University College London researchers found a 3.6 percent decline in mental reasoning in women and men aged 45-49.

They assessed the memory, vocabulary and comprehension skills of 7,000 men and women aged 45 to 70 over 10 years.

Anchor Lisa Mullins talk with study co-author Jane Ferrie of University College London.

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Lisa Mullins: Another medical story out of Britain now. A study published in the British Medical Journal suggests that memory and other brain functions can start to deteriorate in people as young as 45. Previous research on dementia and similar brain afflictions focused mainly on people over 60. The author studied the mental capabilities of thousands of British civil servants from ages 45-70. Dr. Jane Ferrie is from University College London and she coauthored the study. At 59 she says she’s noticed some changes.

Dr. Jane Ferrie: I find it a little bit scary, but I would have to say based on the solvable size of one that one, I do notice that my cognitive function isn’t quite what it used to be. Cognitive decline appears to start very slowly you know, in a relatively minor way in people as young as 45-49. But we’re talking about very small changes that increase with age.

Mullins: But how does this change the current thinking about the progress or the deterioration of the brain?

Ferrie: What we were able to do in our study is one, we included very large numbers, over 5,000 men, over 2,000 women and most previous studies have been relatively small. Also, a lot of previous studies have not had the ability to look at changes in cognitive function in the same people. What we have been able to do now is use data from three clinical screenings of cognitive function so that our participants come in and they do cognitive function tests with us there. That’s the advantage of the methods that we’ve used, that they’ve enabled much more rigorous investigation of this question.

Mullins: Is there a direct link though between what you found in decline of the brain from age 45 on, and as you say, even tiny bits of evidence of decline; and the onset of some kind of dementia, either Alzheimer’s or something else? Does one necessarily lead to the other?

Ferrie: No, we haven’t been able to show that yet. Obviously we hope to be able to continue to follow these people and we will be looking at that as an outcome with some of our participants in later life. Of course, one of the advantages of realizing that this process starts much earlier in life is one, that it will enable much earlier detection, and also it makes it very clear that any interventions need to start much earlier in life. So people need to think about protecting their cognitive function and it seems from research that’s been done to date that the things that protect cognitive decline is very similar to the things that we do to protect our bodies — you know, good diet, good exercise.

Mullins: So for the things that you think really will make a difference, and I don’t know to what extent we know that for sure, but you know, give us three things right now, whether or not we’re younger than 45 or older.

Ferrie: Well, they’re really basic things that we all need to be doing — eating plenty of fruits and vegetables, making sure you have a minimum of at least a half an hour of vigorous exercise a day, keep our bodies and our minds as active as possible.

Mullins: There goes the weekend, but thank you.

Ferrie: Yes.

Mullins: Thank you very much, Dr. Jane Ferrie, one of the coauthors of the study of finding that brain function can start to decline at the age of 45, a study conducted by the University College London, thank you again.

Ferrie: Thank you very much.

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For instance, in the US, there are taxes on tobacco products and in some US states, there are taxes on things like soda and chips.

Denmark’s new government is pushing through a nationwide fat and sugar tax.

Anchor Marco Werman talks to Danish television news anchor Kim Bildsoe Lassen about those new measures.

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Marco Werman: I am Marco Werman, this is The World. When it comes to encouraging healthy habits, some governments nudge their citizens gently. Others go for more drastic measures like taxing items that are considered “unhealthy.” Here in the U.S., there are taxes on tobacco products for instance; and in some U.S. States there are taxes on things like soda and chips. Denmark’s new government is pushing through a fat and sugar tax. Kim Bildsoe Lassen is a Danish television news anchor. He says the new government is expanding on an idea that began under the previous one.

Kim Bildsoe Lassen: There is actually two parts of it. One is the general fat tax that the former government is also involved in where they simply tax the unhealthy foods that include a lot of fat. What this new government that came into power today is doing, is they are adding on this with sugar and other unhealthy foods so that, simply, it will be taxed more. The price of chocolate will rise. The price of sodas will rise. If you want to buy chips it is going to be more expensive. I think that there has been a little debate about it and the former government tried to make it a little bit of an issue. But, generally, I think people in Denmark accept that this is one way of trying to deal with the deficit that we also have in our country – to get more tax in – and it is okay to do it on things that are unhealthy.

Werman: So what kind of percentage increase are we talking on fatty and sugary foods?

Lassen: It’s quite small, but if you buy some chocolate it might rise to 25 cents for a large piece of chocolate. The sodas…I think it’s about 35 cents. It’s not a lot but people will hear it, definitely.

