We’re worlds apart, but like Harry I had to face up to depression

Turning the corner into my mother-in-law’s street some years ago, it hit me. Michael’s car wasn’t there. Which meant Michael wasn’t there. And Michael wasn’t there because he was gone and none of us would ever see him again. We wouldn’t hear him laugh, we would never again be the butt of his jokes and none of us would share again in his generosity.

The moment of that dreadful realisation came back last week, reading Prince Harry’s comments about mental health and his battle with bereavement. Although our circumstances couldn’t be more different – my issues manifested themselves on a north Manchester council estate, rather than in a royal residence – the feelings of loss and subsequent pain will have been very similar.

We used to gather at Michael’s mam’s to watch United on television. It was always a happy family get-together, where brews and gags flowed, with the crowd noise from the television acting as a backing track to the pantomime taking over the living room. And Michael was always at the centre of it.

Parking that day, I had to stay in the car to stop myself from crying. For the previous month or so I hadn’t allowed any emotion in. I couldn’t. I had been concentrating on organising the funeral and getting legal advice on what would happen to his “assets”. I’d had to search his home for an eclectic array of items – from bank statements to a T-shirt my wife had bought him for a birthday.

I had flashbacks to when I entered his house in the days after his death. I’d drawn the short straw, as his closest friends were too upset to go back to the house after they had found him dead. Refusing to believe he was gone, his best friend had attempted to hold Michael, screaming at him to wake up. On the wall opposite, Michael had written in black marker pen: “I’M SORRY!”

My father-in-law accompanied me on that visit, as we stepped over hundreds of unopened letters littering Michael’s hallway. Stubbed-out cigarettes covered the floor. My father-in-law, a man’s man from a notoriously tough area of Manchester, sobbed on my shoulder and stammered: “Our Michael … Dear God …”

I wouldn’t allow my father-in-law upstairs as I had a rough idea of the scene that would greet me as I stepped on to the landing. The means for his suicide had not been cleared away and that message on the wall was jumping out like a neon sign.

‘As Prince Harry has proved, it doesn’t matter what your background or circumstances, mental illness can hit anyone.’ Photograph: Chris Jackson/Getty Images

Searching his belongings, I found evidence that his benefits had been sanctioned, due to him missing one appointment. The bastards had cut his every means of financial support because he had failed to attend one meeting. He hadn’t wanted to claim dole. He had worked most of his life, as a fitter, but he couldn’t stick being patronised by people who were less intelligent than him, so he gave up job after job.

His depression was a big part of this. But still he didn’t get help. However much we all tried to engage him, he shrugged us off. He only went to the doctor to discuss his problems when the dole office required proof he had a mental illness. They still wanted him to take unpaid work.

In the spare room, there was a pile of CVs aimed at charities to secure this “free labour” imposed by the benefits system. I found a certificate from the Open University. He had achieved a first-class honours degree in applied mathematics and he’d never told any of us. We knew he was doing a course, but he was bashful about it. In marking his work, his tutors were glowing in their predictions of a bright future that never came. In a drawer by his bed I found pictures of family, of past loves and happy times he had spent travelling the world.

He had no money left. Since the dole had cut him off, he was relying on a credit card to buy food. Too proud to ask for help, the alarm bells rang in the week before his death when he accepted a tenner from his mam. Previously he would never accept a pint from anyone, never mind money.

He told us he was depressed one Christmas after an uncharacteristic outburst. It was a shock as he was your typical Manchester “lad” in his mid-40s – tough, hard-working, streetwise and the life and soul of any social situation from parties to ordering a McDonald’s breakfast.

Despite our best efforts, we couldn’t help him. It haunts us daily. My wife and I had spoken during the week of his death about doing a Tesco shop for him, to make sure he was eating. Life got in the way.

Instead, I took the phone call that will forever crush me. Michael’s mam, my mother-in-law, rang our landline, which was a sign something was amiss, and tearfully delivered the news that Michael had taken his own life. While my wife was still half asleep, standing in our kitchen, her dad broke down as he told her the devastating news.

Conversely, I began to think practically. I needed to make all the arrangements to make it easier for the family. I didn’t grieve for one second.

This was all stored away in my head. I had never spoken about any of it, as his family and wide circle of friends were collectively distraught and I didn’t want to make it worse.

No stranger to bereavement – on the last count I had lost 12 close friends and family members by the age of 35 – I’d endured so much loss that I had become blasé about death. This was not healthy. At least this parked emotion was starting to reveal itself months later, even if I must have looked deranged, shaking and tearful in a car outside my mother-in-law’s.

At that point I made the decision to seek help. After braving a trip to the doctor, which in itself was an ordeal of self-loathing, I was put in touch with a service run by Greater Manchester Mental Health NHS foundation trust in Salford, where I lived.

There was a waiting list, one experience I doubt Harry shared with me, and the days dragged as I battled to keep myself together for the sake of my family. Although I was more accepting of mental health issues than Michael had been, like many men I had never been comfortable talking about anything even semi-serious regarding feelings and emotions.

My first session with a therapist was painful for both of us. She was lovely, reassuring and patient, but I believed I was ungrateful to feel depressed when I had a lovely family, a job, my own home and my physical health. I also thought death was part and parcel of life, so common had it been for me.

My therapist was clearly shocked by my dismissive outlook and she told me it was no wonder I was experiencing depression. It was the first time in my life that someone had told me that I had every right to feel bad. She told me there was a reason for it all and it wasn’t punishment for anything. Until that moment I thought I was weak, spoiled and selfish for feeling down, when so many other people in the world had nothing.

