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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Australia’s Great Barrier Reef, under severe stress in a warmer, more acidic ocean, has returned from near-extinction five times in the past 30,000 years, researchers said Monday.

And while this suggests the reef may be more resilient than once thought, it has likely never faced an onslaught quite as severe as today, they added.

“I have grave concerns about the ability of the reef in its current form to survive the pace of change caused by the many current stresses and those projected into the near future,” said Jody Webster of the University of Sydney, who co-authored a paper in the journal Nature Geoscience.

In the past, the reef shifted along the sea floor to deal with changes in its environment — either seaward or landward depending on whether the level of the ocean was rising or falling, the research team found.

Based on fossil data from cores drilled into the ocean floor at 16 sites, they determined the Great Barrier Reef, or GBR for short, was able to migrate between 20 centimeters (7.9 inches) and 1.5 meters per year.

This rate may not be enough to withstand the current barrage of environmental challenges.

The reef “probably has not faced changes in SST (sea surface temperature) and acidification at such a rate,” Webster told AFP. Rates of change “are likely much faster now — and in future projections.”

The World Heritage-listed site, which attracts millions of tourists, is reeling from successive bouts of coral bleaching due to warming sea temperatures linked to climate change.

Webster and an international team wanted to view the reef’s current plight within a longer-term context.

Over 10 years, they studied how it had responded to changes caused by continental ice sheets expanding and waning over 30 millennia.

Fish nurseries

Their research covers a period from before the “Last Glacial Maximum” or LGM — the peak freeze about 21,000 years ago during the last Ice Age.

The average sea level at the time was some 120 meters (394 feet) lower than today.

As sea levels dropped leading up to the LGM, there were two massive “death events” — about 30,000 and 22,000 years ago, the team found.

These were caused by the reef being exposed to air. What remained of it inched seaward to rebound later.

As ice sheets melted after the LGM, two die-offs — 17,000 and 13,000 years ago — were due to sea level rise, the team found. In these cases, the reef moved itself landward.

The fifth death event took place about 10,000 years ago, apparently due to a massive sediment dump amidst a higher sea level.

Webster said the GBR “will probably die again in the next few thousand years anyway if it follows its past geological pattern” as Earth is believed to be due for another ice age.

“But whether human-induced climate change will hasten that death remains to be seen.”

In April, a study said nearly a third of the reef’s coral was killed in a “catastrophic die-off” during a violent heatwave in 2016.

Changes in sea temperature and acidity can cause corals to “bleach” — ejecting the algae that live in their tissue and provide them with food.

Bleached corals are more susceptible to disease, and without enough time to recover, may disappear for good.

Coral reefs are home to about a quarter of ocean life, and act as nurseries for many species of fish.
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More than three million cases of dengue fever, the world’s fastest-spreading tropical disease, could be avoided annually if global warming is capped at 1.5C, said a study that purports to be the first to show the health benefits of a cooler planet.

The mosquito-borne viral infection causes flu-like symptoms and can be fatal if it develops into severe hemorrhagic form.

The annual number of cases has increased 30-fold in the last 50 years, says the World Health Organization (WHO).

Using computer models, researchers from the University of East Anglia in Britain found that capping warming at 2 degrees Celsius (3.6 Fahrenheit) could cut annual dengue cases in Latin America and the Caribbean by up to 2.8 million by the end of the century.

A further half a million cases could be prevented if the rise in global temperatures is kept down to 1.5C, the report said, with parts of South America most likely to benefit.

“There is growing concern about the potential impacts of climate change on human health,” said lead author Felipe Colón-Gonzále.

“This is the first study to show that reductions in warming from 2C to 1.5C could have important health benefits.”

Since the year 2000, climate change has caused severe harm to human health by stoking more heatwaves, the spread of some mosquito-borne diseases and under-nutrition as crops fail, according to a Lancet report last October.

Current national pledges to curb emissions put the world on track for a warming of about 3C above pre-industrial times, far above the goal of “well below” 2C set at a 2015 summit in Paris.

The WHO has previously estimated there could be 250,000 extra deaths a year between 2030 and 2050 because of climate change.

“Understanding and quantifying the impacts of warming on human health is crucial for public health preparedness and response,” said co-author Iain Lake in a statement.

“Clearly a lot more needs to be done to reduce (carbon dioxide) and quickly if we are to avoid these impacts,” he said.

