Friday, 13 March 2015

Thousands die on Bangladesh's roads every year. One app offers hope.

Coming to rest against a tree at the side of the highway, the car had narrowly avoided catastrophe. Jennifer Farrell’s first instinct as a doctor was to help the motorcyclist. Just moments before, a bus had been crossing paths with the young American medic’s vehicle on the N2 – one of the world’s deadliest highways – when the motorcyclist had overtaken at speed. Running from the wreck towards the injured man, she had already anticipated that he would swiftly get up, grab his motorbike and flee.

“There’s a lot of vigilante justice in the world of road traffic accidents in Bangladesh,” she says. “People will pull people out of cars and beat them to death.” The ever-present threat of injury, or worse, on the country’s roads is a harsh reality that many in Bangladesh have simply become accustomed to.

Comparatively speaking, for every two fatalities in road accidents in the US, there are 160 deaths on the streets and highways of Bangladesh. Just under half of those killed are pedestrians, with 82% of injured parties in all road accidents succumbing to their wounds because of a lack of basic medical care at the scene.

“We’re trained in the US from the time that we are two or three years old how to dial 911, and you always just think that it’s there and you don’t realise that it’s not like that in most parts of the world,” says Farrell. Even as we speak by Skype, as if to underline the problem, the invasive and repetitive sound of car horns fills the space of her sixth-floor apartment in Dhaka.

Farrell, a Duke alumnus and Tulane University-educated doctor from Santa Monica, California, is the founder and CEO of CriticaLink – the world’s first mobile app-driven emergency medicine system, currently undergoing a trial in Bangladesh’s capital.

According to the World Health Organisation, fewer than 10% of road traffic accidents are attended by ambulances, a commodity in limited supply in a country with a population of 149m. To date, there is also no emergency telephone number to call to report accidents or summon emergency services, nor is there any emergency medical training available to doctors or nurses.

It wasn’t until her final year of college that Farrell had her first taste of trauma medicine in the developing world. With four years as a volunteer paramedic with her campus ambulance under her belt, she received a grant that took to her to South Africa to work in prisons and schools, teaching first aid to medics. By 2012, she had arrived in Bangladesh to assist a trauma surgeon in conducting similar training sessions in Asia.

“We spent about a month doing trainings with youth volunteers, doctors, medical students and security guards. We trained hundreds of people, but my biggest concern was how to connect these people with the people who need them. So this is when the idea for CriticaLink came: using mobile technology to connect these people to the people on the streets that need their help.”

Having seen the extent of mobile usage firsthand after her own car crash on the N2 highway, Farrell is adamant mobile technology has a vital role to play in bringing emergency medical care to developing countries.

“I have a picture that someone else took of everyone taking a picture of us. There’s a crowd of a hundred people and everybody is pulling out their phones to snap pictures and upload it on Facebook. If they can snap a picture and upload it on Facebook, they can snap and a picture and send it to the reporting centre.”

The premise for the innovative system is simple, and it works much the same way as Uber – the only difference is that someone is coming to potentially save your life rather than give you a ride. Using the CriticaLink mobile app, a phone call or an SMS message to report accidents goes to a call center, where volunteer operators are able to alert nearby first responders with the help of location-based technology. Within seconds, the responders have the whereabouts of the accident, with maps, up-to-date information and images at their fingertips.

So far, Farrell has trained some 3,000 people from all walks of life, with 500 registered unpaid volunteers, both male and female, aged on average 21 or 22 years old.

They are rigorously trained by qualified medics in triage, checking vital signs, protecting the head and neck, controlling bleeding, caring for burns, performing CPR and splinting fractures before they are allowed into the field. Even then, they must pass a gruelling process of review sessions, a series of practical workshops, and written and practical exams.

Although still in the pilot stage, with 125 fully certfied first responders participating in the beta test, the system seems already to be having an impact: since the start of the trial in November, it has had a number of success stories, most notably last month when a garment worker was severely injured falling from a bus.

After receiving a report from a bystander who witnessed the accident, the call center alerted through the app one of the CriticaLink first responders, who headed to the scene. “It was actually outside one of our areas, but he was close by and he went. He then alerted some of the others through the app to come and help and to meet him in Uttara, where we do have a team,” Farrell says.

From the Uttara suburb of Dhaka, they took the victim by auto-rickshaw to the nearest hospital, where she was refused treatment due to the severity of her wounds. After she was stabilized, she was eventually accepted and operated on at Dhaka Medical College and Hospital, where the responders had called ahead to make sure that a blood donor was waiting and then informed the family.