Those sessions and my therapist’s kindness fundamentally changed my life. After this treatment, I went on a Recovery Academy course, also run by GMMH, which allowed me to converse with other people with depression and feel humbled by their inspiring stories of survival.

I became open about my depression. I still take medication, but now I am happy to talk about it and that helps. I have even ended up working in mental health, as I wanted to help others and prevent other families going through what we had endured.

Before engaging in the help available through the NHS, I had been unable to write about Michael’s death. I tried so many times. I just couldn’t do it. But facing up to my need for help allowed my mind to become freer and I was finally able to put pen to paper, which has served a therapeutic role in itself.

Whenever I am at my mother-in-law’s now, I look up to the wall above the dining table, where she has a framed picture of Michael from our wedding day. I look up and I wink to him and thank him for the time we spent together.

We will always miss him, but his experience can act as an example of the importance of getting help. Our family’s resilience shows there is hope, if only we seek assistance. As Harry has proved, it doesn’t matter what your background or circumstances: mental illness can hit anyone.

In the UK, The Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here

We’re worlds apart, but like Harry I had to face up to depression

It"s good to talk: pupils gather for world"s largest mental health lesson

“Talking about mental health does not make you weak,” the world’s largest mental health lesson has been told. Til Wykes, a clinical psychologist, told an audience of more than 500 13-18-year-olds from around the country: “We want to get people to come to treatment early because if they come early, they recover faster and they recover better.”

The event on Tuesday at Hackney Empire in east London, compered by the 4Music presenter Maya Jama, was designed to teach children and young people about what mental health is, how to protect it and deal with problems when they arise. Officially recognised as the Guinness World Record for the largest-ever mental health lesson, with 538 young people present, the hope is that it also raises general awareness about the issue among young people and helps combat the stigma surrounding it.

There were gasps from the pupils as they heard one in 10 five-to-16-year-olds have mental health problems, amounting to 850,000 children, and 75% do not get the help they need.

Wykes, who works at King’s College London, told pupils that in a class of 30 that meant on average three would have mental health problems at some point – or possibly more as the current estimate of one in 10 is believed to be out of date – so they were all likely to be touched by the issue in some way.

Dame Til Wykes, who helped organised the event, said if people come early, they recover faster and they recover better. Photograph: Martin Godwin for the Guardian

Hussain Manawer, the poet, mental health campaigner and soon-to-be astronaut who organised the event with Wykes, told the audience: “If you are going through something you need to speak to someone about it, but if you don’t feel comfortable about talking to your friends then maybe you need to evaluate who your friends are.”

Video messages of support from a host of celebrities were played and there was even backing from the Duke and Duchess of Cambridge and Prince Harry, who stressed “how important it is to talk about mental health”.

Manawer, who has his own YouTube channel, Hussain’s House, and has just released his first single, I’m ashamed, also drafted in entertainers to talk in person about mental health and entertain the children after the formal part of the lesson, which conformed to strict rules dictated by Guinness World of Records, including no toilet breaks or talking by pupils, except when asked to respond.

The 30-minute lesson touched on famous figures of the past such as Virginia Woolf, Isaac Newton and Winston Churchill who have suffered from depression, alongside contemporary names such as JK Rowling, Professor Green and Kelly Holmes, illustrating that being successful does not offer immunity from depression.

Pupils were told that that in a class of 30 on average three would have mental health problems at some point. Photograph: Martin Godwin for the Guardian

The dangers of cannabis – particularly high THC skunk – were also discussed, the damage done by using pejorative terms to describe people with mental health problems and the importance of sleep, as well as how staying online at bedtime has the potential to disrupt it. The audience was told about the importance of communication and the services offered by the Samaritans, Childline and Young Minds.

After the lesson, the pupils were entertained by the YouTube comedian Humza Arshad, Jordan Stephens (one half of hip-hop duo Rizzle Kicks) and singer Sinéad Harnett, although there were still serious points to be made.

“Hear me, I would have this [subject] on the national curriculum, I have no idea why it’s not,” said Danny-Boy Hatchard, who played Lee Carter – a character with mental health problems – in EastEnders. “Not all of us will use the circumference of a circle or algebra [but everyone will use this].”

It"s good to talk: pupils gather for world"s largest mental health lesson

Tsimané of the Bolivian Amazon have world"s healthiest hearts, says study

A high carbohydrate diet of rice, plantain, manioc and corn, with a small amount of wild game and fish – plus around six hours’ exercise every day – has given the Tsimané people of the Bolivian Amazon the healthiest hearts in the world.

It may not be a life that everyone would choose. The Tsimané live in thatched huts with no electricity or modern conveniences. Their lives are spent on hunts that can last for over eight hours covering 18km for wild deer, monkeys or tapir and clearing large areas of primal forest with an axe, as well as the gentler pastime of gathering berries.

But as a result of this pre-industrial lifestyle, the Tsimané have hardly any hardening of the arteries. Heart attacks and strokes, the biggest killers in the US and Europe, are almost unknown.

The study published in the Lancet medical journal and being presented at the American College of Cardiology conference shows that an 80-year-old Tsimané man has the vascular age of an American in his mid-50s.

Researchers, who investigated the lifestyles of the Tsimané and checked out their arteries with CT scanners, say that there are lessons for those of us who live sedentary lives in urban areas and eat packaged foods.

“This study suggests that coronary atherosclerosis [hardening of the arteries] could be avoided if people adopted some elements of the Tsimané lifestyle, such as keeping their LDL cholesterol, blood pressure and blood sugar very low, not smoking and being physically active,” said senior cardiology author Dr Gregory S Thomas from Long Beach Memorial Medical Centre in the US.

