By ARIEL FERNÁNDEZ, ANDREA RODRÍGUEZ and JOHN MYERS JR., Associated Press

SANTIAGO DE CUBA, Cuba (AP) — People across the northern Caribbean were digging out from the destruction of Hurricane Melissa on Thursday as deaths from the catastrophic storm climbed.

People stay inside a shelter for families displaced by gang violence, flooded by rain brought by Hurricane Melissa, in Port-au-Prince, Haiti, Wednesday, Oct. 29, 2025. (AP Photo/Odelyn Joseph)

The rumble of large machinery, whine of chainsaws and chopping of machetes echoed throughout southeast Jamaica as government workers and residents began clearing roads in a push to reach isolated communities that sustained a direct hit from one of the most powerful Atlantic storms on record.

Stunned residents wandered about, some staring at their roofless homes and waterlogged belongings strewn around them.

“I don’t have a house now,” said a distressed Sylvester Guthrie, a resident of Lacovia in the southern parish of St. Elizabeth, as he held onto his bicycle, the only possession of value left after the storm.

“I have land in another location that I can build back, but I am going to need help,” the sanitation worker pleaded.

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Emergency relief flights began landing at Jamaica’s main international airport, which reopened late Wednesday, as crews distributed water, food and other basic supplies.

“The devastation is enormous,” Jamaican Transportation Minister Daryl Vaz said.

Some Jamaicans wondered where they would live.

“I am now homeless, but I have to be hopeful because I have life,” said Sheryl Smith, who lost the roof of her home.

Authorities said they have found at least four bodies in southwest Jamaica.

Prime Minister Andrew Holness said up to 90% of roofs in the southwest coastal community of Black River were destroyed.

“Black River is what you would describe as ground zero,” he said. “The people are still coming to grips with the destruction.”

More than 25,000 people remained crowded into shelters across the western half of Jamaica, with 77% of the island without power.

Death and flooding in Haiti

Melissa also unleashed catastrophic flooding in Haiti, where at least 25 people were reported killed and 18 others missing, mostly in the country’s southern region.

A woman lies inside a shack flooded by rain brought by Hurricane Melissa at a shelter for families displaced by gang violence in Port-au-Prince, Haiti, Wednesday, Oct. 29, 2025. (AP Photo/Odelyn Joseph)

Steven Guadard, who lives in Petit-Goâve, said Melissa killed his entire family.

“I had four children at home: a 1-month-old baby, a 7-year-old, an 8-year-old and another who was about to turn 4,” he said.

Haiti’s Civil Protection Agency said Hurricane Melissa killed at least 20 people in Petit-Goâve, including 10 children. It also damaged more than 160 homes and destroyed 80 others.

Officials warned that 152 disabled people in Haiti’s southern region required emergency food assistance. More than 11,600 people remained sheltered in Haiti because of the storm.

“It is a sad moment for the country,” said Laurent Saint-Cyr, president of Haiti’s transitional presidential council.

He said officials expect the death toll to rise and noted that the government is mobilizing all its resources to search for people and provide emergency relief.

Slow recovery in Cuba

Meanwhile, in Cuba, people began to clear blocked roads and highways with heavy equipment and even enlisted the help of the military, which rescued people trapped in isolated communities and at risk from landslides.

People recover belongings from a home flooded by Hurricane Melissa in Santiago de Cuba, Wednesday, Oct. 29, 2025. (AP Photo/Ramón Espinosa)

No fatalities were reported after the Civil Defense evacuated more than 735,000 people across eastern Cuba. They slowly were starting to return home.

The small, iconic town of El Cobre in the eastern province of Santiago de Cuba was one of the hardest hit by Hurricane Melissa.

Home to some 7,000 people, it is also the site of the Basilica of Our Lady of Charity, patron saint of Cuba and deeply venerated by Catholics and practitioners of Santería, the Afro-Cuban religion.

“We went through this very badly. So much wind, so much wind. Zinc roofs were torn off, some houses completely collapsed. It was a disaster,” said Odalys Ojeda, a 61-year-old retiree, as she looked up at the sky from her living room where the roofing and other parts of the house were ripped off.

