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Mercy Or Monster?

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After cancer had spread throughout her body, and death was inevitable, Patricia Ferguson decided she wanted to be in control of it. So, she went on a hunger strike.

“She had always said she would rather take an overdose than become a burden,” says her son, Sean Davison.

Having flown from Cape Town, South Africa, to Dunedin, New Zealand, to be with his mother during her final days in 2006, Davison was confronted with a horrific scenario and a decision that is hard to comprehend.

Unable to move her limbs, Ferguson was bedridden. Bruises and bed sores covered her body and her flesh was starting to rot. She wished her pain would end and no longer wanted to be a burden on her loved ones. She had starved herself for more than a month but her body refused to give in.

Finally, she pleaded for her son to give her a lethal dose of morphine pills that she had saved up over days. Witnessing her suffering for weeks, Davison sorrowfully agreed to help his mother.

“My instinct was to keep her alive. But I realized that this was what she wanted, and if I didn’t help her she would have suffered a lot more,” he says.

He crushed the pills, mixed them in a glass of water, and handed it to his mother. After about an hour she peacefully fell asleep.

Davison says this was an act of compassion; New Zealand authorities said it was a crime. He was arrested and later sentenced to five months house arrest.

Helping his mother die seemed to split society. Although many sympathized with Davison – including Archbishop Desmond Tutu, who wrote a letter that helped prevent him spending time behind bars – others were appalled by his actions. While being kept as a prisoner in his mother’s house, Davison received two death threats.

In 2010, while awaiting his trial, Davison, now the Head of the Forensic DNA Laboratory at the University of the Western Cape, founded Dignity SA. It is an organization that is fighting to legalize assisted dying in South Africa.

“My mother would never have gone on that ill-fated hunger strike if she knew she had the option of an assisted death,” Davison wrote in a column in December last year.

But, just like he faced resistance in New Zealand, Davison has detractors in South Africa. Dr Albu van Eeden is the CEO of Doctors For Life, a group of doctors that campaigns against controversial issues, such as euthanasia, abortion and homosexuality. He claims suicide is an infectious disease.

“The concept of suicide contagion is a very well established principle in psychology and psychiatry,” he says.

Suicide contagion is defined as the exposure to suicide or suicidal behaviors from family, friends, or media, and can result in an increase in suicidal behavior. Van Eeden believes that 99.9% of suffering can be effectively treated with medicine.

“It’s just erroneous now when we have the most effective pain treatment in the history of the world, now suddenly there is a need for assisted suicide,” he says.

Assisted suicide is when a doctor provides the medication and/or information for a terminally-ill patient to end their own life, while euthanasia involves a doctor administering the medication. Today, euthanasia is legal in the Netherlands, Belgium, Colombia, and Luxembourg. Assisted suicide is legal in Switzerland, Germany, Japan, Canada, and in the US states of Washington, Oregon, Colorado, Vermont, Montana, and California.

In South Africa, assisted dying is illegal but some are trying to change that in courts and Parliament. The most recent case is that of the well-known advocate Robin Stransham-Ford, who insisted his cancer and kidney failure infringed on his constitutional right to dignity. In 2015, on the day Stransham-Ford succumbed to the cancer‚ the High Court ruled that a doctor could help him end his life. Numerous organizations, including the Department of Justice, the Department of Health, and Doctors For Life, asked the Supreme Court of Appeal to review this. In December 2016, the decision was overturned.

Aubrey Magerman, Attorney and Director at Magerman Attorneys, feels that assisted dying should be legalized; he says it is still a crime in South Africa.

“We’re back at square one, where we would be criminally culpable to assist someone in ending their life,” he says.

Magerman believes everyone should have a constitutional right to a dignified life and a dignified death.

“I have had my own grandparents pass away out in the rural Northern Cape under terrible circumstances, with no assistance, and in horrible pain, and being unrecognizable for weeks on end. It is terribly traumatizing for anybody. I wish, when it come to my time [to die], I will have the opportunity [to undergo assisted suicide].”

Magerman refers to the popular MP Mario Oriani-Ambrosini, who had stage-four lung cancer.