Werman: Right. Not a lot, but noticeable. How bad is the obesity problem in Denmark right now?

Lassen: It’s not as bad as in the States, but it is a growing problem. We see it for the first time among children, among young people who don’t exercise enough; they eat unhealthy. So it’s a rising problem and that, of course, is also one way of addressing that.

Werman: Kim Bildsoe Lassen, an evening news anchor on Danish television, speaking with us from Copenhagen. Thank you so much.

Lassen: Thank you. It was nice to be here.

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At a small health clinic in western Uganda, it is medication day for psychiatric drugs, an event that happens every month or so. A clerk sits near an unscreened window, counting out pills for the long line of patients.

People have walked for miles past small farms and through red clay hills to get here.

Beatrice Mudumya, 23, waits quietly. In 2009, she developed an illness she calls “mental head.” All she did was sleep.

Mudumya says her family prayed, but that didn’t help, so they took her to the hospital. Antidepressants got her going again.

Now she is back to farming and fetching water and washing clothes, but the antidepressants she is getting come from a charitable organization, and it’s their last day at this clinic until more donations come in.

Mudumya is about to become like a lot of Ugandans with mental illness – diagnosed but without treatment.

Julius Kayiira, director of Mental Health Uganda, knows of many people with mental illnesses who have never been treated. He can even show you photographs of people chained to trees, the chains eating into their flesh.

Kayiira’s organization provides social support, job training, and care to people with mental illness. He says organizations like his face an enormous funding gap, and he blames that gap, in part, on the United Nations.

“It’s so hard for us to have any project funded by any international partners because you find they don’t have [mental health] in their strategic funding areas,” he says.

In 2000, the UN set out a strategy for helping impoverished nations in a set of objectives called the Millennium Development Goals. The goals, which have been called the most politically important pact ever made for international development, include eradicating extreme poverty and hunger, and reducing the incidence of infectious diseases such as HIV and malaria.

“The Millennium Development Goals have given direction to almost everybody,” says Kayiira. Yet the goals say nothing about treating mental illness.

“This is a major blow to our efforts,” he says.

Mental health advocates around the world say the same thing – that the exclusion has held back mental health as a global health issue.

“The Millennium Development Goals are one of the most important instruments for global policymaking,” says psychiatrist Vikram Patel of the London School of Hygiene and Tropical Medicine. “When something is not part of the MDGs, they simply fall off the net, as it were.”

The World Health Organization estimates that more than 450 million people suffer from mental disorders, and a new report by the World Economic Forum figures the annual global costs of mental and neurological illnesses at $2.5 trillion. That is three times the economic cost of heart disease.

Yet one of the chief architects of the Millennium Development Goals, Columbia University’s Jeffrey Sachs, has defended the omission of mental illnesses. Sachs did not make himself available for this story, but he has responded in print to critics like Vikram Patel.

“The reason that the MDGs do not explicitly address noncommunicable diseases such as cardiovascular or psychiatric diseases is that the MDGs focus on the gap in health status between rich and poor countries, a gap mainly accounted for by infectious diseases, malnutrition, and unsafe childbirth,” wrote Sachs. “The goals were crafted to address these large gaps rather than to solve all pressing health problems.”

But Patel counters that many people with mental illnesses like depression and schizophrenia cannot provide for themselves and are more prone to other illnesses, poverty, and premature death. Depression alone ranks as the number one cause of disability worldwide, according to one measure used by the World Health Organization.

The UN this week is holding a special two-day summit on noncommunicable diseases such as cancer, heart disease, and diabetes. Yet, once again, mental illness is not a focus.

Julius Kayiira, director of Mental Health Uganda, remains frustrated. He says greater recognition of mental illnesses by the world body could make a big difference.

He knows that because the UN has, at least once, focused attention to mental health. That was in a treaty on the rights of people with disabilities. Kayiira says almost immediately after that treaty was adopted, his group got two new funders.

Reporter Joanne Silberner travelled to Uganda as part of a Rosalynn Carter Fellowship for Mental Health Journalism.

Patrick Cox’s 2007 series on obesity

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Marco Werman:  Obesity is not just a problem in the U.S.; globally, people are getting fatter.  New figures published today show that worldwide, the percentage of adults who are obese has approximately doubled in the past thirty years.  Professor Majid Ezzati of Imperial College London, led the international team of researchers that examined health data from 199 countries and territories.  No big surprise that American adults were the most overweight among all high-income countries, but many less wealthy regions of the world are also seeing high rates of obesity.  Which regions, and why?