Dengue infects around 390 million people worldwide each year, with an estimated 54 million cases in Latin America and the Caribbean, according to the study, published in the Proceedings of the National Academy of Sciences (PNAS).

There is no cure for dengue and medical experts recommend early detection and expert care as the most effective way of overcoming an infection.
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Archaeologists using drones have discovered more than 25 geoglyphs etched into a swath of coastal desert in southern Peru near the Nazca Lines, a culture ministry official said Monday.

Most of the newly found geoglyphs, which include figures of a killer whale and a woman dancing, appear to have been made by the Paracas culture more than 2,000 years ago, hundreds of years before the Nazca people created similar giant drawings nearby, said Johny Isla, an archaeologist who heads the culture ministry’s conservation efforts in the region.

An additional 25 geoglyphs that had previously been spotted by local residents have also been mapped with drones, Isla said.

Drones “have allowed us to broaden our documentation and discover new groups of figures,” Isla said on a tour of the geoglyphs in the province of Palpa.

But unlike the Nazca lines, most of which can only be seen by flying above them, many of the so-called Palpa Lines were carved into hillsides and can be seen from below, Peru’s culture ministry said in a statement.

The geoglyphs created by the Nazca and Paracas cultures are striking reminders of Peru’s rich pre-Columbian history and are considered archeological enigmas, as no one knows for sure why they were drawn, or so large and for so long.

“In total we’re talking about 1,200 years in which geoglyphs were produced” in the region, said Isla.

Declared a UNESCO world heritage site in 1994, the Nazca Lines have faced damage by squatters looking for land to settle on and motorists veering off a nearby highway.

In 2014, environmental group Greenpeace apologized to Peru for staging a picture to protest dirty fuels at the Nazca geoglyph of a hummingbird, which government officials said was damaged as a result.

Isla said the Greenpeace incident prompted the culture ministry to ramp up efforts to protect archaeological sites in the region, helping lead to the new discoveries.

“We still haven’t walked among them, we’ve only taken pictures. This is the first stage of research,” Isla said.
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Indian Prime Minister Narendra Modi said on Sunday he expected around a 30 percent drop in the number of vehicles entering Delhi, as he opened two new expressways around the capital aimed at decongesting its streets and reducing deadly pollution.

A damning report by the World Health Organization this month said India was home to the world’s 14 most polluted cities, with Delhi ranked sixth most polluted. Air quality has worsened over recent winters, prompting Modi’s office to directly monitor measures to clean up the capital’s air.

“The expressways will greatly benefit the people of Delhi National Capital Region (NCR) by reducing pollution and will bring down traffic jams,” Modi said.

The NCR is a rapidly urbanizing and polluted area around New Delhi that is one-third the size of New York state, but houses 2.5 times more people.

Illegal crop burning in farm states surrounding New Delhi, vehicle exhausts and swirling construction dust have contributed to what has become an annual crisis.

The 135-kilometer (84-mile), six-lane Eastern Peripheral Expressway was built in 17 months at a total cost of around 110 billion rupees ($1.62 billion), the government said.

More than 50,000 vehicles that transit the capital city on their way to other destinations would no longer need to enter New Delhi, Transport and Highways Minister Nitin Gadkari told reporters on Saturday.

It offers signal-free connectivity and is the first green highway fully lit by solar power, has drip pumps for watering plants alongside the highway and has rain water harvesting. Modi also opened an initial stretch of an 82 km Delhi-Meerut highway, which is India’s first 14-lane.

Modi’s administration is marking its fourth year in office this weekend and has vowed to speed up infrastructure development as it heads into a national election in 2019. 
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Another person has died in Congo of a confirmed case of Ebola, bringing the number of fatalities to 12, said the country’s Health Ministry.

The new death happened in Iboko, a rural area in northwestern Equateur province, said the Health Ministry statement released Sunday. There are also four new suspected cases in the province, said the statement.

Congo now has 35 confirmed Ebola cases.

Health workers have identified people who have been in contact with confirmed Ebola cases in three areas in Equateur province, the rural areas of Bikoro and Iboko and Mdbandaka, the provincial capital of 1.2 million that is a transport hub on the Congo River.

Congo’s health minister Saturday flew by helicopter to Bikoro and Iboko to see the deployment of health workers who will be tracing those who have been in contact with Ebola cases and inoculating them with a new experimental vaccine. Health minister Oly Ilunga was accompanied by representatives of the World Health Organization and UNICEF. The vaccination campaign in those rural is to begin Monday.

