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The Center Holds: Vital Conversations on Public Health’s Great Stage

 

Lauren Gunderson is a playwright, screenwriter and short story author from Atlanta, GA. She received her BA in English/Creative Writing at Emory University, and her  MFA in Dramatic Writing at NYU Tisch, where she was also a Reynolds Fellow in Social Entrepreneurship. She was named the most produced playwright in America by American Theatre Magazine in 2017 and 2019, was awarded the 2016 Lanford Wilson Award from the Dramatist Guild, the 2016 Otis Gurnsey Award for Emerging Writer, and was awarded the prestigious 2014 and 2018 Steinberg/ATCA New Play Award for her play, I and You (also a Susan Smith Blackburn Blackburn and John Gassner Award finalist) and The Book of Will. That play was an NNPN Rolling World Premiere that started at Marin Theatre Company and has seen over 40 productions nationwide. She is also a recipient of the Mellon Foundation’s 3-Year Residency with Marin Theatre Company.

Gene Matthews, JD is a senior investigator at the NC Institute for Public Health, where he conducts legal research and provides technical assistance to public health practitioners on legal topics. He is also the Director of the Southeastern Regional Center of the Network for Public Health Law, which provides legal assistance on a variety of public health topics, enabling practitioners, lawyers and policymakers to apply the law to pressing public health issues. From 1979-2004, Gene worked at the CDC, serving for many years as the Chief Legal Advisor in the Office of General Counsel. Mr. Matthews received both his BA in history and mathematics and his JD from UNC. He co-instructs a course on health law and ethics for the Executive DrPH program.

Interview by Gary Gunderson

Gary Gunderson: So let me leap in to just a few days ago when Gene Matthews and I and TC were at the UNCG School of Public Health talking to 21 students who are busy becoming professionals in the work of public health. And I watched Gene Matthews, who’s one of the real deans of this entire movement, had been general counsel for the CDC under numerous sorts of crises, such as we’re experiencing now. And what he did was… we were talking about, in a theoretical manner, about the work of public health as a field of messaging, and we were sharing five years of work that we’ve done together along with some other extraordinary leaders about how we work as communicators to help speak to the public, about the public, in public, because we love the public, and that this is a field that actually is in love with the thing called public.

And what he did was he ended up moving towards poetry at the end, and I did what I frequently do in these settings, was in effect a benediction on the field of public health. And I was mulling on that and then a little bit later, Lauren, I saw your Facebook post about saying, “In this moment, we need to continue to develop the skills and strengths of actors.” And I thought, “Well, why don’t we have Lauren bring some of her extraordinary gifts as a teacher, as one who evokes the skills of those who move into public spaces and give voice to characters.”

Maybe your skills in theater could be helpful to those of us in public health, and not just formal public health, but those of us who are in roles where we are speaking into the public about the health of the public. Maybe your teaching skills could be useful to those of us in those kind of work. In effect, public health is a kind of theater, except it’s played for life and death in real time.

I know, Gene knows, Tom knows, you’re married to a virologist who gives you explicitly in time information about the viral epidemics, but I also know that as long as you’ve been writing, you’ve been curious about the work of science as drama, and much of your writing has been exploring the human drama of scientists, of those around the emerging science, and you continue to write into that field, deeply respectful of the human arts of science. So I was eager for you to be in dialogue, in sort of appreciative dialogue, with people like Gene. There are dozens and dozens of people like Gene who understand their own life as a work of leadership, evoking the strengths of human.

Yesterday when I talked to Gene sort of tuning him up for this, he went exactly to a story I actually want him to tell right now of when he was in the basement of the CDC during the anthrax situation and, lo and behold, William Butler Yeats seemed appropriate for the moment. But Gene, I want you to tell that story to Lauren a little bit.

Gene Matthews: Just cold, right off the top?

Gary Gunderson: Why not?

Gene Matthews: Well, okay. After 9/11, I was Chief Legal Officer at CDC. We probably worked somewhere, I think I counted up 57 straight days of 12 to 18 hours consecutive. Your mind does funny tricks. We didn’t have enough sense to understand about resting and pausing and pacing because we’d never been there before. And some of that’s being repeated now with coronavirus. But I ended up one late afternoon in front of a group of visitors to CDC down in the basement, and I was asked to say something, and just right out of nowhere came this line that I said to them, it’s a poetry, things fall apart the center cannot hold. And I said, “Right now during this difficult time, the center has to hold. Not the Center for Disease Control, but the center of our culture, of who we are. It has to hold together,” and we went on.

