The California public health system will start delivering healthy meals to 1,000 patients with congestive heart failure or type 2 diabetes… and little purchasing power. The patients, who are part of a pioneering three-year pilot program, will receive a personalized diet and nutritional education to determine the impact of good nutrition on their ailment, and whether a healthier menu can lower their medical costs.
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The U.S. said it is hosting a senior-level Chinese delegation to witness its drug prevention and treatment efforts, even as the United States continues to battle opioid abuse that is killing more than 60,000 people annually.

The State Department said Tuesday the Chinese will visit drug abuse prevention programs in Washington and New York and highlight the role that U.S. agencies, private treatment centers and non-government community coalitions play in fighting drug abuse in the U.S.

An average of more than 160 people are dying every day in the U.S. from opioid abuse. But the State Department said the U.S.-Chinese effort to reduce the demand for illicit drugs adds to the two countries’ “recent productive cooperation” by imposing restrictive controls on synthetic opioids.

The State Department said it is aiming to cut drug abuse, “as addiction knows no national borders, and illicit drug use anywhere enriches transnational criminal drug traffickers.”

Last October, U.S. President Donald Trump declared opioid abuse a “national public health emergency.”
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Health officials in the Democratic Republic of Congo began a vaccination drive to control an Ebola outbreak that has infected more than 50 people and killed as many as 25. But as aid workers and health experts say this vaccination drive is a careful, methodical process in which trust is a key element.

Health officials in the rural corner of northwest Congo that has been hit with Ebola say workers are seeking out those at the highest risk to vaccinate, a move that tries to cut off the virus at the pass while also making good use of the limited supply of the vaccine.

At the moment, officials have only 7,500 doses of the experimental vaccine.

World Health Organization spokesman Tarik Jasarevic explained the campaign, which began this week in the rural communities of Bikoro and Iboko.

“This is not a general mass immunization, as is being done for some other diseases,” he explained. “We are looking into people who have been in contact with those who tested positive for Ebola, and their contacts. So we make a ring around the person who contracted the virus.”

That is careful work and involves much more than medicine, said UNICEF field worker Jean Claude Nzengu.

He said workers go to the households to talk about the vaccination that stops transmission, the advantage of the vaccination, what the residents need to do, how to behave, and finally take them to be vaccinated.

Congolese health authorities first reported the Ebola outbreak in early May. This is not Congo’s first encounter with the often-deadly virus, which causes an acute, serious illness. The WHO puts the survival rate around 50 percent.

Trust

But as health officials learned when Ebola rampaged through West Africa, killing more than 11,000 people between 2014 and 2016, earning public trust is a major element of the fight.

Last week, three infected patients escaped from isolation units in the city of Mbandaka. Two were found dead a day later and the other was found alive and returned to quarantine.

Jasarevic said it takes cooperation from the entire community for an Ebola outbreak to be defeated.

“It is only human that people who have their relatives in isolation units want them to be at home, want them to be with their family at home in what could be the last moments of their lives,” he said. “But we need really to explain to everyone how disease is being transmitted. If a person who is sick is in an isolation unit, it not only increases the chance of survival for this patient, but it will also prevent the spread of the virus to the family.”

The vaccination drive began last week, with health care workers receiving the first doses.

The experimental vaccine, made by U.S.-based Merck pharmaceuticals, has been shown in trials to be safe for humans.
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Every morning, Asma’u Muhammadu removes the wet sheets from her bed and sets them out to dry. She opens the door to let in the fresh breezes that will air out the smell of urine in the mud-walled room. Along with the sheets, she brings out wet rags she uses to line her inner garments.

“I am dealing with yoyon fitsari. I don’t know when the urine pours out from my body until I see it leaking down the sides of my legs,” says the 27-year-old woman.

Yoyon fitsari is the term used in the Hausa language to describe vesicovaginal fistula (VVF), a medical condition in which a hole between the birth canal and bladder leaves women unable to control their urine. Women with a hole between the birth canal and the rectum, rectovaginal fistula (RVF) experience uncontrollable leakage of stool. Some women have both VVF and RVF.

Some women are born with fistula, which is rare. Other causes include injuries sustained during pelvic surgery and hysterectomies, inflammation and infections in the genital area, and sexual violence.

But the leading cause of fistula is prolonged and obstructed labor. In Nigeria, between 400,000 and 800,00 women are currently living with fistula.

The World Health Organization describes fistula as “the single most dramatic aftermath of prolonged or neglected childbirth,” and estimates more than two million women live with fistula worldwide.

Young marriage only partly to blame

Nigeria has the world’s highest occurrence of obstetric fistula and the Nigerian government says early marriage is largely to blame. Often, the bodies of young wives are not physically prepared for childbirth. 