Even the Basilica was damaged.

“Here at the sanctuary, the carpentry, stained glass and even the masonry suffered extensive damage,” Father Rogelio Dean Puerta said. “The town was also badly affected. Many people lost their homes and belongings. We need help.”

In the more rural areas outside the city of Santiago de Cuba, water remained accumulated in vulnerable homes on Wednesday night as residents returned from their shelters to save beds, mattresses, chairs, tables and fans they had elevated ahead of the storm.

A televised Civil Defense meeting chaired by President Miguel Díaz-Canel did not provide an official estimate of the damage. However, officials from the affected provinces — Santiago, Granma, Holguín, Guantánamo, and Las Tunas — reported losses of roofs, power lines, fiber optic telecommunications cables, cut roads, isolated communities and losses of banana, cassava and coffee plantations.

Officials said the rains were beneficial for the reservoirs and for easing a severe drought in eastern Cuba.

Many communities were still without electricity, internet and telephone service due to downed transformers and power lines.

A historic storm

When Melissa came ashore in Jamaica as a Category 5 hurricane with top winds of 185 mph on Tuesday, it tied strength records for Atlantic hurricanes making landfall, both in wind speed and barometric pressure. It was still a Category 3 hurricane when it made landfall again in eastern Cuba early Wednesday.

A hurricane warning remained in effect Thursday for Bermuda. An earlier warning for the central and southeastern Bahamas was lifted but the U.S. weather agency warned of additional rainfall up to 10 inches.

Hurricane conditions were expected to continue through the morning in the southeastern Bahamas, where dozens of people were evacuated.

Melissa was a Category 2 storm with top sustained winds near 105 mph Thursday morning and was moving north-northeast at 21 mph according to the U.S. National Hurricane Center in Miami.

The hurricane was centered about 295 miles northeast of the central Bahamas and about 605 miles southwest of Bermuda.

Melissa was forecast to pass near or to the west of Bermuda late Thursday and may strengthen further before weakening Friday.

Rodriguez reported from Havana and Myers Jr. reported from Kingston, Jamaica. Associated Press reporters Dánica Coto in San Juan, Puerto Rico, and David Constantin in Petit-Goâve, Haiti, contributed to this report.

By ALI SWENSON and OBED LAMY, Associated Press

MINOOKA, Ill. (AP) — Bill Swick has a rare degenerative brain disease that inhibits his mobility and speech. Instead of the hassle of traveling an hour to a clinic in downtown Chicago to visit a speech therapist, he has benefited from virtual appointments from the comfort of his home.

But Swick, 53, hasn’t had access to those appointments for the last month.

Bill Swick looks at his wife Martha Swick at their home in Minooka, Ill., Friday, Oct. 24, 2025. (AP Photo/Nam Y. Huh)

The federal government shutdown, now in its fifth week, halted funding for the Medicare telehealth program that pays his provider for her services. So, Swick and his wife are practicing old strategies rather than learning new skills to manage his growing difficulties with processing language, connecting words and pacing himself while speaking.

“It’s frustrating because we want to continue with his journey, with his progress,” 45-year-old Martha Swick, a caregiver for her husband since his diagnosis three years ago, said during an interview at their home in Minooka, Illinois. “I try to have all his therapy and everything organized for him, to make his day easier and smoother, and then everything has a hitch, and we have to stop and wait.”

Their experience has become common in recent weeks among the millions of patients with Medicare fee-for-service plans who count on pandemic-era telehealth waivers to attend medical appointments from home.

With Congress unable to agree on a deal to fund the government, the waivers have lapsed, even with support from Republicans and Democrats. As a result, medical providers are deciding whether they can continue offering telehealth services without the guarantee of reimbursement or whether they need to halt virtual visits altogether.

That’s left a patient population of mostly older adults with fewer options to seek specialists or get help when they can’t physically travel far from home.

