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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.

Health

[IN NUMBERS] Coronavirus Update: COVID-19 In Africa

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While most cases of the COVID-19 coronavirus have been reported in the U.S. , Europe, and China, the virus is spreading rapidly across the African continent.

The confirmed worldwide cases for the virus have surpassed 18 million with the current figure being at 18,304,554.

The increase in new reported cases around the world has led the World Health Organization (WHO) to declare the coronavirus a global pandemic.

The death toll continues to rise globally. It is currently at 694,052.

The U.S. leads with 158,480 deaths. Brazil comes second with 94,130. The U.K is with 46,210 deaths; Mexico is with 47,746, and Italy’s deaths are at 35,166.

China, where the virus originated from, maintains that the country’s death toll is at 4,634.

The figure of the global recoveries stands at 11,508,854.

The African continent has 964,042 confirmed cases of Covid-19, while the death toll stands at 20,407. The continent has made 617,722 recoveries.

Here are the country-wide numbers for Africa:

Country Confirmed Cases Confirmed DeathsConfirmed Recoveries
Algeria31,4651,23121,419
Angola1,19955461
Benin1,805361,036
Botswana804263
Burkina Faso1,15053947
Burundi3951304
Cameroon17,25539115,320
Cabo Verde (Cape Verde)2,547241,860
Central African Republic (CAR)4,614591,635
Chad93675813
Comoros3867330
Congo3,20054829
Cote d’Ivoire (Ivory Coast)16,18210211,801
Democratic Republic of the Congo (DRC)9,1332157,424
Djibouti5,240595,028
Egypt94,4834,86542,455
Equatorial Guinea4,821832,182
Eritrea279225
Eswatini (formerly Swaziland)2,775431,214
Ethiopia19,2893367,931
Gabon7,531505,223
Gambia498968
Ghana37,81219134,313
Guinea7,364466,505
Guinea-Bissau1,98127803
Kenya22,5973828,740
Lesotho71819173
Liberia1,20777673
Libya3,83783623
Madagascar11,6601188,825
Malawi4,2311231,919
Mali2,5411241,943
Mauritania6,3231575,115
Mauritius34410334
Mayotte3,008392,738
Morocco25,53738218,435
Mozambique1,94613654
Namibia2,40612187
Niger1,147691,032
Nigeria43,84188829,308
Reunion6083472
Rwanda2,06251,144
Sao Tome and Principe87415787
Senegal10,3862116,901
Seychelles11439
Sierra Leone1,843671,375
Somalia3,220931,598
South Africa511,4858,366347,227
South Sudan2,429461,175
Sudan11,7387526,137
Tanzania50921183
Togo96119660
Tunisia1,561511,221
Uganda1,19551,070
Western Sahara1018
Zambia6,5801714,701
Zimbabwe3,921701,016

Note: The numbers will be updated as new information is available.

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4 Ways Women Can Better Advocate For Their Own Health

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Nurse giving woman checkup - getty images

One morning, when I was 14 years old, I woke up with excruciating stomach pain—the worst I’d ever had. My mom took me to urgent care, and the doctors there concluded that I had gastritis, or essentially a “bad stomach ache.”

But I knew they were wrong. I knew it was more than just a bad stomach ache. I kept pushing my parents until they finally took me to the hospital. After doing a variety of exams, the doctors said something along the lines of, “We really can’t find what’s wrong, but you seem to be in a lot of pain.” They gave me two options: wait four hours until the next available CAT scan, or let them do exploratory surgery and see what they find.

I decided to do the exploratory surgery. It ended up being a major, major surgery—over six hours long—and they found a tear in my intestine. They had to remove about 10 feet of my intestine, and it turns out that if I had waited for the CAT scan, I actually would have died. So, I like to say that that was the first time I learned how to trust my gut (in this case, my literal gut).

I think about this experience all the time, but I found myself reflecting on it even more as I was reading my friend Dr. Alyson McGregor’s new book, Sex Matters: How Male-Centric Medicine Endangers Women’s Health and What We Can Do About It. I don’t know how much of my near-death experience was linked to my being female, but I do know that when it comes to our medical system, women have consistently experienced poorer outcomes in every area of health than men.

