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10 Nisan 2017 Pazartesi

We need to talk about... public healthcare - podcast

Vicky Frost is joined by Guardian members; Sarah Boseley, the health editor of the Guardian; Professor Jane Dacre, president of the Royal College of Physicians; Helen McKenna, senior policy adviser at the King’s Fund, an independent healthcare charity; and Denis Campbell, the Guardian’s health policy editor. They consider the current state of the National Health Service in the UK, President Trump’s approach to healthcare reform in the US, and the global approaches that seem to be working best. What can we learn from each other about funding effective healthcare? And are our expectations realistic?


• In the next episode of this series, we will be discussing the global rise of nationalism. Find out more, and submit your questions to our panel here.



We need to talk about... public healthcare - podcast

22 Mart 2017 Çarşamba

Cryogenic preservation: from single cells to whole organs – Science Weekly podcast

Subscribe & Review on iTunes, Soundcloud, Audioboom, Mixcloud & Acast, and join the discussion on Facebook and Twitter


Last year, around 3,500 organs were transplanted into patients in the UK alone. That said, a large number of organs were also discarded because the moment a donor dies, doctors have only eight or so hours to find a patient on the organ register who is a match and can be almost immediately ready for surgery. One recent estimate suggested that as many as 60% of the hearts and lungs donated for transplantation are discarded each year. But a new technology could be about to change this: whole-organ cryopreservation.


This week, Hannah Devlin looks at the past, present, and future of these technologies with University College London’s Professor Barry Fuller. We also hear from Newcastle University bioethicist Dr Simon Woods about some of the ethical issues that arise with any biotechnology, including cryopreservation.



Cryogenic preservation: from single cells to whole organs – Science Weekly podcast

26 Ocak 2017 Perşembe

How a blind runner tackles marathons – tech podcast

Simon Wheatcroft went blind at age 17. Yet today, he runs marathons. Leigh Alexander explores the incredible story of how he is able to do this with the help of some particularly innovative technology. This is a re-run of a podcast we launched in June 2016



How a blind runner tackles marathons – tech podcast

14 Aralık 2016 Çarşamba

The male contraceptive pill: how close are we? – Science Weekly podcast

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On June 23rd 1960, the US Food and Drug Administration approved the world’s first combined oral contraceptive pill – or COCP – known as Enovid. And whilst there have been many developments in COCPs for women in the six decades that have followed, effective counterparts for men have yet to appear on to the market. Why has it taken so long? How close are we to a male contraceptive pill?


This week, Hannah Devlin hears from the University of Edinburgh’s Professor Richard Anderson, who was part of a recent World Health Organisation funded trial into a male contraceptive jab. We also talk to Dr Diana Blythe of the NICHD’s Male Contraceptive Development Program, about the progress being made Stateside using gels instead of jabs. And finally, we hear about non-hormonal alternatives in development from Aaron Hamlin, executive director of the Male Contraceptive Initiative.



The male contraceptive pill: how close are we? – Science Weekly podcast

29 Kasım 2016 Salı

Big Unknowns: can we stop ageing? – Science Weekly podcast

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On 4th August 1997, Jeanne Louise Calment died in a French nursing home. Born 122 years and 164 days earlier, Jeanne currently holds the record for the greatest fully authenticated age to which any human has ever lived. And with the ever-growing average life expectancy for humans showing no sign of slowing down, how close are we to cracking the code of longevity?


Helping Nicola Davis delve into the age-old problem of ageing this week, prominent biomedical gerontologist Dr Aubrey De Grey reveals his unique, seven-step approach to the problem of ageing. We ask Harvard University’s Dr Justin Werfel why programmed death might be a good thing. And we hear how the University of Kent’s Dr Jenny Tullet is using roundworms to reveal clues about the genetics of ageing.



Big Unknowns: can we stop ageing? – Science Weekly podcast

6 Eylül 2016 Salı

Sex when you"re asexual – Close Encounters podcast

Real-life accounts of sex and relationships, with writer Alix Fox. This week Alix heads to Manchester to meet a man who has defined as asexual since he was a young teenager. But while university was where many people embraced their sexuality, for Jords it resulted in a series of challenging confrontations with a highly sexed culture.


Share your story: if you have a question about what you’ve heard, or want to share a tale about your own encounters, email us in confidence at closeencounters@theguardian.com.


A Rethink Audio / Guardian production. Close Encounters’ theme, Bells, by Secret Circuit, is available now on Emotional Response.


  • 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.


Sex when you"re asexual – Close Encounters podcast

26 Temmuz 2016 Salı

Learning to love my small penis – Close Encounters sex podcast

Alix Fox is on a mission to get Britain talking openly and constructively about sex, one person at a time. In this third edition of Close Encounters, our series of podcasts about real, revealing and revelatory stories of sex and relationships, we meet Ant, who tells how it’s taken him a long time to appreciate his body, and how he’s now attempting to make the rest of the world embrace theirs, too.


Not long ago, Ant wrote and performed a poem about living with a small penis that got the media talking about male body image, and led thousands of other men to offer their support. Now he’s using that momentum to build even grander projects. Find out what Ant is up to at the moment at antsmith.net.


Share your story: if you have a question about what you’ve heard, or want to share a tale about your own encounters, email us in confidence at closeencounters@theguardian.com.


  • A Rethink Audio / Guardian production. Close Encounters’ end theme, Bells, by Secret Circuit, is available now on Emotional Response.


Learning to love my small penis – Close Encounters sex podcast

30 Haziran 2014 Pazartesi

A journey to the heart of the planet we made - podcast




  • theguardian.com,



  • This week on Science Weekly with Ian Sample we meet science writer and broadcaster Gaia Vince to examine the profound problems about the human-shaped future of planet Earth raised in her new book Adventures in the Anthropocene: A Journey to the Heart of the Planet We Created.


    In her travels she also witnessed ingenious but perhaps doomed efforts to offset the worst results of climate modify, such as whitewashing a mountain in Peru, generating artificial glaciers in Ladakh and trying to hold back the ocean in the Maldives.


    Ian is joined by Nicola Davis, commissioning editor of the Observer Tech Month-to-month, to congratulate the winner of the £10m Longitude Prize 2014 – antibiotics – and the new millionaire mathematicians developed by the Breakthrough prize.


    Also, they analyse the pros and cons of taking lower-dose aspirin, as new analysis suggests it may possibly lessen the chance of pancreatic.


    Subscribe for free of charge by way of iTunes to guarantee every single episode will get delivered. (Here is the non-iTunes URL feed).


    Comply with the podcast on our Science Weekly Twitter feed and get updates on all breaking science news stories from Guardian Science.


    Email scienceweeklypodcast@gmail.com.




    A journey to the heart of the planet we made - podcast

    20 Haziran 2014 Cuma

    What excellent scientific challenge should win the Longitude Prize? podcast

    This week on Science Weekly presented by Ian Sample, we discuss the Longitude Prize 2014. 3 hundred many years following the 1st prize to learn a way of identifying longitude at sea, a new set of challenges have been shortlisted and thrown open to a public vote to choose the one scientific and technical dilemma that merits the £10m prize fund.