After it was over, I thought, “What was that about?” And I remembered it had to do with the Yeats poem “The Second Coming.” So this was even before you could get poetry on the internet, 2001. So one afternoon then, I went late in the evening before the Decatur Library closed, to pull down the poem and looked at it. And it really helped me. It concludes with those infamous lines, “And what rough beast, its hour come round at last, Slouches towards Bethlehem to be born.”

But reading it, and of course that’s the conclusion. The preface, it talks about the center not holding and then he describes this rough beast materializing in the desert with the body of a man and the head of a lion, and the gaze as pitiless as the sun, and wakened from 2000 years of slumber, and it slouches toward Bethlehem to be born.

But the clue to me that was valuable then and what I teach my students now, comes in that opening verse. “Things fall apart; the centre cannot hold; Mere anarchy is loosed upon the world.” And he talks about this blood dipped tide and the best lose the courage of their convictions and the worst are filled with righteous intensity, and he goes on.

So I teach my doctoral students, when I teach public health emergency law and global health law in a class, at the end I do this poem. And I said, “You have to understand, the clue to me to that poetry is mere anarchy being loosed upon the land. This is what we’re fighting right now with coronavirus. It’s what we fought then after 9/11, when we had this invisible thing we were fighting, okay? And coronavirus, you can’t see it, but it’s something there and it’s doing things now to us culturally. And my point is you in public health are the mortal enemies of anarchy. And that rough beast has much more to fear from you than you have to fear from it.

And it’s real simple and straightforward. You have the shield of all the data and all the science and all the facts, real facts—not alternate facts—real facts. And you have the sword of the ability to frame the messaging to our community that can eviscerate that rough beast. Here is what it is and here is what we know. And so it should fear you, not you fear it. And we have to have the courage of our convictions as were referenced in the poem.”

So I do that periodically. I could probably recite good portions of the poem, but you can go online now and hear William Butler Yeats on YouTube reciting it back in the 1930s. So anyway, that’s the…

Lauren Gunderson: I actually just did that thing on poetryfoundation.org. You can find “The Second Coming” and I don’t think I’d read it since high school. And it’s interesting, right after the first part of the poem, there’s a break in the line as poets use that, of course, to differentiate a turn in mood. And right after the line you quoted, the best lack all conviction while the worst are full of passionate intensity, there’s a break, and then the next line is, “Surely some revelation is at hand. Surely the Second Coming is at hand.”

Gene Matthews: The Spiritus Mundi.

Lauren Gunderson: Yes. And that sense of in that dark, complex, chaotic, uncertain world, that’s when you need the revelation and that’s when it usually comes. And it’s the laughter at the funeral that makes people realize we’re all in this together, right? It’s the candle in the darkness. It does seem that that is what we’re in the middle of. We are in the thicket of fear, well-meaning and deserved fear, and completely absurd, and everything in between. And it takes words, as funny as that is.

We developed this language as the human creatures we are, and oftentimes it’s deeply insufficient. It doesn’t describe exactly what you feel, it’s not detailed enough to give the full picture. But then sometimes it is and it really, really is exactly what you need to understand yourself and others, to put things in context. It’s such an incredible tool. It’s so perfect of you to find that in poems because poems are the most delicate and specifically intentional use of words in the human condition. So it does not surprise me that a poem shed some light for you in that strange time.

Gene Matthews: I always close my classes with a poem that resonates back to the topic of the class. I’m sort of teaching public health leadership to understand when you come to those dark moments, you’ve got to figure out something inside you, a place to go to. And you look to the arts. It can be music, it can be reading literature, poetry, going out and walking in nature, something that feeds your soul in those dark moments. And you have to find your own.

For me, I stumbled across poetry. That very worn down evening in the basement of CDC, and I’ve used poetry a lot since then. It reaches into the human learning process from a different angle, from either reading material or having lectures or engaging in dialogue. So I always do it, and part of it is that Russian principle about poetry, that poetry read aloud has ten times the impact of poetry read silently. Poetry recited from the heart, has ten times the impact of poetry read aloud. And now I’m going to give you an object lesson, and I read them, I recite most of these things. Gary’s heard me do a bunch of them. To a certain extent, it’s a parlor trick, but to a certain extent, you connect in a way that’s different, that gives meaning. The classes remember me 10 years later for the poetry. I was teaching public health law!

