http://viewchange.org Videos from ViewChange.org (Filtered by topics: The Health Show) en-us Wed, 13 Jun 2012 10:57:00 +0000 Copyright 2011 Link Media, Inc. http://www.viewchange.org/videos/the-health-show-using-larvicide-to-prevent-malaria As more people use bed nets to combat malaria, mosquitoes are adapting, making identifying and disrupting their breeding sites crucial. A Tanzanian pilot study led by Dr. Nicodem Govella is testing how effective larvicide is in reducing malaria in a large city. Wed, 13 Jun 2012 10:57:00 +0000 http://www.viewchange.org/videos/the-health-show-using-larvicide-to-prevent-malaria Malaria, Tanzania, Dar es Salaam, Mosquito net, Mosquito, Larvicide, Larva, Health, Sub-Saharan Africa, Liverpool School of Tropical Medicine >> VOICEOVER: One of the best ways to protect the most vulnerable people from malaria is a bed net. They're highly effective because malaria-carrying mosquitoes usually bite at night. But mosquitoes are adapting to survive. Their behavior is changing.>> DR. HILARY RANSON [Liverpool School of Tropical Medicine, UK]: Bed nets work very well at tackling mosquitoes that feed indoors at night, but as more and more people use bed nets, the mosquitoes start biting earlier and biting outside. So attacking the larva or the immature stage of the mosquitoes is a good complement to using bed nets.>> VOICEOVER: It's not just mosquitoes that are adapting. Africans are moving to cities in large numbers. So identifying and disrupting mosquito breeding sites makes sense.>> DR. HILARY RANSON: In an urban setting, it's easier to identify those bodies of water where the mosquitoes lay their eggs, and to target those. In rural areas, they're just too numerous and dispersed, but in a city, it's feasible to identify the major breeding sites, and apply insecticide to kill the immature mosquitoes.>> VOICEOVER: A pilot study in Dar es Salaam, Tanzania, led by Dr. Nicodem Govella, is testing how effective larvicide is in reducing malaria in a large city.>> DR. NICODEM GOVELLA [Ifakara Health Institute, Tanzania]: We target the larvae because the egg doesn't eat anything, the pupa doesn't eat anything and the adult mosquito targets our blood. The larvae ingest this larvicide, they get poisoned, and then die. >> VOICEOVER: The only way to find out if the mosquito larvae are being killed is to see if the number of adults has fallen.>> DR. NICODEM GOVELLA: This is not a safari tent, but a technology for monitoring mosquito densities.>> VOICEOVER: These six funnel-shaped entrances tilt upwards. Mosquitoes can enter easily, but getting out is much harder.>> DR. NICODEM GOVELLA: In order for the trap to work, you need bait, and the bait we use is the human being. Okay, so a person is supposed to sleep inside here and act as an attractant to mosquitoes. A person sleep until the morning, when he wake up and starts emptying all the mosquitoes trapped in the chambers.>> VOICEOVER: The results show that in the six wards of Dar es Salaam where larviciding took place, the density of adult mosquitoes fell by 57 percent. So it appears to be effective, but it's not cheap.>> DR. HILARY RANSON: It's very labor intensive to identify all the breeding sites and to apply insecticides. One of the projects that we're involved with in Dar es Salaam is to try and see whether it's necessary to apply the insecticide to every breeding site, or whether you can have again more or less the same level of control by just targeting the most productive sites. http://www.viewchange.org/videos/the-health-show-innovative-hospital-design-driving-improved-care-in-rwanda Within the rolling hills of Burera district in Rwanda lies a revolutionary new hospital. Dr. Peter Drobac, the driving force behind Butaro Hospital's innovative but affordable design, gives a tour of the hospital and its features. Wed, 13 Jun 2012 09:57:00 +0000 http://www.viewchange.org/videos/the-health-show-innovative-hospital-design-driving-improved-care-in-rwanda Rwanda, Health, Partners In Health, Hospital, Health care provider, Healthcare, Patient, Burera District, Africa, Medicine >> VOICEOVER: The rolling hills of Burera district in Rwanda, a picturesque backdrop for a revolutionary new hospital. Its designers believe it proves high-quality healthcare can be provided in even the poorest countries. Before, a single doctor struggled to care for 350,000 people in this area. Now, this one hundred and fifty bed hospital has eleven of them. Dr. Peter Drobac was the driving force behind Butaro Hospital's innovative but affordable design.>> DR. PETER DROBAC [Director, Partners in Health, Rwanda]: So this is the pediatrics ward. It's a typical ward here in the hospital, and it's in fact our busiest ward. And Rwanda, like a lot of other African countries, suffers from a health worker shortage. The ratio of doctors and nurses to patients is not as high as we're accustomed to in the US and in England, and as a result, it's even more important that the nurses can keep their eyes on all of the patients at all times. And so from here, the nurse can see all of the patients down on this side, and all of the patients down on the other side as well.>> VOICEOVER: Infection control is a problem in all hospitals. Here, high ceilings and permanently open, louvered windows create cheap, effective ventilation.>> PETER DROBAC: Because heat naturally rises, the air moves up, along with the heat, and out of those non-operable windows. And that effect is accentuated by large four-meter diameter fans. Twelve times every hour, 100 percent of the air inside of this room is totally turned over and refreshed, and that's sort of the magic number to ensure that the risk of an airborne infection like tuberculosis is really minimized.>> VOICEOVER: Other weapons in the fight against infection include anti-germicidal ultraviolet lights and easy to clean floors.>> PETER DROBAC: The floors are made of an epoxy resin material. We think it's important because this type of material is chemically resistant, it's smooth, and it's easy to sterilize. So we think that this type of flooring material is replicable and represents a big advance.>> VOICEOVER: Another design innovation is this central conduit wall. Oxygen and electricity supplies for medical equipment are right beside the patients. And it allows them to look out at the wonderful views.>> PETER DROBAC: The large windows on this side of the ward not only allow a lot of natural light into the ward, but also for patients lying in bed, they can enjoy a really stunning view of the mountain valleys. There's actually substantial evidence that a tranquil environment that promotes a healthy state of mind actually promotes healing of the body as well.>> VOICEOVER: Every aspect of the design is about serving local needs. The community gained financially because the hospital was built by them. But the fact that the hospital was built for them has been even more enriching. http://www.viewchange.org/videos/the-health-show-revolutionizing-prenatal-care-in-developing-countries Health Show host Dr. Ayan Panja interviews Professor John Wyatt, inventor of a fetal heart rate monitor that is powered by a hand crank and can be used in contexts where electricity is unavailable. Wed, 13 Jun 2012 08:57:00 +0000 http://www.viewchange.org/videos/the-health-show-revolutionizing-prenatal-care-in-developing-countries Developing country, Prenatal care, Maternal health, Neonatology, Health, Africa, Medical ultrasonography, Infant, University College London, Mains electricity >> DR. AYAN PANJA: Pregnancy always involves some risk. But it can be much more dangerous in certain places. In the least well-off parts of the world, mothers are over forty times more likely to die, compared with mothers in Europe or America. And the risks for their babies are just as worrying. Professor John Wyatt is here with us. What's your concern here?>> PROF. JOHN WYATT [Neonatologist, University College London]: Childbirth is always a dangerous time for the baby, but it's particularly so in low-resource countries across the world. Up to a million babies a year die, particularly because of a shortage of oxygen and other problems during the process of delivery. One of the most important things is to be able to measure the baby's heart rate during labor. And in the West, this is done using handheld devices that use Doppler ultrasound, and which are usually either mains powered, or use replacement batteries. The problem is that in low-resource countries, often it just isn't possible to have a reliable mains supply, and often replacement batteries are not available.>> DR. AYAN PANJA: So what have you come up with?>> PROF. JOHN WYATT: Well, the idea is to use the same kind of principle that's used in wind-up radios to generate electricity actually for this medical equipment. And so by winding, simply by winding, we generate electricity, enough to be able to then take a measurement using this Doppler ultrasound probe, which can then listen to the baby's heart.>> DR. AYAN PANJA: Fantastic. Do you mind if I have a go? We've got a patient here, so. Thank you very much; I'm looking forward to using this. Hi. Nice to meet you, I'm Ayan.>> CLAIRE: I'm Claire.>> DR. AYAN PANJA: Claire, thank you for coming in. Do you mind if I have a listen in?>> CLAIRE: Yeah, sure.>> DR. AYAN PANJA: That'd be brilliant. How many weeks are you?>> CLAIRE: 28.>> DR. AYAN PANJA: 28. Fantastic. First baby?>> CLAIRE: Yes.>> DR. AYAN PANJA: We'll just wind this up. Brilliant, green light's on, so that should work. Just pump a little bit of gel on there. Lovely. All right. Switch it on. Sounds like a pretty strong heartbeat to me. Perfect. Thank you very much. That was brilliant. Good luck.>> CLAIRE: Thanks.>> DR. AYAN PANJA: So that was exactly like the probe that I use in my own surgery. Very, very good, it works really well. What have other health workers said about this?>> PROF. JOHN WYATT: Well, we've done this trial among some health workers, particularly in southern Africa, and so far I've had very positive responses. Midwives in particular have been very positive about this, and in one clinic where this was being used, the midwives were very reluctant to hand it back because it was such a useful piece of kit, and they preferred it compared to the battery operated devices that they had.>> DR. AYAN PANJA: Professor Wyatt, thank you very much. http://www.viewchange.org/videos/the-health-show-virtual-pathology Thanks to a special camera and the Internet, Dr. Lan Huong from Ho Chi Minh City can send pictures of bacteria samples to experts in Amsterdam for analysis, the beginning of a collaborative online community of hospitals around the world. Tue, 12 Jun 2012 11:27:00 +0000 http://www.viewchange.org/videos/the-health-show-virtual-pathology Vietnam, Health, Academic Medical Center, Amsterdam, Ho Chi Minh City, Fever, Bacteria, Netherlands, Rockhopper, The Health Show >> VOICEOVER: Bacteria are all around us.