The vaccination campaign is already under way in Mbandaka, where four Ebola cases have been confirmed. About 100 health workers have been vaccinated there as front-line workers face high risk from the virus, which is spread via contact with the bodily fluids of those infected, including the dead.

The next few weeks are crucial in determining whether the outbreak can be brought under control, according to the World Health Organization. Complicating factors include its spread to a major city, the fact that health workers have been infected and the existence of three or four “separate epicenters” that make finding and monitoring contacts of infected people more difficult.

WHO Director-General Tedros Adhanom Ghebreyesus told a meeting in Geneva on Saturday that ”I am personally committed to ensuring that we do everything we can to stop this outbreak as soon as possible.”

WHO is using a “ring vaccination” approach, targeting the contacts of people infected or suspected of infection and then the contacts of those people. More than 600 contacts have been identified.

WHO also is accelerating efforts with nine neighboring countries to try to prevent the Ebola outbreak from spreading there, saying the regional risk is high. It has warned against international travel and trade restrictions.

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.

 
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Streams flowing in the south of England may hold clues to the search for life on Mars. VOA’s Steve Baragona has more.
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Smog, industrial waste and contaminated water are just a few of the environmental problems facing many of the biggest cities today. But there is another type of pollution that’s becoming increasingly prevalent in our cities: noise pollution. Medical experts say people exposed to constant noise can suffer from a variety of psychological and physical ailments. As Saleem Shayan reports, it’s a particularly serious problem in megacities like Karachi in Pakistan where noise is a constant companion.
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The World Health Organization’s annual conference ended on a high note Saturday, with the organization’s director general praising delegates for giving him a strong mandate to implement an ambitious program of reforms and initiatives that will improve global health.

WHO chief Tedros Adhanom Ghebreyesus paid homage to his predecessor, Margaret Chan, saying the reforms begun under her leadership to make the World Health Organization more responsive and better able to tackle emergencies were now paying off.

“The current Ebola outbreak in the Democratic Republic of the Congo has demonstrated exactly that. … Let me assure you that I am personally committed to ensuring that we do everything we can to stop this outbreak as soon as possible,” Tedros said. “And the commitment of the government, of course, and the leadership is at the center, which we really admire.” 

The World Health Assembly, the decision-making body of the WHO, passed a number of resolutions aimed at improving global health. Some deal with diseases that have plagued humanity for centuries, while others are newly emerging.

But all these decisions, Tedros said, involve commitments to make the world a healthier, safer place. For example, he noted the assembly had approved a road map to reduce deaths from cholera by 90 percent by 2030.

“You endorsed our five-year strategic plan on polio transition, to strengthen country health systems that could be affected by the scaling down of the Global Polio Eradication Initiative,” he said. “You passed resolutions on tuberculosis and noncommunicable diseases. … And you have agreed to increase the development and use of digital technologies to improve health and keep the world safe.”

Tedros urged the delegates to go back to their countries with renewed determination to work every day for the health of their people. How well they succeed in this endeavor, he said, will be measured by the outcomes, by whether they result in real change on the ground.
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The UN children’s fund warned the Ebola outbreak in Democratic Republic of Congo threatens the health and well-being of children, and special care must be taken to help them survive. 

Ebola is highly contagious, killing between 20 and 90 percent of its victims, and the UN children’s fund is engaging communities in the fight against Ebola.  UNICEF spokesman, Christophe Boulierac said schools are crucial for minimizing the risk of transmission among children.

“UNICEF is scaling up prevention efforts in schools across all three affected health zones,” he said. “This includes on-going efforts to install hand washing units in 277 schools and supporting awareness raising activities reaching more than 13,000 children in Mbandaka, Bikoro and Iboko.” 

Previous outbreaks of Ebola in DRC and most recently in the horrific epidemic in West Africa have shown the high-level of trauma experienced by children at the loss of family members.   Boulierac told VOA orphaned children often become social outcasts because of their association with this fatal disease.

“There is as you mention, rightly, the risk of stigma and the risk that the child when his father, his care-giver, his mother is affected; the child is psychologically affected,” he said.

Boulierac said UNICEF is taking preventive measures, including providing trained therapists to families affected by the Ebola outbreak and helping children cope psychologically with the trauma of losing loved ones.
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