Professor Majid Ezzati:  The countries that came out as having some of the highest levels of overweight and obesity were some of the Pacific Islands, some of the countries in North Africa and the Middle East, some of the Caribbean countries, and, and…  And possibly surprising, actually in the Southern Africa region they had some of the highest levels of obesity in the world.  And as you mentioned, among the high income countries, the United States was by far the single highest one.

Werman:  I mean, a lot of people immediately turn to the spread of fast food around the world, people sitting more in front of TV…  I mean, are those factors?  Sedentary lives and fast foods?

Ezzati:  It doesn’t have to be eating a different type of food, fast food.  It could be eating more of the same, but as long as it is eating more of either the same or different foods and being less active…  And less activity may not be sitting in front of TV, but it may be the fact that people who are active in farming and fetching water and wood for their homes are doing less of that.  Now some of those are good things for life, but there seems to be no replacement for those activities that may be going away with urbanization and some conveniences of life.

Werman:  Is some of the variation in obesity rates from country to country due to genetics?  Maybe there are different ethnic groups prone to different body types.  I’m just wondering, is it safe to use a single definition of obesity, worldwide?

Ezzati:  Research has at least indicated, if not shown, that genes may affect weight gain, but remember that people in these countries had the same genes three or four decades ago.  So what genes cannot explain is the massive rise that has happened in any one country over three or four decades.  It may tell us something about the geographical differences, but clearly there is something else happening in the background to be acting on top of these genes to increase obesity.

Werman:  Do you have any sense of what that thing happening in the background is?

Ezzati:  Well, I mean I think…  I think, you know, different hypotheses have been used.  One of them is that it is just easier to eat these days than it was a few decades ago.  A few decades ago, if you wanted a particular food, you actually had to go and make it.  In many places in the world, it’s actually easy to just get it and eat it.  So not just the cost of it, but the convenience of eating has become more.  We probably use systems of transportation, and in our occupation, things that use less energy, so all of these are on top of it.  But remember, we don’t have to go and reverse everything that has changed to be able to reduce obesity.  What we want to do at this point is not necessarily get rid of cars—that’s going to be quite difficult—but to figure out what are the actions that, as societies, as nations, we can take today that would lead to either curbing and ideally reversing the increase that has happened.  And we should be going after those actions.  It could be putting lots of taxes on sugar-sweetened beverages.  It could be making bike lanes that are really good and safe.  Whatever they are, as possibly extreme as they may sound, they should be pursued if we believe that the health effects of this rise in obesity are large.

Werman:  Fascinating research, indeed.  Professor Majid Ezzati is the Chair in global environmental health at Imperial College, London.  His studies of obesity, blood pressure, and cholesterol levels worldwide, have just been published online by the medical journal, The Lancet.  Professor, thank you very much.

Ezzati:  Thank you.

Copyright ©2009 PRI’s THE WORLD. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to PRI’s THE WORLD. This transcript may not be reproduced, in whole or in part, without prior written permission. For further information, please email The World’s Permissions Coordinator at theworld@pri.org.

Ursula Lindsay from Cairo, Egypt:

Many Egyptians remember the fights that broke out in their bread lines back in 2008. A young woman told me she had been hit and pushed out of bread lines by other customers. She also complained that the government ration of bread wasn’t enough to feed her six-person family.

Rationing subsidized bread was one tactic the authorities used to solve the 2008 crisis. They also set up public kiosks to sell bread in a more orderly fashion. President Hosni Mubarak even ordered the army to bake bread. The 2008 “bread crisis” passed, but the problem has never really gone away. Food inflation in Egypt continues to run at a staggering 17 percent. Poor Egyptians spend more than half their income on food.

If global food prices rise again, millions here could face food insecurity. But the government has taken some steps to address the problem. It has cracked down on a black market in subsidized wheat. And it is reorganizing the subsidy system, trying to make subsidies efficient and targeted at those Egyptians who need them the most.

Furthermore, many here believe that the government will make an extra effort in this presidential election year. President Mubarak, who has ruled for the last 29 years, will probably run for another term. But there is a chance he will designate a successor.

In this time of political uncertainty, the regime will probably do everything it can to avoid unrest. The question is whether that will be enough.

Elliot Hannon from New Delhi:

In India, the price of vegetables can make national news. And lately, that hasn’t been a good thing.

News report: “It’s one emergency meeting after another on the skyrocketing prices of onions across the country.”