McGregor writes: “One of the biggest and most flawed assumptions in medicine is this: if it makes sense in a male body, it must make sense in a female one.”

Our methods for evaluating, diagnosing, and treating disease for both men and women are based on previous research performed on male bodies. But women are physiologically different from men on every level—and these differences can have major impacts on everything in medicine, from how drugs are prescribed, to how routine tests are performed, to how pain is assessed and treated, to how systemic disease is diagnosed.

Here’s an example. Coronary artery disease is the leading cause of death in both men and women, but women have statistically poorer outcomes and higher mortality. Why? Because women’s symptoms are simply different from men’s. While men might experience left arm pain and chest heaviness (“typical” heart disease symptoms), women often present with only mild pain and discomfort, possibly combined with fatigue, shortness of breath, and a strong feeling that “something isn’t right.” Since women’s symptoms are not the symptoms that doctors typically associate with heart disease, their heart disease is 50 percent more likely to be initially misdiagnosed.

There are hundreds more examples like this one. It’s clear that there is work to do when it comes to unconscious biases in medicine—but, as women, how can we best advocate for our health and ensure that our concerns are heard and taken seriously?

1. Be prepared.

Your doctor may have gone through years of medical school, but that doesn’t mean they’re all-knowing. Research your conditions, your prescriptions, and how your prescriptions interact with each other. This way, you can have an informed conversation with your physician if something is wrong. Also, keep an up-to-date list of your prescriptions and allergies with you at all times so that any provider who cares for you will have all of the information they need.

2. Ask questions.

Even after you do your research, you may still have questions. Don’t be afraid to ask them—especially gender-specific ones. For example, “Has this medication been tested in women? If, so are there different dosing guidelines?” Or, “Will this prescription/test/procedure affect my birth control/pregnancy/breastfeeding?” It’s important to make sure you’re not only being treated for the correct conditions, but also that you’re being treated properly as a woman with those conditions.

3. Trust yourself.

Just like 14-year-old me trusted her (literal) gut! No one’s voice should take precedence over yours when it comes to your body and your health care. As women, we tend to be more attuned to our own bodies than men. We are more likely to notice symptoms when they first appear, and we usually seek treatment more frequently and earlier than men. If you feel like you’re being misdiagnosed or undertreated, keep pushing until you get answers—your life may depend on it.

4. Make your voice heard.

It’s important to advocate for yourself on an individual level, but you may be inspired to do even more. Financially, you can donate to research and advocacy foundations, or even specific research projects within your local universities and hospitals. Other effective advocacy ideas that don’t cost anything are to join a medical research trial, join a support group, or harness the power of social media to share your story. Any of this could be what makes it possible for others to get the treatment they need.

Carrie Kerpen, ForbesWomen

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How The Billionaire Behind The Movie ‘Contagion’ Is Working To Stop This Pandemic—And The Next One

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Producer Jeff Skoll attends a special screening Q&A of 'An Inconvenient Sequel: Truth to Power' at The Cinerama Dome on July 27, 2017 in Los Angeles, California. (Photo by Frazer Harrison/Getty Images for Paramount Pictures)

Jeff Skoll has been funding pandemic preparedness for more than a decade, even longer than Bill Gates. In recent months, he’s increased his philanthropic giving to help combat Covid-19.

Nine years ago, Jeff Skoll’s film company Participant Media partnered with Warner Brothers to put out Contagion, a movie about a global pandemic that started with a virus from a bat. An American businesswoman (played by Gwyneth Paltrow) came home from a trip to China and unknowingly spread a novel, and at times, deadly disease. While many viewed the film as pure science fiction, Skoll had ulterior motives. He hoped the movie would help build support for funding the U.S. Centers for Disease Control and Prevention and also warn the world about the potential dangers of a global pandemic.