    Ian is joined by Guardian on the internet environment editor Adam Vaughan, Observer Tech Month to month commissioning editor Nicola Davis and Dr Emily Grossman, educator, broadcaster and expert in molecular biology.


    We also hear from two members of the new Longitude committee, Astronomer Royal Lord Martin Rees and the UK’s Chief Medical Officer Dame Sally Davies, on the scientific issues that could win the prize, and how the public – yes, that means you and me – can establish the nature of that challenge.


    The public vote closes at 7.10pm on Wednesday 25 June:


    Click right here to vote online.


    Or text/sms the following keyword to 60011
    To vote for antibiotic resistance text ANTIBIOTICS
    For sustainable nutrition text Food
    For dementia care text DEMENTIA
    For restoring mobility text PARALYSIS
    For fresh water text WATER
    For zero-carbon flight text FLIGHT


    Subscribe for totally free via iTunes to make sure each and every episode gets delivered. (Here is the non-iTunes URL feed).


    Stick to the podcast on our Science Weekly Twitter feed and obtain updates on all breaking science information stories from Guardian Science.


    Email scienceweeklypodcast@gmail.com.



    What excellent scientific challenge should win the Longitude Prize? podcast

    30 Nisan 2014 Çarşamba

    The international battle for clean air podcast transcript

    HM: Hugh Muir


    SB: Simon Birkett


    JV: John Vidal


    DP: David Pasadas


    SB: Sarah Boseley


    KLK: Katie Leach-Kemon


    AC: Aaron Cohen


    SJ: Sam Jones


    AP Ana Peñalosa


    HM Simon Birkett is on a mission.


    SB It’s an extraordinary feeling, whenever I ask people to sign up to the campaign or help – everyone did.


    HM He wants to rid his city from air pollution.


    SB I wrote a letter to the European commission, and the next thing I was getting calls from Brussels.


    HM And there’s quite a few pollutants out there.


    SB So we get diesel exhaust, for example, tyre and brake wear; we get construction dust, coal particles, benzene.


    HM His campaign group is called Clean Air in London. He says there’s a hidden epidemic.


    SB Well it is. I would argue that we are with invisible air pollution where we were 30 years ago with smoking. And I know, actually, that quite a lot of scientists and also media commentators, particularly those who have been following this story for many years, have actually moved their families outside London and now commute in.


    HM He’s one of many around the world trying to do something about the air we breathe. With all the fantastic advances we hear about carbon capture, renewable energy, electric cars … why are we still pumping so much pollution into our atmosphere. Today on the Global development podcast we’ll take you to the Philippines, to one of the top three polluted cities in the world. Then to Mexico to hear how their government is tackling the crisis. And we’ll hear from the Guardian’s health editor, Sarah Boseley – she’ll tell us how pollution is affecting all of our lives. This is the Guardian Global development podcast. I’m Hugh Muir, that’s all to come.


    First then, to Manila where the Guardian’s environment editor, John Vidal, sent us this report.


    JV This is metro Manila, a 12 million strong megalopolis in the Philippines. It’s no different from any number of other major cities in Asia. The smell is awful and the noise makes it almost impossible to talk. In the end, I’ve had to record this back in the studio so that you can hear me properly – that’s how bad it can be. The hospitals here are full of people with respiratory and heart diseases. The latest figures suggest 2 million people in Asia will die prematurely of air pollution this year. The WHO, that’s the World Health Organisation, now thinks that one in eight people in the world dies from air pollution.


    Jeepneys are the most popular form of transport for Manila’s poor. But these brightly coloured buses also leave vast plumes of diesel smoke in their wake. David Pasadas has lived in the city for years and is a consultant on urban and green issues.


    DP In the Philippines, normally, right now, the law says that all vehicles have to be Euro 2 compliant, new vehicles. But old vehicles, they have a hard time meeting even Euro 1 standards because a lot of the public vehicles are using these rebuilt engines. And so you see a lot of vehicles, when they’re accelerating, like these Jeepneys and these tricycles, you see visible plumes of black smoke or white smoke.


    JV Is that also because the fuel they use has been adulterated, has been smuggled in – what’s going on with the fuel?


    DP Because we are an archipelago of 7,100 islands, it’s very easy to smuggle in fuel – and there have been reports of that. Aside from that, there’s a lot of contaminants in the fuel, unless you get it from a reputable gas station. And I guess it’s not just in the Philippines but it’s a common pattern in Asia.


    JV But you’re a refugee, you now live in a suburb 20km outside the main city. What happened to your health when you moved outside, did it improve?


    DP Actually it’s not as bad. It improved, but I was getting a lot of respiratory allergies in the city because you could literally see the pollution coming from the vehicles. You would feel it on your skin and your face after a long day of work taking the public transport. A lot of that is really because a lot of these public transport drivers have a hand-to-mouth existence, meaning the probably earn maybe £15 in a day, after a hard day of work. They don’t religiously maintain their engines. So you see a lot of engines here that are actually already starting to burn oil.


    JV You’re young, and many of the people in the Philippines are very young. We get the impression that there’s building up a sort of public health crisis which will show itself in 20-30 years’ time as these respiratory diseases become worse and worse. Is that understood in the Philippines, that air pollution really is a serious problem now?


    DP Originally, I thought only the middle class and the upper middle class understood these things because there were paying for like inhalers … and expectorants. But lately I’ve also tried to talk to some of these, for example, these Jeepney drivers. And I was surprised to learn that they are aware of the risks, and it’s like they’re caught in a situation where they want to change but they don’t know how.


    JV And because it costs a lot of money to change.


    DP It costs money if you’re running a dilapidated surplus engine. Because these public transport conveyances they don’t really get to taste a new engine per se. What they mean by new engine in their case is really a surplus rebuilt engine. So the life of the engine has a limited expectancy. And what they do is to save money they try to prolong it. And that’s where the problem occurs.


    JV But you could also say that the life of the human who’s driving some of these cars is pretty limited as well.


    DP Is greatly shortened yes, yes. I think they are aware of that. But if you’re living a hand to mouth existence I think some of them have this fatalistic view on life; meaning if you talk to them about climate change and other issues about the world what they’ll tell you is I have to feed my family and that’s what’s paramount to them.


    JV And it’s not going to get any better. Within 20 years the Philippines is expected to be using an extra 10m or 15m cars – that’s per year! And there’s no sense that the industry, the fuel companies or the city are able to do anything about it. And that’s not even counting the air pollution that comes from factories or homes. The problem is it’s shortening the lives of everyone. Pollution here follows the poor. It’s a world problem but they’re breathing most of it.


    HM Earlier this year, in March, some unseasonably warm weather affected countries in northern Europe. Not a bad thing in itself. But when combined with sand blown in from the Sahara desert, and the fumes from cars and power stations, well, it caused panic in the newsrooms. So what really happened? Sarah Boseley, the health editor here at the Guardian explains.


    SB There really was a bit of a panic about the air pollution levels in the UK and in parts of Europe as well. I think that’s maybe partly because we’re increasingly aware that air pollution is very problematic. So the Saharan sand is a very minor issue actually by comparison with what we’re getting from diesel cars and, more to the point, diesel lorries and taxis and the like.