In fact, last month the cost of onions – a staple of Indian cooking – nearly doubled from last year’s price. Even more modest increases have led to the ousting of governments in the past. To help ease the burden, the Indian government banned the export of onions and even began importing them from its long-time adversary, Pakistan.

Poor weather has hurt farming output and contributed to the rise in price for food. But there have also been complaints of hording and speculation by traders, as well as mismanagement of food production and distribution. The rise of other goods, like fuel, has also made buying the basics more expensive.

At a roadside cart brimming with vegetables, Lakshmi Das surveys the options for the night’s meal. She says the spiralling cost of food has changed the way she shops. “Previously I used to buy a kilo of vegetables all at one time. Now I’ve cut it down. You can’t stop eating so what I do instead of buying 4 or 5 vegetables at one time, I buy just a little at least twice a day so that I don’t waste any of them”.

And so, instead of spending 200 Rupees, she now spends only 50 each time she shops. That has also made business difficult for Kapuri Davi, who wakes up each morning at 6 am to buy vegetables to sell door-to-door on her cart. “Business has gone down for sure. Now I’m barely able to manage my expenses at home, but nothing beyond that because of the price rise”.

While paying more for onions and tomatoes doesn’t necessarily affect the wealthy…. those not feeling the pinch remain an almost microscopic minority. India is a country where hundreds of millions live below the poverty line andif prices continue to rise, the worry is that India’s most vulnerable, like Davi and some of her customers, soon won’t be able to manage at all.

Jessica Golloher from Moscow:

Over the summer, Russia experienced its worst heat wave and fires on record. Millions of crops were destroyed. The horrific drought forced Russian President Dmitry Medvedev to ban many grain exports, including wheat. As a result, the prices of many foodstuffs have soared past record levels set during the 2007-08 food crisis.

There is a song about buckwheat, one of Russia’s main staples, in which the artist laments that Pasha and Masha want buckwheat with rice, only there is none. Not for all the dollars or Euros in the world, no buckwheat!

That little ditty might sound bizarre to most people. Why would Russians take time out of their busy lives to sing about a grain? Easy answer: the stuff is like gold here; it’s a staple, generally eaten at every meal.

The good news is, that Russia’s beloved grain is now back on the shelves after a several month hiatus, at least in most stores. The bad news is, the price for a kilo has jumped by more than 180 percent. And, buckwheat isn’t alone.

Figures from Russia’s state statistics service show that a kilo of both cabbage and potatoes nearly doubled in price during 2010. Other staples such as bread, butter and milk grew upwards of nearly 23 percent last year.

Elena Skrynnik is Russia’s agriculture minister. Here she is addressing the price hikes, through a translator, on state-run television.

“The main reason for such a dramatic increase in prices is the drought. We see a massive jump in prices for potatoes and buckwheat. We’re taking all possible measures to control the situation and the recent price rises are just speculative growth. The financial backing we’ve given farmers has stabilized the market. But yes, it’s a difficult situation”.

The Russian government recently said that it would release grain reserves and possibly put a cap on prices. Sergei Moiseev is with the Finance Institute. Here he is addressing the issue on Russia’s English-language television channel.

“I don’t dismiss the possibility of a top limit for prices on crucial food items like bread, butter, milk. The effect of these measures is very limited. That’s why there will be no limit for the wide range of goods, due to the fact that 2 years ago when those goods disappeared from shelves, and when prices were unfrozen the prices rebounded”.

Despite all the hubbub about prices, Elena Nikolaevna says she’s not going to worry about it because, well, she’s lived through a lot more here in the former Soviet Union. She says, you know, everything’s going to be just fine. They even said so in the newspapers. Now this is nothing, everything will be fine”.

….as long as Russians can have their buckwheat and rice.

• On The World: global food prices spike
• 2010 Global Hunger Index
• Food and Agriculture Organization of the UN (FAO)

Beirut's air is engulfed with toxic fumes

Beirut’s streets are filled with aging Mercedes belching clouds of toxic fumes into the air. The city has experienced a building boom that’s led to more people using more vehicles on the country’s already crowded roads. Dr. Najat Saliba is one of them.

She’s a chemistry professor at the American University of Beirut. Saliba wanted to monitor the levels of toxins a driver inhales while stuck in traffic because it’s an experience she’s intimately familiar with.

“The idea came because I’m stuck in traffic every day, so I wanted to monitor how much Particulate matter I was breathing,” Saliba said.