Muhammadu was married at 12 years old and had her first pregnancy at 15. She labored at home for two days before going to the hospital, but it was too late.

“On the fourth day, I gave birth and my baby wasn’t alive,” Muhammadu said. Her mother also has VVF fistula. They take care of each other.

But health workers say other cultural factors contributing to the high occurrence of fistula need to be addressed and focusing on early marriage oversimplifies the problem.

“I think we should de-emphasize the issue of early marriage as far as a direct cause of VVF is concerned,” says Dr. Bello Lawal, a fistula surgeon and the chief medical director at the Maryam Abacha Women and Children Hospital, the only one in the northwestern state of Sokoto that performs fistula repair surgeries.

“There are some traditional practices whereby a surgical procedure is carried out on a woman who is supposed to have a condition known as goriya, which is supposed to be a growth in the private part, that is supposed to be removed by the traditional barber, and in the process, they usually cause damage to the bladder or they cause damage to the rectum, and that can lead to recto-vaginal fistula or vesicovaginal fistula,” Lawal explains.

Traditionally in Hausa culture, barbers are called to remove goiters, remove enlarged tonsils, perform male circumcision and execute yankan gishiri, similar to female genital mutilation.

Goriya is said to be a tumor-like blockage of vaginal tissue, but Dr. Lawal said, “There is no tumor. Most of these cases, which we call goriya, are usually psychological cases.” Goriya is a form of the pseudoscience that has led to millions of women developing VVF.

The practice is also performed in cases of infertility.

Lack of skilled doctors 

Many women have had several failed fistula repair surgeries. Due to the stigma, most of them say their husbands divorced them. Dozens of former fistula patients live at the back of the Maryam Abacha Women and Children Hospital. They say they cannot go back home to face humiliation in their communities.

Only about a dozen doctors in Nigeria are skilled enough to perform the intricate fistula repair surgery, like Dr. Sunday Lengmang, a surgeon at the ECWA Evangel VVF Center in Jos.

Lengmang is considered one of the most skilled fistula repair surgeons in the world and the Evangel VVF Center is the only hospital in Nigeria that performs urinary diversion surgeries to handle complex fistula cases.

“Fistula affects the poorest of the poor in the poorest countries of the world,” he said, adding that this means the doctors working in this area must be highly motivated. 

“But apart from that, we also have the issue of the difficulty in finding doctors who have the skills,” he said.

With about 12,000 new cases reported around the country each year, the 14 Nigerian hospitals that perform repair surgeries are only able to handle about 5,000 operations, leaving an enormous backlog. USAID’s Fistula Care Plus says about 200,000 women in Nigeria are waiting for fistula surgeries.

Hospitals mostly rely on funding from outside of Nigeria. Donations fund the Evangel VVF Center, where surgeries are free of charge for patients. At other facilities, patients bear some of the cost of the surgery, which is about $300.

In her remote village, Muhammadu says her husband has stayed with her, despite her condition, and she is content. He has told her not to go the hospital for treatment since the fistula has not affected her ability to have babies. She has two daughters. 

She wants the fistula to go away, but says it is “destined by God to happen that way.”

This reporting was supported by Code For Africa, a data journalism initiative.
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A computer was better than human dermatologists at detecting skin cancer in a study that pitted human against machine in the quest for better, faster diagnostics, researchers said Tuesday.

A team from Germany, the United States and France taught an artificial intelligence system to distinguish dangerous skin lesions from benign ones, showing it more than 100,000 images.

The machine — a deep learning convolutional neural network or CNN — was then tested against 58 dermatologists from 17 countries, shown photos of malignant melanomas and benign moles.

Just over half the dermatologists were at “expert” level with more than five years of experience, 19 percent had between two and five years’ experience, and 29 percent were beginners with less than two years under their belt.

“Most dermatologists were outperformed by the CNN,” the research team wrote in a paper published in the journal Annals of Oncology.

On average, flesh and blood dermatologists accurately detected 86.6 percent of skin cancers from the images, compared to 95 percent for the CNN.

“The CNN missed fewer melanomas, meaning it had a higher sensitivity than the dermatologists,” the study’s first author Holger Haenssle of the University of Heidelberg said in a statement.

It also “misdiagnosed fewer benign moles as malignant melanoma… this would result in less unnecessary surgery.” 

The dermatologists’ performance improved when they were given more information of the patients and their skin lesions.

The team said AI may be a useful tool for faster, easier diagnosis of skin cancer, allowing surgical removal before it spreads.

There are about 232,000 new cases of melanoma, and 55,500 deaths, in the world each year, they added.

But it is unlikely that a machine will take over from human doctors entirely, rather functioning as an aid.