    At the end of March, we had the release of a really important report from the Institute for Health Metrics and Evaluation, based at the University of Washington in Seattle. They have been responsible for a whole series of papers, really good papers, looking at what they call the global burden on disease. So they’ve been calculating what diseases the world suffers from, how many lives are lost and how many years people live with disabilities because of those diseases. Now they’ve looked at transport as well, which is a bit of a departure from the usual infectious diseases, chronic diseases, including cancers and such like.


    What was really interesting in this was that they put together both the air pollution factors and also road injuries. And when you do that you actually come up with some quite stunning and worrying figures about the damage that our road transport is doing to us.


    KLK Hello everyone. Thank you all for coming today and for your interest in this research.


    SB Katie Leach-Kemon from the Institute of Health Metrics and Evaluation at the University of Washington in Seattle, who produced the paper, had some interesting things to say about the way they collected the data, which is not always easy because countries put it together in different ways.


    KLK You can also use the tools to look at risk-factor rankings across countries; so this shows in Nigeria and China what the risk factors are for premature death and disability. You can see in China air pollution, ambient air pollution from all sources not just vehicles, actually ranks fourth and in Nigeria it ranks eighth.


    SB They say, in fact, that deaths from road transport are higher. They have a greater burden on the population of the planet than deaths from the things that we all think of as being the big killers: HIV, tuberculosis and malaria. And that injuries and pollution from vehicles jointly contribute to six of the top 10 causes of deaths every year.


    AC: As more people are living next to busy roads, the population exposure to traffic related air pollution is increasing.


    SB And also we had Aaron Cohen, who is principal scientist at the Health Effects Institute in Boston, which is a non-profit … And their interest is air pollution. He was talking about the ultra-fine particles that emanate from diesel school buses.


    AC The geographer Michael Jarrett at University of California at Berkeley in a recent HGI report estimated the proportion of the population living near busy roads in several major world cities. This slide shows residential proximity to the burgeoning road network in Beijing, where he estimates that 76% of residents currently live within 500 metres of major highways; and 50 metres of busy streets where levels of traffic-related air pollution emissions are the highest.


    SB It’s increasingly worrying that there are such high levels of pollution in developing countries. Very likely developing countries haven’t taken this on board yet because most people think of transport as being a really fundamental important thing for developing countries because you have to get your goods from A to B in order to be able to sell them. People have to be able to get to the jobs. Obviously having good transport, having a car, all helps development. But unfortunately the downside for health is very much something that people think of as an afterthought.


    HM Sarah Boseley in London. And I don’t know about you but now I’m trying to work out how far I live from a major road. Of course air respects no borders. Different countries deal with the problems of pollution in different ways. So what are governments doing to make our cities more liveable? We sent Global development reporter Sam Jones to Mexico City to find out.


    SJ I’m standing on a roof garden in Mexico City with Ana Peñalosa, who works for the environmental secretariat of Mexico City. We’re surrounded by grey, lots of traffic noises and some aeroplanes but there’s a sudden stretch of green here, Ana, can you tell us a little bit about it?


    AP We’re at the top of one of the buildings, the offices of the environment department secretary of Mexico City, and we have a green roof here. It’s open to all the people who work here. In this building we have the air quality direction. So they are doing all the analyses about the air quality and monitoring of the whole city. We’re actually in downtown, and it’s a lot of cars passing around all the time.


    SJ I think we can hear those.


    AP So this space, it’s like being away from that.


    SJ What’s the public reaction been? You say it serves a very useful purpose, it helps purify the air because it drags down some of the nasty gases which are there because there’s a lot of motor vehicles in Mexico City, as we can hear loud and clear. And it’s good for children, and if you work in this bit of the environment department you can come and have exercise classes on the roof. But what has the public reaction been, what of the people who live in Mexico City, what have they told you about what the project means to them having these green roofs.


    AP Well, I think that in general people are very keen. There are a lot of people growing plants and even vegetables in their available spaces at home, like some balconies or even in their rooftop. And the environmental Education department has a lot of these kind of projects and workshops teaching people to grow their own food. Even though there are some big parks like Chapultepec, we’re trying to bring closer to people these green spaces. Like, for example, in hospitals it’s really important because it helps to heal people as well. And in public schools, to teach children to grow plants and vegetables and have green spaces where it’s available, where it’s possible.


    SJ And the government, this is one of the measures that they’ve put in place to try and improve the air quality. And there’s a bicycle scheme, similar to the Boris bikes in London or the bicycle scheme in Paris, what other steps has the government taken to try and reduce the problems of very polluted air in the city?


    AP Well having implemented things … but of course we believe that transportation modes are directly related to air quality in the city. And of course we’re working really hard on that. For example, the public bike scheme started four years ago and it’s been a tremendous success. And of course people are realising that the alternatives, like transportation alternatives, that are actually more convenient … It’s important that citizens realise that every action they take it’s important, and it counts for having air quality and quality of life in general.


    SJ You’re from Mexico City. Can you describe what the pollution was like 10 years ago or 20 years ago?


    AP Yeah, it has changed, it has improved – but it’s always more and more people living here, and the city is growing, and you have to monitor and control it continuously.


    SJ And as a native of Mexico City, how would you rate the air quality today, this afternoon. If you look around and you take a big, deep breath, how would you describe the air this afternoon?


    AP It could be better. I’m from here as you said, you know, it’s fair enough, it’s all right.


    SJ There’s noticeable smog, I think, and some of the buildings as we get towards the sides of the valley fade away into blues and greys – but it doesn’t feel quite as bad as it was when I was last here 11 years ago. I mean you think there’s definitely been an improvement?


    AP Yeah, when I was a child, yeah, it’s definitely a really noticeable difference. All I can say is that we have to keep working on this and of course changing habits; choosing bicycles instead of your car.


    SJ So progress.


    AP Yes, definitely. And I really think that Mexico should be a global example of policies to improve air quality in one of the largest cities of the world.


    HM Sam Jones speaking to Ana Peñalosa. Well I’m pleased to say we’ve gathered all the correspondents you’ve just heard in our studio: that’s John Vidal, Sam Jones and Sarah Boseley – welcome to all of you. Sam, let me start with you; tell me a bit about what it’s like because you left London you went to Mexico City was it obvious that the air was different, was it obvious that the atmosphere was different to you?


    SJ It’s a very noticeable difference. There’s a constant haze, a kind of pall that hangs in the sky. If you try and climb up a few flights of stairs you’ll find your lungs are working a little bit harder than they would in London.


    HM Of course we heard about the green roofs and cycle schemes, do those sort of things really make a difference?


    SJ I think they have made a difference. The Mexico City I saw last week was very different to the Mexico City I saw 11 years ago. Going back 11 years, there was much more pollution, it was denser, the streets were still full of the kind of iconic green-and-white Volkswagen Beetle taxis, they’ve disappeared now. You’re seeing liquid gas-powered buses; and perhaps the most noticeable difference is seeing people cycling in Mexico City, which I wouldn’t have imagined a little over a decade ago. Brave people take to their bikes in Mexico City – about 27,000 journeys a day so far and that’s rising.