“This was a poor garment worker who probably wouldn’t have made it. She had no money to pay for transport to a hospital and had multiple internal bleeds and a head trauma,” says Farrell.

Providing a good Samaritan service free of charge in a country where the national average annual income per capita is just $700 presents the greatest challenge to the project thus far. “This kind of system has never existed in Bangladesh, so the idea of someone coming to help you out of their own free will is one that people are very sceptical of. ‘Are you going to steal from me? What do you want from me? Are you really here to help?’” explains Farrell. “I think it’s going to take time for people to recognise that we’re there to help them.”

Each year, accidents claim 5.8 million lives worldwide, nearly all of which happen in developing countries like Bangladesh. It is not uncommon to find 4,000 patients in an 800-bed hospital awaiting attention: on the floors, in the stairwells, two to a bed and, in some cases, in between and underneath them as well. To add to this, up to 100 trauma patients a day can arrive at emergency rooms seeking urgent treatment.

Of course, it is not just road traffic accidents that are pushing the overburdened healthcare system to breaking point. Bangladesh has been awash in waves of political violence in recent months amid ongoing deadlock between the government and opposition. Over 100 Bangladeshis have been killed, including the murdered American-Bangladeshi blogger Avijit Roy, in a rising tide of violence, train derailments and petrol bomb attacks on buses and buildings. And there are of course well-documented disasters, such as the Rana Plaza factory collapse on 24 April 2013, which crushed 1,129 garment workers to death.

Farrell found out the day after the disaster that she had been successful in obtaining a Fulbright scholarship to help set up CriticaLink. “I remember hearing the news about Rana Plaza and going, ‘If they don’t give this to me, they’re crazy. This is exactly why we need to do this project.’

“For me it was a sign to the rest of the world that this was something that was necessary. It was also when I knew this concept would work, as people were already trying to use social media, WhatsApp and mobile messaging to coordinate themselves.”

With plans in place to expand the project to other parts of the country by the end of 2015, Farrell is already leading training sessions in Bangladesh’s second-largest city, Chittagong, which came to world prominence due to its infamous shipbreaking yards. Workers here toil dismantling the asbestos-ridden hulks of oil tankers and container ships with limited or inadequate safety equipment; they account for a third of the trauma patients at the city’s medical center.

Ultimately, CriticaLink is a blueprint for helping millions across the developing world access medical services currently out of reach or non-existent in their countries. For her part, Farrell is confident that the app will bring about much-needed change in Bangladesh and elsewhere in the world with a greater importance being given to emergency medicine in particular – so long as there is a will and the human resources to deal with the problem.

“The skeleton of this whole system can be adapted not just to handle emergency services, but to help sexual assault cases in India or obstetric complications in rural areas. My goal is to see CriticaLink functioning and working in Dhaka, but with the ability to go anywhere. There is something there that tomorrow you could take to Ghana, to Nairobi, to South America. There’s room for technology and innovation in health, even in places with limited resources.”

Friday 13 March 2015

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Decoration day: Ebola leaves no graves to decorate in Liberia

An article on the importance of burial rituals following the ebola crisis.

Finda Fallah sat in her tiny one-bedroom apartment, boiling up rice and leftovers with one of the few children in her family still alive.

It was the night before Decoration Day, one of the nation’s most important public holidays, when Liberians clean, paint and decorate the graves of their relatives to honor lost loved ones.

But this year, after the Ebola outbreak decimated her family, there were no plots for Ms. Fallah to tidy. Burials were banned because of the highly contagious nature of corpses. The only grave Ms. Fallah could visit was that of her brother-in-law, whose funeral led to the infections in her family.

The thought of his grave made her angry, especially because her mother, sister, husband, two nephews and her 8-month-old baby, Fayiah, were cremated, leaving painfully little to mark their passing.

“I can’t go outside,” she said the next day, when the holiday came.

Decoration Day is a tradition adopted by freed American slaves who in the early 1800s settled in the area of West Africa that became Liberia. The national public holiday, which had its 99th anniversary on Wednesday, is often as much a celebration of life as a memorial to the dead.

But this year, it was a somber affair in the aftermath of the Ebola epidemic. The outbreak disrupted the intimate funeral practices that sometimes involve the bathing of dead relatives, the braiding of hair and the kissing and touching of bodies at burial services.