Gary Gunderson: You’re confirming my hunch that public health leadership is a type of theater, and theater is a type of public health leadership. Lauren, talk a little bit about that. Have there been other times when fear is loosed upon the land that theater has been part of the response of the public to hope?

Lauren Gunderson: Yeah. I think there’s a ton of examples. Part of what theater does is less give a specific answer, but examine and overturn the question, and play the question out in a dozen ways. I like to think of plays as thought experiments. So what the experiment is what would you do if the circumstances presented in this play were your circumstances? Whether they are Hamlet circumstances or Oedipus Rex, or Antigone, or any modern play. It is a chance for, as a collective congregation, and audience, to say, “Wow. What would I do? Would I do that? Maybe I would? Oh, I would never do that. Oh, that’s exactly me. That’s exactly like my friend.” It is a chance to find connectivity and play out what would I do.

So many plays, that is the crux of what makes them rigorously interesting is in your mind, why you care is because you are thinking, “What would I do if this were me or someone I loved?” So one example that was brought to my attention recently, which I had forgotten, is Shakespeare. Of course, the plague was always coming and going in London. And even as an infant, plague swept through Stratford and he could’ve died, but thankfully didn’t. And later in his life, of course, right before he wrote some of the greatest tragedies of his career, was another wave of plague that closed all the playhouses and sent everyone away.

And it’s interesting because … why I bring this up, in Romeo and Juliet, there is a major plot moment that I had completely forgotten that is directly related to the experience of plague. It doesn’t necessarily provide hope because, spoiler, Romeo and Juliet is a tragedy, doesn’t end well. Never does, no matter how many times you read it or see it. But the major critical plot point that separates and confuses our hero, Romeo, from getting to his Juliet is about plague. It is because the priest that was supposed to give him the note was quarantined because the whole city was on lockdown because of plague.

So the fundamental plot point of that play that most people, certainly in the western world, have had a chance to see or been forced to see or something is based on that common experience. So everyone would’ve known what that was like and would’ve gone ah! I think what the lesson in there … again, not necessarily a hopeful one, but an educational one, because of all of this plot, these beautiful young couple that should’ve lived so long were thwarted because of this public health issue. Maybe they’ll take quarantines more seriously. Maybe they’ll take those rats in the streets and tell somebody as soon as they see them right away. There’s a part of it that goes: This is the consequence of plague sweeping the land.

Now back then, there wasn’t a ton that you could do, but there was something, and that sense of what can we all do to better each other. That’s, I think, some of how the theater plays out these real world consequences to things that, in this case, everyone at that time would’ve had some experience with.

But I also think kind of in between theater and poetry is… I’m reminded, Dad, of your office and that poster that was so profound when I first saw it. I still think about it. It was a poster that just says, “The church has AIDS.” And those four words in bold letters is such a distillation of the power of language, the power of poetry and to me, it’s art. The idea of it is art, the presentation of it, the simplicity of it is art, and it kind of is now. The church has COVID-19, the country has COVID-19, your city has COVID. It really does … it takes language and the simplicity of language, which is again what poetry does and what theater does too, you’re really not allowed to wander too much in a play because we only have you for a few hours.

But it reminds me of that power, of the articulation of something, and the articulation of something bold. That is a thought experiment, right? What if that were true? Oh, it is true. Oh, what do I do with that? That is the entire journey of every play, are those three questions.

Gary Gunderson: Wow. So that was a poster—I’ll send y’all a picture of it—that the South African Southern Methodist Church did in the context of the HIV/AIDS pandemic long before the retrovirals were available. It was actually an extraordinary gesture. It means a lot to me, Lauren, you actually remembered seeing that. It’s actually hanging in my office today at Baptist Hospital.

So you gave an example of teaching students preparing for a career in public health. What does that have to do with people in public health right now in communities being locked down, having to make hard calls about what to do with where do you put homeless people who are coming to the emergency room and diagnosed presumptive positive, the crises that are in the moment. What does this conversation have to do with their work of public health?

