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A300-bed Christian hospital in Eswatini has largely stopped seeing patients. Staffers at a Christian maternity clinic in Côte d’Ivoire are watching HIV drugs rapidly disappear from their shelves and do not know where to acquire more even if they can raise money for them. Students at a Christian nursing school in Malawi lost the scholarships that helped them afford tuition and meals.

In the month since President Donald Trump’s executive order freezing foreign aid shuttered the US Agency for International Development (USAID), lifesaving care mostly remains cut off around the world, despite court orders and promised waivers.

Across Africa, hospitals, clinics, and nonprofits have scrambled to raise or redirect money on their own, but administrators know emergency fundraising isn’t a reliable way to cover operation costs. In the short term, many just want to keep vulnerable patients on tuberculosis medicine or antiretroviral drugs (ARVs) for HIV, or keep their staffs paid.

Programs on the ground reported to CT that they have not received any new disbursements from USAID and can’t get answers from the US government about if or when funding will resume.

Over the weekend, the Trump administration placed almost all USAID staffers on leave and fired at least 1,600. Even if the State Department were to absorb some of USAID’s work, as the administration has outlined, it’s unclear how billions of dollars’ worth of programs would be resumed and overseen without staffing.

In Tanzania, a Christian clinic treating 300 children with HIV had to put USAID-funded staff on leave and has been scouring for funds to cover ARVs for its young patients, whose immune systems are particularly vulnerable without drugs to keep HIV at bay.

The clinic is part of Shirati Hospital, historically a Mennonite mission hospital. Dale Ressler, an American, serves as executive director of Friends of Shirati, which raises private donations for the hospital.

Ressler has been in touch with the doctor in charge of the clinic about how to keep medicines going for the children. In the past few weeks, Ressler was able to raise $10,000 for ARVs, he said. But the medicines are hard to find, with supply chains broken by the USAID shutdown.

The $10,000 should be enough for three weeks of treatment for its patients. Still, Ressler said staff members at the clinic were preparing to talk to the children about the possibility of the drugs running out.

“Some of the smaller ones won’t necessarily understand,” Ressler said. “Children 12 and up will know the risks. They’ve been told every month their whole life, ‘If you don’t take [the medicine], you’ll die.’”

Certain projects around the world received waivers to continue operating despite Trump’s stop-work order—particularly HIV testing and drug distribution through the President’s Emergency Plan for AIDS Relief (PEPFAR).

Yet none of the HIV treatment programs contacted by CT said they had received funds since then, so groups that proceed must do so in good faith, hoping the US government will pay them for the contract work.

The New York Times reported that Phoenix, the system for disbursing money to partners in the field, remains shut down, and the acting USAID administrator has argued in court that the ongoing freeze in funds is justified.

Reuters exclusively reported last week that the administration had approved $500 million in PEPFAR funding, but if that money is coming, it hasn’t made it to many health facilities yet.

The funding freeze has halted operations at The Luke Commission (TLC) hospital in Eswatini, a small landlocked nation in Southern Africa. A 300-bed Christian hospital with about 700 employees, TLC specializes in surgeries and critical care and treats HIV, tuberculosis, and snakebites.

The Christian hospital— whose services are free to patients—leans heavily on USAID, with about $7 million of its $21 million budget coming from the US government, according to the latest tax filings. Consistent aid payments helped when other sources of funding were unpredictable, said Echo VanderWal, executive director of TLC.

“If I could describe [USAID] for us in two words, it would be ‘faithful friends,’” said VanderWal in an interview. When other parts of the health care system shut down during the pandemic, the USAID country director called VanderWal every day to ask how the hospital was doing.

But VanderWal thinks a shakeup of US aid could be good. She has seen how projects from US agencies and other foreign aid can be redundant or feed corruption.

“The need for accountability and transparency and integrity in global aid is long overdue,” she said. “I’m devastated that it’s happening like this.”

TLC leaders asked its US donors if it could redirect funds to tuberculosis and HIV medicines so patients wouldn’t lose access to the lifesaving drugs. Since the USAID shutdown, the hospital is mostly doing drug refills. The hospital has laid off some staff members, and others aren’t getting full salaries.

The COVID-19 pandemic left the facility in financial straits. During the pandemic TLC had a heavy patient load and made a significant investment in an oxygen plant. As a result, the hospital had already reduced some services before the USAID cut.