    In terms of the green roofs, it seems to have captured the public’s imagination to a certain extent. I mean putting green roofs on top of buildings is not going to cure problems in a city of 21 million people with a massive, massive pollution problem. But it does seem to be serving an educational purpose and people are starting to think about the way they travel. But, clearly, you’re going to need rather more than that to sort out the effects of millions and millions of highly polluting cars.


    HM John Vidal, we’ve recently seen Paris halving the amount of traffic that it’s allowing into its city centre to reduce smog, and Beijing tried that too – does that work?


    JV No.


    HM Why not?


    JV There’s still far too much of it. The scale of what’s going on at the moment is so enormous, and I’m a bit of a pessimist. If you can see pollution that’s only the very top bit. What really gets people is what you can’t see, they’re so small, we’re talking about the 2.5 microns; this is the stuff that goes right down in your lungs, you can’t see that. We think that if we can smell pollution, that it’s bad. It’s not. The worst stuff is the stuff you can’t smell, you can’t see it, it’s invisible, it gets right down in there – that’s the really dangerous stuff. That’s the stuff the WHO is now realising is leading to the heart attacks and so many respiratory problems. We’ve just swapped one kind of pollution, which was factories burning coal, for another kind of pollution, which is really largely from gases like NO2 and the particulate pollution, and that’s the dangerous stuff. So just getting rid of a few cars is not going to be enough. You have to do it on a very large scale to make any difference at all.


    HM And, Sarah Boseley, it’s not just about a shorter life expectancy is it there are implications for children as well; tell us about those.


    SB Well it’s interesting. Once upon a time we used to think that pollution perhaps made things lot worse for people, and particularly for kids. And as time has gone on, we’ve realised that actually you’re talking about an awful lot of diseases and cancers. And the latest thing, I mean I was quite stunned to see a study in October last year that said that air pollution could actually cause low birth rate in babies. And that is really quite an incredible link. In fact it’s a European study so you’re not even looking at the developing world. I’ve been to Kathmandu and seen horrible, horrible pollution … Again, as John is saying, it’s often the stuff we’re not seeing. You’re seeing low birth weight babies and they think that air pollution may have been a cause for that.


    JV In east London I was talking to respiratory doctors at King’s College, and they’re measuring, by the age of five they can see that the birth weight of babies has gone down and you can already see the neurological effects on children that age.


    HM And why east London? What do we know about east London?


    JV Because there’s very, very heavy traffic going through those main roads. If you’re living within a 100 yards of those roads, you are effectively being polluted – and seriously polluted.


    SB It does stand to reason, actually, because we know that smoking causes low birth weight so why shouldn’t air pollution.


    HM Sam Jones, do you feel that people you met in Mexico City actually felt that this was a priority; obviously the politicians go to international gatherings and they know that globally people think it’s important, but do the people on the ground really feel we must do something about the air?


    SJ I don’t think it’s reached critical mass by any means. It’s a gigantic city and most people have more pressing concerns. Many people are living a hand-to-mouth existence, and I think it’s fair to say that improving air quality is not even on their list of priorities at the moment. Politicians are doing what they can, and the environmental secretary of Mexico City is very keen to stress that it’s actually advising Tehran on its air quality at the moment. I was told while I was there that some of the C40 cities have shown an interest in some of the smartphone applications that the Mexico City government is using. But in terms of on the ground take up and involvement in any kind of push to improve air quality – no evidence of that.


    JV Hugh, can I just say I think that a major problem is that we thought this was one of the environment problems which had gone away … It hasn’t. And so there’s a big perception gap with the politicians – they haven’t realised; one in 12 people dying of diseases linked directly to air pollution is extraordinary.


    HM But I explained that though because it did seem logical that once you’d got rid of all the dirty fuel that this problem would be better.


    JV It hasn’t gone away. We, the media, I think have been very bad at it, we haven’t realised. What has also happened is that the medics are beginning to appreciate much, much more the links. So there are a lot of advances which have been done in the field of medicine which are making people understand this is much more serious than we thought.


    SB Yes, but I would say actually that pollution is a complicating factor in other diseases. So, actually, you can’t blame just the pollution for the deaths, it’s just not like that. People have a genetic propensity and there will be other things in their lives that are causing the problem. So that’s one of the reasons why it’s been overlooked.


    HM So does that mean that we are underestimating the amount of it because some people will die. And, as you say, their deaths won’t be attributed to pollution – there will be other things. But in fact pollution will have been the crucial factor.


    SB No, I think we are starting to appreciate it and that’s what these studies are about. The WHO has attributed far more lung cancer and bladder cancer now to air pollution, for instance. And they can do some very clever stuff with studies where they factor out everything else. So we are seeing it, as John says, for the first time. But I think in the past that perception that it had gone away was perhaps because it was mixed up with other stuff too.


    HM Sam, in Mexico City, what did you feel was driving their initiative there; was it an altruism that we should think more about people’s health or was it a political imperative; what do you think was behind it?


    SJ I think some of it is altruism and some of it is a kind of firefighting. When you’ve got a city that big and it’s ever growing, if you’ve ever flown into Mexico City you look past the wing and it stretches on and on and on, there’s more people arriving every day, it’s a genuine megacity, something has to be done because it won’t be habitable if things get much worse. Twenty years ago they had the bright idea of moving the refineries out of the city, which has made a massive difference, clearly.


    The other factor in all this is Mexico is an emerging country, an emerging economy, it recently hosted a huge high-level meeting on global development and how to work better, and it’s projecting itself as a forward-looking country, as the kind of country that will take seriously developed country concerns such as environments, such as air quality. So it’s two pronged: yes they’re trying to make things better for the people who live there because they have to because it’s giant and it’s very polluted, and also they’re trying to show that they are capable of being this world player.


    HM But, John Vidal, it’s difficult isn’t it because you have this phenomenon of countries emerging and becoming more industrially developed, but a lot of things come with that. And it’s difficult for the developed world to say to those countries that are emerging, “Don’t do this” because they say, “Well hang on, that’s what you did to become as powerful and as rich as you are.”


    JV Yes but there are lessons to be learned from everyone’s progress, if you like. I think what’s happening in China is very, very interesting because there you have pollution on a very, very great scale now. And that’s mainly industrial pollution mixed with the traffic. And there, I think, the authorities are realising that unless they do get it under control then they stand a real risk of civil unrest, of civil problems and all kinds of other things attached to it. So if you live in a polluted city, and I’ve been to these places, people get really hacked off and they really don’t like it. And that’s a trigger for political dissent. And I think that will be one of the reasons why China gets its act together much quicker than some other countries.


    HM So to what extent to you think the international bodies, the international health bodies, are really gripping this? They may not have solved it but they’re on top of the scale of the problem.


    SB I don’t think, actually, they’re focusing on it as perhaps a lot of people would like them to. And that’s simply because there’s so much else happening all the time. We’re now into a situation where we have to worry about the spread of chronic diseases. So we’ve got heart disease and cancers caused by other things such as lack of exercise and eating the wrong foods – that’s the up-and-coming thing now, what they call the non-communicable diseases. So what happens is that there are fashions in health in the things that people turn their attentions to, and this isn’t as high a priority as a lot of people would like.