>> DR. LAN HUONG [Hospital for Tropical Diseases, Vietnam]: So this is a human culture of a woman, admitted to the ICU of Hospital for Tropical Diseases, and the woman is 45 years old and when admitted has a very high fever.>> VOICEOVER: At the Academic Medical Center, here in Amsterdam, they're doing a lab round. But the lab is in Vietnam. A special camera has been developed which can take high-resolution photographs of samples of bacteria. Doctor Lan Huong, at the Vietnamese Hospital for Tropical Diseases in Ho Chi Minh City, is sending pictures from her patients to the Dutch experts. And they can discuss the cases over a video link.>> DR. CAROLINE VESSER [AMC, University of Amsterdam, Netherlands]: It seems quite obvious to take pictures of bacterial plates and discuss these pictures. No one's done it, at least not in this way. This is a way to collaborate, to interact with people on the other side of the world.>> VOICEOVER: The Vietnamese patient is in intensive care with a very high fever. Her brain became inflamed after she ate a raw snail, and now she has a bacterial infection as well.>> DR. CAROLINE VESSER: And she has a catheter hasn't she? A urinary catheter?>> DR. LAN HUONG: Yes.>> DR. CAROLINE VESSER: In these kinds of patients at mixed cultures...>> VOICEOVER: The Dutch doctors are happy to share their expertise. And they benefit, too, by seeing a wide range of bacterial cultures from a tropical country.>> DR. LAN HUONG: So your advice is to look at the leukocytes in the urine and take a blood culture.>> DR. CAROLINE VESSER: Yes.>> DR. LAN HUONG: Wonderful.>> VOICEOVER: Thanks to their camera, the doctors in Vietnam are learning from the Dutch specialists, while helping their patients at the same time.>> DR. LAN HUONG: You only need a good internet line, and you have a camera, which is very handy, sitting next to me, quite small. It's really wonderful to us, because it help us to improve immediately our microbiology aspect.>> VOICEOVER: Dutch patients benefit, too. Every bacterial sample taken here in Amsterdam is now recorded using digital imaging. Technicians can compare and diagnose samples at the click of a button. The images are also stored for training purposes. But this is just the first step. They hope to create an online community of hospitals from around the world, able to consult and exchange information at any time.>> PROFESSOR MENNO DE JONG [AMC, University of Amsterdam, Netherlands]: To expand, you need a web portal. So if you have a question about a certain culture, you can post it on that web portal, using the same camera, the same quality of pictures. For instance there may be a question about this particular colony on this particular culture plate, you can add a comment and leave it in the website. So this will also be a tool where different laboratories around the world, which have this camera inside their laboratory, can interact.>> VOICEOVER: All a hospital needs to take part is the special camera and Internet access. In the meantime, the Vietnamese Hospital for Tropical Diseases is already seeing the benefits.>> DR. LAN HUONG: So it's really great to communicate from Asia to Europe, and we can speak and talk and share pictures. And I really, really hope that the other hospitals can receive the benefit of the program. http://www.viewchange.org/videos/the-health-show-reversing-the-medical-brain-drain It wasn't easy for Dr. Ayodyha Wataliyadda to leave her family in Sri Lanka. But thanks to an initiative of the British and Sri Lankan governments, she is able to gain valuable work experience in the UK while eventually returning to practice medicine in her home country. Tue, 12 Jun 2012 10:27:00 +0000 http://www.viewchange.org/videos/the-health-show-reversing-the-medical-brain-drain Sri Lanka, Brain drain, Health, Physician, NHS trust, Senior registrar, Pediatrics, Royal College of Physicians, United Kingdom, Northern England >> TITLE: Huddersfield, West Yorkshire, Northern England>> DR. AYODYHA WATALIYADDA [Senior Registrar, Pediatrics]: That was my daughter. And she's 5 years old, about to start school next year.>> VOICEOVER: It wasn't easy for Dr. Ayodyha to leave her family in Sri Lanka to come and work in Yorkshire in northern England.>> DR. AYODYHA WATALIYADDA: I was working as a medical officer in field of pediatrics, as a senior house officer, then a registrar, and then I wanted to specialize in pediatrics so I have been working in the field of pediatrics for about seven or eight years.>> VOICEOVER: Ayodyha was supported to come to the UK by the Foreign Placement Coordination Center, backed by the Sri Lankan government. In return, she signed an agreement that for every year spent in the UK, she will work for at least four years back in her home country. If this doesn't happen, she will have to pay a substantial penalty.>> DR. AYODYHA WATALIYADDA: It's basically an essential requirement back in my country to get one or two years of foreign experience.>> DR. AYODYHA WATALIYADDA: Can I just have a look at your leg please? Okay, there we go.>> VOICEOVER: Five-year-old Matthew fractured his leg falling off his bicycle.>> DR. AYODYHA WATALIYADDA: Does it hurt? Can you just move your toes a little bit for me? All right. That's brilliant.>> VOICEOVER: Ayodyha also works with premature babies.>> DR. SAL UKA [Consultant, Huddersfield and Calderdale NHS Trust, UK]: At registrar level we're talking about a senior doctor who out of hours in particular would be the most senior pediatrician on site so they do need to be able to demonstrate confidence and competence in managing pediatric emergencies in particular, but also managing newborn emergencies as well. >> VOICEOVER: Ayodhya is putting her years of experience into practice. But she is also learning new skills.>> DR. AYODYHA WATALIYADDA: Back in my country, the gestational age that we start to resuscitate a baby is after 28 weeks after gestation, but here we take in 24 weeks onwards babies.>> VOICEOVER: This baby girl, born seven weeks early, is suffering from low blood sugar and anemia. The treatment is quite straightforward, but there are certain skills that Ayodyha can only learn in the UK.>> DR. AYODYHA WATALIYADDA: We lack resources there. Mainly some investigations, some equipment, and even the trained skilled people, we lack there. But here in the UK, I have seen a very well organized structure and things are in abundance.>> VOICEOVER: Only four months into her post, Ayodyha is settling in well.>> DR. AYODYHA WATALIYADDA: Usually we get the weekend off, so I manage to go to a few places around Yorkshire. I am settling in okay. I'm settling in very well, actually. I have almost fallen in love with West Yorkshire.>> VOICEOVER: Sri Lanka has a shortage of medical specialists, but this scheme means that they will benefit from highly trained doctors who are more than willing to use the experience gained to help improve the health services in their home country.>> DR. NICK BEECHING [Royal College of Physicians, UK]: I think the benefits are enormous and they go both ways. For Sri Lankans, they know that they're coming to previously approved jobs, their proper training posts, and that they'll be properly looked after when they get here. From the government point of view in Sri Lanka, they know they're going to get their graduates back. They're very expensive to produce, the old brain drain can't happen because they have a limited period here.>> DR. AYODYHA WATALIYADDA: It's not that we are going to stay here forever. We'll be gaining the experience, gaining the knowledge. At the same time we'll be doing a service to the NHS as well. So I have a duty to go back. It's my country, so I'll be going back in two years' time. http://www.viewchange.org/videos/the-health-show-fighting-malnutrition-with-ancient-seeds Food prices have recently skyrocketed in the western highlands of Guatemala, and chronic malnutrition is stunting the development of children both physically and mentally. However, indigenous plants once common to the area may hold a solution. Tue, 12 Jun 2012 09:27:00 +0000 http://www.viewchange.org/videos/the-health-show-fighting-malnutrition-with-ancient-seeds Guatemala, Agriculture & Food, Malnutrition, Neural development, Food security, Child development, Nutrition, Essential nutrient, Rockhopper, The Health Show >> VOICEOVER: In the western highlands of Guatemala, a silent disease is rife. Chronic malnutrition is stunting the development of children -- both their bodies and their minds. Maria Leonor and her extended family are not getting enough to eat. Most children in this house are malnourished. Higher food prices, partly due to the changing climate, results in a limited and monotonous diet of maize and beans.>> MARIA LEONOR: Everything is too expensive. The price of maize is going up and up, every day. We just eat tortillas and beans, nothing else. We can't afford to eat any other food.>> VOICEOVER: The problem is not a shortage of calories. What's missing are essential vitamins and minerals vital for these children's development. The damage done during these critical early years can never be repaired.>> DR. CARLOS ARRIOLA [Director, Bethania Clinic, Guatemala]: The lack of proper nutrition is limiting their intellectual development. It doesn't only affect their physical growth, but their brain development as well. This is a life sentence, not just for the children, but also for the country.>> VOICEOVER: Maria Leonor's thirteenth child, four-year-old Debora, is lethargic. It's a classic sign of chronic malnutrition. Her grandchild Elsa has a stomach infection, another common sign. Her daughter-in-law is desperate.>> MARIA NATIVIDAD: I am worried. I fear he is going to die. He has malnutrition. He has been like this for three months. There is nothing I can do.>> VOICEOVER: A previous food crisis prompted Sister Juana to take action. She's encouraging families to create their own kitchen gardens. Sister Juana distributes seeds to the rural communities where malnutrition hits hardest. Juana brings seeds of indigenous plants, which are resilient and highly nutritious. Popular with local people's ancestors, they slowly disappeared over the years. These tomatoes are high in vitamin C.>> SISTER JUANA [Nutrition Expert, Bethania Clinic, Guatemala]: This is the only kind of tomato that our ancestors grew. It is very nutritious. Children should learn to eat it from an early age.>> VOICEOVER: Dora has been working hard in her kitchen garden. With Juana's help, she has brought a wide variety of vegetables back to life. Chatate is a nutritious herb high in vitamin A.