“I do not believe that America is going to give nothing to foreign aid,” VanderWal said. “I believe they are going to invest in a continued legacy of compassion to the world. … Possibly it’s going to be structured differently. I sure hope so.”

The frozen aid may have eliminated some wasteful programs, but it also cut PIM, a Christian maternity clinic in Côte D’Ivoire, specializing in mothers and children with HIV. The clinic treats 5,800 patients, according to Kip Lines, executive director of CMF International, a Christian mission organization in the US that supports PIM. The HIV medicine keeps a pregnant mother from passing the virus to her baby.

Run by Ivorians, the clinic was part of PEPFAR and received USAID funding. It had a signed contract with USAID through 2025 and was not prepared for the freeze.

The ARV distribution network in Côte D’Ivoire also shut down with the freeze, said CMF’s Lines. (CMF does not receive USAID funding.)

Without the network, the clinic isn’t sure where to procure ARVs.

“Even if the State Department said today, ‘Yes, we’re re-funding this program,’ none of the organizations that received the USAID funding locally are in operation,” Lines said. “They let their staff go. The offices are closed.”

CMF reached out to ACONDA VS-CI, the organization that oversees drug distribution, and got no response. ACONDA’s social media presence halted in late January, with its last post a recruitment for staff to fight HIV. CMF’s staff on the ground said the organization had shut down. ACONDA did not respond to an inquiry from CT.

When HIV funding disappeared in January, CMF asked US churches to raise money for the clinic’s operating costs, particularly the salaries of clinic staffers who would have to be laid off otherwise.

Churches responded by supporting the salaries in the short term, but the bigger fundraising need going forward is for the ARVs, which cost about $30,000 a month, if the clinics can acquire them.

Last week CMF was able to send $10,000 for ARVs to PIM, and Lines said the clinic was “buying them wherever they can find them.”

The emergency funding is helpful, but Lines wonders: If PEPFAR isn’t operational again in a few months, will PIM have to shut the clinic down?

In some places, the funding freeze is threatening efforts to make countries less dependent on foreign aid.

Malawi, one of the poorest countries in the world, has long struggled with a shortage of health care workers. It has among the world’s lowest numbers of nurses per capita.

In recent years, USAID sponsored a scholarship to support nurses-in-training at Nkhoma Hospital, a rural mission hospital now run by Malawian Christians.

Most of the 350 students at Nkhoma College of Nursing and Midwifery pay their own tuition, but a USAID scholarship program supports a cohort of 20 nurses who need assistance. Some are the children of subsistence farmers, the first in their families to attain this level of education.

These 20 nurses were halfway through their three-year education when the funding freeze hit last month. The students were ready to start their semester, but the school received word that they would receive no funds for their tuition or their room and board.

The students were crying, saying they had nowhere to go, said multiple staffers at the school. Food is scarce now because it’s the time of the year Malawians call “hunger season.” Proceeds from a previous year’s crop are dwindling, and the next season’s maize crops aren’t harvested until May.

“Students, they cannot go home and say, ‘Give us maize and give us some food,’” said Rose Mazengera, one of the Malawian administrators at the nursing school. At the hospital, the doctors see more children with malnutrition during this season.

Nkhoma Hospital is already stretched thin serving a poor rural population and did not have money to cover the students’ fees and food.

In one letter to the school, reviewed by CT, a nursing student asked for a few months to pay his tuition, saying he had planted maize and would be able to harvest it in May in order to pay the school by June. “This is my only source of getting the fees,” he wrote.

In desperation, the school’s leaders sent a request to African Mission Healthcare, a foundation that has supported mission hospitals, to help keep the nurses in school. The foundation agreed to cover this semester of tuition for the 20 nurses.

But the school’s administrators don’t know if that support will continue. Before the shutdown, US government support felt reliable.

The freeze “came to us as a surprise and a shock,” said Newton Kamchetere, another nursing school administrator. “If their training is interrupted or curtailed, in the near future we will have deficiencies in terms of health care workers. … It will have a huge impact in the long run.”

It’s a compounding crisis too: Some nursing students who weren’t receiving the scholarship relied on family members working on USAID-supported projects to help pay their tuition.

“We are always grateful for the things the US government has been doing in Malawi … especially with HIV,” Mazengera said. But she expects the funding cuts will increase the mortality rate for children under 5 years old, a key health indicator.

“I’m just hoping and praying some of these things can be reversed,” she added. “It is a thing which needs God’s intervention.”

Last week in Nkhoma Hospital’s daily chapel, Kamchetere delivered the message and talked about Paul’s words in 1 Corinthians 12:26 about the church as a body.