    HM What are ordinary people doing; I suppose I’d just like to get some sense of what the ordinary listener can do because all of this is being solved at a very macro level, at a governmental level but ordinary people have to go out and walk in polluted air. What sort of things were they doing in Mexico, Sam, quickly?


    SJ The people who are concerned about this are trying to use carpooling to cut down on the amount of pollution, or rationalise it a little bit more. Mexico City is rather too big to walk round. Those who care and who can get on the bike scheme and pedal their way round, that’s rising. But if you’re poor and you’ve got a long distance to travel in Mexico City, you’re not left with very many options, it’s basically the bus.


    HM John, I thought technology was supposed to save us from all of this. Why isn’t it or will it?


    JV Face masks, that’s what we need.


    HM That’s very old technology, isn’t it?


    JV It is. In a funny way you’ve got to stop breathing in the worst bits. Unfortunately, most of the masks are really not much use at all, frankly.


    SB I was just going to say, actually it doesn’t stop the particulates.


    JV Exactly. But every time you see somebody with a mask you think this area’s polluted so you do actually take more care, so in a way it is quite good. No, the only way anyone has ever found to reduce air pollution is to either cut down, get the factories burning much less fuel and get the cars to burn electric or something completely different, or get rid of the cars. That’s the only way you’re going to do it, otherwise it will build up and build up.


    HM And, Sarah, what’s the health advice? Is there any credible, sensible health advice being given to people who live in areas that have this serious problem?


    SB Well, the distressing thing is how little you can do about it, and pregnant women are a case in point; what do you do? You can give up smoking, you can give up alcohol, you can’t stop yourself in Bradford breathing in the diesel fumes from the buses and the lorries, and it’s not just cars of course. But you can try to help the community as a whole by walking, by cycling, by those sort of things, but you can’t actually protect yourself – you have to make a fuss about it.


    JV Hugh, there was one thing which I noticed … which was rather beautiful; the most polluted place in the whole of Britain happens to be Kensington and Chelsea – the richest borough in the whole of London. And this was quite extraordinary. Why? Because of the cars. They all drive very large diesels around there and also because they’ve got some big railway engines which burn a lot of diesel. But it is funny that the pollution does actually follow the rich as well.


    HM Well it does show, doesn’t it, how things change because not so long ago diesel was supposed to be the thing that was going to save us from all of this.


    JV Exactly.


    HM And that thinking has all been turned on its head.


    But that’s it for this edition of the Guardian Global development podcast. My thanks to John Vidal, Sam Jones and Sarah Boseley, to all our contributors, and of course to you for listening. If you have any comments about the programme or want to add your voice to the discussion, head to theguardian.com/global-development and please subscribe to hear future podcasts via iTunes or another pod catching service. My name’s Hugh Muir, the producer was Matt Hill. Until next time, goodbye.



    The international battle for clean air podcast transcript

    16 Mart 2014 Pazar

    Science Weekly podcast: the wonder of human skin

    This week’s podcast is only skin deep as we dedicate the demonstrate to an extended interview with Professor Des Tobin.


    Des informed Dr Natalie Starkey about the newest scientific study into anti-ageing skin remedies, how a pill might replace skin lotions, and why skin well being is crucial. He and Natalie have been chatting at final year’s British Science Festival in Newcastle, where Prof Tobin gave a presentation.


    Subscribe for free by means of iTunes to guarantee every single episode will get delivered. (Right here is the non-iTunes URL feed).


    Follow the podcast on our Science Weekly Twitter feed and obtain updates on all breaking science information stories from Guardian Science.


    Email scienceweeklypodcast@gmail.com.


    Guardian Science is now on Facebook. You can also join our Science Weekly Facebook group.


    We’re constantly right here when you need us. Pay attention back by means of our archive.



    Science Weekly podcast: the wonder of human skin

    28 Şubat 2014 Cuma

    Fighting insecticide resistance - podcast

    Professor Hilary Ranson, from the Liverpool School of Tropical Medication, speaks about her function to management ailments that are spread by mosquitos, like malaria and dengue fever.


    Hilary highlights the increasing risk posed by mosquitos getting to be resistant to the insecticides employed to control them, and says that much more wants to be completed to realize the scale of the dilemma.


    She also suggests ways that distinct groups inside the global development community and the personal sector can work with each other to much better manage the spread of insect-borne diseases.


    Join the neighborhood of global advancement professionals and professionals. Become a GDPN member to get a lot more stories like this direct to your inbox



    Fighting insecticide resistance - podcast

    24 Ocak 2014 Cuma

    Rwanda"s wellness services evolution – podcast transcript

    RE: Ruth Evans


    AB: Agnes Binagwaho


    PF: Paul Farmer


    SN: Sabin Nsanzimana


    Clip: “This province lost about 120,000 people.”


    RE That’s over a fifth of your population died in the genocide.


    “They did yes.”


    RE After the 1994 genocide which claimed up to a million lives Rwanda was one of the poorest countries in the world. The health system had collapsed and epidemics of infectious diseases including AIDS, malaria and tuberculosis were having a devastating impact on the country.


    Today, however, Rwanda’s economy has been transformed and its gross domestic product more than tripled over the last decade. And alongside this economic growth Rwanda has also recorded some remarkable outcomes in health. In the last 10 years the country has been dramatic declines in premature mortality with deaths from AIDS and TB falling by 78% some of the greatest declines in Africa. Maternal mortality also declined by 60% and under five child mortality by 70% to less than half the regional average.


    Doctor Paul Farmer, professor of global health at Harvard University was one of the authors of a recent article in the British Medical Journal.


    PF It’s important for the world to understand this because these are the steepest declines in mortality ever recorded at any time and in any place; and if we can’t explain coherently how that came to pass it would be a shame for other places where we’d also like to see steep declines in mortality and early suffering.


    RE I’m Ruth Evans and in this month’s development podcast we’ll be examining what Rwanda has achieved in the health sphere and asking how it’s done this and are there any lessons for other countries?


    AB I think all the people in the world want their children to be healthy, in better shape than they were themselves, but educated, and really to be a bit more rich.


    RE Agnes Binagwaho is Rwanda’s minister of health. She says health is a key pillar of the government’s vision 2020 strategy for economic development and poverty reduction.


    AB We totally understand that health is a social issue. That mean they are a social determinant of health and if we just look at the ministry of health we will get nowhere. We need to tackle the social determinant of health if we want to improve the health status of our population.


    RE And as a result she says Rwanda spends some 16% of the national budget either directly or indirectly on healthcare with much of it financed by foreign aid in the past. But it is isn’t just a question of throwing money at the problem. Rwanda only spends $ 55 or about £35 per person on health a year, slightly lower than the average for its neighbours. And in 2010 it also only had 625 doctors for a population of some 12 million people.