Studies here have shown air pollution levels are sometimes three times the level deemed safe by the World Health Organization. But Saliba didn’t just want to know how much fumes a driver fumes a driver might suck in stuck in traffic, she wanted to know the collective pollution from driving around the city.

So, with help from a few car companies, she got a van equipped with $75,000 worth of pollution monitoring equipment that will travel the streets for two hours, twice a day in heavy traffic.

And so began a study with an extremely long name, “Monitoring Particulate Matter Emissions During Traffic In Real Time On A Busy Street In Lebanon.”

“The good thing about this machine is that we can monitor it remotely,” said Carljoe Muhanna, the medical student in charge of the project. “I can monitor it from home or wherever, with a laptop. So I go in and then I have all the values in front of me. I don’t even need to be inside the van. Every six seconds the values the machine is recording I can read it at home.”

Muhanna said a website that will show the position of the van and the pollution levels. It will even be on Facebook, on the page of the Nissan franchise in Lebanon that’s funding the project. Not coincidentally, Nissan has a new “green car” coming out called the Leaf.

“Nissan as a corporation is under a green evolution,” said Abdo Sweidan, head of Rymco Motors. “So everything that helps in the awareness of pollution and particulates in the air is of high importance to us.”

Sweidan was asked if an auto company’s goal is to sell more cars, and if more cars lead to more air pollution, doesn’t that put his goals, and the goals of the study, at odds?

“Absolutely not,” Sweidan said. “If we sell good cars, we are going to sell more good cars. If there are safety compliances in this country that are dictated by policy makers to only import good cars for the environment, then manufactures of environmentally friendly cars will be able to sell more of the same.”

In other words, the more Nissans he sells, the fewer old Mercedes there are on the streets spewing. Many cars in Lebanon are so old they’d be junked in Europe or the US. Sweidan said he’s all for tighter environmental regulations, and enforcement, on vehicles.

He said as it stands now, “the only regulation that exists is that there are no regulations.”

Regulations, Sweidan said, would make the air cleaner, cut down on air pollution and help him make a few bucks in the process.

The new pollution monitoring van, Sweidan and other supporters said, will hopefully increase the public’s awareness about the need for such regulations.
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• The American University of Beirut Launches an Air Pollution Study in a Moving Van
• Nissan & Bank Audi joins efforts with AUB to monitor traffic toxic emission

The discussion is live through next week.

Acai berries (Photo: Kelley Weiss)

The Amazonian berry known as açaí is rapidly gaining popularity in the United States. Proponents tout its unsubstantiated health benefits. But the berry has a very different reputation back in Brazil. Reporter Kelley Weiss reports. Download MP3

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LISA MULLINS: I’m Lisa Mullins and this is The World. Many Americans go crazy for acai. You’ve likely seen the ads for products made with the little Amazonian berry, spelled a-c-a-i, with a little tail underneath the c. Those ads tend to make a whole slew of unsubstantiated health claims about acai, but the berry has a different story in Brazil, as reporter Kelley Weiss found out on a recent trip.

KELLEY WEISS:  This small purple berry is sold in juice and pill form here in the US. And people have been making a lot of claims about it.

FEMALE SPEAKER:  People are crazy about the acai berry. It can even blast cancer cells.

MALE SPEAKER: If you’re looking for an easy way to lose weight in a free trial of acai…

WEISS: But in Brazil, where the berry grows, acai has a different reputation. At the Acai Naturale juice bar in Salvador, the staff makes frozen smoothies, served up in scoops.

BENEDITO ITAMAR GAMA DOS SANTOS: The most popular combination is acai, banana and granola.

WEISS: With cheeseburgers on the menu as well, there’s no indication that you’ll lose weight here. In fact the acai weight loss claims that many Americans cling to baffle Brazilians. Gabriela Santana is a lawyer in her late 20s. She says acai is so fattening she only eats it once a month.

SPEAKING PORTUGUESE

GABRIELA SANTANA: Acai to lose weight. No way. If you drink or eat acai every week you’ll end up gaining weight.

WEISS: After hitting the gym, 26-year-old Bruno Camozzato comes by for his regular acai energy fix. He’s in workout clothes that show off his muscles.

SPEAKING PORTUGUESE

BRUNO CAMOZZATO: Usually on the weekends I eat a lot of acai after lifting weights because it’s got a lot of calories and ‘cause I like the flavor.

WEISS: Acai took off in Brazil’s larger cities after athletes discovered it. But in the impoverished Amazon, people depend on acai as a staple of their diet and they have for a long time. Benedito Itamar Gama dos Santos sells acai pulp in Macapa. A large scar crosses his face, one eye is permanently shut and he has few teeth.