Bill Swick, right, looks around while study with his wife Martha Swick at their home in Minooka, Ill., Friday, Oct. 24, 2025. (AP Photo/Nam Y. Huh)

Swick, whose corticobasal degeneration causes symptoms similar to Parkinson’s disease, can’t feed or dress himself anymore and struggles with balance and walking. Add on the logistical nightmare of driving to the city in traffic, and in-person speech therapy appointments aren’t a worthwhile ordeal for him and his wife.

But missing even a few appointments can impede progress for patients with dementia and other degenerative conditions who depend on continuity of care, experts said.

It “feels like you’re taking a step back,” Swick said in the interview.

A temporary pause, with significant impact

Before the COVID-19 pandemic, Medicare only paid for virtual medical appointments under narrow circumstances, including in designated rural areas and when patients logged in from eligible sites, like hospitals and clinics.

That changed in 2020, when Trump’s first administration dramatically expanded telehealth coverage in response to the public health emergency. Medicare started reimbursing a wide range of telehealth visits, stripping the geographic requirement, and allowing patients to take calls from their homes.

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Congress has routinely extended the telehealth flexibilities and was poised to do so again before their Sept. 30 expiration. But when budget negotiations stalled and the government shut down Oct. 1, the vote never happened, leaving the program temporarily unfunded.

With more than 4 million Medicare fee-for-service beneficiaries using telehealth in the first half of 2025, according to Brown University’s School of Public Health, the pause has had a major impact on an already vulnerable population.

Swick’s speech therapy services are provided by the Chicago-area business Memory and Aphasia Care. Owner Becky Khayum said many of her clients are in different cities and states and sought her therapists out because they specialize in frontal temporal dementias.

“Now suddenly without telehealth services, they do not continue to have the support to participate in those activities that are so important to them,” Khayum said. “The risk is we could see social withdrawal; we could see depression and anxiety increased.”

Virtual visits can also be useful in different areas of medicine. Dr. Faraz Ghoddusi, a family medicine provider in Tigard, Oregon, said he uses telehealth to check in and help his patients manage their conditions, like diabetes and chronic lung disease. He said that in the current Medicare telehealth pause, one of his patients wasn’t having regular check-ins and ended up in the emergency room.

Susan Collins, 73, in Murrieta, California, said Medicare-reimbursed telehealth appointments were a “tremendous relief” to her when she was a full-time caregiver for her late husband, Leo. Before he died last year from progressive supranuclear palsy, a rare brain disorder, she struggled to lift him from his wheelchair in and out of the car for his in-person doctor visits 60 miles from their home.

“He was much safer at home,” Collins said, noting that telehealth was a useful resource when her husband needed a medication or symptom consultation but not a complete physical exam.

Doctors respond differently, leaving a patchwork

The latest guidance from the Centers for Medicare and Medicaid Services does not ban medical providers from providing telehealth services during the lapse – but it stops short of promising they’ll be reimbursed if they do.

In response, providers are deciding whether they can absorb the risk of continuing care without assurance that they’ll be paid for it when the government reopens.

Khayum in Illinois said she had to stop providing telehealth services to Medicare patients because her small business couldn’t handle the volatility of potentially losing out on payments. Ghoddusi, the family medicine provider, said his Oregon practice is honoring telehealth appointments made before Oct. 1 but not scheduling additional ones for Medicare patients until the funding is restored.

Genevieve Richardson, owner of a speech pathology business in Austin, Texas, has stopped providing telehealth services to her Medicare clients who are spread across the country. She has been referring them to outpatient clinics in their areas who can provide stopgap services in person.

Major hospitals are also grappling with whether to provide virtual care to Medicare patients. Dr. Helen Hughes, medical director of the Office of Telemedicine at Johns Hopkins Medicine, said the hospital initially continued the care, but paused scheduling more Medicare telehealth visits as of Oct. 16 as the shutdown continued.

She said the uncertainty surrounding the waivers has been “a total roller coaster.”

The congressional stalemate persists

The government shutdown is in its fifth week with no clear end on the horizon. Meanwhile, Medicare telehealth flexibilities and a separate Medicare program offering patients hospital-level care at home both remain paused.