    At the National AIDS Day celebrations in December Kigali stadium was full to capacity with young people wearing bright orange and green T-shirts and the mood was colourful and festive. But 20 years ago there was little to celebrate. AIDS and TB were two of the biggest causes of premature mortality after the genocide. Many woman had been raped and infected with HIV and the government faced a huge challenge. By December 2002 only a handful of tens of thousands of Rwandans with advanced HIV were receiving expensive antiretroviral therapy or ARVs, mostly through private clinics says Doctor Sabin, head of Rwanda’s HIV AIDS programme.


    SN That time was actually no treatment, there was not even testing available until 2003 when the large scale of programmes was started really in Rwanda in opening of new facilities, voluntary counselling and testing, and even ARVs becoming easy, especially with the government linking it to the bad history of bad genocide that the country had passed on a number of cases of rapes and so on. So that was really the top priority of the new government to make sure that HIV is not going to be another big threat after those dark moments.


    RE From the start Rwanda’s AIDS programme was characterised not only by efforts to address both prevention and treatment but also by the recognition that the epidemic couldn’t be tackled without addressing other problems such as opportunistic infections and malnutrition. The entire healthcare system would need to be strengthened.


    SN We have already unrolled 122,000 of ARVs, which represent according to the treatment criteria, about 94% of those in need.


    RE Having the drugs is one thing, making sure that people adhere to the protocols of taking them is another. And a lot of people doubted that relatively poor African countries where malnutrition is also a problem that people would adhere to the drugs. Has Rwanda disproved that do you think?


    SN We have seen really very good adherence, more than 83% of people adhere very correctly. And we have seen a lot of change in terms of controlling the epidemic both for prevention and for treatment. Beds are being empty in hospitals just because people are receiving ARVs and not becoming very sick.


    RE Today the general prevalence of HIV is 3% the same as 10 years ago and the antiretroviral drugs are free. According to the World Health Organisation by 2010 Rwanda, along with much richer Botswana, was one of only two countries in sub-Saharan Africa to have achieved the United Nations goal of universal access to antiretroviral therapy.


    At a clinic in Gasabo district on the outskirts of Rwanda’s capital Kigali, a doctor is sorting the tablets to give HIV positive patients. So these are the antiretrovirals. You have a cupboard full of drugs here. You have plentiful supplies but 10 years ago there weren’t any antiretrovirals in this country, or very few, they were very expensive; so can you describe to me what difference having those antiretroviral drugs has made to the lives of the women that you see.


    Translated: “The death threat was high before but at this time it has really changed. If you even see them their appearance has changed. You can’t tell if they are HIV positive or not. There is a great impact since they have started having this medicine for free.”]


    RE When I first met Chantal 10 years ago she was sad, traumatised and very sick. She’d lost all her family in the genocide, had been raped multiple times and found herself not only pregnant as a result for HIV positive. Today she still lives in a village on the outskirts of Kigali with her son who is now 19. Life continues to be very hard but the transformation in her appearance is dramatic.


    Translated “I take two tablets a day. There are 30 tablets.”]


    RE When we first met they were only just introducing antiretrovirals into the country and they were difficult to get and you didn’t even have the bus fare to go to the clinic to go and see if you could have antiretrovirals. But now you have the medicine and you don’t have to pay for it, is that correct?


    C [Translated] “Yes we get the medicine for free. But you can’t take the medicines without having something in your stomach. This year I did not cultivate anything because I was very ill. I had a very serious cough. I also went to the hospital so there is nothing in my garden because this year I did not plant anything.”]


    RE But generally you feel healthier than you were 10 years ago?


    C [Translated] “We get used to it. I’m still ill and I’m still sad but I’ve got used to it. These medicines have many side effects, you can have a liver problem. They also cause something in your stomach which they need to operate. But there are some other medicines which the medical insurance doesn’t pay.”]


    RE Medical insurance is another pillar of Rwanda’s health strategy for universal health coverage. The aim is to reduce out of pocket expenditure which can have a catastrophic effect on poor families like Chantal’s. A community based scheme has been rolled out nationwide and according to the minister of health by June 2012 over 90% of the population had been enrolled with another 7% covered by civil service, military or private insurance plans.


    AB It’s a universal coverage scheme across the country for each and every one. The object is to decrease catastrophic expenditure. That means that this instrument is owned by the people and reimburse the care the people have. It’s for paying for them to get care.


    RE Was there a resistance from the communities initially; was there a huge campaign to educate people about why they should have to pay this insurance?


    AB No I think the minister of health and the first lady submit a project to global fund and this project aim to pay the health insurance of the million poorest. When the people saw how the poorest got access to care it was almost automatic. First of all this insurance is community owned, so this is a success. Secondly, it has increased access to care and increased the uptake of corrective care.


    RE And they still have to pay 10% of their care upfront?


    AB Yes.


    RE So they’re out of pocket. But this is a much smaller proportion than they would have had to have paid before.


    AB Absolutely. We don’t want to give free care like this. We pay at point of care so that people understand that care has a cost. And they want to graduate from poverty it’s something to make them proud to pay for themselves and we don’t believe in free things.


    RE There’s no doubt that this insurance scheme has helped far more people to access healthcare they might not otherwise have been able to afford.


    Translated “It’s really a good system, it helped. You just need to have 200 when you’re going to the hospital. Only 200. And for the medicine you can pay only 500. And before you could pay, let’s say, 5,000 so it’s a good system, it really helps. If you have the medical insurance in the house you can go anytime to the hospital.”]


    RE Initially this insurance was a flat rate payment but now it’s more complex. Since 2006 the poorest have been subsidised by a three tiered fee structure. Even though many genocide survivors like Epephanea are poor and live in very basic mud houses with leaking tin roofs and even though they have many ongoing complications from HIV they don’t qualify for the free insurance category.


    E [Translated] “There was this new system introduced to put people in different categories. So we are not on the category of people who they help to pay for medical insurance. Before it was only 1,000 but they have increased their price up to 3,000. After genocide we tried to work hard so that we can show the people who killed our people that we are still able and still have power to do something and we managed to get something. So if they see it they think that we are rich when we are not.”]


    RE Each household has been assessed according to how much land or how many cows it has. But the problem is that the assessment was only done once and people’s circumstances change. For many poor people the insurance for their families can be the equivalent of a month’s rent or a term’s school fees.


    As she shows me her insurance papers Chantal says it’s a struggle to find the annual payment of 3,000 Rwandan francs or just under £3 for herself, her son, Bertrand, and Alice, a genocide orphan that she also looks after.


    C [Translated: "I had to pay 9,000 it"s a lot because I also need to get something to eat. I was in the third category where I had to pay the medical insurance for everything because they said that if someone owns a house they can pay for their medical insurance."]


    RE But is it better to have the health insurance and have to pay less when you need to go to see a doctor or go to a clinic? Is that better than the system before when you had to pay everything upfront out of your pocket?


    C [Translated] “The medical insurance it’s good for women who are going to give birth to the hospitals. But for me it’s always hard. I can’t say that paying 100% is also easy but it looks the same to me because I don’t get enough medicine.”]


    RE The universal health insurance system may not be perfect says Doctor Paul Farmer who is also the co-founder of the International Non-governmental partners in health. But he says it’s a huge step in the right direction.