“One day he couldn’t take the pain anymore and he killed himself. His family found him with his brain and blood splattered all over the bedroom walls and on the bedding. So, I don’t think the State should tell us how to die,” he says.

Despite this, Van Eeden says assisted dying can have consequences beyond easing a person’s suffering.

“Once you allow it you are stretching man’s tendency to stretch the limit or the borders which makes the slippery slope happen,” he says.

“In Canada, they now want to make it possible for people who are asking for euthanasia to donate their organs. Suicide was originally only meant for terminal illness, for people with unbearable suffering, until they said ‘on what basis is physical suffering worse than mental suffering?’ So then they said ‘ok, we’ll allow it for mental suffering as well’.”

“So now you find a person can go to their doctor and say ‘I’m depressed, I’m worthless’. Maybe he’s a disabled person or an old person, and he says I don’t mean anything for anybody, I’m a burden to society, to my children, I think I’m in the way. I want to rather commit suicide and please you’re the doctor, you must do it for me. Now they can say to him, ‘You know what? Your life is worthless but it can have purpose, you can give your organs for donation… And this just shows you what a monster suicide becomes.”

Van Eeden is also worried about the regulation of the laws.

“Holland was not able to keep its regulations. Firstly, they said there would be a waiting time, and two or three doctors must agree with the decision, but all these things went out the door. Initially, it was only for patients above the age of 18, now it’s changed so that children above the age of 12 years old can ask for euthanasia without the consent of parents. The limits are constantly being stretched,” he says.

Magerman agrees that regulation is vital if assisted dying laws are introduced.

“What is required here is for the State to step in. It should be up to Parliament, which is the body charged with making legislation. It is not something that can be regulated in the courts.

“It creates absolute uncertainty. It is simply for Parliament to say we will for now on regulate assisted suicide or euthanasia and the parameters of that will be set.”

But Van Eeden has concern that State regulation opens the door for laws to be abused.

“It will always be cheaper to take a life than to treat a person and try and help him. So there’s a very strong financial incentive to any government once you start allowing assisted suicide.”

It’s a complex issue with many legal, ethical and religious variables to consider. Those against assisted dying say that it goes against the sanctity of life that is stressed by most religions.

One iconic religious leader defies this. Archbishop Desmond Tutu, in October 2016, said he would like to have the option of assisted dying.

“I have prepared for my death and have made it clear that I do not wish to be kept alive at all costs. I hope I am treated with compassion and allowed to pass on to the next phase of life’s journey in the manner of my choice,” he wrote in the Washington Post.

“For those suffering unbearably and coming to the end of their lives, merely knowing that an assisted death is open to them can provide immeasurable comfort,” he added.

In 1998, South Africa’s President Nelson Mandela asked the Law Reform Commission to look into assisted dying.

The commission decided that assisted dying should be legalized, even writing a draft bill. Despite this, it was never debated in Parliament, and continues to gather dust.

In 2014, Tutu lambasted the way Mandela was used as a political prop days before his death, calling it ‘disgraceful’.

“My friend was no longer himself. It was an affront to Madiba’s dignity,” wrote Tutu, who is often referred to as South Africa’s moral conscience.

Would assisted dying legislation have allowed Mandela to die with more dignity? It’s impossible to answer definitively, but a sobering thought nonetheless.

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Health

Cure For Counterfeit Drugs?

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Blockchain technology is also revolutionizing supply chains in the pharmaceutical industry, in the process, helping track fake medicines.

From genomics to robotics, technology is truly revolutionizing the healthcare sector. And while it’s easy to become consumed by exciting, futuristic trends like artificial intelligence (AI) diagnosis, digitized patient records and 3D-printed medical tools, technology is also transforming the pharmaceutical industry. How medication is prescribed, dispensed and administered is big business with McKinsey predicting the value of Africa’s pharmaceutical industry to be $65 billion in 2020.

But fake drugs are an ongoing and complex issue – they can cause death, have unknown side-effects, fail to treat illnesses, and sometimes even add to the spread of disease. According to World Health Organization (WHO) statistics, 42% of detected cases of falsified (or substandard) pharmaceuticals occur in Africa – reports estimate that between 72,000 and 169,000 children die each year from pneumonia because of counterfeit antibiotics while fake malaria drugs cause an additional 64,000 –158,000 deaths every year in sub-Saharan Africa. Both antimalarials and antibiotics sit among the most commonly-reported counterfeited drugs.