>> SISTER JUANA: In the past, all the gardens had chatate; it's a strong plant. It doesn't need much water; it will survive the dry season. >> VOICEOVER: Today, Juana is teaching Dora how to cook the herb Hierba mora.>> SISTER JUANA: You can mix these herbs with scrambled eggs, and you can add some onions when they're in season.>> VOICEOVER: The new dish is ready and about to face its most important test: Dora's children.>> DORA: I feel happy and proud, because I now have my own vegetables. My children haven't fallen ill; they haven't even had a fever. They are doing just fine. http://www.viewchange.org/videos/the-health-show-pure-water-in-two-minutes The Health Show interviews Timothy Whitehead, the inventor of a water bottle that makes water safe to drink in two minutes using a filter and UV light. Tue, 12 Jun 2012 08:27:00 +0000 http://www.viewchange.org/videos/the-health-show-pure-water-in-two-minutes Water & Sanitation, Sub-Saharan Africa, Water security, Water supply, Water, Portable water purification, Ultraviolet, United Kingdom, Ayan Panja, Purified water >> DR. AYAN PANJA: Nearly nine hundred million people around the world don't have access to safe drinking water. It's a huge problem, not just for local people, but travelers. It's an issue that's been worrying Timothy Whitehead, who's with me now. Tim, how did you become concerned about this?>> TIMOTHY WHITEHEAD [Inventor, Pure Water Technology]: I was traveling in Zambia a couple of years ago, and I just saw there's so little water there. People relied on chlorine and iodine tablets to sterilize water, which takes a long time, and it just tastes horrible. So I thought there must be a better solution.>> DR. AYAN PANJA: And you've come up with a device to tackle this, haven't you.>> TIMOTHY WHITEHEAD: I have, yes. I designed a water bottle -- this is part of my degree project -- which filters and sterilizes water within two minutes. >> DR. AYAN PANJA: Wow, should we have a look at how it works?>> TIMOTHY WHITEHEAD: Yeah. So it's got two chambers, an outer one and an inner one, and we first fill up the outer one from our lake, stream, or dirty puddle.>> DR. AYAN PANJA: Yes.>> TIMOTHY WHITEHEAD: And let's just say it's a bit of a dirty lake, so put some soil in it.>> DR. AYAN PANJA: Yeah, looks like lake water to me, yeah, for sure.>> TIMOTHY WHITEHEAD: And then just like a cafeteria, you take the inner chamber, and you plunge it down, and the filter at the bottom will get rid of all the sediment and yuck from the water, so it becomes clear.>> DR. AYAN PANJA: Oh yes, fantastic. And what about the bacteria that are left there, what happens to that?>> TIMOTHY WHITEHEAD: So then we've got a UV bulb, I don't know if you can see that, suspended in the middle.>> DR. AYAN PANJA: Oh yes.>> TIMOTHY WHITEHEAD: And that sterilizes the water. So there we have the bulb.>> DR. AYAN PANJA: Yeah, you can see it lighting up there. And you do this for how long?>> TIMOTHY WHITEHEAD: This is for ninety seconds. The UV light disrupts the DNA of the viruses or bacteria in the water, and that renders them harmless, so they're safe for us to drink. There, and I think that's just about ninety seconds.>> DR. AYAN PANJA: Brilliant. Should we give it a go?>> TIMOTHY WHITEHEAD: Yeah, do you want to...?>> DR. AYAN PANJA: Excellent. Yeah, let's have a taste. I'm intrigued. I'll take a sip after you take a sip. Excellent. Cheers.>> TIMOTHY WHITEHEAD: Cheers.>> DR. AYAN PANJA: It's pretty drinkable, actually. It's no different from what comes out of the tap, really. And who do you think is going to use this, in the main?>> TIMOTHY WHITEHEAD: I think it's primarily for disaster scenarios, tsunamis or anything where there's lots of water around, but you just can't drink it. And with this, you could just filter and sterilize it within two minutes and it'd be safe to drink.>> DR. AYAN PANJA: Fantastic. And have you had it tested scientifically for effectiveness?>> TIMOTHY WHITEHEAD: Yes. I'd carried out tests at Loughborough University, looking at the combination filter and the ultraviolet light, and we did e.coli bacterial tests, and it sterilized 99.9 percent of known viruses and bacteria. http://www.viewchange.org/videos/the-health-show-container-hospital Jermain Romeize is suffering complications during childbirth in post-earthquake Haiti. Fortunately, she is being looked after in a maternity hospital, which was built entirely out of shipping containers as a rapid response to the earthquake. Mon, 11 Jun 2012 08:04:00 +0000 http://www.viewchange.org/videos/the-health-show-container-hospital Health, Haiti, Médecins Sans Frontières, Maternal health, Hospital, Maternal death, Hypertension, Blood bank, Cold chain, Head of Mission >> VOICEOVER: Jermain Romeize has been in labor for six hours. She has preeclampsia -- high blood pressure, dangerous for both mother and baby. >> DOCTOR: Breathe, breathe. Now push, push. >> JERMAIN ROMEIZE: Wow, mercy, mercy. >> VOICEOVER: Fortunately, she safely delivers a healthy baby boy: Stanley. Giving birth in Haiti is risky. It has the highest maternal mortality rate in the Western Hemisphere. Skilled medics supervise only a quarter of births. But Jermain and her baby are lucky. She's being looked after in a specialist maternity hospital. It's built entirely out of shipping containers. It was created as a rapid response to the devastation caused by the earthquake, which put many health centers out of action. >> SYLVAIN GROULX [Head of Mission, Medecins Sans Frontieres, Haiti]: There was a need; the hospital in which we were in prior to the earthquake, unfortunately the structure was no longer safe. >> VOICEOVER: This one hundred and twenty bed facility is one of four container hospitals built by Medecins Sans Frontieres in Haiti for local doctors and nurses. A container hospital like this can be set up in five or six months. >> SYLVAIN GROULX: All of the electrical furnishings that you see, the air conditioning units for example, all of the plumbing as well, this all came as part of the package. >> VOICEOVER: These services create safe, hygienic workspaces for the Haitian staff. >> SYLVAIN GROULX: It's very, very important for us to have proper working conditions for our lab techs. It has cold chain, so fridges, and freezers, for example here we have our blood bank. >> VOICEOVER: The hospital specializes in caring for mothers whose lives, or those of their babies, are in danger. This woman has complications in her pregnancy, so her baby is being carefully monitored using ultrasound. >> NURSE: Your baby is normal. He looks okay on the scan. When he is born, we'll have to take him for tests, to check that he doesn't have any respiratory problems. >> VOICEOVER: Over three hundred babies are born here every month. Many of them are small and weak, so this neonatal ward is designed to give them the special care they need. >> SYLVAIN GROULX: These children are all born premature. They really need intensive care 24 hours a day. >> VOICEOVER: Basic incubators have replaced the more sophisticated ones that were lost in the earthquake. Life remains extremely challenging in Haiti. But for today at least, Jermain is able to just enjoy her first moments with her baby. http://www.viewchange.org/videos/the-health-show-usns-comfort-part-2 The USNS Comfort is a hospital ship bringing medical relief and surgical care to local communities in Central America. Seventy-four-year-old Juana Mejia is on the ship to undergo surgery for the removal of her cataracts. Mon, 04 Jun 2012 09:40:00 +0000 http://www.viewchange.org/videos/the-health-show-usns-comfort-part-2 Latin America, Cataract, USNS Comfort (T-AH-20), Guatemala, Health, Hospital ship, Lens (anatomy), Surgery, United States Navy, Rockhopper >> VOICEOVER: At 74, Juana Mejia has several health problems. But one particularly worries her. >> JUANA MEJIA: I can't see with this eye. I only see shadows during the day. >> VOICEOVER: Juana has cataracts. She needs surgery, but like many people here in Guatemala, she can't afford it. This health mission, run by the US Navy, is on a ten-day visit. They're working out who can benefit from their advanced medical skills, which are in short supply here. After the initial assessment, Juana and other patients are transferred to this floating hospital for treatment. The USNS Comfort is a military hospital ship that has been deployed to Latin America on a five-month humanitarian mission. Juana is now on board getting ready for surgery. US Navy doctors and nurses run the ship. >> LIEUTENANT EVA CHOU [Ophthalmologist, US Navy]: The main procedure that we've been doing throughout our mission here are cataracts. >> VOICEOVER: A cataract is a clouding of the lens of the eye, which gradually blocks vision, making it difficult to focus. They usually develop over a long period. >> LIEUTENANT EVA CHOU: In developed countries, people tend to notice this change in their vision a lot sooner because we use our eyes all the time to read, for the computer, to go shopping. But out in these rural areas it's more difficult for people; so these cataracts are much more mature. >> VOICEOVER: Mature cataracts are common in poorer countries. Removing them depends less on advanced technology than on the surgeon's skill. >> LIEUTENANT EVA CHOU: We're using a technique that was developed in India for people who have waited so long for their surgeries that the modern type of procedure would just be disastrous. >> VOICEOVER: Juana's operation has started. We'll be showing it in some detail. Surgeons open up the capsule that contains the cataract. >> LIEUTENANT EVA CHOU: We can create some space between the cataract and the capsule itself and fish it out of the eye. There it is, that is the cataract. >> VOICEOVER: The cataract pops out. It is almost one centimeter long. It's this thick, dark build-up that was blocking Juana's sight. A permanent plastic lens is now implanted in her eye to restore her vision. A few stitches and it's over. >> LIEUTENANT EVA CHOU: We're almost done. >> VOICEOVER: This surgery takes less than an hour. The team will conduct over 300 cataract surgeries during this mission. Next morning, Dr. Chou checks Juana's progress. >> LIEUTENANT EVA CHOU: Relax both eyes for me. Okay. We're just going to test your vision now. >> JUANA MEJIA: I can see the things over there. The bed, something green, and something white. >> LIEUTENANT EVA CHOU: Very good. This is a patch that I want you to use to protect your eyes. >> VOICEOVER: Procedures like this could improve the sight of millions. http://www.viewchange.org/videos/the-health-show-sms-for-life SMS for Life is a pilot program in Tanzania that uses mobile phones and text messages to keep track