    PF Are there problems? Of course there are problems but they’re not as bad as the ones we just saw in the United States with the roll out through the, again, great technological tools, but in Rwanda they rolled this out in the course of a couple of years. And did they have a lot of help? Sure they had partners of course. Are we proud to be their partners? I’m sure those who help finance it and think of it – the multilaterals and bilaterals, I’m sure they’re proud of it too, they should be. But the Rwandans need to say hey we did this and we did it imperfectly but with the aspiration in mind of having a universal social protection that reaches everybody. And however difficult any kind of barrier, such as co-payments are, however problematic those are the idea of universal coverage is the most important one.


    RE But improving access to care also increases demand for services and Rwanda faces one of the greatest shortages of human resources for health in the world. Many health professionals were killed during the genocide and countless others have left. Efforts are now underway to train new doctors and nurses but this will take many years. Meanwhile 45,000 community health workers, three for each village or cell, have been elected by communities and trained by the Ministry of Health to take care of many basic primary healthcare tasks.


    AB They are really our voice house to house on how to prevent HIV, how to adhere to treatment if we are HIV positive, how to go for HIV diagnosis if you are a pregnant woman, how to deliver in a health centre. They are our voice and allow us to be really client centric.


    RE These community health workers play a key role in family planning, antenatal care and childhood immunisation campaigns. They can also refer patients to health centres and hospitals. They’ve also been trained to diagnose and give treatment for malaria, pneumonia and diarrhoea. What differentiates Rwanda’s community health workers from similar schemes in other African countries is the number. Ethiopia, for example, has 38,000 community health workers for 93 million people; whereas, as we’ve heard, Rwanda has 45,000 for just 12 million.


    AB As they are volunteers we don’t want to overload them. Of course we award them against service rendered but it’s not so much. So we better have people who are very well known in the village; a village is 100 to 200 houses, very well known, elected, we train them so that they are available they don’t have to go far to give services and they can continue their day to day life and other job they have. So we deliberately chose the village as a unit, a couple to run the services and add a third one to just take care of pregnant women and new born for the first years. So that’s how they became 45,000.


    RE For the past eight years Cecile has been one of three elected community health workers responsible for 750 people in Kibirizi village in Southern Rwanda. She proudly wears a uniform with pictures of mosquitoes and messages about malaria printed on the blue cloth.


    C [Translated] “I’ve had many trainings. We agreed to treat malaria, diarrhoea and cold diseases. We also look to the malnutrition for the children. I love giving advice to people who need it and giving treatment to children and I see them recover. I really love my job. We also check malaria and we know which medicines to give them and whenever it’s complicated we give them transfer to hospitals.”


    RE Deaths from malaria dropped dramatically by 87% between 2005 and 2011. And as we’ve heard maternal mortality also fell by 60% and under five child mortality by 70%. Doctor Paul Farmer has analysed the reasons for these dramatic results.


    PF There is no question that community health workers are a big part of the reductions in mortality that have been documented in this country because there the delivery mechanisms for a lot of the deliverables whether it be a bed net, a malaria bed net, or a vaccination campaign or care for pneumonia – whatever the deliverable is the idea that doctors and nurses are pushing those deliverables out to communities it’s not true. You just look at the human resource challenge or crisis in Rwanda you see it can’t be the doctors or nurses because there just aren’t enough of them to account for it. It has to be community health workers.


    RE A performance based pay system is also being introduced to reward not only community health workers but health centres and hospitals when they hit targets such as increasing the proportion of women delivering at health facilities or the number of children receiving a full course of basic immunisations.


    J My name is Joseph I’m head of health centre.


    RE Joseph manages a health centre serving 55,000 people in Kigali and he says the financial incentives to meet targets are popular with his staff.


    J [Translated] “It makes them happy. They get the bonus money according to what services they are giving. It also encourages them to give better services so that they could get better money.”]


    RE In the last 10 years Rwanda has made a great deal of progress in the health sector. How have you seen that manifest here in the clinic in terms of the facilities that you can offer people and also the types of illnesses that you are dealing with?


    J [Translated] “There has been great change. Death threats have gone down for the pregnant women and for children who are under five years. And we also take good care of people with HIV. So the numbers of deaths has really gone down. We work with healthy workers in the villages and in the cells to give advice to people who are sick, especially for the children who are under five years. And whenever the problem is great they are sent here to the health centre to be taken care of.


    We have introduced a new system where they use mobile phones to send SMSs, it’s called ‘Rapid SMS’. If they have a problem they could immediately send it to Rapid SMS so that we know what the problem is. We also have a system where they give monthly reports through mobile phones. We get the reports immediately using the Rapid SMS. It has really helped a lot.”]


    Translated “We have been given this phone by our parent our parent Kagame … His Excellency. It has really helped us a lot. When a woman is pregnant and is about to give birth we can use it to call to the health centres to send the ambulance. Or if someone is sick and his sickness is complicated we can use it to ask how to give him treatment so it really helps.”]


    RE Rwanda has been quick to adopt many technological and clinical innovations including a comprehensive health information management system says the minister of health.


    AB Of course with the technology we can overcome the lack of health personnel because those community health workers where lay people can ask advice and take good decisions with remote support of professionals. We use technology to report. We have a very good health information system that allows us to know our epidemiological situation and take the right decision at the right time and also to know if there is a part of the country that has a strange report. So we go there and try to find out. So this is timely. Before it would take us six months to analyse a lot of people. Now we have artificial intelligence to help us for that.


    RE So it’s really transformed the communication within the country both in terms of being able to disseminate things from the centre to the community health workers and for them to be able to alert you when there’s a problem.


    AB Before we had 15,000 reports, nobody can read 15,000 reports.


    RE Another significant success has been immunisation with the government claiming 93% coverage for nine childhood vaccines. Measles used to kill a lot of children but in 2012 there were only two cases in the country. And the last confirmed case of polio was 20 years ago says Doctor Maurice Gatera, head of Rwanda’s immunisation programme.


    MG What makes most of them a success it is integration at central level, the seed level, the facility level and the community level. At national level our division is working on the malaria programme. Where we try to integrate mosquito nets with immunisation programme. And our immunisation cards contain also nutritional status. At the community level also we use outreach services – you go to the community … that makes a success of immunisation programme. So far all children in Rwanda have received vaccine at 90% and measles vaccines at 97%.


    RE Doctor Gatera says vaccination saved the health service money in the long run because fewer children have to be treated for diseases at clinics later.


    MG Everybody, every parent, he knows that the child has to be immunised. It has become a culture. And what mostly make the success of this programme it is because of the community own it. We think about our Rwandan babies in the future.


    RE The slogan on one of your vehicles outside was ‘A Healthy Country is a Wealthy Country’.


    MG OK.


    RE That was on a vehicle outside. So do you think that health is actually a prerequisite for development that you cannot have economic progress and development without a healthy population?


    MG Yes sure. To invest in health it is to invest in the future economy of the country.