Mei Kwong, executive director of the Center for Connected Health Policy, said the simplest solution to renewing the telehealth waivers would be for Congress to vote separately on them.

The hands of federal health care administrators “are kind of tied,” she said. “So, you really do need Congress to act.”

But with lawmakers divided and looking for leverage, hopes for such action are low.

Martha Swick, practicing word exercises with her husband in their home on a recent morning, said if a solution isn’t found soon, “my resource collection is going to run out.”

“I’m just doing what I’m able to at home as a wife and a caregiver,” she said. “But eventually I’m really going to need those appointments to come back.”

Swenson reported from New York.

St. Paul voters heading to the polls Nov. 4 will see a ballot question on an operating levy for St. Paul Public Schools that would increase the district’s per-pupil revenue.

Here’s what that means, why it’s on the ballot and what its approval could mean for property owners.

What is on the ballot?

Voters will be asked to vote yes or no on an increase to the district’s general revenue by $1,073 per pupil for 10 years, beginning with taxes payable in 2026. The result will cost the average St. Paul homeowner — with the median home valued at $289,200 — $309 per year, or $26 per month. The 10-year tax is subject to increase with inflation.

The ballot language will read:

“The board of Independent School District No. 625 (Saint Paul), Minnesota has proposed to increase the School District’s general education revenue by $1,073 per pupil, subject to an annual increase at the rate of inflation. The proposed new referendum revenue authorization would be first levied in 2025 for taxes payable in 2026 and applicable for ten (10) years unless otherwise revoked or reduced as provided by law.”

What does that mean?

If approved, the levy would raise $37.2 million annually for 10 years for St. Paul Public Schools, adjusted each year for inflation.

The funds would become part of the district’s general fund, which covers staff salaries and benefits, utilities and maintenance, transportation, curriculum, classroom equipment and administrative costs.

Previous levies

Voters approved similar requests for additional funding in 2018, 2012 and 2006. The 2018 levy gave the district $1,180 per student, or $18.6 million per year plus inflation, in new revenue. The 2018 levy — a 10-year levy — wasn’t earmarked for specific projects, but was meant to protect existing programs from further cuts while helping to pay for a district-wide strategic plan.

The levy referendum on the ballot in November would not revoke and replace the 2018 approved levy, which currently provides $1,167 per student, but will add onto it, according to Tom Sager, the district’s executive chief of financial services. Under state law, the school board could then choose to approve a one-time renewal of the 2018 levy as it’s set to expire without needing to bring it ahead of voters.

How much more will homeowners pay?

While the average St. Paul homeowners with a median-value home would see a $309 per year, or $26 per month, increase in their property taxes if the levy is approved, property owners won’t know the total changes to their property taxes for next year until city, county and school district levies are finalized in December.

How much to expect with city, county and school levies?

If the proposed city, county and school district levies are approved, including the special school district referendum, homeowners in St. Anthony Park, Battle Creek, Sunray, Highwood and downtown St. Paul would see their property taxes go up the least of any neighborhoods in the city, percentage-wise, while still seeing hikes of several hundred dollars.

Homeowners in the North End, Payne-Phalen, Thomas-Dale/Frogtown and the West Side neighborhoods would see their property taxes go up the most percentage-wise.

St. Paul schools levy for 2026

In September, the St. Paul school board approved a property tax levy at 1.98% less than the previous year as part of an annual process. That number will be finalized in December, but cannot be raised any higher. The tax is for 2026. Impacts on individual homeowners will depend on property values and doesn’t guarantee a 1.98% decrease on their property taxes that go to the district.

Why is this question on the ballot?

Without additional funding from the proposed levy, district officials say they expect to make at least $37 million budget cuts for the 2026-27 school year. If approved by voters, the increase will generate approximately $37.2 million per year in additional revenue.

The school board approved a $1 billion budget in June for 2026 with an estimated $51.1 million budget shortfall, which the district planned to cover using $35.5 million in reserve funds and $15.6 million in budget cuts and new revenue, including funds from the levy.