“Most of the Tsimané are able to live their entire life without developing any coronary atherosclerosis. This has never been seen in any prior research. While difficult to achieve in the industrialized world, we can adopt some aspects of their lifestyle to potentially forestall a condition we thought would eventually effect almost all of us.”

Coronary atherosclerosis is the build-up of plaque in the arteries leading to the heart, which slows the blood flow and can cause blood clots – which may in turn lead to a heart attack. The researchers found that almost nine out of 10 of the 705 Tsimané adults who took part in the study had no risk at all of heart disease; 13% had a low risk and only 3% – 20 individuals – had moderate or high risk.

Even in old age, 65% of those aged over 75 had almost no risk and only 8% (four out of 48) had a moderate to high risk. By contrast, in the US, a study of more than 6,800 people found that half had moderate to high risk – five times as many as among the Tsimané people – and only 14% had no risk of heart disease at all.

In the Tsimané population, heart rate, blood pressure, cholesterol, and blood glucose were also low. The study suggests that genetic risk is less important than lifestyle. “Over the last five years, new roads and the introduction of motorised canoes have dramatically increased access to the nearby market town to buy sugar and cooking oil,” said Dr Ben Trumble, of Arizona State University, US. “This is ushering in major economic and nutritional changes for the Tsimané people.” Those whose lifestyle is changing have higher cholesterol levels than others who stick to hunting and fishing.

Senior anthropology author Prof Hillard Kaplan, from the University of New Mexico, said the loss of subsistence diets and lifestyles could be classed as a new risk factor for vascular ageing. “We believe that components of this way of life could benefit contemporary sedentary populations,” he said.

Tsimané people are more likely to get infections than those in the US, but even so, he said, “they have a very high likelihood of living into old age.”

The researchers cannot yet say whether diet or the active lifestyle is the more important component, said Kaplan, but they want to go on to investigate that by following those of the community whose lifestyles change with exposure to the town. “My best guess is that they act and they interact,” he said.

And it could be as much the foods that the Tsimané do not eat that gives them healthy hearts as the food that they do. Their diet is high in unrefined carbohydrates (72%) with about 14% protein and it is very low in sugar and in fat – also 14%, which amounts to about 38g of fat a day including 11g of saturated fat. “In the evolutionary past, fat and dense energy in the form of sugar were in short supply,” Kaplan said.

Tsimané of the Bolivian Amazon have world"s healthiest hearts, says study

Welcome to Onitsha: the city with the world’s worst air

Approaching Okpoko market through thick smog on the back of an okada (motorcycle taxi), the natural reaction is to cover your nose to protect yourself from the dust storm – but the effort is futile.

When a lorry zooms past, kicking up yet another red cloud of dirt, a trader turns the head of a sleeping toddler away from the road, a protective act that is as poignant as it is pointless.

This is a typical day in the southern Nigerian port city of Onitsha – which last year gained notoriety when it was ranked the worst city in the world for the staggering levels of PM10 particulate matter in its air.

Onitsha’s mean annual concentration was recorded at 594 micrograms per cubic metre by the World Health Organization – massively exceeding the WHO’s annual guideline limit for PM10s of 20μg/m3.

PM10 refers to coarse dust particles between 10 and 2.5 micrometres in diameter, while PM2.5s are even finer and more dangerous when inhaled, settling deep in a person’s lungs. Sources of both include dust storms, gases emitted by vehicles, all types of combustion, and industrial activities such as cement manufacturing, construction, mining and smelting. Onitsha scores highly on most of the above – as do other rapidly growing Nigerian cities such as Kaduna, Aba and Umuahia, all of which also featured in the WHO’s 20 worst offenders for PM10s.

In Onitsha’s very busy Okpoko market, my air quality monitor registers 140 for PM10s and 70 for PM2.5s – all way over recommended healthy levels, but still nothing compared to the readings triggered in other parts of this densely populated commercial and industrial hub.

The entire vicinity of the market is perpetually dusty, as wood-sellers saw lumber into different shapes and sizes. The air here is made worse by all the fine sand particles that fly off the back of trucks as they visit one of the many dredging companies on the bank of the River Niger, just behind the wood market.

Some residents of Onitsha are unaware of the dangerous levels of pollution. Photograph: Hadassah Egbedi for the Guardian

One female traffic warden has been working in the same spot here for two days. How does she cope with the dust? “I am just doing my job,” she replies reluctantly. “Dust does not kill people.”

But she is mistaken. According to the United Nations Environment Programme (Unep), around 600,000 deaths throughout Africa every year are associated with air pollution, while an October 2016 report by the Organisation for Economic Co-operation and Development (OECD) suggested that polluted air could be killing 712,000 people prematurely every year across the continent.

The warden’s attitude towards this invisible but deadly threat is widespread among Onitsha’s residents – but not necessarily because they are nonchalant about their health. Most are simply unaware of the issue.

Some say they have more pressing concerns, such as how to feed their family. Others have simply become accustomed to living in a dirty and polluted environment.

Onitsha is grossly polluted – not just in terms of the air quality, but also the solid waste that litters the streets, blocking drainages and canals. With not a single waste bin in sight, heaps of unregulated rubbish dumps occupy roadsides and street corners.

Rubbish clogs Onitsha’s streets, drainages and canals. Photograph: Hadassah Egbedi for the Guardian

Ikechukwu Obizue, a businessman in the neighbourhood of Nwangene, says residents can only do so much when there is little corresponding effort by the city’s government.