“When the other part of the body suffers, we should all be concerned—we need to help one another. I have seen that working,” Kamchetere said. “May the good Lord open other doors so at the end of the day we will alleviate the poverty and suffering.” Christianity Today

President Donald Trump’s administration said on Sunday it was placing all personnel at the foreign assistance agency USAID, except leaders and critical staff, on paid administrative leave and eliminating 1,600 positions in the United States.

Billionaire Elon Musk’s Department of Government Efficiency has led an effort to gut the US Agency for International Development, the main delivery mechanism for American foreign assistance and a critical tool of US “soft power” for winning influence abroad.

“I regret to inform you that you are affected by a Reduction in Force action,” said an email sent to one of the workers being fired that was reviewed by Reuters. Those who got the note will be let go from federal service effective April 24, the email said.

USAID said on its website that just before midnight on Sunday US Eastern Time, all direct hires except essential workers will be put on leave and 1,600 USAID personnel in the US would be cut.

An earlier notice sent to staff and reviewed by Reuters said about 2,000 US positions would be eliminated.

The White House did not immediately respond to a request for comment.

On Friday, a federal judge cleared the way for the Trump administration to put thousands of USAID workers on leave, a setback for government employee unions that are suing over what they have called an effort to dismantle it.

Two former senior USAID officials estimated that a majority of some 4,600 USAID personnel, career US Civil Service and Foreign Service staffers, would be placed on administrative leave.
“This administration and Secretary (of State Marco) Rubio are shortsighted in cutting into the expertise and unique crisis response capacity of the US,” said Marcia Wong, one of the former officials. “When disease outbreaks occur, populations displaced, these USAID experts are on the ground and first deployed to help stabilize and provide aid.”

Trump ordered a 90-day pause on foreign aid shortly after taking office on January 20, halting funding for everything from programs that fight starvation and deadly diseases to providing shelters for millions of displaced people across the globe.

The administration has approved exceptions to the freeze totaling $5.3 billion, mostly for security and counter-narcotics programs, according to a list of exemptions reviewed by Reuters that included limited humanitarian relief.

USAID programs got less than $100 million in exemptions, compared to roughly $40 billion in programs it administered annually before the freeze. Reuters

Seventeen hospitals in Florida are suing UnitedHealthcare, alleging they were underpaid for emergency services delivered to thousands of out-of-network patients.

The facilities, all part of HCA Healthcare, claim the insurer reimbursed the care at rates that were too low, in violation of the law. According to a lawsuit filed in the Ninth Judicial Circuit Court of Florida, the underpayment totals approximately $145 million.

According to the plaintiffs, since 2022, more than 5,500 patients—all covered by UnitedHealthcare—have been treated at HCA facilities for emergency medical needs. Despite the fact that the hospitals do not accept the medical plans of these patients, the facilities are required by federal and state laws to provide care.

The hospitals argue that, typically, such services would be reimbursed at market rates for the area. However, they say the insurer has paid less for the out-of-network patients than is customary for emergency room visits.

“Under Florida law, United is solely responsible for payment to the hospitals for emergency services and care provided, and United ensures that the member is not liable for any additional amounts that the member would have owed had the member obtained services from a participating provider,” the court filing reads.

HCA said they have not agreed to any discounted reimbursement amounts for the patient cohort in question and expect to be paid the full amount owed to an in-network facility.

The 17 plaintiffs include:

• Osceola Regional Hospital
• Central Florida Regional Hospital
• Poinciana Medical Center
• Oviedo Medical Center
• UCF Lake Nona Hospital
• Marion Community Hospital
• Putnam Community Medical Center
• North Florida Regional Medical Center
• Lake City Hospital
• West Florida Regional Medical Center
• Fort Walton Beach Medical Center
• Tallahassee Medical Center
• Twin Cities Hospital
• Gulf Coast Hospital
• Lawnwood Medical Center
• Raulerson Hospital
• St. Lucie Hospital

Attorneys representing HCA are demanding a jury trial to resolve the dispute. HealthExec

Medical device maker Medtronic is looking at options to modify its global manufacturing footprint as part of efforts to mitigate any impact of US President Donald Trump’s tariff plans, a company executive told Reuters on Tuesday.

The company, whose products range from insulin pumps to surgical robots, has been closely monitoring Trump’s tariff plans due to its presence in Mexico. The country houses the device maker’s third largest manufacturing facility, according to its latest annual report.