Gene Matthews: It’s interesting, there’s a lot of work that was done after 9/11 and after SARS about messaging. Most of it is not being practiced right now, of course. Howard Markel, he’s the great medical historian out of Ann Arbor, Michigan, who wrote the book Quarantine! about the 1892 cholera epidemic coming into the US. And in his book he talks about the selective amnesia that sets in on a population after one of these big events, and then we come back to normal. We forget all about what… the economy starts coming back and whatever. I heard him on a podcast just recently talk about the other piece of this is in emergencies public want to hear authenticity. They want to hear from the public health leaders.

So, Lauren, not to throw rocks, but Markel’s language, they do not want to hear political theater, and they recognize it. And it is a temptation for leaders at the national, at the state or the local level, elected officials want to use their old tools that they’re comfortable with of I’m in control and I’ve got this and everything’s going to be fine. And that’s not what scared people want to hear. They want to hear in public health, from authentic leaders, and you see Tony Fauci being the person that they gravitate to. And there’s plenty of polling data now that’s referencing that. They don’t want to hear from politicians, unfortunately. They don’t, and that’s just real. So that’s one piece of it.

The other piece of it on the messaging, coming down to the granular level of a doctor who’s on an interview or a public health person who’s found in the community. It’s the work that Gary and I have been doing for about five years now, that public health can message with credibility across these political divides.

It’s a particularly American thing to let the media or politicians separate us into camps based upon our politics or our religion and a few other social indicators. But in these emergencies, we’re clearly together, and we’re exhausted. The data is clear, the population is exhausted with this political polarized food fight between the far left and the far right. It’s useful to know in these moments, in these emergencies, that number one, this is not who we are. This is what I said on the video that I did with Gary on our website. We are not a population, when it comes down to it, that wants to throw political spitballs at each other. And in an emergency like this, you can speak across these divides, and speak in ways that resonate to everyone. And you have that teachable moment. People want to hear from those who are expert in this, who have dealt with viruses, and who do not fear it.

Your husband, Lauren, is probably like me. I’ve dealt with viruses for 40 years. Now they’re something you’ve got to respect and there’s risk there, but I do not lay awake at night tossing and turning about coronavirus and COVID-19 and all of that so much as the impact of this upon our culture now. This is a severe economic blow that may resonate all the way back to the Great Depression. And again, in those moments, it was listening to something authentic and you could say Roosevelt’s fireside chats, or Churchill’s great speeches after Dunkirk were political theater. Well maybe yes, but that was a different thing. That was a totally different critter. And what we have now, what people are wanting is authentic communication from trusted people who know the facts and will shoot straight.

Gary Gunderson: We also want those trusted people to be effective communicators.

Gene Matthews: Yeah.

Gary Gunderson: And so they’re playing for life and death, but theater at its best is about life and death. So, Lauren, how would you hear this?

Lauren Gunderson: I think you’re right, Gene. I think that what people who aren’t experts in medicine and virology and pandemics, which are most of us … what we know to be true is that internal barometer of emotion and self-worth and empathy. We know when people are hurting, we know when people are scared, and that doesn’t take a degree to understand. And I think that’s why, when we see calm, scientifically minded leaders in charge, that’s why when Dr. Fauci speaks, I listen Because intuitively I know that he prioritizes science and medical integrity and population health. And so I have no doubt that he’s doing a good job with that in mind.

Theater goes back to this point of authenticity, of truth.

Gene Matthews: Yeah.

Lauren Gunderson: And Aristotle says that when you are creating character, understanding character, it is not what they say, it’s what they do that proves who they are. That’s for every person. Of course it is. You can say whatever you want, and it can be a constant stream of lies like a lot of the people in charge now, but it’s what people do that defines who they are.

What I’m seeing, and deeply inspired actually in the last couple of days, of seeing so many people find ways to reach out to their communities and to the world, a lot of it via social media. And what they are doing is staying in. What they are doing is say, “Let’s do what the CDC tells us to do.” What they are saying and doing is in alignment, and I am quite inspired by that. To me, this feels like theater on a grand level. Almost theater in the theaters of war kind of category because it’s so big and so huge and so important. But I’m seeing people do the thing, and that is theater writ large.