Melanoma in some parts of the body, such as the fingers, toes and scalp, are difficult to image, and AI may have difficulty recognizing “atypical” lesions or ones that patients themselves are unaware of.

“Currently, there is no substitute for a thorough clinical examination,” experts Victoria Mar from Monash University in Melbourne and Peter Soyer of the University of Queensland wrote in an editorial published with the study.
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Hundreds of women’s rights activist rallied in Belfast on Monday to put pressure on British Prime Minister Theresa May to reform Northern Ireland’s highly restrictive abortion rules after neighboring Ireland’s vote to liberalize its laws.

Voters in Ireland on Friday backed the removal of a constitutional abortion ban by two-to-one.

That leaves British-ruled Northern Ireland as the only part of the British Isles with a restrictive abortion regime, and May on Sunday faced calls from within her cabinet and the opposition to scrap Northern Ireland’s strict rules.

Not May’s call?

A spokeswoman for May said on Sunday changing the rules should only be undertaken by a government in Northern Ireland.

The province, divided between unionists who favor continued British rule and nationalists who want to unify with Ireland, has had no devolved regional government since January last year after a power-sharing agreement collapsed between the two communities’ main parties.

Activists gathered outside Belfast City Hall carrying placards emblazoned with messages such as “I am not a vessel” and “Mind Your Own Uterus.” They said it was May’s responsibility to act.

“1, 2, 3, 4, we won’t be silenced any more,” the crowd chanted. “5, 6, 7, 8, it’s time for May to legislate.”

Abortion is permitted in Northern Ireland only if a woman’s life is at risk or there is a risk to her mental or physical health that is long-term or permanent. It is not permitted in cases of rape, incest or fatal fetal abnormality.

Both Northern Ireland’s mainly unionist Protestants and its mainly nationalist Catholics tend to be more socially conservative than elsewhere in Ireland or Britain.

The main unionist party, the DUP, opposes liberalizing abortion laws, while the main nationalist party, Sinn Fein, backs some changes. DUP lawmakers in London provide votes needed to support May’s minority government.

Trip has its risks

It is estimated that around three women travel from Northern Ireland to England for an abortion every day, while others risk prosecution by self-medicating with abortion pills.

“It is awfully unfair that people here should not be able to get an abortion,” said schoolgirl George Poots, at the rally with her mother and brother. “At present they have to worry about travelling to England and I also think of the women who cannot travel.”

Anti-abortion group Precious Life said Ireland’s vote would spur it to “up the battle to protect Northern Ireland’s unborn children.” “Northern Ireland is now the beacon of hope to the pro-life movement around the world,” leader Bernie Smyth said. 
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Officials began vaccinating health workers and others on Monday in Bikoro, where Congo’s current Ebola outbreak was first declared at the beginning of May.

Congo’s Health Minister Oly Ilunga traveled to oversee the Ebola vaccinations of at least 10 people in Bikoro, where at least five of 12 Ebola deaths have happened.

Bikoro Hospital director Dr. Serge Ngalebato said he and other health officials were vaccinated for protection when treating Ebola patients.

“We who are on the front lines of caring for the sick. We are reassured,” he told The Associated Press by telephone. Monday’s vaccinations included three doctors at Bikoro Hospital, two health experts, two nurses, one representative of women in the community and one pygmy representative, he said.

The procedure, which is voluntary, will take time and follow up to make sure there is a positive response, Ngalebato said.

Congo’s vaccination campaign, which began in Mbandaka last week, is targeting more than 1,000 health workers and contacts of the sick in three health zones.

More than 360 people were vaccinated before Monday, said health ministry spokeswoman Jessica Ilunga.

As of Monday Congo updated that there were 54 cases of hemorrhagic fever:  35 confirmed Ebola cases, 13 probable and six suspected.

Amid worries of the spread of Ebola, several schools in the Iboko health zone, about 180 kilometers (112 miles) southeast of Mbandaka, have been closed, according to reports by U.N.-backed Radio Okapi.

Many residents in one of the Iboko localities told Radio Okapi that they prefer to stay at home to avoid infection, following the death of a woman who had Ebola in the nearby Bobala area.

One resident said that what they first thought were rumors were becoming reality with the death and that they were very scared to interact. Four confirmed Ebola deaths have taken place in the Iboko health zone, according to Congo’s health ministry.

Several heads of schools in the area also said they would suspend school activities to protect the children.

This is Congo’s ninth Ebola outbreak since 1976, when the hemorrhagic fever was first identified.

There is no specific treatment for Ebola. Symptoms include fever, vomiting, diarrhea, muscle pain and at times internal and external bleeding. The virus can be fatal in up to 90 percent of cases, depending on the strain.

Ebola is initially transmitted to people from wild animals, including bats and monkeys. It is spread via contact with the bodily fluids of those infected, including the dead.
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