“Fake medicine distribution is rampant because business processes are siloed between the various industry stakeholders, which puts the industry at risk of fraud,” explains Heidi Patmore, a marketing consultant specializing in technology that’s changing consumer behavior.

“One solution to this would be cross-company process automation which could easily be enabled by a blockchain data interchange. This creates an open information system that all players can use to verify the authenticity of medication because it can track and trace it from when it’s manufactured to when it is dispensed to the patient.”

Companies such as IBM and SAP are working on blockchain solutions to weed out Africa’s counterfeit medication network. When medicine is returned to pharmaceutical manufacturers, for example, it is often re-sold instead of being destroyed. How can a small local pharmacy ensure what is returned is authentic? SAP are working with their existing client base – Merck, GSK, Ingelheim, McKesson and others – on a blockchain project to verify that any returned drugs are original.

IBM Research’s solution for Africa (currently in development in Haifa, Israel) includes a mobile interface and permissioned blockchain backend that enables each certified and authorized party in the network to initiate action, finish their transaction, and track its progress.

“It also includes the monitoring of temperature to ensure compliance with the proper conditions for transportation and asset transfer,” adds Inna Skarbovsky, a blockchain architect from IBM Research – Haifa. “Blockchain ensures full provenance for each medicine package, uniquely identified with a barcode or a serial number. This makes it possible for all authorized parties to track the drugs through the entire supply chain and the drugs’ life-cycle.”

This also allows significant cost reductions by eliminating each participant’s need to manage a separate system for traceability of its components. “It also improves procedural efficiency for change-of-hands, make it much harder for counterfeit drugs to be introduced into the supply chain and to be distributed to end-users,” says Skarbovsky.

Towett Ngetich, CEO of Uthabiti Health, a Kenya-based pharmaceutical company

Towett Ngetich is the CEO of Uthabiti Health, a Kenya-based pharmaceutical company that has implemented blockchain to bring transparency and accountability back to a country where statistics show that 30% of medicines sold are counterfeit. Uthabiti, which means ‘verify’ in Swahili, was started after Ngetich’s first-hand experience with the effects of fake health products: “Back in university, a significant number of students fell victim to unplanned pregnancies and unsafe abortions. With deep research, it was uncovered that there had been a supply of fake contraceptives and backstreet abortion pills into the student market,” explains Ngetich. More findings showed the presence of fake antibiotics, antiretrovirals (ARVs) and non-communicable diseases (NCD) medicines in the Kenyan pharmaceutical supply chain.

“Pharmaceutical science is the center of healthcare – one mistake in any drug composition or formulation has the risk of endangering a significant number of people. The need to access safe, affordable and quality health products in its simplest form means life and death in diagnosed health complications. Blockchain gives patients the ability to track and trace products using attached IDs – it also gives Uthabiti Health the ability to know where all our health products sit within each supply chain,” he says. Uthabiti Health procures medicines from different pharmaceutical manufacturers. Once received, they go to an internal laboratory for quality testing and are then labeled with the product’s safety lab report – attached in their codes is a unique blockchain ID. The medicines are then passed on to their partnering retail points, ensuring that the medicines dispensed to patients can be verified with something as simple as a text message.

“This brings in consumers in safe-proofing the supply chain of pharmaceuticals,” adds Ngetich.

The proliferation of fake drugs throughout Africa is complex – on average, medicine changes 30 hands before reaching the destined pharmacy – but blockchain technology has great potential to help stop counterfeit medicine distribution because it brings traceability and trackability to the entire pharmaceutical supply chain, ensuring the immutability of information. 

Blockchain ethics?

Candice De Carvalho

While blockchain is still a relatively niche technology, it is slowly changing how organizations operate. Blockchain promises better security and transparency, but not necessarily for the customer, in the case of drug allocation: “Where blockchain technology could likely increase efficiency and simultaneously decrease the abuse of medicines, customers benefit. The pharmaceutical and related industries are unique however, in that the ‘consumer’ is also a patient – a vulnerable group with special needs and rights,” explains Candice De Carvalho, the founder of Easy Ethics CPD.