    RE Rwanda has also introduced an HPV or human papilloma virus vaccination programme against cervical cancer. Doctor Gatera says this has so far covered 97% of eligible adolescent girls compared to only a quarter of eligible girls in the US. The vaccines have been given through the schools during a nationwide four day campaign, and community health workers have followed up with any girls who were not at school. This new vaccine has been quite controversial partly because the vaccines were initially a donation from the pharmaceutical company that makes them. But the minister of health is adamant that this is the right way to go.


    AB We know that this vaccine is efficient at a very high percentage, safe and we were able to provide it so it should be really almost criminal not to go and fight for it. So we did.


    RE The vaccination was donated by Merck, was that right?


    AB Yes.


    RE And that was quite controversial wasn’t it?


    AB Yes but it’s controversial for little minds not controversial for global health of people who want really the health of people to be cared. Public/private partnership is the future.


    RE Some sceptics claim that Rwanda’s progress largely reflects high spending on healthcare much of it financed by foreign aid. Others argue that the 1994 genocide resulted in a unique opportunity for reform; so Rwanda’s experience really doesn’t apply in other countries. But Doctor Paul Farmer disagrees.


    PF It is true that the government has had substantial developmental assistance. It’s pretty easy to say, “OK here’s the hypothesis that is donor largesse that has driven forward this decline in mortality.” That is false because we can just say compare the amount of aid that Rwanda received per capita with all of the neighbouring countries or some of the other places I’ve worked in like Haiti and you’ll see that that’s a false hypothesis. The amount of investment per person in the health sector has been less than surrounding countries. So it’s again the way that those resources have been used that’s been distinctive here.


    RE Doctor Farmer says substantial credit for Rwanda’s progress must go to the efficiency and vision of the central government. The same government that has been widely criticised by the international community for its poor record on democracy and human rights. But the health successes are widely acknowledged and appreciated by ordinary Rwandans.


    Translated “The government of Rwanda they have really tried very much because before people were killed by malaria. Women who were pregnant were killed by malaria. Children who were under five years they were killed by malaria but it has really changed. There are many people who are suffering outside here but still the government is still doing what it can.”


    RE But the minister of health maintains that Rwanda’s achievements are not merely the result of a top-down approach to health policy.


    AB The health agenda has been done with a huge participatory process; that mean the population has owned it, civil servants have owned it and parliamentarians have owned it so that means everybody was around one agenda. So it was a huge dialogue around each agenda in the health sector. So this is the key factor of the success.


    RE Doctor Paul Farmer believes that there are many interwoven reasons for Rwanda’s successes but one stands out for him.


    PF The real secret is the commitment to equity. And to see that play out from some grand idea, let’s have justice and fairness and equity, into delivery and that’s been really something here – quite unique. And I’ll give an example when you actually say the poorest quintile receive the majority of our attention and we’re also going to go to the more rural areas that have been historically underserved and women’s groups to actually turn those ideas into policies that then get delivered then that’s the secret sauce linking this equity vision to real delivery.


    RE According to Doctor Farmer and other global health experts if these gains can be sustained Rwanda will be the only country in the region on track to meet each of the health-related millennium development goals by 2015. Yet, not long ago it was the country least likely to do so. Many challenges still lie ahead however, for example, chronic childhood malnutrition remains high, with 44% of children classified as stunted in 2010.


    AB It’s a big challenge educating people what to put in the plate of a child. There was great progress because now we are number one in east Africa, and fifth in Africa in tackling that – but we still have a long way to go.


    RE The government recognises that Rwanda will face great challenges if it is to meet its stated goal of becoming independent of aid by 2020. Nearly half of its health sector budget was externally financed in 2010 and the decision by several foreign donors to suspend or withhold aid last year, a response to Rwanda’s involvement in Eastern Congo, could have serious implications for the future sustainability of the country’s health gains. But Doctor Farmer believes the challenges ahead do not diminish the present successes and he says there are many lessons Rwanda can offer other countries not only in the developing world.


    PF I think there are a lot of places that can learn from this experience and it’s not just the United States again that has a lot to learn, it’s shaking faith in social production in some European countries they’re saying, “Well we can’t do it” or “it’s not sustainable” or whatever the ‘it’ is, but the Rwandans I think are showing us that this idea of universal coverage, and when people ask me is it sustainable the first thing I think yes this is the only thing that is sustainable. I think it’s not sustainable to not do what Rwanda’s doing, to not think about equity of access to care, to not think about the burden of disease, to not think about innovation both in bringing in new tools whether they be a new treatment, a new vaccine, new communication platform – it’s not sustainable to not do that.


    RE Doctor Paul Farmer ending this month’s development podcast. My thanks go to Sadiki Businge my translator, and the European Journalism Centre for the International Developing Reporting Grant that facilitated my trip to Rwanda.


    For more great downloads go to theguardian.com/audio



    Rwanda"s wellness services evolution – podcast transcript

    20 Ocak 2014 Pazartesi

    Rwanda"s wellness support evolution – podcast

    Rwanda’s advances in healthcare come beneath the spotlight in this month’s worldwide development podcast. We appear at important areas of improvement and examine whether other building nations can understand from the evolution of the Rwandan well being services.


    Ruth Evans speaks to the country’s overall health minister, Agnes Binagwaho, and Paul Farmer, professor of worldwide health at Harvard University in the US. She also visits Kigali, the Rwandan capital, exactly where she interviews workers and healthcare recipients.


    Well being is a important pillar of the Rwandan government’s Vision 2020 technique for financial improvement and poverty reduction. The country spends only $ fifty five (£35) a particular person on overall health yearly, somewhat less than its neighbours, and in 2010 it had just 625 doctors serving around 12 million folks. But it has managed to notch up some impressive advances.


    Medical insurance coverage is a central element of the healthcare system. Two recipients clarify how it operates, who benefits and how much it expenses.


    Evans meets two of the country’s 45,000 community health workers, who are qualified to take care of main healthcare duties. There are 3 such staff in every single village and they are elected by regional individuals.


    We check out how the remedy of HIV and Aids has improved significantly in Rwanda. According to the United Nations programme UNAids, there were an estimated 210,000 folks in the country residing with HIV and Aids in 2012. Sabin Nsanzimana, who functions at the Bio Health-related Centre, explains how Rwanda has managed to increase the use of expensive antiretroviral treatment (Art).


    Common Art consists of the combination of at least 3 antiretroviral (ARV) medicines to suppress the HIV virus and stop the progression of HIV condition. In December 2002, an estimated 870 of the tens of 1000′s of Rwandans with innovative HIV have been acquiring Art, largely by way of personal clinics. That variety subsequently increased drastically following the introduction of voluntary counselling as well as the testing and provision of ARVs.


    Rwanda has also implemented a human papilloma virus vaccination programme to fight cervical cancer, as Maurice Gatera, head of the immunisation programme, explains. The nation has so far innocculated much more than 80% of teenage ladies towards the virus, according to the Centres for Condition Control and Prevention, the nationwide public health institute of the United States. By comparison, only a third of girls aged 13-17 in the US have been completely vaccinated.


    Translator: Sadiki Businge


    The reporting journey to Rwanda was facilitated by an worldwide improvement reporting grant from the European Journalism Centre



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