“Onitsha is quite dirty, but the government is not doing anything about it. We do environmental sanitation monthly, but then the city returns to being dirty,” Obizue says. “It is the government’s responsibility to keep the city clean, not the work of the residents – people in this city are too busy hustling to make an income.”

‘We don’t take air pollution seriously’

In Nwangene, my air monitor shows 667μg/m3 for PM10s – a reading in excess of the 594 annual figure that gave Onitsha its title of the world’s most polluted city. What’s more, the smaller and even more dangerous particulate (PM2.5) reading of 290 is far in excess of the WHO’s annual figure of 66.

We are in deep trouble. People will keep dying as stakeholders remain nonchalant

Nelson Aluya

The air quality proves just as bad at Ochanja market, with PM10s registered at 586 micrograms and PM2.5s at 266. Yet in these highly polluted areas, few people show any sign of trying to protect themselves from the threat.

There are only a few air masks in sight. A good number of aluminium and copper recyclers are not wearing masks, even while smelting metal scraps. Worse still, most smelting activities are done in the open, releasing monstrous clouds of smoke into the core of the city.

At one of the few state-approved dump sites on Creek Road, Ikechuckwu works at a smelting workshop. He is sweating profusely as he sits on a pile of ash, taking a break from work. He explains he has been smelting iron for a little over five years – but says not to worry about his health.

“I know how to take care of myself,” he brags. “I am not wearing a nose mask because I don’t need it. I take medicine to cater for my health.”

Residents conduct a monthly cleanup, but the city quickly fills with waste again. Many locals blame government inaction for the problem. Photograph: Hadassah Egbedi for the Guardian

It is hard to determine to what extent these high concentrations of particles are affecting the residents of Onitsha, since there is no official data – but the health effects attributed to sustained exposure to PMs, especially PM2.5s, are well proven.

For a state government that can barely manage its waste disposal system, however, regulating its air quality appears a far-fetched aspiration. The now defunct Anambra State Environmental Protection Agency was widely criticised for failing in its responsibility to effectively tackle environmental pollution, and in its place, the Anambra State Waste Management Agency was created – with little effect.

The state’s Ministry of Environment, Beautification and Ecology did not respond to the Guardian’s questions regarding air pollution in Onitsha.

“The major problem is that we don’t take air pollution seriously in Nigeria,” says medical practitioner Dr Nelson Aluya. “As the population increases and we become more industrialised, we ought to have active air-monitoring agencies and a federal environmental protection agency. We say they are there – but are they active?”

In truth, air quality monitoring and control is not on the radar of many African governments. Nigeria has a long list of environmental protection laws and regulations that are barely enforced.

“Even in the healthcare sector,” Aluya continues, “there is no standardised care to monitor those who have chronic obstructive pulmonary diseases resulting from exposure to bad air, and no standard procedure in hospitals to check for oxygen levels.

“So you see, we are in deep trouble. If we have not recognised the fact there’s a problem, then how do we solve it? Unfortunately, people will keep dying as stakeholders remain nonchalant.”

Guardian Cities is dedicating a week to investigating one of the worst preventable causes of death around the world: air pollution. Explore our coverage at The Air We Breathe and follow Guardian Cities on Twitter and Facebook to join the discussion

Welcome to Onitsha: the city with the world’s worst air

The world’s safest bed for baby?

To the uninformed viewer it has a touch of the straitjacket about it, but according to its makers this “smart crib” is based on sound paediatric advice. Called a Snoo, the cot is a collaboration between Yves Behar, the designer of Jawbone, a wristband that tracks movement and sleep, and Dr Harvey Karp, an LA paediatrician and the author of The Happiest Baby on the Block.

Karp argues that human babies are born less developed than other mammals and the first three months of life are, in effect, a “fourth trimester”. It follows that his method for promoting a restful baby is to recreate a womblike experience. He recommends employing “the five Ss” to soothe a crying infant: swaddling, side/stomach positioning, shushing, swinging and sucking. His methods are controversial: critics claim there is no evidence for his concept of a “calming reflex”, but this hasn’t stopped the paediatrician earning celebrity endorsements from, among others, Michelle Pfeiffer and Madonna.

Behar’s fuseproject design studio worked with Karp for five years to develop a cot to soothe crying babies, and the result is, according to Behar, the “world’s safest bed”.

The crib has three microphones to detect if the baby is crying, and underneath the mattress are movement sensors, speakers and a motor. These devices combine to detect noise and movement, and then trigger white noise and/or a gentle rocking movement until the baby drifts back to sleep. The Snoo sack contains a built-in sensor to monitor the baby’s temperature and is designed to mimic the “snug embrace” of the womb, while allowing sufficient soothing movement. The onesie is, of course, removable for washing.

The mattress is fitted with sensors to detect a baby’s crying – it responds with a gentle rocking motion. Photograph: Happiest Baby

Naturally, no smart cot would be complete without its own app. Parents can monitor their child’s sleep using the Snoo app and fuseproject promises that future updates will allow parents to track their baby’s sleep habits over time for signs of progression or irregularities. The aim is not only to improve the infant’s sleep but that of its parents.

As Behar says, “As a father of four children, I am intimately familiar with sleep deprivation. It is more than a burden – it can quickly become a health problem for both parents and the baby.”

The world’s safest bed for baby?

Arsenic in Bangladesh: how to protect 20 million from the world"s largest poisoning

It’s the largest poisoning of a population in history (pdf). More than 20 million people are thought to be at risk of drinking water contaminated by arsenic in Bangladesh.