Skoll, 55, became a billionaire just over two decades ago as a result of stock he received as eBay’s first president. He left eBay in 2001 and has since co-produced more than 100 films and TV programs, all with socially relevant themes including the climate change documentary An Inconvenient Truth featuring Al Gore, factory farming documentary Food Inc., the miniseries When They See Us and the 2016 Academy Award best picture winner Spotlight, about The Boston Globe’s investigations into child sexual abuse by Catholic priests. 

While his impassioned film-making pretty much ground to a halt temporarily with California’s shelter-in-place orders, his 2011 movie Contagion has become the must watch-at-home hit of the pandemic—it’s the number one selling title to date this year, according to Warner Brothers, the distributor. (It won’t disclose the number of times it’s been rented or sold.) In late March, Participant, Contagion screenwriter Scott Z. Burns and director Steven Soderbergh worked with Matt Damon, Kate Winslet, Laurence Fishburne and other cast members to produce public service announcements about washing your hands and staying home.

Beyond backing a movie about a pandemic, Skoll has been funding pandemic preparedness and prevention since 2009 — six years before Bill Gates’ now well known TED talk warning about them — through the Skoll Global Threats Fund, to which he pledged $100 million. (The other threats: climate change, water scarcity, nuclear weapons and conflict in the Middle East.)

Since the start of this year, Skoll has contributed an additional $200 million to his charitable foundation—$100 million of which was announced in late April and will go toward fighting Covid-19. He put the other $100 million in earlier this year, he tells Forbes, adding that he hadn’t bothered to publicize it. “I don’t see this as a money squirt,” Skoll explains. “This is a resource allocation to an area we know well. And this is an emergency.”

Newly bulked up, the Skoll Foundation promised to quadruple its grantmaking this year to $200 million. New beneficiaries in 2020 include some of the poorest folks in Los Angeles and the contact tracing program being launched across California.“This is the rainy day we’ve all been saving for,” Skoll says of his charitable giving. “If not now, when?” 

He’s been working up to 20 hours a day in his kitchen in Beverly Hills — on a call in early June, he jokes that it’s his “command center,” equipped with a couple of iPads, a MacBook and some bluetooth devices — talking to people around the globe, taking the pulse of the pandemic and searching out individuals, organizations and companies with new ideas. “Just the science, the learnings of the virus — almost every day there’s some revelation that we didn’t know,” says Skoll.  

The pandemics research that Skoll started funding through the Skoll Global Threats Fund spun off into a nonprofit called Ending Pandemics in January 2018, with a seed grant from Skoll. “It’s all about early detection and rapid response,” says Ending Pandemics President Dr. Mark Smolinski.


Skoll has been funding pandemic preparedness and prevention since 2009 — six years before Bill Gates’ TED talk warning about them — through the Skoll Global Threats Fund, which he spun off into Ending Pandemics in 2018.


Skoll got wind of the novel coronavirus early on, back in December —where it started. “We had colleagues on the ground in Wuhan. We had an idea that a zoonotic disease had jumped to humans,” he says. By January he and his team began to be concerned about countries with trade ties to China — particularly in Africa, where some of the social entrepreneurs that the Skoll Foundation has supported are operating. 

In early February, the Skoll Foundation made its first Covid-19 related grant: $3 million to the African Field Epidemiology Network, a group working with the African Centres for Disease Control and Prevention (the Africa CDC) to help coordinate African countries’ response and to boost surveillance and detection. The Bill & Melinda Gates Foundation donated to the same group around the same time. Beginning with those two grants, says Africa CDC Director Dr. John Nkengasong, “we were able to rally rapid responders to Addis Ababa [for training] and send them to Nigeria and Cameroon. We were able to scale up diagnostics.” Funding from others then followed, including the MasterCard foundation, Germany, Sweden, the U.K. and the U.S.  

In  March  it made a grant to the Southern African Center for Infectious Disease Surveillance Foundation (SACIDS) and a similar group in East Africa. One outcome: Mozambique, which had the infrastructure to test for Covid-19 but limited money to buy tests, got the needed funds and ramped up testing four-fold, according to Smolinski. 

The Skoll foundation’s next move was to quickly create a fund for both its current and past grantees — mostly social entrepreneurs. Sixty-four organizations were given $50,000 grants. “We figured they would need emergency funding,” Skoll explains.