“May we pause to remember all of those who lost their lives during this Ebola crisis; I say they were heroes and not victims,” said the Rev. Christopher Toe, at a church service for Decoration Day on Wednesday. “Had they not died, the international community would not have come. Had they not died the U.S. government would not have sent all the U.S. Marines they sent.”

“They did not die in vain,” he added.

A handful of deputy ministers and ministry of health staff members sat in the pews of the half-filled Presbyterian church in the heart of the capital, Monrovia, for the national celebration. Members of the United Nations Ebola mission and the Centers for Disease Control and Prevention joined them.

“Today is not an official government of Liberia memorial day ceremony for Ebola victims,” said Tolbert Nyenswah, the head of Liberia’s Ebola response. “Because Ebola is not over.”

The countdown until Liberia is officially declared Ebola-free is on. It began on March 5, when the last known Ebola patient, Beatrice Yardolo, 58, an English teacher, was discharged from a Chinese Ebola treatment unit.

Ms. Fallah, who herself was infected with Ebola, had to care for her children, nieces and nephews in an elementary school that was turned into a makeshift holding center where people suspected of having Ebola were housed, in squalid conditions, before being taken to one of the few treatment centers in the city at the time.

In a damp blue classroom, Ms. Fallah fed and cared for them, trying to separate the sick from the well. She was the only adult caring for seven children. Then the center was ransacked by angry residents in August, and she and her children were left wandering through the vast neighborhood, known as West Point.

Ms. Fallah still dreams about her little nephew, Tamba Nilo, who died in a treatment center, rolling around in a long T-shirt, saying “I’m hungry.”

Ms. Fallah believes her psychological survival now depends on forgetting. She bows her head and passes through special routes in the narrow sandy alleyways to avoid the school and the cramped house where she and her family used to live. She tries not to let her eyes dwell on women who remind her of her mother.

While Ms. Fallah survived, she does not know how much longer she can last, having only limited support from a nongovernmental organization that is paying her rent and sponsoring her niece’s school fees. Ebola survivors are now lobbying for more support.

Friday 13 March 2015

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Tanzania: Iringa bus crash toll reaches 50 - eight bodies identified

The death toll of the traffic accident that occurred at Changarawe village in Mafinga, Mufindi District, Iringa Region, on Wednesday morning increased to 50 people on Thursday after eight casualties died in hospitals.

Eight bodies were identified by relatives by Thursday. On Wednesday morning, 42 people who were travelling in a bus christened Majinja died instantly as 23 others were seriously injured after a container which was carried by a truck fell on the Dar es Salaam-bound bus from Mbeya.

Iringa Regional Police Commander, Ramadhani Mungi said most of the identified bodies are Mbeya traders from Soweto market saying they are yet to recognize eight people who died on Thursday.

However, he said, the identification process is going on at Iringa Referral Hospital and Mufindi District Hospital.

Mr Ramadhani Mungi, said from the scene of the carnage yesterday that the accident occurred at Changarawe village at around 10 am.

He said the container fell on the bus as the truck driver was attempting to avoid potholes along the road. "The container fell on the bus with registration number T 438 CDE when the truck carrying the container swayed while attempting to avoid potholes along the road," he narrated.

According to Mr Mungi, the accident was caused by the truck driver whose identity was not immediately established, as he was attempting to avoid the potholes while on high speed.

The Iringa Regional Commissioner (RC), Ms Amina Masenza, said the deceased's bodies were taken to Mufindi District Hospital mortuary for preservation pending collection by their relatives.

She said the injured persons were taken to the same hospital for medical treatment, while those in critical condition have been referred to the Iringa Regional Referral Hospital.

Following the accident, President Jakaya Kikwete has sent a condolence message to the RC, saying the nation has suffered a great loss.

"I'm shocked, saddened and pained from the bottom of my heart to learn that over 40 people died and several others were seriously wounded in the grisly accident," Mr Kikwete said in a statement issued by the Directorate of the Presidential Communications in Dar es Salaam.

President Kikwete assured the bereaved families that he was with them "during this hour of great need." He wished the injured passengers speedy recovery.

Iringa Chief Medical Officer, Robert Salim said the identified bodies have been collected by their relatives.

Friday 13 March 2015

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DNA testing could help address humanitarian crisis at the border

Recently, the remains of yet another migrant were reported in Brooks County, Texas, a county bordering Mexico. That's the 17th dead body in that county in the first two months of 2015. Sadly, that's not really news. Hundreds of undocumented migrants are found dead along the southern U.S. border each year, and many are buried without identification. What is surprising is that most are from Central America -- not Mexico.