Arsenic occurs naturally in groundwater supplies throughout parts of Bangladesh, India and Nepal. It was first identified as a problem in Bangladesh in 1987, and concentration levels in some places exceed 50 milligrammes per litre (mg/l) – way beyond the maximum level recommended by the World Health Organisation of 10 mg/l.

Each year, an estimated 43,000 people die from arsenic poisoning in the country. The government has taken a number of steps and made policies to try to address the problem. But despite a country-wide campaign and social mobilisation activities by the government and NGOs (pdf), knowledge and awareness levels among communities remain far below expectations.

We know that there are cheap and potentially life-saving solutions to this problem. What we need to do now is promote these solutions, and increase access to them.

An invisible problem

Arsenic doesn’t change the taste or colour of water so the first problem we encounter is making people understand that it is present in their community.

From skin lesions, stomach cramps, diarrhoea and vomiting blood, to cancers of the bladder, lungs, skin and kidneys, the symptoms and effects of arsenic poisoning are debilitating and palpable. But without a proper diagnosis, often people do not know whether they are suffering from typical diseases or ones caused by long-term exposure to arsenic.

It is even more difficult, therefore, to make people realise that prolonged contact with arsenic-contaminated water may cause illness or even death. Liza Akhter, a 21-year-old girl in Bagerhat District, south-west Bangladesh, said to one of my colleagues: “The thing about arsenic is you get poisoned slowly, so you don’t know who has been affected around you already. Arsenic kills you every day, slowly.”

It is the poorest who face the biggest problems and those suffering from the symptoms of arsenic poisoning often find themselves in a vicious circle. Even though they may be suffering from multiple debilitating diseases, they often cannot afford to get treated.Many do not have enough land to install a water point so they are reliant on community points or the traditional untreated shallow tube wells. Often the roof of their home is not strong enough to support a rainwater harvesting system.

Those who are better off are more involved in the decision-making process and therefore have more control over where water is distributed. Very often, they can afford to install deep tube wells on their own land and access safe sources of water below the contamination levels.

So what can be done?

In affected areas Practical Action has been working to educate people about the symptoms of arsenic poisoning. We have provided testing kits so that people can check if their water supply is contaminated and, if need be, install arsenic-removal systems or look into alternative safe water supplies.

Arsenic removal systems, where contaminated water if filtered through four chambers, are one available option. Due to a lack of testing systems, however, households don’t often know whether the removal system is working properly. We also find that the distribution of these filters is usually done in an ad hoc manner through government projects or by NGOs.

The distribution of arsenic removal systems should be linked with suppliers to ensure post-installation services for repairing, replacing and changing the filter for long-term sustainability. Proper pricing plans are also essential for running a community-managed water point sustainably, and ensuring they are not abandoned due to financial problems.

Rainwater harvesting does offer an alternative, but a lack of rain and the deterioration of water quality and taste during the dry season make it less popular. Usually, the equipment is not cleaned properly before the monsoon season which means that the water can become contaminated, causing sickness and diarrhoea. Other alternative sources of water could be found through “conjunctive use”, where surface water is stored in a groundwater basin in wet years, and withdrawn in dry years.

Facilities to test water quality are also needed at home along with a national testing mechanism; science clubs in schools or laboratory facilities in colleges could even be explored for establishing such facilities. Most importantly, an integrated approach between the health and water sectors is needed for working with the communities in arsenic affected areas. We would also like to see government mapping of awareness levels among communities, as this is something we just do not know presently.

All patients suffering from arsenic poisoning – arsenicosis – have less capacity to work, their income reduces, and their households are gradually marginalised. The provision of safe water alone is not enough; proper treatment for arsenic poisoning is also essential.

We know that there are solutions, but we need to scale up this work so that the 20 million people in Bangladesh, and millions more in India and Nepal, who are at risk from arsenic poisoning, can at least take a drink of water without worrying it is killing them.

Join our community of development professionals and humanitarians. Follow @GuardianGDP on Twitter, and have your say on issues around water in development using #H2Oideas.

Arsenic in Bangladesh: how to protect 20 million from the world"s largest poisoning

The Mediterranean Diet: The World’s Healthiest Diet

The Mediterranean region is famous for its healthy recipes and eating habits which emphasize seasonality, traditional preparations, and natural produce. The Mediterranean diet has various sources of food and focuses mainly on the intake of olive oil as an important source of beneficial fat. The diet has been studied since the 70s, and researchers have found that the Meditteranean population has low rates of obesity and chronic diseases such as diabetes, heart disease, and high cholesterol.

The Mediterranean menu includes whole grains, legumes, beans, vegetables, fruits, and fish. The diet also encourages to eat less red meat products because they have a high percentage of fat, calories, and cholesterol. Also, as a traditional diet; 28 Day Mediterranean Diet Plan has awesome daily recipes that are weight loss friendly and offer a traditional Meditteranean flavor. The 4 weeks nutrition program reduces the proportion of cholesterol and modulates blood pressure without depriving the body of the various important nutrients needed.

Mediterranean diet foods:

1. Eating small amounts of yogurt and special kind of cheese because they contain calcium.

2. Whole grains and starches such as pasta, bread, rice, bulgur, bran, and potatoes.

3. Fish is usually steamed or grilled, which is advised to eat several times per week, you can also have tuna or salmon or mackerel, and avoid fried fish.

4. Boil eggs, several times a week,

5. Eating red meat, no more than once a week.

6. Two vegetarian meals at least once each week.

7. Eating various kinds of legumes, vegetables, herbs, grains, fresh fruits, to help reduce LDL cholesterol in the body, leading to weight loss.

8. Nuts, they contain a high proportion of fat except for walnuts, hazelnuts, and almonds. Also, beware not to consume them to a large degree unless you’re exercising daily.