SPEAKING PORTUGUESE

DOS SANTOS: Acai is part of our meals, both at lunch and dinner. We mix it in with manioc flour and we eat it with either meat or fish.

WEISS: It’s easy to eat acai here because the berry grows wild along the Amazon River.

JEREMY BLACK: You can see the acai growing, the purple up there off the top. It almost looks like a date tree or something…

WEISS: Jeremy Black is co-founder of the American acai company Sambazon. He says he and his brother Ryan introduced acai to the US ten years ago. Ryan Black says since then a lot of people on the internet have been making distorted claims about the berry, just to make money.

RYAN BLACK:  It is from the Amazon and it’s exotic and it carries these really strong nutritional properties to it. Unfortunately that has been sort of hijacked. Acai has nothing to do with take a pill and you’re going to sit on the couch and lose weight. It’s a whole food found in nature.

WEISS: The Black brothers themselves describe acai as a super-fruit. But Dr. John Swartzberg, head of the UC Berkeley Wellness Letter, says the jury’s still out on acai.

JOHN SWARTZBERG: There’s not a lot of real hard science in terms of what the properties of this berry are.

WEISS: He says acai berries do have antioxidants and fiber, and they do have a lot of calories. So for those curious about acai, here’s Swartzberg’s advice.

SWARTZBERG: Ignore those ads and ignore any of the hype. Try acai and if you like it, fabulous. And that’s the criteria I’d use.

WEISS: Just keep in mind, he says, acai won’t cure cancer or help you lose 20 pounds. For the World, I’m Kelley Weiss.

Copyright ©2009 PRI’s THE WORLD. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to PRI’s THE WORLD. This transcript may not be reproduced, in whole or in part, without prior written permission. For further information, please email The World’s Permissions Coordinator at theworld@pri.org.

In this podcast, our monthly top-five roundup of language stories:

5. Why Google Translate rules (and why human translators shouldn’t feel threatened.) Google, as we’ve come to expect by now, does things differently. And that includes translation. We tend to think of translators as human or robotic. Google Translate combines the best of both. Which is why its translations can be poetic — yes poetic – as well as accurate. Of course, it’s still not difficult to outwit Google Translate, and make it fail. But with each new iteration, it’s getting better. However, it’ll only continue to improve so long as humans keep translating stuff (because Google Translate uses online human translations as its source material). Also, one day, Google may need to clarify that its translation tool, however ubiquitous and accurate it becomes, is no substitute for learning a foreign language. Humans live and thrive — and love and make money — by communicating with each other. And they do that most effectively with their mouths, tongues and vocal chords.

4. Over-egging the job title pudding. The BBC reported that a weight-loss company recently advertized for a Product Testing Associate. This job would consist of eating an extra 400 calories a day, as well as popping a few of the company’s Proactol pills. That got a bunch of readers of the online BBC article to relate their own favorite misleading job titles: modality manager (translation: nurse, not to be confused with mortality manager); coordinator of interpretative teaching (tour guide); welcoming agent and telephone intermediary (receptionist); and field force agent (tax collector). All of a sudden, I’m thinking my job title — language podcast host — isn’t grand or pretentious enough. So henceforth, I will be known as a digitized philology presentation practitioner.

3. Accent discrimination. As a native English speaker with Brit accent (it’s drifted into the Atlantic after 20+ years in the United States) I think I’ve experienced positive accent discrimination. Many Americans have told me they’ll believe anything a Brit tells them — a good, if dangerous, thing for a reporter to hear. However, there are plenty of examples of the other type of discrimination. The latest concerns a US-based native French speaker who’s a senior partner in a global consulting firm. She speaks of being dis-invited to meetings with American clients, because of the fear that her accent would put them off.

2. The rise of Hindi (and English). My Big Show colleague Rhitu Chatterjee told me about an old friend of hers. He was born and raised in New Dehli by a Marathi-speaking mother and a Telugu-speaking father. Because of the language divide, the languages of the household were Hindi and English; Rhitu’s friend neither spoke nor understood the native tongues of either of his parents. That story writ large is the linguistic story of modern India — multilingual marriages, migration to big cities, a big generational shift to Hindi and English. English has now eclipsed Bengali as the the second-most popular language in India, according to recent census analysis, and Hindi continues to dominate.