Although overall transparency in the supply chain increases through the use of blockchain, and this confers patient benefits, these must be weighed against patient privacy and confidentiality. 

“With emerging technologies more freely available, we’ve observed an interesting shift in patient behavior, where data privacy is regarded less as an absolute by patients, in favor of a kind of sliding scale, where privacy itself is a currency that purchases medical benefits along the way,” adds De Carvalho. “Patients, for the right benefits, are perhaps more willing to part with some privacy privileges.”

De Carvalho questions the genuine knowledge that patients have of any exposure they experience through their use of novel medical device or systems innovations. The key drivers for the business are not necessarily unified with the total needs of the patient. However, the more the technology owners protect and balance the patient’s need for confidentiality and consent, the more they will ultimately see business benefit. 

“In the context of a doctor-patient relationship, the doctor has a positive duty to enhance patient understanding so that the patient enjoys a truly informed consent. Does this then mean that technology providers are now responsible in the same way that medical health workers are?” she ends.

-Tiana Cline

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Agriculture

Green-Sky Thinking

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In Johannesburg, city-dwellers like Linah Moeketsi have taken the future of sustainable farming into their own hands. Where land is becoming scarce, they look to the skies.


Doornfontein is one of Johannesburg’s older inner-city suburbs with decaying buildings and dingy alleys that wear a dour, monochrome look.

Daily commuters and street surfers jostle with delivery vans and mountains of metal scrap but the grey of the concrete city makes it hard to believe that there could be a patch of green in a most unlikely location.

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Above the humdrum of life here is a rooftop hydroponics farm looking down on the city, but upwards to a new route to restoration and urban preservation.

Atop the eight-floor Stanop building – offering a breath-taking view of the city and the landmark Ponte Towers in the distance – one woman has made it her mission to turn a grimy grey terrace into a green lung on the city’s skyline.

“City life is taking on a totally new direction… even people who think they couldn’t one day farm, find themselves on rooftops,” Linah Moeketsi tells FORBES AFRICA.

Moeketsi grows herbs, used to treat non-communicable diseases (NCDs), in a 250m x 500m greenhouse on the building’s terrace. But her rooftop farm is sans any soil – it uses a hydroponics system.

“I think because we are in the city and we would like to produce for people in the city, hydroponic farming is one of the answers because you can actually harvest more than twice the produce, and the growth rate is quicker and there is produce that you can have throughout the year that people demand because it is in a controlled environment,” she says.

On a windy Wednesday morning in October, we meet Moeketsi at her aerial green facility, a couple of days before she is to send some of her plant produce to the market.

She talks about her journey as an offbeat farmer. It all started when her father fell ill in 2013, when doctors failed to correctly diagnose his disease.

“They couldn’t see that he was diabetic. He didn’t show the signs of diabetes, but he had this foot ulcer that just wouldn’t go away,” she says.

“The future of city farming is great simply because we have more and more young people getting into this space. Even though it’s farming, they are looking at it from a very different angle.

Moeketsi decided to do her own research, so she read up books on African medicinal plants and used some herbs that belonged to her late mother, who had been a traditional healer.

“It took me a good eight months to help my dad and I actually saved him from having an amputation.”

The news of Moeketsi curing her dad’s diabetes using herbs spread. Sadly, her father died in 2016, at the age of 87. But she is proud to have helped prolong his life.

“So he passed away in his sleep, not sick, nothing, he was just old. But he was always grateful; he was like, ‘even when I die, I’m going to die with both my limbs’, so we would make a joke about it.”

READ MORE| Businesses At The Heart Of A Greener Future

After her father’s demise, Moeketsi rented some land and turned her knowledge on natural herbs into a fully-fledged farm. However, when the owner of the land returned, she was forced to vacate.

Land was always going to be a problem in the city. But instead of giving up, Moeketsi looked to the skies.

“Because of this passionate drive for an answer, I found myself researching what’s happening outside Gauteng and South Africa, and I saw in Europe, they were farming on rooftops,” she says.

In 2017, her dream became a reality when she secured a deal with the City of Johannesburg as part of an urban farming program, and started the rooftop project a year later.