9. Eating vegetables steamed or boiled without high-calorie extras.

10. Always use olive oil instead of butter and other oils, for example, you can make a sauce for pasta by adding one tablespoon of olive oil, garlic, onion and one tablespoon of tomato sauce to prepare a healthy sauce for your pasta.

11. Eating fresh fruits instead of sweets.

12. You can have coffee, tea, but without sugar and in moderation.

Foods that should not be eaten in this diet:

1. Processed foods.

2. Fried foods in general.

3. Junk food – fast food.

4. Sugary drinks like regular soft drinks and diet kinds, as well manufactured juices.

5. Sausage, hamburgers, and bacon.

6. Cakes and cookies and chocolate cake.

7. Processed meat, high-calorie.

That’s it,

The Mediterranean diet has been around for decades now and received no criticism by the World Health Organization, in contrast to other diets. It also ranked third out of 35 diets according to U.S. News & World Report.

References:

1. http://www.webmd.com/heart/news/20141014/another-study-links-mediterranean-diet-to-better-heart-health


2. http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801


3. http://www.herbalismchoice.com/2016/09/28-day-mediterranean-diet-plan.html

The Mediterranean Diet: The World’s Healthiest Diet

Isabelle Dinoire, recipient of the world"s first partial face transplant, dies at 49 – video

A French woman who underwent the world’s first partial face transplant has died in hospital aged 49 after a long illness. Isabelle Dinoire, who lost her mouth and nose after being mauled by her dog, made medical history in 2005 when she was given a partial face transplant using tissue from a brain-dead woman in a 15-hour operation at Amiens Picardie hospital

Isabelle Dinoire, recipient of the world"s first partial face transplant, dies at 49 – video

India rolls out world"s first leprosy vaccine as fight goes on "war footing"

The first lesions appeared on teenager Rammurat’s feet. To those in his village near Gorakhpur, in the vast Indian state of Uttar Pradesh, the cause of the pale sores was clear.

“Some said it was black magic. Some said it was the spirit of the dead catching us,” he recalls.

“What will people think? What will the neighbours think?” he wondered when finally diagnosed at a nearby mission hospital – too late to entirely save his feet. “People used to hate looking at a leprosy patient. You see a lady [with symptoms] coming into the village, they will run away.”

India is officially leprosy free, meaning the disease afflicts fewer than one in 10,000 people. But specialists understand the true infection rate to be far higher, and the disease is still endemic in some of the country’s poorest districts.

Today India accounts for more than 60% of the world’s new leprosy cases and health officials have quietly moved to a “war footing” against it, one senior researcher says.

This week the government announced a major step: the world’s first leprosy vaccine, developed in-country but tied up for years in testing, will be rolled out in Gujarat and Bihar, two states where the problem is sharpest.

Among the oldest recorded references to leprosy – the ulcers, the gnawing away of a fingers, eyes and noses – appear in 4,000-year-old Hindu epics, the disease christened kustha, Sanksrit for “eating away”.

Long associated with sin and contagion, one Vedic legend holds that even a king was banished after developing the telltale sores. Rammurat, a 14-year-old when his symptoms appeared, sought treatment, but stood no chance against the stigma.

The government has provided residents of Tahir Pur who have leprosy with hand-operated rickshaws. Some have lost tissue in their feet due to leprosy-related injuries. Photograph: Michael Safi for the Guardian

Older now, Rammurat lives in a 30-hectare slum on Delhi’s north-eastern fringes. Rubbish collects in open sewers along the tight lanes of the neighbourhood and children mingle with tethered goats and chickens in the midday heat. It could be any poor community in the capital, but for the preponderance of wounds: missing toes, fingers, or entire limbs wrapped in white gauze.

Allotted to people with the disease a half-century ago, these blocks in Tahir Pur have grown into Asia’s largest leprosy colonies, home to 2,000 patients and their families, and a remnant of centuries of official policy to segregate them from the world. Rammurat arrived 25 years ago, seeking acceptance and access to treatment. “I moved here to save myself,” he says.

A few hundred metres away is the Leprosy Mission’s Delhi hospital, one of 14 specialist care centres the Christian group runs in India. Inside, hundreds crowd around waiting rooms and dispensary windows awaiting medicine, among them up to 150 leprosy patients each day.

It diagnoses on average one new case of the disease per day. “That’s alarming,” says Stephen Levi, the hospital’s superintendent. “And when we ask them to bring their other family members in, they don’t.”

Beside psalms and lists of symptoms on the hospital’s tiled walls there are, less congruously, pictures of the nine-banded armadillo: the north American mammal the only other species to naturally host leprosy, and a boon for researchers, who are still unable to grow the disease in labs.

For all the fear it conjures, leprosy, caused by the pathogen Mycobacterium leprae, has been effectively treatable since the 1940s. It isn’t particularly contagious either, its spread requiring regular contact with an untreated sufferer, and an immune system already compromised by genetics or poverty. Nor is it “flesh-eating” – limbs more likely to rot away because of injuries sustained by repeated use after the sensation of pain is lost.

“The real problem is the level of stigma,” says Dr Sunil Anand, the executive director of the Leprosy Mission. “Those who get leprosy tend to be ostracised and stigmatised by the community, they tend to hide away.”

Children work packing balloons in Tahir Pur, home to the largest leprosy colonies in Asia Photograph: Michael Safi for the Guardian

That makes containing the disease, or treating it before disfigurement sets in, harder. “Discriminatory practices then come into play. Like schools not giving admission to children with leprosy, or from a leprosy family. It’s the same in jobs, even healthcare,” he says.