Last year, more than 50,000 unaccompanied children from Central America crossed into the United States. According to a recent nonpartisan congressional Government Accountability Office report, the children migrate north because of violence and economic concerns in their home countries, and to reunify with family members already in the States.

But the journey is treacherous, and some migrants don't make it -- hence the 400 dead bodies along our border each year. When a migrant doesn't survive, tracing his or her identity is not simple. Back home, the disappearance is a nightmare for their families who have no idea if their loved one is alive or dead. The Colibrí Center for Human Rights reports that relatives of missing migrants contact dozens of agencies in hopes of finding family members, often at great cost.

On the U.S. side, authorities struggle to identify the body, with DNA being one of the last considerations. While DNA testing seems routine on TV crime shows, in reality, it's expensive to run DNA tests and, even if you can, you need to compare results with people in a database. It is challenging enough to collect DNA from relatives of missing Americans, much less to track down relatives in distant villages in Central America. Without an international DNA database, processing DNA from unidentified migrants is not cost-effective, especially for forensic agencies and nongovernmental organizations already strapped for funds.

Just because it's hard, however, doesn't mean we shouldn't do it. Every human being has a right to an identity, even after death. Knowing where our loved ones are and whether they are safe are key values of a civil society.

An infrastructure exists to conduct this kind of DNA testing, and there is proven technology for developing secure international DNA databanks. Moreover, scores of well-intentioned nongovernmental organizations already are working with migrant families to reunify families. What we don't have is a coordinated effort to bring advocate groups together on behalf of victims and families. Too many groups are expending resources to track individuals case by case, rather than working together, and with forensic agencies, to develop a better system that respects the privacy rights of victims and families.

Another reason to develop a humanitarian DNA system for migrant families is the large numbers of unaccompanied children who enter the United States each year and whose safety we are obliged to protect. As we saw this past year, authorities have been struggling to house, screen, process and repatriate thousands of children from Central America. The sheer volume means we risk sending some of them back to situations where they will be exploited or harmed. DNA testing could prevent them from being handed over to a trafficker pretending to be their parent or uncle. A DNA system also would increase the odds of connecting detained migrant children with families in the United States -- or indeed, of identifying them if they turn up dead in a desert.

Definitions of "family" vary among cultures, so no decision to repatriate should be based solely on biological relations. The best interests of a child should supersede all other factors. Importantly, DNA and personal information collected for humanitarian purposes should be protected from secondary use by law enforcement. It is possible to protect individuals at risk of exploitation without compromising legitimate legal processes.

Working together, nongovernmental organizations, government and law enforcement can bring more families together and provide answers to more families wondering what has happened to their sons and daughters. So let's catalog DNA from relatives of the missing, here and across the border. Let's catalog DNA from human remains before they are buried. Let's develop humanitarian-rooted processes to confirm claimed relationships before we place children with traffickers.

Every three days, we discover another body in Brooks County, Texas. Every day, 137 children from Central America turn themselves in to the U.S. Customs and Border Patrol. These numbers add up to a human rights crisis that requires a humanitarian response. DNA is just one biometric tool, but it is a powerful one. We should be using it for humanitarian purposes to identify the dead and protect thousands of children in our trust.

Sara Huston Katsanis, a former DNA analyst in a forensic laboratory, is an instructor and genetics policy researcher in the Science & Society initiative at Duke University.

Friday 13 March 2015

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Death toll in Russia blaze rises to 11

The death toll after a massive fire ripped through a shopping mall in Russia has risen to 11.

Officials initially announced the deaths of a woman and four men after the blaze destroyed the three-storey building in Kazan, the capital of Tatarstan and about 800 kilometres east of Moscow.

However, six more bodies had been found, up to 25 people were still missing and it could take several days to comb through the debris, emergency ministry spokesman Andrei Rodygin told RIA Novosti news agency on Friday.

A security guard had initially tried to extinguish the fire himself and it took some time before the fire brigade was called, reports said.

Although the fire has been put out, an area of 4,000 sq m (43,000 sq ft) was razed to the ground.

Business owners who had broken through a police security cordon to save their goods from the fire were feared to be among those trapped in the rubble, Tass news agency reported.

Five hundred riot police were sent to seal off the centre to stop people entering the building, it said.

A total of 650 shoppers were rescued from the centre.