the amount of malaria drugs in different areas, preventing stocks of malaria drugs from running out at critical times. Mon, 04 Jun 2012 08:40:00 +0000 http://www.viewchange.org/videos/the-health-show-sms-for-life Tanzania, Malaria, Mobile phone, Artemether/lumefantrine, Kibaha, SMS, African people, Antimalarial medication, Community Health Center, World Health Organization >> VOICEOVER: Malaria kills 800,000 Africans every year. Eighty-five percent of them are children under five. Malaria patients at African health centers, like this one in Mlandizi, Tanzania, need drugs known as Artemisinin-based Combination Therapies, or ACTs. They can wipe out Malaria parasites in just a few days. >> DANIEL CRAPPER [Population Services International, Tanzania]: Artemisinin Combined Therapies are making a huge impact, not just on saving individual children, but also helping prevent the transmission of the disease. >> VOICEOVER: But drugs like Coartem, the first ACT approved by the World Health Organization, are not always available. In Tanzania, incoming drugs start their journey here, at the central medical stores. Lorries then take them to regional stores, and on to district and local health centers. But the system often breaks down. >> DR. MAIMUNA YUSEF [Mlandizi Health Center, Tanzania]: It was so difficult. So far in the last two years we didn't have Coartem at all. It's true. >> VOICEOVER: A new approach is being piloted here in Tanzania, which could prevent stocks of drugs running out. It's called SMS for Life. It uses the most reliable method of communication in Africa -- mobile phones and text messages. >> DANIEL CRAPPER: SMS for Life is simply a management information system. It sheds light onto the availability of essential life-saving drugs. It gives you a picture of where drugs are, and more importantly, where they are not. >> VOICEOVER: Dr. William Mwaga is the man responsible for knowing exactly where all the drugs are in Kibaha district. Every Thursday, he sends a text message asking all his specially trained community health officers to tell him how many malaria drugs they have. >> DR. WILLIAM MWAGA [District Malaria Officer, Kibaha, Tanzania]: The situation before this program was very poor. We didn't know the status of malaria drugs until the end of the quarter. But now, we know the status of the malaria drugs every week. >> VOICEOVER: The answers come quickly. There's an incentive. Health officers who respond within 24 hours receive a small payment, topped up onto their mobile phone. These are the figures Dr. Mwaga received yesterday. Mlandizi Health Center reports a worrying shortage of the ACTs designed for babies and children. >> DR. WILLIAM MWAGA: They have zero yellow Coartem but they have 19 boxes of red Coartem, which is for adult only. >> VOICEOVER: So Dr. Mwaga checks his own store at the District health center. It's good news. He's got plenty of boxes of yellow Coartem. Dr. Mwaga can now send some off to Mlandizi. >> DANIEL CRAPPER: It's not so much a push system where someone at the center level says you will have these drugs. It's moving towards a system where people at the facility, the people who know what the demands are, are ordering the right drugs at the right time. >> DR. MAIMUNA YUSEF: I think that it's useful. We just look at the systems, and we ordered, and you bring it to us. It's very nice. I like it. >> DANIEL CRAPPER: If people with fever are not getting treated within 24 hours, the cure rates significantly decline. By making sure that the right drugs are there at the right moment, we can make a significant impact on the reduction of malaria. http://www.viewchange.org/videos/the-health-show-robotic-surgery Augmented reality is coming to robotic surgery. Here, surgeons test the use of medical scans projected over their camera views, providing an annotated navigational display for patient Gary Keane's prostatectomy. Thu, 19 Apr 2012 08:16:00 +0000 http://www.viewchange.org/videos/the-health-show-robotic-surgery Robotic surgery, Health, Augmented reality, Surgeon, Patient, Surgery, Robot, Imperial College Healthcare NHS Trust, Robotic arm, Cancer >> TITLE: The Health Show >> DR. JUSTIN VALE [Surgeon, Imperial College Healthcare, UK]: Keep going at that angle... >> VOICEOVER: Cutting edge medicine: robotic surgery in action. These robotic arms, including a powerful camera, are slid into the patient through small incisions. At the end of the arms are the surgeon's tools. >> DR. JUSTIN VALE: So the robot is now fully docked. Okay. >> VOICEOVER: This patient has prostate cancer. It's about to be removed. The surgeon sits at a separate console, away from the patient. Each hand action is translated into much smaller movements by the robot. >> DR. JUSTIN VALE: The reason why surgeons like the technology so much is that it's scaled, so that I might move my hand two centimeters for example and the robotic hand will only move one centimeter. You can filter out people's tremors for example, by virtue of the fact that you can scale the instruments. >> VOICEOVER: Now, robotic surgery is about to get even more sophisticated. This team is testing out the use of medical scans projected over what the surgeon can actually see. This is among the latest, most pioneering work of its kind. They call it, "augmented reality." >> DR. JUSTIN VALE: The idea of augmented reality is to give the surgeon a display a bit like a fighter pilot's display so he can look out the cockpit window, but at the same time he gets information on his screen. You can start to give him other visual feeds that may be helpful. At its most advanced form, you would actually be able to overlay an image taken from a patient's preoperative scans so that the surgeon could actually see in his display exactly where structures are. If we take that overlay that we looked at earlier to show us the anatomy, you can see we've superimposed -- very stylized -- a pelvis. The green structure there is the prostate; the purple structure there superimposed is the bladder. >> VOICEOVER: The patient, whose cancer was diagnosed earlier in the year, explains why he opted for robotic surgery. >> GARY KEANE: Six members of my family have died in the past of cancer of one form or another. I was given all of the options, radiotherapy, the normal prostatectomy, or robotic. But in the end I decided on robotic because it's less intrusive and quicker. >> VOICEOVER: The operation was a success. The whole prostate is removed. Other advances in robotic surgery are also in the pipeline. >> DR. JUSTIN VALE: I think that we're on the start of a journey with robotic surgery. I don't think in the future robots will be this large. They will be much smaller devices. Big advances are going to be around things like augmented reality, active constraint stopping surgeons wandering where they shouldn't be. And once you start to do that you can even envisage a time when surgical robots may be true robots and capable of autonomous movement. Hopefully not before I've retired but I think eventually it will come. http://www.viewchange.org/videos/the-health-show-usns-comfort-part-1 As part of a five month humanitarian trip, the USNS Comfort hospital ship is bringing medical relief and surgical care to local communities in Central America. Surgeries are performed on the ship, and primary care evaluations are carried out on shore. Tue, 10 Apr 2012 10:03:00 +0000 http://www.viewchange.org/videos/the-health-show-usns-comfort-part-1 Central America, USNS Comfort (T-AH-20), Health, Medicine, Hospital ship, Guatemala, Surgery, Operating theater, United States Navy, United States of America >> TITLE: The Health Show >> VOICEOVER: This is the US Navy at work: A powerful ship, with hundreds of highly trained officers. But this is not a military operation. This crew of military doctors and nurses are part of "Continuing Promise 2011", a five month long humanitarian mission. Their vessel, the USNS Comfort, is a hospital ship bringing medical relief and surgical care to local communities in Central America. >> CAPTAIN WILLIAM TODD [Director of Surgical Services, USNS Comfort]: We're here to make patients better, and when our patients come to see us, they're looking to make their lives a little bit easier. And we do that for hundreds and hundreds of people over the course of our mission. >> VOICEOVER: Here in Guatemala, at the crack of dawn, doctors, health workers, and nurses head to shore. They've set up temporary medical sites in nearby villages. >> CAPTAIN WILLIAM TODD: The mission itself is divided upon what we do on the ship, which is primarily surgery, and what we do off the ship, which is primary care. Now there's medical care, dental care, optometry. >> VOICEOVER: People who need surgery are transferred onto the ship. Ten-year-old Carlos Ventura has been longing for this opportunity. >> CARLOS VENTURA: I burned my feet when I ran into a bonfire seven years ago. It hurts me to be like this. The doctor told me he will make the top of my foot flat again, that I'll be able to move my feet. >> VOICEOVER: For Carlos's mom, Maria Elena, it's a dream come true. >> MARIA ELENA: It is a great joy for me to know that his feet will grow normally now. I have prayed to God for this opportunity, I thought it would never come. >> VOICEOVER: A former oil tanker, the USNS Comfort is over 270 meters long and 32 meters wide. It's as tall as a ten-story building. Its primary role is to provide medical support for the US military in times of war. >> CAPTAIN WILLIAM TODD: The entire ship is designed around 12 operating rooms; the ship is a floating set of operating rooms. >> VOICEOVER: The pharmacy stores one and a half million doses of medicine, to treat up to 100,000 patients. The ship carries one of only two floating CT scanners in the world. >> CAPTAIN WILLIAM TODD: The technology that we have here is very, very good, because when you have this image preoperatively, it allows you to do a very good job of preoperative planning. >> VOICEOVER: Carlos is now in the operating theater. His much-awaited surgery has started. It's a five-hour procedure. Doctors remove skin from his hip to replace damaged tissue and free his muscles. With proper aftercare, Carlos will be able to move his feet again. >> CAPTAIN WILLIAM TODD: We want to do surgeries that are just life, family, and community-changing surgeries. For that, primarily we're dealing with surgeries that affect function and affect your overall appearance. >> VOICEOVER: Throughout their mission, the surgeons perform over a thousand procedures like this. >> CAPTAIN WILLIAM TODD: I sought out to come on these missions because I believe very greatly on what we're doing as far as getting to these individuals, and the immense satisfaction that you