Budget reductions for 2026 have mainly come from cuts in the district’s central office departments, which make up 8% of the district’s total budget.

Funding from the proposed levy would help maintain programming such as arts and music, college- and career-readiness and language and culture initiatives, according to SPPS Superintendent Stacie Stanley.

Transportation, security and academic support services also face reductions if the district is not able to find additional revenue, according to district officials. However, anything is on the table for potential cuts, they say.

Further background

Local property taxes account for around 20% of the SPPS budget and the district currently spends more than $23,000 per pupil each year.

District officials attribute its budget shortfall to state funding not keeping pace with inflation in the past 20 years as well as increased expenses.

If state funding kept pace with inflation each year since 2003, the district would receive $1,470 more per student than it currently does, or approximately $50 million per year, according to district officials.

There is also uncertainty around potential cuts in federal funding and other revenue losses. Dropping enrollment, which is forecasted based on demographic trends, could add additional financial stress to the district, which receives state funding per pupil.

St. Paul schools officials have worked hard to get the word out on the levy referendum, using tax dollars to do so.

For more information on the 2025 election, including how to vote and information on candidates and ballot questions, go to twincities.com/news/politics/elections.

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Chinda Gregor’s first memory is of the jungles in her native Cambodia where she hid with her mother from the genocidal Khmer Rouge regime, which seized power as the American war in neighboring Vietnam entered its final days in 1975.

After narrowly escaping execution, the pair fled the country after the regime fell nearly four years later. They joined thousands of other refugees from Southeast Asia who immigrated to Minnesota in the wake of the Vietnam War.

Fifty years after the fall of Saigon, their stories will be highlighted during a two-day commemoration of the war’s end at Union Depot in St. Paul this weekend.

“I really want people to know why the Southeast Asian community is here,” said Gregor, who is now a teacher at Bloomington Public Schools. “The Cambodian genocide happened because of the Vietnam War.”

This weekend’s commemoration, which was organized by the Minnesota Humanities Center and the Minnesota Historical Society, will weave together the distinct yet related experiences of four local Southeast Asian communities — Hmong, Lao, Cambodian and Vietnamese — with those of U.S. military veterans to tell the complex story of the war and its aftermath.

“It still reverberates in people’s lives here in Minnesota and throughout the country,” MHC CEO Kevin Lindsey said of the Vietnam War. “You see people still carrying some of the scars.”

Two days of events

This weekend’s free events will feature performances by Hmong, Lao, Cambodian and Vietnamese dancers, musicians and storytellers. Food vendors also will be selling Southeast Asian cuisine.

The programming will run from noon to 7 p.m. on Saturday and 10 a.m. to 5 p.m. Sunday. A full schedule can be found on the MHC website.

MHC and MNHS brought together members of four local Southeast Asian communities and U.S. military veterans to help plan the weekend’s events.

Among them was Larry Johnson, who served as an Army medic in Germany during the Vietnam War and now volunteers with the Minnesota-based Veteran Resilience Project.

Johnson said he hopes the commemoration will raise awareness of the service of Southeast Asian veterans who fought alongside U.S. troops during the war but were long denied the recognition and benefits afforded to American service members.

“They’re still fighting for that recognition,” Johnson said. “That’s a travesty in my opinion.”

Each day’s programming will be anchored by a film screening and panel discussion, Lindsey said.

Saturday’s events will begin with “America’s Secret War,” a Twin Cities PBS documentary about the American military campaign into Laos during the Vietnam War and the Hmong troops who fought for the U.S. Minnesota is now home to the largest Hmong population in the country.

Sunday’s film will be another Twin Cities PBS documentary called “A Time to Heal,” which explores the service of women who worked as nurses during the Vietnam War.

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Lindsey said the experiences of Minnesota’s Southeast Asian immigrants offer lessons for the United States as the country welcomes refugees from more recent wars.

Gregor, who also served on the event’s advisory committee, said she hopes those who attend the commemoration will come away with a greater willingness to “give people grace and not judge people by the color of their skin.”

“We work hard,” she said of refugees. “We came with nothing. This is our country, this is our home now.”