1. New French words to replace English invaders. The Académie française (pictured) is the jealous protector of all things French: it determines what can and cannot be said and written, even if people often ignore its pronouncements. Often, the Académie finds itself with no alternative but to make up new words, usually when the hoi polloi are using one of those nasty English words (like podcasting). Some officially coined terms stick (logiciel, meaning software); others don’t (frimousse, meaning smiley). Authorities have now taken a new tack: they have turned to the people themselves. Citizens sent in their suggestions for words to replace Anglicisms such as buzz and newsletter. A committee decided which to adopt.

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Children by their home, Lojora Village, Southern Sudan.

Jimmy Carter’s first direct experience with Guinea worm was in West Africa. He visited Ghana and traveled to a hard-hit village.

“It’s about the size of Plains, Georgia, where I live. About 500 people. And 300 of its citizens had Guinea worm.”

Now, if you’re not familiar with Guinea worm — brace yourself. It’s not a pleasant condition. You get it by drinking contaminated water. You don’t know you’ve been infected until a year later, when you develop a painful blister. Then a worm slowly emerges. It can be as much as a yard long. And it can come out through your leg, your arm… just about anywhere.

“The most memorable experience was a beautiful young woman, I think about 19 or 20 years old. And I thought she was holding a baby in her arms, and I went over to talk to her child, and I found out she was holding her right breast in her arm, instead of a baby. And a Guinea worm was coming out of a nipple of her breast. And she was in excruciating pain. We found out later that year that she had eleven other Guinea worms emerge simultaneously from her body.”

That was 1988. At the time, Guinea worm plagued millions of people in 20 countries — in Africa and Asia. Not anymore.

“We’ve gotten rid of the disease now in Cameroon, Niger, Ivory Coast, in Togo…”

Doctor Donald Hopkins launched the global Guinea worm eradication campaign 30 years ago. It started at the U.S. Centers for Disease Control, but he soon moved the campaign to Jimmy Carter’s Atlanta-based Carter Center. Ever since, the Carter Center has helped countries set up national programs to defeat the disease.

“We’ve also gotten rid of it in Pakistan and Yemen.”

Only a few thousand cases remain. And almost all of those cases are in one region of one country: Southern Sudan.

“The last Guinea worm on earth will be from somewhere close to where we’re standing right now.”

And where we’re standing is in the village of Lojora, in Southern Sudan’s Terekeka County. It’s hard to imagine a place more cut-off from the modern world. There’s no electricity, no shops, no roads. Just huts of mud and thatch scattered in the brush. A boy — naked and barefoot — herds his family’s goats.

Village chief Jakeyo Le Yong Ladu says when he was a boy, Guinea worm swept through his family.

Chief Jakeyo Le Yong Ladu.

“My mother had Guinea worm. My father had Guinea worm. My sisters had Guinea worm. Nobody could cook. Nobody could fetch water. My father was the head man of the village. When he saw that everybody had Guinea worm, he became so upset, he hanged himself. He took his own life.”

Back then, many considered Guinea worm a curse from God. No one knew what caused it, or how to prevent it. Even today, there’s no cure for Guinea worm. No vaccine. No drugs to combat it. But its transmission can be stopped if a patient is identified early and treated.

On this day, the patient is a man named Dario Mere. He’s stick-thin, in a tattered shirt. He sits on a papyrus mat, while the village watches and two health volunteers lean over his left leg.

Dario Mere awaits treatment for Guinea worm.

A worm pokes out of an open sore.

Simon Taban of Southern Sudan’s Guinea Worm Eradication program is here to supervise the treatment.

Simon Taban: “He had multiple worm.”
David Baron: “Multiple worms.”
Simon Taban: “Yeah, multiple worm. The first one was removed the day before yesterday.”

The second one is being removed today. A health volunteer gently pulls on the worm — trying to coax it out of Mere’s body.

A health worker gently pulls the worm.

“As you keep pulling it — slowly, slowly — you keep massaging it until it finally comes out.”

You don’t want to break the worm. That can leave a portion of it in the patient, causing infection and inflammation and permanent disability. So day by day, inch by inch, the treatments continue. The worm is wound around a piece of gauze. When Dario Mere’s worm finally comes out, it looks like a long strand of angel hair.

The worm, removed from Dario Mere.

Until the worm is removed, it’s critical that the patient stay away from water sources — like ponds — that locals use for drinking. If the patient bathes or swims there, the worm will release its larvae into the water, and if people then drink that water, they’ll become infected.

A poster reminds Guinea worm patients not to step in a source of drinking water.

So another critical part of eradicating Guinea worm is making sure that if people do drink from a contaminated water source, they can protect themselves.