get from knowing that you are helping somebody that has no other recourse many times. That is something that is very, very heartwarming. http://www.viewchange.org/videos/the-health-show-spinal-rehab Leon suffered a devastating spinal injury when his house collapsed on him in during the 2010 Haiti earthquake. But thanks to the Haiti Hospital Appeal, which helps rehabilitate patients with spinal cord injuries, he is beginning to stand on his own feet again. Tue, 10 Apr 2012 09:03:00 +0000 http://www.viewchange.org/videos/the-health-show-spinal-rehab Haiti, Health, Spinal cord injury, Disability, Cap-Haïtien, Earthquake, Port-au-Prince, Rockhopper, The Health Show >> TITLE: The Health Show >> VOICEOVER: Leon Ginsly works tirelessly. He won't stop. >> HANNA: Keep going, okay? >> VOICEOVER: He has energy and determination. Leon wants to get stronger. >> HANNA: You're okay? Fatigue? >> LEON GINSLY: No, no, I'm not tired. >> VOICEOVER: Leon is disabled. He suffered a serious spinal cord injury when his house collapsed during the earthquake that killed tens of thousands of people in Haiti in January 2010. >> LEON GINSLY: The house started shaking. It collapsed. Everyone died, including my wife and eight children. I was the only one that survived. >> VOICEOVER: Leon was left unable to stand up or walk, his wounds infected. Homeless and disabled, the staff at the Haiti Hospital Appeal has looked after Leon. >> DR. PAUL TOUSSAINT [Medical Director, Haiti Hospital, Cap-Haitien]: Most of our patients were depressed when they arrived here. The first step was to rebuild their confidence, the second step was to heal their wounds, to get them back on their feet, through rehabilitation. >> VOICEOVER: Now, Leon can stand up. He can even take small steps by himself. But when he stumbles, it's a reminder that his injury is still holding him back. It's the intensive physiotherapy that has helped Leon make so much progress. >> NURSE: Leon, you have to lift your foot to touch my hand. Hold it, hold it, lift it, and lift it even more. >> VOICEOVER: Leon completes a demanding session every day. >> NURSE: Since you arrived, do you think you have made progress? >> LEON GINSLY: When I came here, I was almost dead, I couldn't move. But the hard work that I have done here has made me very strong. I am getting stronger every day. >> VOICEOVER: His progress, and that of his fellow patients, has surpassed everyone's expectations. This hospital was originally designed as a maternity hospital. Now it's known locally as the Haiti Hospital Appeal, after the British charity that supports it. After the earthquake, it took in twenty-five survivors with severe spinal cord injuries. >> CARWYN HILL [Chief Executive, Haiti Hospital Appeal]: Specialists from abroad and people within Haiti thought that at least 50 percent would pass away. 24 of them have been successfully rehabilitated, of them 19 have returned to their communities and we've been able to re-house about 80 percent of them. >> VOICEOVER: Inclusion is encouraged through sports and games, regardless of the level of a patient's disability. Relatives and staff take part too. These activities keep them strong, motivated, and entertained. As for Leon, the strength he has found through his rehabilitation has turned his life around. He has begun a new journey, to become a disabled athlete and fulfill a dream for himself and his fellow Haitians. >> LEON GINSLY: I want to participate in the Olympic games in England. I would like to be part of the games. I am getting ready and working hard so that the world realizes where I come from and what I have been through. http://www.viewchange.org/videos/the-health-show-genexpert Compared to traditional tests using a microscope, GeneXpert is more accurate and much quicker in diagnosing tuberculosis, and can detect drug resistant strains of the disease. But are the high costs worth it? Tue, 10 Apr 2012 08:03:00 +0000 http://www.viewchange.org/videos/the-health-show-genexpert Tuberculosis, Sub-Saharan Africa, South Africa, Multi-drug-resistant tuberculosis, Drug resistance, Diagnosis, World Health Organization, GeneXpert, Liverpool School of Tropical Medicine, United Kingdom >> TITLE: The Health Show >> VOICEOVER: When Londoner Steve Bradley fell ill, his doctors were baffled. In desperation, they gave him a cocktail of toxic drugs. Eventually, they discovered he had drug resistant TB. The drugs left him nearly blind and unable to walk properly. >> STEVE BRADLEY: I was in intensive care for ten days, and it took the full ten days for them to find I had TB. I think if I'd been diagnosed quicker I'd be back to what we call a normal human being, and basically get into the normal run of lifestyle again, but obviously that's not going to happen for me. >> VOICEOVER: In the UK, TB rates have been rising for 20 years, up to 10,000 cases annually. Since half of them occur in London, it's been called the TB capital of Europe. But diagnosing the disease is a big problem around the world. Now a system is being rolled out that can diagnose TB in just two hours. It's a fusion of existing technologies that can detect the telltale genetic signature of the bacteria. >> DR. TIM MCHUGH [University College London]: The GeneXpert represents a major step forward; not in the biochemistry of it, but in the technology that surrounds that, the means of processing the sample and detecting the result. >> VOICEOVER: Compared to traditional tests using a microscope, GeneXpert is more accurate and much quicker. And it can detect drug-resistant strains of the disease. That's a big advantage in poorer countries like here in South Africa, where drug resistance is growing. Fast diagnosis can also slow the spread of the disease. It's estimated that, without treatment, TB patients infect at least ten other people a year. But these advantages come at a price. >> DR. TIM MCHUGH: Although it's a robust technology, it's a relatively expensive technology. So to prepare a smear on a slide, the major cost is likely to be the person who's reading that slide. With this machine, in sub-Saharan Africa they're selling the cartridges for USD$20 dollars. But USD$20 dollars is a substantial amount of money for a diagnosis. >> VOICEOVER: That's ten times the cost of the old slide test. The cartridges cost even more in richer countries -- about USD$70 dollars. And with the machine itself priced at USD$80,000 dollars, it's a big investment, even for well-off healthcare systems. The price will be lower for poorer countries, but there are other problems. Without a laptop computer and a reliable power supply, the machine can't work. >> DR. BERTIE SQUIRE [Liverpool School of Tropical Medicine]: If we don't get it right with implementing GeneXpert, and working out exactly what it will take, it will just add to the dusty pile of equipment in the corner. >> VOICEOVER: So rich and poor countries alike need independent assessments to find out if new technologies like this are cost-effective. This computer model, created by Bertie Squire and his team, should help. >> DR. BERTIE SQUIRE: What we've been trying to do is think about the kind of evidence that a national policy maker or a hospital of a clinic would like to see before it made the decision to buy GeneXpert or any other diagnostics. We've developed a system which can model the effects of diagnostic systems in terms of the number of patients being diagnosed, in terms if the costs, the training requirements and actually project what those would look like over a decent period of time, say, ten plus years. >> VOICEOVER: The results of this and other trials may determine whether GeneXpert is a good investment or a technological dead end. Whatever outcome, it's too late for patients like Steve. >> STEVE BRADLEY: It would have changed my life. I'd still have been able to work, still be able to continue after the blip of health problems, and get back to a normal working life, which I don't have anymore. http://www.viewchange.org/videos/the-health-show-the-gulper Eighty percent of Dar es Salaam's population lives in unregulated settlements, forced to rely on smelly and hazardous pit latrines. "The Gulper" is transforming the way those latrines are emptied, improving the health of the whole community. Tue, 24 Jan 2012 09:57:00 +0000 http://www.viewchange.org/videos/the-health-show-the-gulper Tanzania, Health, Dar es Salaam, Water & Sanitation, Cholera, Sewage, Toilet, Water supply, Feces, Latrine >> VOICEOVER: Only ten percent of Dar es Salaam, Tanzania's biggest city, is connected to the central sewage system. Eighty percent of the city's population lives in settlements that have sprung up without planning permission. They rely on a huge number of smelly, dirty and unsafe latrines. But a solution is at hand. Meet "The Gulper." These motor tricycles, and the equipment they carry, are transforming the way pit latrines are emptied here. In the past, sewage often ended up contaminating water supplies, particularly during the rainy season. >> ERNEST MAMUYA [Environment Health Officer]: You wouldn't get surprised if you were finding fecal matter rolling with the storm water. It was common. In those areas, we had a problem of widespread cholera and other infections related to the disposal of waste. >> VOICEOVER: The Gulper is designed to reach customers who live down even the narrowest streets. >> JULIUS CHISSENGO: We have gloves, masks, helmets, and gum boots. Then, when we arrive, we assess the toilet for any risks. >> VOICEOVER: Many of the latrines are unsafe because of the old way of emptying them. >> JULIUS CHISSENGO: We used to completely demolish the toilet to drain it. The owners would get upset because it was completely broken. >> VOICEOVER: Julius used to earn his living this way, and saw how dangerous it could be. >> JULIUS CHISSENGO: There was one time when our colleague died because the toilet collapsed in on him and covered him completely. >> VOICEOVER: It's The Gulper's pump that has made life safer and cleaner for Julius. It's not motorized, so it's easy to maintain. It's cheap and, above all, it's effective -- he can clean up to six latrines a day. All the sewage is removed, and very little spills on the ground. >> JULIUS CHISSENGO: We have a container that can hold fifty liters. We usually drain into this, and when it is full, we put it on a motorbike. Then we take it to a place specially designated to pour it all away, and that is that. >> VOICEOVER: There's another way the Gulper has made life sweeter for Julius: he's paid better. Yet customers pay less for the Gulper's services. And it's this affordability that's key to improving health for everyone living in the unplanned settlements. The more sewage that gets dumped centrally, the less risk