“We continue to look at ways to optimize our manufacturing footprint,” Medtronic’s Chief Technology Officer Ken Washington said on the sidelines of the BioAsia conference in the southern Indian state of Telangana.

Trump imposed 25% duties on imports from Mexico and Canada that were to go into effect in early February, but then paused them until March 4, pending negotiations with those two nations.

Medtronic’s Washington did not comment on whether India was part of the strategy to refine the manufacturing operations. The company had in 2021 launched its largest research and developmental center outside of the US in Telangana.

Washington said the company would stay focused on its core work in a reply to Trump’s threats to impose a “25% or higher” levies on semiconductors and pharmaceutical imports.

“A company like Medtronic can’t survive for 75 years if you don’t learn the skill of navigating the ups and downs, and ebbs and flows of different political platforms.”

Washington said he was focused on the adoption of artificial intelligence. He expects digital and AI roles to grow and digital spending to increase, without providing specific details.

“We have set expectations that everyone should embrace AI as a way of doing business.” Reuters

A popular medical monitor is the latest device produced in China to receive scrutiny for its potential cyber risks.  However, it is not the only health device we should be concerned about. Experts say the proliferation of Chinese health-care devices in the U.S. medical system is a cause for concern across the entire ecosystem.

The Contec CMS8000 is a popular medical monitor that tracks a patient’s vital signs.  The device tracks electrocardiograms, heart rate, blood oxygen saturation, non-invasive blood pressure, temperature, and respiration rate.  In recent months, the FDA and the Cybersecurity and Infrastructure Security Agency (CISA) both warned about a “backdoor” in the device, an “easy-to-exploit vulnerability that could allow a bad actor to alter its configuration.”

CISA’s research team described “anomalous network traffic” and the backdoor “allowing the device to download and execute unverified remote files” to an IP address not associated with a medical device manufacturer or medical facility but a third-party university — “highly unusual characteristics” that go against generally accepted practices, “especially for medical devices.”

“When the function is executed, files on the device are forcibly overwritten, preventing the end customer—such as a hospital—from maintaining awareness of what software is running on the device,” CISA wrote.

The warnings says such configuration alteration could lead to, for instance, the monitor saying that a patient’s kidneys are malfunctioning or breathing failing, and that could cause medical staff to administer unneeded remedies that could be harmful.

The Contec equipment’s vulnerability doesn’t surprise medical and IT experts who have warned for years that medical device security is too lax.

Hospitals are worried about cyber risks
“This is a huge gap that is about to explode,” said Christopher Kaufman, a business professor at Westcliff University in Irvine, California, who specializes in IT and disruptive technologies, specifically referring to the security gap in many medical devices.

The American Hospital Association, which represents over 5,000 hospitals and clinics in the U.S., agrees. It views the proliferation of Chinese medical devices as a serious threat to the system.

As for the Contec monitors specifically, the AHA says the problem urgently needs to be addressed.

“We have to put this at the top of the list for the potential for patient harm; we have to patch before they hack,” said John Riggi, national advisor for cybersecurity and risk for the American Hospital Association.  Riggi also served in FBI counterterrorism roles before joining the AHA.

CISA reports that no software patch is available to help mitigate this risk, but in its advisory said the government is currently working with Contec.

Contec, headquartered in Qinhuangdao, China,  did not return a request for comment.

One of the problems is that it is unknown how many monitors there are in the U.S.

“We don’t know because of the sheer volume of equipment in hospitals. We speculate there are, conservatively, thousands of these monitors; this is a very critical vulnerability,” Riggi said, adding that Chinese access to the devices can pose strategic, technical, and supply chain risks.

In the short-term, the FDA advised medical systems and patients to make sure the devices are only running locally or to disable any remote monitoring; or if remote monitoring is the only option, to stop using the device if an alternative is available. The FDA said that to date it is not aware of any cybersecurity incidents, injuries, or deaths related to the vulnerability.

The American Hospital Association has also told its members that until a patch is available, hospitals should make sure the monitor no longer has access to the internet, and is segmented from the rest of the network.

Riggi said the while the Contec monitors are a prime example of what we don’t often consider among health care risk, it extends to a range of medical equipment produced overseas. Cash-strapped U.S. hospitals, he explained, often buy medical devices from China, a country with a history of installing destructive malware inside critical infrastructure in the U.S.  Low-cost equipment buys the Chinese potential access to a trove of American medical information that can be repurposed and aggregated for all sorts of purposes. Riggi says data is often transmitted to China with the stated purpose of monitoring a device’s performance, but little else is known about what happens to the data beyond that.