Yeah, and it keeps going back to these fundamental story-telling, story making ideas, which are the ends, the climactic moments of great plays is what I’ve come to call, because it helps me understand it, a character-defining choice matched with the character-defining action.

Gene Matthews: Yeah.

Lauren Gunderson: So Aristotle calls it that moment of revelation at the end of a play where some truth is revealed, some secret comes out, some notion is proved to be true in front of our very eyes, and our main character has to decide well, what do I do now? What do I do? And that defines who they are. And if it’s a tragedy, it is probably not going to be the decision we would want to do were we to be there. But there are other versions where … other genres of stories that we see the character in real time make the hard decision and do the hard thing, the hard but good thing, hard but true thing. I think that’s what we’re all in the middle of right now.

I’ve seen a lot of memes going around comparing this moment in time and our sacrifice to those of, say, my grandfather, who went to war. Which, not the same thing to sit on one’s couch and watch a little too much TV to do your part for America. But it is true. Our whole lives are being destructed right now, and all of our conveniences and all of our schedules. And I have two little kids, and so convenience and schedule is quite a big deal to us in our survival mode.

Anyway, it’s a time to act. And I think that is what theater continues to try to teach. That’s the reason why I think we came up with the whole thing at all, theater at all, is for human beings to go, “Show me somebody who does something. Show me action, show me doing, not just saying. Anybody can say, but I want to see someone do.”

Gene Matthews: Yeah. The notion to me that is setting here, wanting to be touched, it’s the revelation in these times that we are more like each other than we are different. It is the more … we listen to the social media, and the print and electronic media tends to want to divide us, and to energize us. And the algorithms drive us into anger and hyper vigilance. And we’re listening to the voices of those out on the extremes that are throwing rocks at each other.

But in the end, the moment of revelation is we are in this together, and we have more in common than we different. And those speaking speak with their own true voice, and do not fall in any of the media traps of getting sucked into arrogance or condescension. I wanted to the class last Monday, and I didn’t get a chance to, we in public health cannot afford the luxury of arrogance and condescension towards those in the communities who may have different views than we.

We have to serve all of these communities. We can speak to them. To me, that’s a powerful revelation, and we can do this. We have the ability to do this, whether it is Tony Fouci speaking to the nation or whether it’s a newly hired public health person in Chatham County going out through four different types of communities in a single day and she’s got to negotiate as she’s doing permitting and the public health meat-and-potatoes work. She has to negotiate across those divides, and she can do it. It’s the confidence, speak with your own voice.

Gary Gunderson: So Lauren, I want to give you the last few minutes as a crafter of narrative to sort of give some perspective to those of us who think we’re the actors. But the actual turn in this conversation was the actors acting for the health of the public are the public. And what we think of as the audience of our performance, actually we’re trying to write their lines, we’re trying to write their actions. That’s a pretty profound flip in the brain of those of us who may be standing on one side of the microphone. But I want to… I’m sort of curious about what kind of guidance you would give to us as a crafter of narrative.

Lauren Gunderson: I think we’re all learning from each other, but I don’t know. I’ve just been struck so much by what all of you have been saying, it makes me want to write a play. But most things make me want to write a play. But it is true, I think to Gene’s point and to your point, Dad, we are all in this together. That is why theater exists at all and why it works at all, is because if only people who were like Hamlet cared about watching Hamlet, then there would be an audience one. So we are all learning from each other’s experience, and are all, to Gene’s point, way more like each other than we think, certainly if you’re a virus. We are all way more like each other than we think.

So it may be an interesting thing to, as we continue thinking, what if the virus were writing the play? What would the virus want us to do? And then much like King Lear, we try to do the opposite of the main character, what that main character wants. We try to do the opposite of what Macbeth does because it’s a tragedy, and those are kind of poisoned characters. Some literally, but figuratively their heart is not what we hope our heat is made of.

So thinking like a virus and doing what the virus would want us to, snuggle right up together and share and cough and pretend that this isn’t a big deal and keep going and defy the virus, you can’t tell us what to do. And to Gene’s point, it would want us to be cocky and mean to each other and judge each other. And as I’m saying that, doesn’t that sound like an interesting play? Wow, what a great role for a villain. You get to be Iago, this virus is Iago. Villains are very fun to watch, they’re our favorite characters. We love Iago. Oh, man, what a great role and so delicious in its villainy. But in the ultimate fact, do you want Iago as a friend? Nope, absolutely not.