When we visit her greenhouse, we are welcomed by the sweet lingering scent of herbs. It’s hot and humid, and two fans whir away to cool the air.

Moeketsi walks around the greenhouse wearing dark glasses and a white jacket, with a syringe in hand – she could easily pass off as a medical doctor.

She elaborates on the hydroponics system. There are four pyramids, each attached to their own reservoirs of water. On each pyramid, different plants, ranging from spinach, lettuce, sage, parsley, basil and dill, rest on beds with pipes connecting them to the reservoirs. Moeketsi plucks out one of the pipes and inserts the syringe; water spouts out of the tube and she returns it to the bed.

“Twice a day, you have to check that water is actually going through the pipes, because that’s how the plants get water and nutrients,” she explains, as she unblocks a pipe using the syringe. She says it’s one of the best ways to farm using little water.

“When you put in certain plants in the greenhouse, you know you are guaranteed sustainable farming because you can produce those plants and harvest them,” she says.

Moeketsi adds that this allows her produce to stay consistent season after season.

“So, from that point of view, it makes the city more sustainable in terms of food produce that is easily accessible and cost-effective for the consumer because not everyone around here can afford the high prices of food but they can at least afford what we sell, whether it is at R10 ($0.5) or R15 ($1).”

As Moekesti continues to tend to the plants, a farmer she works with walks in and begins filling up the reservoirs.

Lethabo Madela has known Moekesti for almost six years.

“When you look around Johannesburg, there is no space, so rooftops have saved us a lot, especially those of us that love farming,” says Madela. “I’m learning a lot and I think she [Moekesti] changed the whole concept of farming for me because I used to farm vegetables. I didn’t know culinary herbs or medicinal herbs.”

Moeketsi speaks of other farmers around the city who have taken to the rooftops to farm plants such as strawberries, lemon balm, spinach and lettuce.

READ MORE| Everything You Need To Know About The Future Of Pesticides And Bees

In a suburb called Marshalltown, a 10-minute drive from Moeketsi’s farm, Kagiso Seleka farms lemon balm also using hydroponics.

He produces sorbet and pesto from his produce which is then used to make ice cream.

“It [hydroponics] is great for farming sensitive plants in terms of temperature. Lemon balm does not like frost. But it’s better to grow even out of season so you can set a higher price,” he tells us.

However, he says hydroponics farming is a luxury not many farmers can afford.

“It [hydroponics] does have a bit of a higher capital upfront, but you get a higher yield and higher quality, so people are willing to pay more. Hydroponic planting saves about ninety five percent of water soil farming in a water-scarce country,” says Seleka.

READ MORE| Local Solutions Can Boost Healthier Food Choices In South Africa

“We do have water shortages, and I know people are on the whole ‘organic trip’ but, is it more important to have an organic plant versus a water-saving environment?”

The Program Coordinator for Agriculture at the City of Johannesburg’s Food Resilience Unit, Lindani Sandile Makhanya, says there certainly are more rooftop farmers in Johannesburg now than ever before.

Converting idle terraces into avenues of profit is becoming a norm. There are new rooftop farms being set up every day, offers Makhanya.

He regularly visits Moeketsi’s farm to check on the progress and collect produce to sell.

“Urban farming in Johannesburg is rising, mainly because the idea of producing our own food is very important because most people are moving to urban areas and therefore it stands to reason that we have to try to produce as much as possible,” says Makhanya.

“[There is growth] even in animal production, although we are moving away from the bigger numbers, but we are involving the smaller ones; because of the space issue, they are increasing overall.”

For Moeketsi, her farm has changed her life and given her hope for a better future. In addition to the teas, tinctures, ointments and medicinal products she processes from her plants, she plans to include more by-products such as syrups in the future.

“The future of city farming is great simply because we have more and more young people getting into this space. Even though it’s farming, they are looking at it from a very different angle,” she says. “That is why the city is changing and rooftop farming is going to get bigger and bigger.”

Clearly, farming in Africa is covering exciting new ground.

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Health

How Virtual Therapy Apps Are Trying To Disrupt The Mental Health Industry

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Millions of Americans deal with mental illness each year, and more than half of them go untreated. As the mental health industry has grown in recent years, so has the number of tech startups offering virtual therapy, which range from online and app-based chatbots to video therapy sessions and messaging. 