there is to local people. Cholera is not the only disease in decline. >> ERNEST MAMUYA: The Gulper is getting rid of intestinal diseases: strongoloids, hookworms, tapeworms. There's a reduction of typhoid, amoebic dysentery. If the coverage increases, we are sure of reducing these infections quite a lot. http://www.viewchange.org/videos/the-health-show-snake-bites A single bite from a venomous snake can case tissue damage, paralysis, and even death. Antivenoms can keep you alive, but their side effects are often devastating. That's why scientists at the Liverpool School of Tropical Medicine are working with the Nigerian Ministry of Health to develop cheaper and safer antivenoms. Thu, 19 Jan 2012 09:54:00 +0000 http://www.viewchange.org/videos/the-health-show-snake-bites Sub-Saharan Africa, Snake venom, Nigeria, Anti-venom, Snake, Liverpool School of Tropical Medicine, Health, Bleeding, Echis, Medical research >> VOICEOVER: These are some of the deadliest snakes in the world. In rural areas, their camouflage makes them hard to see. Their venom causes severe bleeding, paralysis or tissue damage. Without quick access to antivenoms, their victims can be permanently disabled -- or die. That's why scientists here at the Liverpool School of Tropical Medicine are working with the Nigerian Ministry of Health to develop cheaper and safer antivenoms. >> PAUL ROWLEY [Snake Handler]: Gently pin his head down, get him by the back of the jawbone. Offer him up to the beaker. You can see he's flicking his tongue out. There we go, good amount. >> VOICEOVER: This is one of Nigeria's deadliest snakes: a saw scaled viper. It's thought it kills more people than any other African snake. Right now, this dangerous procedure is the essential first step for making antivenoms. It's an expensive and complex process. The cost of antivenoms has been rising sharply for the past twenty years. >> DR. ROBERT HARRISON [Liverpool School of Tropical Medicine]: The amount of venom that we've just extracted now is sufficient to kill a human being. >> VOICEOVER: Paul Rowley knows all about snakebites. He's the only person in the UK licensed to extract snake venom for medical research. It's a risky job. >> PAUL ROWLEY: Being bitten by a snake really is painful. Last time I was bitten was by a juvenile rattlesnake and a lot of swelling and intense pain. I felt like my arm was broken. >> VOICEOVER: Paul was given antivenom and it saved his life. But like nearly half of people treated, he suffered a serious adverse reaction. >> PAUL ROWLEY: A week later I took ill again due to the effects of the antivenom and they actually wanted to re-admit me to hospital because it was quite a serious situation. >> VOICEOVER: The team at the Liverpool School is developing a completely new approach. By separating out only the most toxic parts of snake venom, they hope to produce cheaper treatments that don't have such severe side effects. >> DR. ROBERT HARRISON: Venom consists generally of about 200 different proteins. And the problem with this is that a lot of those proteins are not particularly toxic. And so we rationalize that if you make antivenom, which is specific only to the toxins, you won't need as much of the antivenom to affect a cure. >> PAUL ROWLEY: Oh, it's always so explosive, this stuff. >> VOICEOVER: This puff adder, with its large hollow fangs, produces especially toxic venom. The Liverpool team is working to identify the genes that produce only the most dangerous toxins in this and other snakes' venom. Stitched together to create a synthetic sequence, they are then inserted into lab bacteria. These tiny biological factories produce the vital proteins repeatedly -- a much safer process. >> DR. ROBERT HARRISON: If we're successful we will generate a pool of antibodies which when combined will neutralize the main pathological toxins of all the venoms of all the deadly snakes in one region. >> VOICEOVER: They're currently testing the effectiveness of a new antivenom designed to work against all African saw scaled vipers. Preliminary results are due in the next few months. But it will be several years before it can be manufactured in bulk. Until then, making antivenom will remain very risky, even in the hands of seasoned professionals. >> DR. ROBERT HARRISON: So Paul's brought in a spitting cobra from Nigeria now. It's in this trap box. So these are one of the larger animals in our collection and they spit, so we've got to be quite careful with this one. >> VOICEOVER: A synthetic antivenom can't come soon enough. >> PAUL ROWLEY: That's how bad it can get sometimes. http://www.viewchange.org/videos/the-health-show-riders-for-health-2 Access is often the largest obstacle to healthcare. Nowhere is this more apparent than in the rugged, mountainous country of Lesotho, where much of the population lives mired in rural poverty. But one organization, Riders for Health, has introduced an all-terrain option that's linking communities in the most remote regions: the motorbike. Tue, 10 Jan 2012 10:22:00 +0000 http://www.viewchange.org/videos/the-health-show-riders-for-health-2 Lesotho, Health, Riders for Health, HIV, Africa, Sub-Saharan Africa, Healthcare, Rural area, Television, AIDS >> VOICEOVER: The mountain kingdom of Lesotho is a land of heights and extremes. The entire country stands more than 3,000 feet above sea level. The terrain and climate are harsh, and more than 75 percent of the population lives in rural areas. Delivering regular health care to those in the countryside is nearly impossible. But thanks to Riders for Health, a global non-profit, one vehicle is changing the game: the motorbike. It's rugged, it's durable, and it lets healthcare workers reach all their patients, no matter how remote. Challenges abound, but with a motorbike, distance is no longer such an obstacle. Join Rockhopper TV as it follows six people using these motorbikes to alter the terrain of healthcare delivery. >> TITLE: ViewChange >> TITLE: Riders for Health, Rockhopper TV, Lesotho >> VOICEOVER: The mountain kingdom of Lesotho in southern Africa. Here, most people live high in remote villages, far from tarred roads and beyond the reach of most vehicles. In winter, villages are often cut off altogether by snow. For most people, getting around here means walking. It's early morning, and yesterday's snow means a cold start for Thabiso Phoka. He's a nurse at Auray Health Center high in the mountains. >> THABISO PHOKA [Nurse, Auray Health Center]: I'm preparing the package for the outreach. There's a tally sheet inside and the needles as well for the immunizations. >> VOICEOVER: Today, Thabiso's getting ready to travel to the village of Hatakani to immunize babies and run an under five's clinic. It is ten kilometers away over rough ground - half a day's walk for most people - but Thabiso is lucky; he'll be going by motorbike. >> THABISO PHOKA: I always loved the idea of being a nurse because I wanted to help people in the community. The roads are really difficult, and it's tough riding when it's so cold. But now I know I can get wherever I need to without any problems. >> VOICEOVER: Thabiso's destination, Hatakani, is a very remote place. A simple lack of transport means people are often unable or reluctant to get medical help. For Thabiso, this meant diseases went untreated and children remained unvaccinated. But last year he was provided with a motorbike and trained how to ride it. But even for Thabiso, Hatakani is hard to reach, and he has to walk the final leg down to the village. >> THABISO PHOKA: Before the motorbike it was not easy to come. I think they were thinking that we were neglecting them. >> VOICEOVER: Thabiso comes here on a set day every month. Mothers from the village and surrounding area have brought their children for an under five's clinic. >> THABISO PHOKA: The most important things I do in the villages are vaccinations and giving health talks about how people should take care of themselves, because some of the illnesses they come to the health centers with are things they themselves should be able to prevent. The cases we used to see a lot were hygiene related, like diarrhea and scabies, but they're no longer here because we've taught people how to look after themselves. >> TITLE: ViewChange >> VOICEOVER: These new recruits are starting their second day of training. None of them have ever ridden a motorbike before. Isaac Monokwa, like the other trainees, works at a government-run rural health center. >> ISAAC MONOKWA [Ministry of Health, Lesotho]: I work as an HIV/AIDS counselor. My job at the clinic is to encourage people to check their status. I do the tests myself and if they test positive, I talk to them about the treatment they must follow. The motorbike will really help me. I'll be able to get around much quicker and will be able to get to more villages in a day. >> VOICEOVER: But when it comes to learning to ride, Isaac has a long way to go. It seems he'll be testing Soloman's teaching skills, and his reactions. >> SOLOMAN HLASA [Motorbike Instructor]: It's just a matter of giving him a lot attention. >> ISAAC MONOKWA: I had some difficulties changing gears at first. But as I ride more, I'm getting used to it. >> SOLOMAN HLASA: He's not yet confident standing up. >> VOICEOVER: If Isaac can't stand up on the bike, there's no way he'll tackle Lesotho's rough terrain. >> SOLOMAN HLASA: Oh, you can see he's very scared. >> VOICEOVER: But Isaac's determined. He has a very personal reason to succeed. >> ISAAC MONOKWA: I wanted do this work because I discovered I was HIV positive. When I found out, my life became miserable, and back then the treatment wasn't really available. I went for counseling and they were looking for people who weren't ashamed to come out and talk about their status. I turned out to be one of the brave ones and they gave me training. >> VOICEOVER: The weather in Lesotho can change in an instant. Today, Isaac and the other trainees are getting their first taste of riding in the rain and over rough ground. The going's tough for all the riders - but especially for Isaac. >> SOLOMAN HLASA: He comes off the bike but he gets back on very fast. He shows a lot of courage. >> ISAAC MONOKWA: I think it is determination that brought me here. I knew I'd meet these challenges and that I'd fall, but to fall doesn't mean you have to give up. You have to get back on and carry on riding. >> VOICEOVER: Gradually, Isaac starts to get the hang of it. >> SOLOMAN HLASA: So far Isaac has improved a lot, and he's making me proud so far, yeah. >> ISAAC MONOKWA: Today's training was really tough but I liked it. I'm going to sleep like a baby. I'm really tired. >> VOICEOVER: Back at his government health center, and having passed his two weeks