About 16 national Indian laws still discriminate against people with leprosy, he says, a legacy of the ancient aversion to the disease, but also an 1898 colonial law that segregated patients and prevented them having children, passed in response to British panic an epidemic would spread back home.

A eight-year treatment drive by the Indian government shrunk the number of new cases four-fold by 2005. That year the government celebrated the official elimination of the disease, meaning a rate of fewer than one in 10,000 new cases a year. “Maybe that’s possible,” Levi, the hospital superintendent, says of the official rate. “But only because India has such a huge population.”

One of India’s leading leprosy researchers, Dr Uptal Sengupta, is more sceptical. The elimination figure trumpeted by the government and World Health Organisation was produced “in a hurry”, the 75-year-old says from his office, a bobble-headed armadillo on the desk.

More recent leprosy surveys produced by the Indian Council of Medical Research (ICMR) have a much greater prevalence, he says, but the Indian government has declined to release the exact estimate. (A source with access to the research told the Guardian the research showed a national rate of “roughly five to six cases per 10,000”.)

Battling high rates, health officials are also racing against time: leprosy strains are slowly becoming resistant to the multi-drug therapy that so successfully brought the Indian infection rate crashing down.

“When there was a monotherapy, it took only 30 years for the disease to develop resistance,” Sengupta says. “And we are already seeing resistance cases [for the multi-drug therapy].”

An aerial view of one of Tahir Pur’s 29 leprosy colonies in east Delhi. Spanning 74 acres, the colonies make up the largest leprosy complex in the world. Photograph: Michael Safi for the Guardian

The rollout of the vaccine, announced earlier this month, is part of a return to a “war footing” against the disease, he says. “The vaccine is the most important thing for elimination. It’s the best answer.”

Beginning in five hotspot districts in Bihar and Gujarat, the vaccine will be administered both to people with leprosy and those in close and regular contact with them, in combination with the antibiotic Rifampicin. Trials of the vaccine have shown it could bring existing rates down by 65% over three years, according to Dr Soumya Swaminathan, the director-general of the ICMR.

The rollout is accompanied by a new round of “active case detection” – health workers going house-to-house “to hopefully detect new leprosy cases which were undiagnosed in the community”. Fifty districts have already been swept, turning up 5,000 previously undetected cases.

“It’s a multi-pronged attack on leprosy, we’re looking to eliminate it” – a second time – “in the next five to 10 years,” Dr Swaminathan says.

That the vaccine is Indian-developed is also a source of pride. “It shows exactly how Indian research and development can solve our own problems,” she says.

In Delhi at least, efforts to remove the stigma around one of the world’s oldest diseases are also paying off – but not without cost.

As the capital expands, the giant leprosy colonies of Tahir Pur suddenly find themselves on prized land. Businesses are illegally setting up shop and developers are eyeing an area society once spurned. “Now, the non-leprosy people are trying to move in,” Levi says.

India rolls out world"s first leprosy vaccine as fight goes on "war footing"

Where are the world’s most water-stressed cities?

In the southern reaches of Egypt, the city of Aswan is one of the hottest and sunniest in the world. Temperatures reach 41C in the summer and less than a millimetre of rain falls each year. Some years it doesn’t rain at all.

Aswan may be one of the world’s least rainy places, but it’s not even close to being the most water-stressed city. It nestles on the east bank of the Nile, close to the Aswan High Dam and the vast Lake Nasser, one of the largest manmade lakes in the world. With a capacity of 132 cubic km, the dam serves the irrigations needs not just of Aswan, but Egypt and neighbouring Sudan as well.

Water stress – where the human or ecological demand for water is not met – is caused by a variety of factors. There’s the physical scarcity of water due to lack of rainfall, the natural aridity of the area and, increasingly, changes in climate; but poor management and investment in water infrastructure, and pollution, also play their parts.

The problem affects an estimated 2.7 billion people for at least one month of every year, across every continent – and is particularly pressing in cities as the global urban population grows. At present, almost four billion people live in cities, with a further 2.5 billion expected to join them by 2050.

As the urban population grows, so too does the number of people living in settlements that are not connected to a formal piped water supply. Currently, some 860 million people live in slums around the world; their lack of access to clean water carries enormous health consequences.

Yemen is one of the world’s most water-scarce countries, with per-capita availability of water only 2% of the global average. Photograph: Yahya Arhab/EPA

As freshwater supplies dry up, many cities are engaged in a race to the bottom as they turn to groundwater – with some underground aquifers now so overexploited that water is extracted much faster than it is recharged. During the height of the recent drought in California, farms and cities were apparently drilling so deeply for groundwater that they tapped into reserves that had fallen to earth as rain 20,000 years ago.

Over the past few years, both Los Angeles and São Paulo have been hit by major droughts affecting their surrounding states. For California, 2014 and 2015 were the two hottest years in its history; in April last year, the state’s Department of Water Resources found “no snow whatsoever” during its survey in the Sierra Nevada mountains.

Droughts creep up and develop over a period of time. But very often they end suddenly, with a crash of flooding

Carolyn Roberts

“We get all of our water for the year through the winter months, and we hope that accumulates in reservoirs and as snowpack to draw on as a resource over the summer,” says Paul Ullrich, assistant professor of regional and global climate modelling at UC Davis. “In the absence of snow pack or precipitation in winter, we turn to pumping groundwater – but it’s our insurance policy, our emergency fund.”

In response to the absence of snow, the governor of California, Jerry Brown, announced mandatory regulations that prohibited the watering of ornamental grass, required new homes to use drip irrigation, and directed water agencies to set up new pricing structures to maximise conservation.