Riggi says individuals aren’t at acute medical risk as much as the information being collected and aggregated for repurposing and putting the larger medical system at risk. Still, he points out that, at least theoretically, it can’t be ruled out that prominent Americans with medical devices could be targeted for disruption.

“When we talk to hospitals,  CEOS are surprised, they had no idea about the dangers of these devices, so we are helping them understand.  The question for government is how to incentivize domestic production, away from overseas,”  Riggi said.

Chinese data collection on Americans
The Contec warning is similar at a general level to TikTok, DeepSeek, TP-Link routers, and other devices and technology from China that the U.S. government says are collecting data on Americans. “And that is all I need to hear in deciding whether to buy medical devices from China,” Riggi said.

Aras Nazarovas, an information security researcher at Cybernews, agrees that the CISA threat raises serious issues that need to be addressed.

“We have a lot to fear,” Nazarovas said. Medical devices, like the Contec CMS8000, often have access to highly sensitive patient data and are directly connected to life-saving functions. Nazarovas says that when the devices are poorly defended, they become easy prey for hackers who can manipulate the displayed data, alter vital settings, or disable the device completely.

“In some cases, these devices are so poorly protected that attackers can gain remote access and change how the device operates without the hospital or patients ever knowing,” Nazarovas said.

The consequences of the Contec vulnerability and vulnerabilities in an array of Chinese-made medical devices could easily be life-threatening. “Imagine a patient monitor that stops alerting doctors to a drop in a patient’s heart rate or sends incorrect readings, leading to a delayed or wrong diagnosis,” Nazarovas said. The Contec CMS8000, and Epsimed MN-120 (a different brand name for the same tech), “can be used as an entry point into the hospital’s network,” Nazarovas added.

More hospitals and clinics are paying attention. Bartlett Regional Hospital in Juneau, Alaska, does not use the Contec monitors but is always looking for risks. “Regular monitoring is critical as the risk of cybersecurity attacks on hospitals continue to increase,” says Erin Hardin, a spokeswoman for Bartlett.

However, regular monitoring may not be enough as long as devices are made with poor security.

Potentially making matters worse, Kaufman says, is that the Department of Government Efficiency is hollowing out departments in charge of safeguarding such devices. According to the Associated Press, many of the recent layoffs at the FDA are employees who review the safety of medical devices. However, on Monday, the government said it was reinstating workers who focus on medical device safety, among other tasks, and who had been let go.

Kaufman laments the likely lack of government supervision on what is already, he says, a loosely regulated industry. A U.S. Government Accountability Office report as of January 2022 indicated that 53% of connected medical devices and other Internet of Things devices in hospitals had known critical vulnerabilities. He says the problem has only gotten worse since then. “I’m not sure what is going to be left running these agencies,” Kaufman said.

“Medical device issues are widespread and have been known for some time now,” said Silas Cutler, principal security researcher at Censys, a cybersecurity firm with expertise in health care and government sectors. “The reality is that the consequences can be dire – and even deadly. While high-profile individuals are at heightened risk, the most impacted are going to be the hospital systems themselves, with cascading effects on everyday patients.” CNBC

The newly constructed six-storey building of the Government Hospital in Kolathur in Chennai built at a cost of ₹210 crore and awaiting inauguration, would be named after late social reformer ‘Periyar’ E.V. Ramasamy, the Tamil Nadu government said on Sunday.

Chief Minister M.K. Stalin issued directions in this regard. He also inspected the new building during his visit to Periyar Nagar in his Kolathur Assembly constituency on Sunday. The hospital is to be inaugurated by him later this month.

Following its decision to upgrade the Government Peripheral Hospital in Periyar Nagar, the TN government laid the foundation stone in March 2023 for the construction of an additional building with three floors. Eventually, it decided to add three more floors to the building.

Mr. Stalin also visited the ‘Mudhalvar Padaippagam’, a coworking and learning space that he had inaugurated in November last year, and interacted with students there. The learning space was designed to benefit students preparing for national and State-level competitive examinations.

Ministers Ma. Subramanian, P.K. Sekarbabu and Anbil Mahesh Poyyamozhi; Chennai Mayor R. Priya; MPs A. Raja and Kalanidhi Veeraswamy and senior officials accompanied the CM during his visit. The Hindu