Though the Skoll Foundation has traditionally supported social entrepreneurs who work in lower income countries, in the past few months it has made some donations closer to home. Because Los Angeles County has been particularly hard hit by the pandemic, Skoll reached out to Los Angeles Mayor Eric Garcetti to offer assistance. In late April, his foundation made a $2 million gift to the Mayor’s Fund for Los Angeles, which is providing cash assistance to families hit hardest by Covid-19. 

Skoll also connected with California Governor Gavin Newsom and his senior advisor on social innovation, Kathleen Kelly Janus. The Skoll Foundation is donating $8 million to support California’s response to Covid-19, starting with $4.1 million for the public awareness campaign around contact tracing, which Janus says “will be really critical to preventing a second wave of Covid-19.” 

Smolinski’s team, which had already partnered with Harvard and Boston Children’s Hospital to build a crowdsourced symptom reporting tracker called Flu Near You in 2012 to show flu trends in neighborhoods and cities, rolled out Covid Near You in early March. The app lets people anonymously report if they’re feeling healthy or not, with zip code info, as  a way to track current and potential hotspots. 


Skoll’s Ending Pandemics has partnered with governments and public health authorities in 36 countries — 11 of which have surveillance systems tracking Covid-19 and other infectious diseases.


Ending Pandemics has partnered with governments and public health authorities in 36 countries — 11 of which have surveillance systems that Smolinski says are “up to speed.” One is Cambodia, a country of 14 million people, where all four telecom companies support a free mobile app that both receives info about disease and provides information. Calls have gone from 600 a day before the pandemic to 15,000, and the vast majority of the Covid-19 cases in the country were first identified through the hotline, Smolinski says. Cambodia, the country that took in a cruise ship no one else wanted, so far has just 129 cases and no deaths, he adds.

Through the Audacious Project, a philanthropic group with about 30 members launched by TED conference curator Chris Anderson with Jeff Skoll and Richard Branson, Skoll and others are supporting Boston-based Partners in Health, which responded to the Ebola crisis in 2014. The multi-million dollar grant from the Audacious Project enables Partners in Health to share its contact tracing expertise over the coming year with roughly 19 public health departments across the U.S. “We started by helping the state of Massachusetts put together a contact tracing system, and everyone else wanted to know what we were doing,” says Joia Mukherjee, Chief Medical Officer of Partners In Health. “This funding has allowed us to expand our team. What we are hoping is that state and federal money will be forthcoming.” 

Mukherjee applauds Skoll’s approach to philanthropy. “Jeff has always been a systems thinker, and that has been transformative for Partners In Health,” she says. 

Skoll also contributed funding to an ambitious global project called the Global Infectious Disease Epidemiology Network — GIDEoN for short —being spearheaded by Columbia University epidemiologist Ian Lipkin, who directs the university’s Center for Infection and Immunity. Lipkin has lined up the equivalent of the National Institutes of Health in 12 countries including India, Brazil and China and together they’ll share information about outbreaks and disease samples. With GIDEoN,  Lipkin explains, “we’re trying to upgrade the capacity for detecting infectious agents and toxins, particularly in the developing world.” 

While Skoll has been involved in global philanthropy for nearly two decades, he now has an even more personal reason for being involved in the fight against deadly diseases. While working on Ebola in 2014, he contracted a rare tropical disease that took two years to diagnose. He took an 18 month medical leave of absence and is feeling better now.

Despite many challenges, Skoll is an optimist, even about pandemics. Yes, the number of cases will likely increase as U.S. states open back up, he says. But he’s hopeful that a treatment for Covid-19-an existing drug—can work and be scaled up for distribution sometime this summer. “I hope we can get the solutions in place in the next few months. I see a path to it,” he says.

As for future pandemics, Skoll sees a silver lining.  “There are so many zoonotic viruses that jump over from animals to humans. Most of them peter out and turn into something less lethal. I don’t think it’s likely that we’ll see any terrible new pandemic any time soon, says Skoll.  “If anything, the world is on watch now.”

Kerry A. Dolan, Forbes Staff, Billionaires

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