In Brazil meanwhile, the main reservoir supplying São Paulo dropped to just 6% of its capacity and residents were hit with regular water rationing. Some were forced to move away to more water-reliable areas.

A message in graffiti which reads ‘Welcome to the Cantareira desert’ is written on a car which was once submerged in water near Sao Paulo. Photograph: Sebastiao Moreira/EPA

Droughts can last for decades, but they are ­temporary. “Droughts creep up and develop over a period of time, through an uncertain space – and get worse,” says Carolyn Roberts of the Knowledge Transfer Network. “But very often they end suddenly, with a crash, bang and wallop of flooding.”

While the droughts affecting Los Angeles and Sao Paulo – both of which are now said to be over – had a severe impact on these cities, neither can be placed among the world’s most water-stressed. In Los Angeles, “after per capita use, there is twice as much water as there is in the UK even now,” says Roberts.

And São Paulo? “It’s not in a structurally water-scarce environment. But as the city has grown, the ability of the water management infrastructure to withstand a multi-year drought was clearly overwhelmed,” says Steven Schonberger, water global practice manager at the World Bank. “It may have been one of the top water-scarce cities last year – but two or three years from now, with some significant rain, that could all turn around.”

There are many cities, like Aswan, that never receive any significant rainfall. Lima is a particular concern, built on the Peruvian coast: one of the driest desert regions in the world. The city, with a population of around 8.5 million, depends mainly on the Rímac river, plus the Chillón and the Lurín. But due to such an arid climate – just one centimetre of rain falls on average each year – water supply is irregular, and a fifth of the population is cut off from the drinking-water network.

Nets set up by Peruvians Without Water are used to trap water from the moisture in fog. Photograph: Mariana Bazo/Reuters

But what Lima lacks in rain, it makes up for in humidity – reaching 98% at times – and Limans are making good use of this. The Peruvians Without Water movement has built vast nets to trap the thick sea fog and mist that surrounds the coastal city for more than half the year. To date, the local grassroots organisation has erected more than 1,000 nets around Lima, gleaning between 200 and 400 litres of water a day – depending on the amount of fog. The nets won’t solve Lima’s water woes on their own, of course, and the city is also planning to restore a pre-Inca network of channels to make the water supply more reliable.

It doesn’t rain much in the Middle East either, and nor are there many freshwater sources. Indeed, the top five countries with the lowest renewable freshwater resources per person are all in that region: Kuwait, Bahrain, the United Arab Emirates, Egypt and Qatar.

Major cities in these countries – such as Kuwait City, Abu Dhabi and Doha – could certainly be considered among the world’s driest. But while the Middle East doesn’t have much water, it does have a great deal of wealth-generating oil – ensuring that 70% of the world’s water desalination plants are found there (the majority in Saudi Arabia, the UAE, Kuwait and Bahrain). So while parts of the Middle East might not have much natural freshwater, it is certainly investing in creating it.

Singapore, too, has limited access to freshwater relative to its population, but has found a way to create water security. Despite getting rain for an average of 178 days each year, this densely-populated island city still has only 110 cubic metres of freshwater per capita, per day.

Doha, Qatar lacks access to renewable freshwater resources. Photograph: Warren Little/Getty Images

Surrounded by sea water, Singapore does not have a hinterland from which to draw water, and instead relies on its “four national taps”: rain, imported water from Malaysia, recycled wastewater and desalinated sea water. These measures come at a huge cost, but mean that 100% of residents have access to fresh water 100% of the time.

But many less well-resourced cities struggle to manage their water supply in such a holistic way. The aquifer used by Gaza City, for example, has become partly contaminated by saltwater: when freshwater is extracted in a coastal area, seawater rushes in. Meanwhile, reservoirs and pipelines have been intermittently damaged by bombings over the decades.

Amman is also struggling to cope with changes beyond its control. Between 630,000 and 1.27 million Syrian refugees now live in the already parched nation of Jordan (it had just 92 cubic metres of freshwater per capita in 2014). While not all refugees live in Amman, a 20%-to-40% increase in the number of people drawing on water resources will add a significant strain on the system. It is hoped that the $ 900m water sharing agreement between Israel and Jordan, agreed in February 2015, will go some way to alleviating this added pressure.

Related: Where is the world’s hottest city?

So is the world’s most water-stressed city one where all these contributing factors – natural aridity and low rainfall, poor management, increasing population and exploitation of the aquifer – converge? Sana’a, the capital of Yemen, might just be that city.

Water was scarce even before the current conflict began, made worse by an increasing population and poor water management. Just 48% of the Yemeni capital’s 2.2 million inhabitants receive piped water and the rest get water through tankers, which is five-to-10 times more expensive. Around 60% of water is lost through leaks, while the cultivation of khat – a popular mild narcotic – accounts for 40% of the water drawn from the Sana’a Basin.

What’s more, Sana’a draws water from the world’s most over-stressed aquifer, the Arabian Aquifer System, which 60 million people in Saudi Arabia and Yemen rely on. But Yemen doesn’t really have a backup plan: despite having more than 1,000 miles of coastline, the country hasn’t been able to invest in desalination in the same way as its more wealthy neighbours. The conflict has only exacerbated this existing water stress, and there is evidence to show the country’s water infrastructure has been targeted deliberately.

But the experts are still divided on Sana’a. While a common saying there says it will run dry in just 10 more years, Schonberger reckons people have been saying that for decades now. Only time will tell if it becomes the first capital city to run out of water.

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Where are the world’s most water-stressed cities?