Of those who sought medical help 16 remain in hospital, say regional health authorities.

Friday 13 March 2015

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9 victims of Florida military helicopter accident identified, 2 still missing

According to reports the bodies of seven Marines and two soldiers have been recovered from the wreckage. The other two soldiers are feared dead.

After hours of searching up and down the foggy Florida coast for survivors, Military officials announced Thursday morning they would be transitioning their search and rescue operation into a recovery effort and safety investigation.

"At this point we are not hopeful for survivors," said Colonel Monte Cannon the 96 Test Wing Vice Commander at Eglin Air Force Base

Seven marines and four soldiers were aboard the helicopter when it crashed in the Santa Rosa Sound during a routine training mission. Rescuers found wreckage and human remains Thursday, and two bodies of soldiers were recovered.

The chopper was carrying four guardsmen and seven Marines when went it crashed

According to officials, the Louisiana National Guard and the U.S. Marine Corps were operating a nighttime training exercise when the helicopter, carrying four guardsmen and seven Marines, went down. Media reports say the night was heavy with a thick fog.

Nine bodies have been identified so far.

Local crews, like the Pace Fire District, have been helping military officials search the Santa Rosa Sound for any debris or human remains but heavy fog has made their job difficult.

"The biggest thing is the weather it's a hindrance to us with the fog our visibility is limited so we're going out in groups to make sure that the safety factor is there for the boats involved," said Robby Whitfield, Chief of the Pace Fire District.

The cause of the crash is still under investigation. The recording device, similar to a black box on an airplane, is still believed to be under water with the wreckage.

Military officials have not released any names of those aboard the Black Hawk that went down.

"We have retrieved remains. That's all I can say at this point. We have an armed service medical examiner out there right now and he's working that stuff," said Eglin Fire Chief Mark Giuliano.

Another helicopter accompanying the crashed Black Hawk during the training drill returned safely.

An investigation into the cause of the crash is currently under way.

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Hunt for survivors afer new Bangladesh factory disaster

Rescue teams searched Friday for survivors in the rubble after a factory collapsed in Bangladesh, killing at least seven people and sparking fresh criticism over the country's appalling record on workplace safety.

Hundreds of soldiers and emergency personnel worked through the night to clear debris from the site of a half-built cement factory in the port town of Mongla, the area's top administrator Shah Alam Sarder told AFP.

Twelve people were plucked alive from the rubble overnight but rescuers, who were using two cranes as well as steel cutters, were having to work painstakingly slowly for fear of triggering a fresh collapse.

Six bodies have been recovered so far and another could be seen lying under the rubble. At least 53 people were injured, including six whose conditions were critical.

More than 90 staff were on the site when the structure started to cave in on Thursday afternoon, trapping scores of workers under a mass of newly-mixed concrete and steel.

"We're trying to reach the (seventh) body by cutting through a maze of steel but it's taking hours because any mis-step could trigger a collapse in the debris or on the other side of the factory" which is still in tact, fire department director Sheikh Mizanur Rahman told AFP.

Local police chief Jahedur Rahman told AFP that up to 10 people remained unaccounted for.

Most debris cleared

However the fire service doubted whether any more workers would be found, saying that more than 80 per cent of the debris had now been cleared. The collapse comes less than two years after a garment factory complex imploded outside the capital Dhaka, leaving at least 1,138 people dead and highlighting Bangladesh's perilous labour conditions.

While that disaster did prompt some improvements and greater monitoring of safety in the garment industry, campaigners say that conditions in other workplaces remain as dangerous as ever.

"The horrifying collapse of yet another factory is a stark reminder that the root causes of threats to workers rights have yet to be addressed across the manufacturing sector in Bangladesh," said Sarah Labowitz, an expert on labour rights at New York University Stern School of Business. Survivors said that poor scaffolding and shoddy construction was the cause of the disaster.

The government has tasked a nine-member committee to complete an investigation into the case within a week, Sarder told AFP. Masud Kazi, one of the workers who was injured, told the Daily Star newspaper that he and his fellow construction workers were pouring concrete onto the roof when it started collapsing.

"Suddenly, everything broke down," he said.

"I heard a loud noise and saw the roof caving in through the middle," another survivor told private television station Jamuna. The police chief Rahman said several people were seriously injured after jumping from the collapsing roof.

"Most of the workers who were on the ground floor were mostly able to escape unhurt," he added.

Friday 13 March 2015

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