state-wide The Time is Now Children's Mental
Health Campaign, which stopped here as part of several regional forums
held across Massachusetts.

At the meeting were calls for
advocacy mixed with stories from parents affected by authorities'
inability to properly address their children's health needs.

One
mother recounted her struggle against a local school system to keep her
child in school despite a behavioral and emotional disorder. Due to her
child's acting-out behaviors, she was expelled from school and daycare
programs without getting help for the underlying issues. After being
rejected from various programs and landing in a hospital, she said her
7-year-old daughter said she wanted to kill herself.

Her case, she said, highlighted the need for sweeping changes.

"We can't tinker around the edges," the mother said. "We really have to think hard about reform."

Another
young Somerville resident expressed frustration that his friend had
been thrown in jail after reaching his 20s without ever having received
attention for mental health issues that had been present for years.

"I
can't help my own best friend," he said. "Tons of crimes are committed
because of mental (issues) and the help people aren't getting. I'm
asking for help."

Matt Noyes, a representative from Health Care
for All who helped organize the forum, spoke of the need for more
legislation from Beacon Hill to help buoy the 2008 legislation, An Act
Relative to Children's Mental Health, meant to reform children's mental
healthcare.

Noyes urged parents to send postcards to their
representatives in support of An Act for Coordination of Children's
Mental Health Services, which would allow mental health clinicians to
bill private insurance for time spent coordinating a child's care with
collateral contacts such as parents, doctors and teachers.

Massachusetts
currently houses several large mental health state agencies, but Noyes
said they are often unable to work together. The campaign's new
legislation calls for the commissioner of the Massachusetts Department
of Health to take the lead in coordinating them.

Noyes also
addressed the stigma associated with mental illness, which he said has
held back the cause as other health issues continue to receive
attention both from the public and legislatures.

"If you had
diabetes, you would not hesitate to get treatment, with or without
insurance," Noyes said. "The brain is part of our body. We need to
raise awareness of the validity of mental health as just as serious as
other physical illnesses … We shouldn't be ashamed."

Anne
Herzberg, an English Language Learners counselor at Somerville High
School, said the school is doing its best with the resources it has.

"The
school's responsibility is to provide skills to promote life-long
success," she said. "Of course, when a parent comes forward asking for
more help, the school will try to help, but there are limitations."

"A lot of students are slipping not because they aren't asking," she added, "but because they get lost in the shuffle."

Tom Nash contributed to this report.

The
report, overseen by former John Hancock CEO David D'Alessandro,
concludes that the MBTA masked massive debt and left 57 "urgent" safety
projects unfunded, the total cost of which would be $543 million.

Among
the safety issues highlighted is a water leak between the Harvard and
Alewife T stations along the Red Line, which includes Somerville's only
T stop in Davis Square.

"The Alewife/Harvard Project has been
proposed and unfunded for three straight years as conditions worsen,"
the report states. "In addition to the potential of derailment, if the
situation exacerbates, speed along that portion of the Red Line could
slow to 10 mph. This will have a residual service impact with delays
along the entire Red Line."

D'Allessandro told WTKK-FM after the
report's release he would not ride along that portion of the Red Line,
although he backed away from the statement in later interviews. Gov.
Patrick has since sent inspectors to the area to monitor the situation.

Among
the report's recommendations is that expansion of MBTA service take a
back seat to improving the safety of the existing system, stating "(it)
makes little sense to continue expanding the system when the MBTA
cannot maintain the existing one."

Asked whether this could have
implications for the Green Line extension project into Somerville,
legally mandated by the federal government as a way to offset pollution
from the Big Dig project in Boston, Somerville Mayor Joe Curtatone said
any attempt at delaying the project further would see a quick response
from the city.

"There are no questions, there is no discretion,"
Curtatone said of the federal mandate. "If [the MBTA] does delay or
tries to play games, we will sue them and we will win."

Curtatone
said he had not had any discussions with the MBTA about the safety
issues addressed in the report relating to the Davis Square Red Line
station.

"I was disappointed but not shocked," Curtatone said of
the report's findings. "You had years of deferred maintenance
liabilities, and the problems compound over time."

"If we want
a 21st century economy, we will need a 21st century infrastructure," he
added. "The T and the transit system in this commonwealth are grossly
underfunded … and the buck is just being passed around."

Wig
Zamore, a member of the MBTA Rider Oversight Committee and Somerville
Transportation Equity Partnership added that the state stands to lose
five times the amount of money it would spend on building the Green
Line if the project were delayed beyond the mandated 2014 completion
date.

"I think D'Alessandro did a good report (but) the report
didn't really look at the regulatory context," Zamore said. "The
federal regulations require that the state has to be proceeding on
schedule."

As to the safety of the Red Line between Harvard and
Alewife, Zamore said the possibility of a derailment along the Red Line
needs to be put in context.

"The truth is all users of
transportation in Massachusetts are at some risk," he said, noting the
state ranks 46th in the country in the amount spent on bridge repair.
"I think (the report) is correct that there are a number of scary
situations, but the only solution is to roll up our sleeves."

Meanwhile, Somerville resident Andrea Lenco rides the Red Line to and from Davis Square as many as four times a day.

"That's
[expletive]," Lenco said after being told of the safety issues as she
was waiting for an inbound train. "Honestly, I don't know if it's going
to keep me from riding this route. I'd rather be on the T than a bus
that doesn't come for 45 minutes."

The Massachusetts Department
of Transportation will present its latest assessment of the Green Line
extension project at Somerville High School on Nov. 18 at 6 p.m. The
D'Alessandro report is available at www.mbtareview.com.

As recently as the 1970s, most issues that affected a
large majority of people would generate much public debate and
involvement in the democratic process of electing people to represent
us – local, county, state and national. The number of small PDS-like
types of grassroots organizations throughout the 1970s and into the
very early 1980s was amazing to watch if you were lucky enough to have
lived here during that time.

After that, public interest on a
local level seemed to wane around here. Maybe it was the crazed '80s
that kept us all so busy we didn't notice things happening around us.
Low voter turnout, still to this day, is somehow translated by some to
mean people are "happy with things the way they are."

Don't buy
it – the real heart of the problem is simply that people are too busy
trying to stay afloat to notice every single issue. It seemed so
shocking at the time when the Mystic View Task Force took up the fight
to put Assembly Square on the right track – like they were fighting the
"old boy network" on some level. It seemed even more shocking when
other small politically-based movements started to pop up here and
there, some managing to take hold of different segments of the voting
population.

That's the problem – none of this is new – and none
of it should be simply dismissed as "old" vs. "new" Somerville. We all
live here, and see the changes that are happening. Some of us more than
others, and that's okay – but maybe we can start coming together on
more issues instead of being divisive and perpetuating myths and trying
to act like we all don't want the same things – safe schools for our
children, adequate police and fire protection, honest representation in
local government. Maybe then we can work in the little things that we
selectively desire from an ideological standpoint – collaboratively,
not closed-mindedly.

We have to start be being more involved –
not just blow the roof off the barn because parking times were lowered
and fees were raised, not just because our property taxes have gone up,
not just because one person favors a certain set of ideological
principles over the next person. There has to be more collaboration,
cooperation and working together to get these types of things moving in
the right direction.

It starts by going out to vote, especially
if you can't spend time working with a local community group, sit on a
local board, or put yourself out there by running for office. It's not
just your right, it's your responsibility to those people, like them or
not, agree with them or not, that put themselves out there every day
and night – the true believers that we can make a change right here,
right now. We did it when we elected Barack Obama President – we can
certainly do it when it comes to local elections.