training, Isaac's ready to hit the road. >> ISAAC MONOKWA: I'm very excited because this will be my first day. Today I'm going to a village called Gamosethe. I'm going to follow up on patients who I've not seen for over a month. I think they'll be happy because before I wasn't able to get to them, so I think they'll be excited to see me. >> VOICEOVER: And he was right. >> TITLE: ViewChange >> TITLE: Riders for Health, Rockhopper TV, Lesotho >> VOICEOVER: Takiso Setsabi is on his way to one of the seven rural health centers he serves. He's one of thirty sample transporters operating in Lesotho - the missing link between rural clinics and hospital laboratories. >> TAKISO SETSABI [Nurse]: I love riding the bike because it's not here for fun but to help the community. It makes me really proud because there aren't many of us who ride. >> VOICEOVER: At Takiso's destination, Fatima Health Center, the nurse, Tjoloba, is with one of his HIV positive patients. Mamahloli has walked for four hours to get here from her village. The drugs she takes to manage her HIV have been causing her painful side effects, so she's stopped taking them. >> TJOLOBA TJOLOBA [Nurse, Fatima Health Center]: We are going to check kidney and liver function so we can change her drugs to another first line regimen, which has lesser side effects. >> VOICEOVER: The faster Tjoloba can get the results, the sooner he can get Mamahloli back on treatment. He knows that Takiso's on his way, but that wasn't always the case. Before the motorbikes, Tjoloba would have to rely on patients volunteering to take samples to the hospital laboratory, 20 kilometers away, on public transport. >> TJOLOBA TJOLOBA: Previously there was no choice. The samples include the TB bacilli as well as HIV. If anything could happen for the spilling of those samples within the public transport that means every passenger within would be at risk of contracting some infection. >> VOICEOVER: Samples often sat waiting for someone to take them and Tjoloba had to collect the results himself. Sometimes the whole process would take two to three months. It was a delay that cost lives, especially with diseases like tuberculosis. >> TJOLOBA TJOLOBA: TB is very important to get results immediately. While we are still waiting for the results the patient could be infecting other people and we end up with a lot of deaths. >> VOICEOVER: But now, Takiso visits the health center twice a week. Today, as well as Mamahloli's samples, he's collecting blood and sputum from nine people who may have TB. He's been trained how to handle and transport these samples. >> TAKISO SETSABI: Because I ride on these rough roads every day, I know how to handle them. When I get to parts that are really pot-holed, that shake you around, I stand up. In a car, the samples would just be rattling around all over the place. >> VOICEOVER: Many samples used to be ruined by lengthy storage or in transit. But now, Takiso can get to the lab quickly, ensuring the samples arrive in good condition. >> TAKISO SETSABI: I register the samples and I also help with basic laboratory tests because they've taught me how to do that. >> VOICEOVER: A couple of days later and Takiso is returning to Fatima Health Center with the results. And for Tjoloba, there's great news about his suspected TB patients. >> TJOLOBA TJOLOBA: All the results for TB are beautifully negative. >> VOICEOVER: There's good news for Mamahlodi too. The results show her liver and kidneys are functioning well, so she can be given more suitable lifesaving treatment straight away. And for those like her who have to walk so far to get here, the reliability of sample transport means it's never a wasted journey. >> TITLE: ViewChange >> VOICEOVER: Tukula Mothonyana is a TB officer based at Maluti Hospital in Lesotho. >> TUKULA MOTHONYANA [TB Officer]: I run TB clinics here and get people started on treatment. TB is a very dangerous disease because it's so infectious. It spreads quickly and easily from person to person through the air, so it's important to get people on treatment fast. My biggest challenge is when some people default on their medication. Often, they start to feel better, and so they stop taking the drugs believing they're already cured. >> VOICEOVER: Defaulters are common in Lesotho. Often they don't collect their treatment or attend check-ups because it's so difficult for them to get to their nearest health center. Tracing them quickly is vitally important, but finding defaulters can be a major challenge. Experienced rider Mathato, is taking recent trainees and fellow health assistants, Puleng and Lintle to try and track down one such TB patient. The first stop is his local council office. But there's some bad news. >> PULENG: We have just discovered that Mr. Fata Masupa has just passed away already. >> VOICEOVER: It may be too late for their defaulter, but it's still vital they find his family. There's a risk they too might be infected and could be passing it on to family and neighbors. Having been pointed in the right direction, they set off. But with no road names or house numbers, it's never that simple. >> MATHATO [Nurse]: It seems that there are two people with the same name and surname so this one is not the one we are looking for. The one that we are looking for is that one down there. >> VOICEOVER: A case of mistaken identity, so the search continues. But sometimes, patients deliberately give false details to health workers, as Tukula knows all too well. >> TUKULA MOTHONYANA: It makes it really difficult when some of them give us false names and addresses. When you want to visit them you go to the village and find no one knows them. >> VOICEOVER: But why don't they want to be found? Well, health workers Lesotho always encourage patients to get tested for HIV so they know their status. But many people here just don't want to know. Back with Mathato and her team, and they've managed to find the widow of the deceased defaulter. >> WOMEN: So sad to discover that the person we are tracing is dead. And she's still mourning. >> VOICEOVER: They suspect that by defaulting on TB treatment the dead man may have developed a more dangerous strain known as Multidrug-Resistant Tuberculosis, or MDR TB. >> WOMEN: The family, they might be infected, we don't know but we advised her to go for the checkup. >> VOICEOVER: This constant vigilance is what's needed to keep this dangerous strain of drug resistant TB contained. >> TITLE: ViewChange >> VOICEOVER: Across Lesotho, motorbikes are constantly ferrying medical samples from clinic to lab, or allowing health workers to reach the communities they serve. These services rely on their bikes day after day. But keeping them going on these tough tracks is no mean feat. In charge of keeping Lesotho's fleet of a hundred and twenty motorbikes on the road, is mechanic Thaele Seleke. >> THAELE SELEKE [Motorbike Mechanic, Lesotho]: A bike is a small thing; it's not like a car. A car can last a bit longer. But really when you look at this machine it needs you to take care of it just like a baby. Watch it closely. I've got 120 babies here to watch. >> VOICEOVER: If any of Thaele's 'babies' need serious attention - a new clutch, a set of shock absorbers or a major engine problem - he brings them here to the workshop. But most of his time is spent out visiting the bikes all over the country. >> THAELE SELEKE: It's all about preventing problems from happening. We detect them before they can happen. It's unusual because we are the only ones who are doing this kind of job here. >> VOICEOVER: This preventative maintenance is what sets Thaele and his team apart. >> THAELE SELEKE: We always do this as a routine each and every month. Check everything, service everything; make sure that it's tip-top. >> VOICEOVER: Vehicles all over Africa are in a terrible state. At hospitals, you'll often find vehicles, some nearly new that are left rusting because of a blocked air filter or a worn out tire. But Thaele and his team go that extra mile to make sure they spot and fix problems before the bikes break down. With eight bikes to get through, there's no time to waste. But Thaele gets all the riders involved. >> THAELE SELEKE: I do like very much when I work on someone's bike. The rider should be there so that we should discuss few things. I always pass my knowledge to them. >> THAELE SELEKE: What you're doing isn't right. You have to have a tape, so you know the exact measurements - about 30 millimeters. >> THAELE SELEKE: The small things - they should know how to check them on their own. >> VOICEOVER: They're all trained to do daily checks. But it's not just about keeping the bikes running. >> THAELE SELEKE: If you don't do a check you before you ride, really you are risking your life because it might lose things like bolts, or chain warn out then when it cuts off really you fall off terribly. So we make sure we prevent such things. They shouldn't happen. >> TITLE: ViewChange >> TITLE: Riders for Health, Rockhopper TV, Lesotho >> VOICEOVER: Lesotho has the third highest HIV prevalence in the world. Almost one in four people here are living with the virus. But Lesotho is fighting back and HIV counselors like Lefulesele Masokanye are in the frontline. Today she's come to St. Magdalena rural clinic. Much of her work involves trying to prevent mother to baby transmission of HIV. She's here to follow up on those suspected of defaulting on treatment or missing checkups. >> LEFULESELE MASOKANYE [Mentor Mother, Berea District, Lesotho]: I have got the list now for the people we are visiting today and the first one is a pregnant woman and she's positive. So we are going to look if she has already taken the drugs to prevent the virus to pass through to the baby. >> VOICEOVER: A lot of Lefulesele's time is spent out in the villages, encouraging pregnant mothers to attend check ups and get treatment. If they're put on prophylaxis early enough in pregnancy, there's a very good chance they won't pass HIV to their babies. But it can be a difficult job persuading people who live so far from the clinics. >> LEFULESELE MASOKANYE: When they get home they don't take it seriously. That's why we have to follow to see that they're doing the right thing. >> VOICEOVER: Lefulesele has come to see Mamojaki and her three-month-old baby girl. But soon after arriving, she realizes there's bad news. >> LEFULESELE MASOKANYE: Her mother didn't get prophylaxis at all. And even the baby didn't get it after she has been born and so the baby could be positive. >> VOICEOVER: Mamojaki says she didn't go for check ups because she's afraid people would shun her if they knew she was HIV positive. It's something Lefulesele comes up against all the time, and she understands it better