Still a nascent industry, with most startups in the early seed-stage funding round, these companies say they aim to increase access to qualified mental health care providers and reduce the social stigma that comes with seeking help. 

While the efficacy of virtual therapy, compared with traditional in-person therapy, is still being hotly debated, its popularity is undeniable. Its most recognizable pioneers, BetterHelp and TalkSpace, have enrolled nearly 700,000 and more than 1 million users respectively. And investors are taking notice.

Funding for mental health tech startups has boomed in the past few years, jumping from roughly $100 million in 2014 to more than $500 million in 2018, according to Pitchbook. In May of this year, the subscription-based online therapy platform Talkspace raised an additional $50 million, bringing its total funding to just under $110 million since its 2012 inception.

The ubiquity of smartphones, coupled with the lessening of the stigma associated with mental health treatment have played a large role in the growing demand for virtual therapy. Of the various services offered on the Talkspace platform, “clients by far want asynchronous text messaging,” says Neil Leibowitz, the company’s chief medical officer.

Users seem to prefer back-and-forth messaging that isn’t restricted to a narrow window of time over face-to-face interactions. At BetterHelp, founder Alon Matas notes that older users are more likely to go for phone and video therapy sessions, whereas younger users favor text messaging.

“Each generation is getting progressively more mobile-native,” says John Prendergass, an associate director at Ben Franklin Technology Partners’ healthcare investment group, “so I think we’re going to see people become increasingly more accustomed, or predisposed, to a higher level of comfort in seeking care online.”

The ease and convenience of virtual therapy is another draw, particularly for busy people or those who live in rural areas with limited access to therapy and a range of care options.

Alison Darcy, founder and CEO of Woebot, a free automated chatbot that uses artificial intelligence to provide therapeutic services without the direct involvement of humans, says that with Woebot and other similar services, there is no need to schedule appointments weeks in advance and users can receive real-time coaching at the moment they need it, unlike traditional therapy. The sense of anonymity online can also lead to more openness and transparency and attracts people who normally wouldn’t seek therapy.

Along with stigma, the cost of therapy has historically acted as a barrier to accessing quality mental-health care. Health insurance is often unlikely to cover therapy sessions. In most cities, sessions run about $75 to $150 each, and can go as high as $200 or more in places like New York City. Web therapists don’t have to bear the expense of brick-and-mortar offices, filing paperwork or marketing their services, and these savings can be passed on to clients. 

BetterHelp offers a $200-a-month membership that includes weekly live sessions with a therapist and unlimited messaging in between, while Talkspace’s cheapest monthly subscription at $260-a-month, offers unlimited text, video and audio messaging.

But virtual therapy, particularly text-based therapy, is not suitable for everyone. Nor is it likely to make traditional therapy obsolete. “Online therapy isn’t good for people who have severe mental and relational health issues, or any kind of psychosis, deep depression or violence,” says Christiana Awosan, a licensed marriage and family therapist. 

At her New York and New Jersey offices, she works predominantly with black clients, a population that she says prefers face-to-face meetings. “This community is wary of mental health in general because of structural discrimination,” Awosan says. “They pay attention to nonverbal cues and so they need to first build trust in-person.”  

Virtual therapy apps can still be beneficial for people with low-level anxiety, stress or insomnia, and they can also help users become aware of harmful behaviors and obtain a higher sense of well-being. 

Sean Luo, a psychiatrist whose consultancy work focuses on machine learning techniques in mental health technology, says: “This why some of these companies are getting very high valuations. There are a lot of commercialization possibilities.” He adds that from a mental health treatment perspective, a virtual therapy app “isn’t going to solve your problems, because people who are truly ill will by definition require a lot more.”

Relying on digital therapy platforms might also provide a false sense of security for users who actually need more serious mental-health care, and many of these apps are ill-equipped to deal with emergencies like suicide, drug overdoses or the medical consequences of psychiatric illness. “The level of intervention simply isn’t strong enough,” says Luo, “and so these aspects still need to be evaluated by a trained professional.

Ruth Umoh, Diversity and Inclusion Writer, Forbes Staff.

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