So thinking in terms of this virus, not necessarily as a total villain, because the truth is great villains actually have a soft side, and the thing that they are after, that is understandable. And so we can kind of understand and respect this virus and the way it spreads but also know that we can be better and we can make better choices. Our character defining choice can be the one that you and other public health figures would want us to do.

Because the truth is it’s all about how it ends, right? Every play is only as good as its ending. And we want this ending to be a triumphant one, one where we all come out the other side and say, “We may have lost some people, but we learned, and we’re better, and we’re stronger now, and we respect what we’ve been through.” So let’s hopefully project a good ending and will ourselves there. We’re all the playwrights now. We’re all writing towards the happy ending.

Gary Gunderson: Beautiful. So Lauren, the reality is we’re not talking in the abstract. The mother of my two grandsons is in the first city in the United States to go into a lockdown. You’re sheltering at home. What’s the drama you’re living in?

Lauren Gunderson: Yeah. It’s a bit surreal. I think everyone has that word on the brain. Also it makes sense. I think this is the right thing. I keep actually being floored that cities are taking major measures to stop this thing. I’m kind of blown away that even though our country is slower on the uptake, but we are doing it. Governors and mayors of cities are stepping up and saying, “Let’s do major initiatives to try to quell this thing.” And so I’m impressed, I’m grateful. But the reality is it’s very odd.

I’m a theater professional. I gather, that’s what we do. We gather together, the togetherness and the live presence of it is what makes us so valuable to society and so different than anything streamed or downloaded or watched on a screen. So it is a hard reality.

It’s interesting. The boys know about it. They understand that there is a virus, and that we are trying to stop it. So they fancy themselves a bit superheroes. We shall stop this. And one thing that happened a couple of days ago was they brought the news home with them from school about the virus and they asked Nathan about it, and my husband of course, being the virologist that he is, said, “Let’s take a look at it.” So he pulled up pictures, electron microscope pictures of it, and the boys asked questions about it. Why is it called a coronavirus? Well, corona means crown and so it looks like it has a crown, and here’s how it works with a cell, and here’s how it gets in, and here’s this and that. So the value of teaching and storytelling was very present in that moment. And they now understand it. In fact, they said, “Let’s make crowns because of the coronavirus,” so we made little crowns out of paper yesterday.

Yeah, it’s scary when you think about the people around us all. All of our restaurants are closed except for take-out, schools are closed, there are so many people who are terrified because work is stopped, and kids are home, and it’s a very real, overwhelming feeling. I don’t quite know what to do with it. We just started lockdown, this is day one of lockdown. So it went into effect at midnight. And the reality of yeah, we’re not supposed to go anywhere now is different than well, maybe try not to go our very much, but keep your hand sanitizer nearby if you do. I’m like, “No, we’re supposed to not go anywhere.” Yeah. I don’t know. It’s a weird time. I think nobody knows quite how it’s going to feel. I think the first days will be one feeling, and then the next three weeks will be a very different feeling.

Gary Gunderson: That’s it.

Lauren Gunderson: But taking care of people, checking in on people, I am grateful for all of the social media suddenly. I’m grateful for FaceTime and Zoom and all of them, Twitter and Facebook even. I’m grateful that there’s a way for people to be in constant contact. A friend of mine and colleague, Sean Daniels, is a recovering alcoholic, and he reached out specifically online saying that this is a very hard time for those in recovery, being isolated in these extraordinary circumstances, anxious times. And so he made himself available to anyone to call if they needed, because the meetings are shut down. There’s no AA meetings, at least in our cities.

So the real acts of generosity are starting to come through, which that is the course of humans, oddly. When things are okay, we can be quite cruel to each other. But when they’re not, you really see some of the best of people, which makes me think we’re going to be okay in the end.

Gary Gunderson: Of course, I’m very grateful for Gene Matthews, one of our great teachers of the arts and crafts of public health, the great theater of the public. And especially to my daughter, Lauren, a produced American playwright, and we can see why in her enormous sensitivity to the human drama in all its forms, even those parts of the human drama that don’t think of themselves as theater at all. So thank you, Lauren, for this time and I look forward to talking to some others of our great heroes of public health in this moment who are helping us remember who we are in what to do in this moment of crisis.

 

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