than most. She's also HIV positive. >> LEFULESELE MASOKANYE: We have to tell everybody, because we have been through this so we have to stop this. I stand there, I tell them that I'm HIV positive, look at me; you can see I'm still healthy. I just tell her she should go there, don't be scared of the people. This is her life, and life comes once, and the treatment is free. She's not going to pay anything. >> VOICEOVER: Cases like Mamojaki's are very close to Lefulesele's heart. They're the reason she does this job. >> LEFULESELE MASOKANYE: I was pregnant so I went to the clinic. I found that I'm HIV positive so they said I should come back and do my checkups but I didn't go. >> VOICEOVER: Lefulesele had a baby girl. She didn't return to the clinic until a month after she was born. It was during that visit that she was asked if she'd consider working as a HIV counselor. >> LEFULESELE MASOKANYE: I heard about an interview for the mothers who are positive, so I went there and I passed the interview. But I didn't realize that when I was holding her she was already dead. I found out when I got home. >> VOICEOVER: Her baby daughter had died in her arms at just one month old. >> LEFULESELE MASOKANYE: I had a very nice girl and I miss her a lot. >> VOICEOVER: A few days later, and Lefulesele has come to check up on Relenbonile, another HIV positive mother. But today's not a nice day to be out on a motorbike. >> LEFULESELE MASOKANYE: It is very bad today, very bad. All of a sudden hailing, sunshine, cold at the same time. Even lightning! >> VOICEOVER: But for Lefelesele, it's all worth it. Relenbonile has been to all her check ups. She's taken the treatment throughout pregnancy, birth, and through to weaning. Her baby's recently been tested and is HIV negative. http://www.viewchange.org/videos/vinegar-revolutionizes-cervical-cancer-screenings A medical team from the United States is training Rwandan doctors and nurses in a new program dubbed "See and Treat." A quick test using vinegar allows for an immediate diagnosis of cervical cancer, and low-cost treatment techniques are readily available. Wed, 28 Dec 2011 09:07:00 +0000 http://www.viewchange.org/videos/vinegar-revolutionizes-cervical-cancer-screenings Rwanda, Health, Pap test, Cervical cancer, Cell (biology), Reproductive health, Developing country, Cervix, Acetic acid, Obstetrics >> VOICEOVER: Over 800 women have descended on this rural health clinic in Rwanda. They?re desperate to be screened for cervical cancer. Only a hundred of them will get the chance to be seen today by a team of American medical volunteers. Lead by Dr. Pam Silverstein, they?re piloting a scheme that they hope will one day save the lives of thousands of women. >> DR. PAM SILVERSTEIN [Consultant Obstetrician and Gynecologist]: We came into this knowing there was a big need. The death rate from cervical cancer is 30 percent of the total female cancer deaths. >> VOICEOVER: Since the experts and labs needed for high tech screening don?t exist here, a program called "See and Treat" has been developed as a low resource alternative. After filling in a questionnaire and receiving private counseling, the women are ready to be screened using a technique called VIA - Visual Inspection with Acetic Acid - or, as it is more commonly known, vinegar. >> DR. PAM SILVERSTEIN: The speculum is used to open the vagina and then you can see the cervix at the end of it. This is vinegar at the end of this gauze; it?s 5 percent ascetic acid. It?s placed on the cervix for one minute and what the vinegar does is coagulate the protein so when you have abnormal cells in the cervix it coagulates to become a white lesion that you can see with a naked eye. >> VOICEOVER: Using this test, around 18 percent of the women being screened at this clinic are shown to have abnormal cells in their cervix. >> DR. PAM SILVERSTEIN: We do have a positive result, which means there's a white lesion right at 11 to 12 o'clock on the cervix. >> VOICEOVER: This rapid diagnosis leads to immediate treatment. >> DR. PAM SILVERSTEIN: Now we will do the cryotherapy. This is a cryo tank. It's filled with carbon dioxide. Here's the cryo tip. The high pressure creates temperatures at minus 68 degrees centigrade. So this will freeze the layer of cells that have the abnormal cells in it, causing that to blister up and be a dead layer of cells that then gets shed by the body over several weeks. >> VOICEOVER: Though the equipment costs three and a half thousand dollars, treatment only costs around a dollar per patient, so it's very cost effective. >> DR. PAM SILVERSTEIN: These women usually come from two to three hours away, so doing it in one day is a vital aspect of appropriate screening and treatment in developing countries. >> VOICEOVER: The team manages to screen 110 women and treat 23. But as volunteers, they can't afford to stay any longer. So they've devoted much of their two-week visit to passing on their skills. >> DR. PAM SILVERSTEIN: The outcome of this project was really gratifying because I realized that we can send teams not only to other places in Rwanda but other places in Africa and this could be replicated in many developing countries in the world. http://www.viewchange.org/videos/new-device-makes-circumcision-safer Rwanda is introducing a new tool in the fight against HIV/AIDS: an innovative device that makes male circumcision safer and more efficient. If adopted on a large scale, it has the potential to sharply decrease the number of new HIV cases. Wed, 14 Dec 2011 09:57:00 +0000 http://www.viewchange.org/videos/new-device-makes-circumcision-safer Rwanda, Circumcision, HIV, Health, Sub-Saharan Africa, Africa, AIDS, Safe sex, Rockhopper, The Health Show >> VOICEOVER: There is a war against HIV infection and AIDS. This instant blood test reveals the winners and losers. For these teenagers, it's good news - the line in the top box means they're not infected. But the even better news is that they can reduce their chances of ever becoming HIV positive by taking one simple step, a step that could save millions of lives around the world. Circumcision. >> DR. AGNES BINAGWAHO [Permanent Secretary, Ministry of Health, Rwanda]: Circumcision is the most efficient tool to fight HIV/AIDS. When you are circumcised, you have a 60 percent decrease in the risk to be infected against somebody who is not circumcised when you have risky sex. >> VOICEOVER: This large protective effect was demonstrated by three clinical trials in Sub-Saharan Africa involving 11,000 men. They showed that circumcision reduces HIV infection in heterosexual relationships. This proven effectiveness has prompted the Rwandan Minister of Health to set an ambitious goal. >> DR. AGNES BINAGWAHO: Our target is to circumcise two million men, adolescent, adult and children, newborn, by the end of 2012. >> VOICEOVER: But how can circumcision on this scale be achieved in countries like Rwanda, where the hospitals and professionals skilled in anesthetics and surgery are in very short supply? Tzameret Fuerst heads a company that has created Prepex, the only circumcision device ready to market which doesn't need anesthetic. >> TZAMERET FUERST [CEO, PrePex]: The Prepex device has been tested in Rwanda for the past year, and the outcome of these studies is a device that can conduct adult male circumcision with no needles, no knives, no loss of blood, safe, simple, and cost-saving adult male circumcision in resource limited settings. The device works on a very simple principle. We essentially stop the flow of blood to the unwanted tissue, which is the foreskin, and the foreskin over the course of a week will dry up, become very, very dry, and then after a week you'll cut that foreskin off in the same way that you'll cut your nails. >> VOICEOVER: The exposed skin becomes tougher, and acts as a stronger barrier against HIV. Jean Paul Bitega, the military surgeon in charge of the Prepex study, explains. >> LT COL JEAN PAUL BITEGA [Head of Clinical Affairs, Kanumbe Military & District Hospital]: A person living without shoes, they have very hard skin. They are walking on stones every day without any wounds. So it's the same thing with the penis. Once you remove the foreskin the probability to have a wound is less. >> VOICEOVER: In a country where there are only three hundred doctors for a population of ten million, Jean Pauls skills are too valuable to be used exclusively for circumcision. Prepex's simplicity means that nurses can replace the doctor after just one week of training. The first task of the nurses is to choose which of five sizes to use. Once the circumcision line is marked, fitting the device is very straightforward. >> TZAMERET FUERST: You place this ring at the base of the penis, insert this ring under the foreskin, so now the foreskin is completely covering the inner ring, bring this elastic ring right on top, and release. The foreskin is trapped under the elastic band stopping the flow of blood to the unwanted foreskin tissue. >> VOICEOVER: The process may look simple, but it should only be done by trained medics. All the men receive group and individual counseling about safe sex. >> TZAMERET FUERST: Its important to remind ourselves that male circumcision is not the silver bullet. It's 60 percent, it's not 100 percent, which is why it's important that it's implemented as part of a comprehensive HIV prevention strategy. >> VOICEOVER: After a week, the men return to have the device removed. >> TZAMERET FUERST: The foreskin will be safely removed using blunt edged scissors that cannot harm the glands, cannot harm the penis in any way. During the whole procedure, really the only point of pain or discomfort is when you're extracting the inner ring, which will be like removing a bandage on a wound. It will be two seconds of pain and pop it's out. >> MAN 1: Im delighted because I didnt feel any pain. I continue to do my job normally with no problem. I am not inconvenienced at all. >> MAN 2: Before the circumcision it was very ugly to see but now my penis is improved. It's very smart! >> DR. AGNES BINAGWAHO: People leave the circumcision with a smile. Nobody does the traditional expression when you have circumcision, this doesn't happen. >> VOICEOVER: An earlier study of three hundred men has proved that this method is safer, faster and cheaper than conventional surgical circumcision. And it's urgently needed. >> TZAMERET FUERST: Every 16 seconds someone dies of AIDS. So the impact is phenomenal. We're talking about roughly 4 million lives that can be saved over the next decade or so. >> DR. AGNES BINAGWAHO: My dream is for Rwanda, and Africa and even the rest of the world as a whole, being more safe by having the males circumcised and have less risk to be infected by HIV.