The Carter Center and its partners distribute basic water filters — made of mesh cloth and plastic piping — that people here use to filter the larvae out. It’s simple technology.

What’s hard is distributing millions of filters to thousands of villages and making sure that everyone uses the filters every time. All it takes is one gulp of contaminated water and the goal of eradication can be set back another year. And that’s why Jimmy Carter ventured to Southern Sudan last month — to rally the local workers, and the public, for what he hopes is the final push.

While a chorus sang a welcome song, a line of white Land Cruisers approached the village of Lojora through the brush, kicking up dust. Secret Service agents stepped out, then the former U.S. President. Jimmy Carter conferred briefly with local health workers.

“What’s the main thing you’d like for me to say? Congratulate them on progress made?”

He took a seat under a tent, beside a banner that read: ”Stop Guinea Worm in 2010.” Then he stepped up to a podium planted in the dirt.

Former U.S. President Jimmy Carter in Lojora Village. A pipe filter, of the sort locals use to protect against Guinea worm, hangs from his neck.

“Thank you. Well, it’s a great honor and pleasure for me to come to this wonderful place in Sudan, Southern Sudan. We’re very grateful at the great progress that has been made here in reducing the incidence of Guinea worm. As you may know, when we first began our project in Southern Sudan, there were more than 100,000 cases that we found. And I’m sure there were many others that we could not discern at that time. Last year, we had about 2500 cases, and we believe that in the next two or three years, we’ll have zero cases of Guinea worm in Sudan.”

President Carter shook hands with health workers. He accepted ceremonial gifts. He held photo-ops with babies.

Ceremonial dancers welcome Jimmy Carter.

Then the motorcade left, and the village was back to its daily struggles. And those struggles are considerable. These people are hungry and poor — in a land scorched by decades of civil war. The war is over, but tribal fighting remains.

And there’s growing political tension — with nationwide elections scheduled for next month, and a vote on independence for Southern Sudan planned for next year. Many fear this region could spiral back into war, and that could undo the progress against Guinea worm.

Makoy Samuel Yibi heads Southern Sudan’s Guinea Worm Eradication Program.

“If we had to run away because there is fighting, or if the community is displaced and moving any direction where you cannot know where they went to, then of course you will be missing cases, and in that way there will be no chance of interrupting transmission. So that’s the worst nightmare actually for the program.”

Herder Garbino Kenyi, his ankle bandaged for Guinea worm treatment.

Of course, if war resumes, the people of Southern Sudan will have a lot more than Guinea worm to worry about. But if peace holds, getting rid of Guinea worm could help this region rebuild and prosper. Farmers will be healthier — better able to plant crops. Children will be less likely to miss school — assuming, that is, they have a school to go to.

If the global eradication effort succeeds, it’ll be thanks to many people in many countries over many years. Jimmy Carter likes to say he’s just one of those people. Of course, given his prominence, he was able to bring money and attention to the fight. He helped make the world care about an otherwise neglected disease.

President Carter is now 85 years old, and I wondered: where would he rank the defeat of Guinea worm on his list of life’s accomplishments?

Carter: “I would say very near the top.”

Baron: “Seriously.”

Carter: “Seriously. You know, we brought peace between Israel and Egypt, and we opened up diplomatic relations with China, and did some other things that I need not mention. But I think that when we see the last case of Guinea worm gone from the earth, there would be few if any other achievements of my life of which I would be more proud.”

And he’s already planning a return trip to Southern Sudan — in a few years, he hopes — to celebrate the death of the last Guinea worm.

For the World, I’m David Baron, Lojora Village, Southern Sudan.

Listen to an interview with former U.S. President Jimmy Carter

The former U.S. President talks about why he took on the fight against Guinea worm and how his upbringing and Christian faith influence his attitude toward diseases of the world’s poor. Click below to listen:

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President Jimmy Carter interviewed by The World's David Baron. Photo courtesy of The Carter Center/Louise Gubb.

• Q&A: US healthcare reform
• On The World: Living with American health care

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This text below is a phonetic transcript of a radio story broadcast by PRI’s THE WORLD. It has been created on deadline by a contractor for PRI. The transcript is included here to facilitate internet searches for audio content. Please report any transcribing errors to theworld@pri.org. This transcript may not be in its final form, and it may be updated. Please be aware that the authoritative record of material distributed by PRI’s THE WORLD is the program audio.

MARCO WERMAN:  The last piece of the health care reform law is now on its way to President Obama.  He’s expected to sign it next week.  The law’s main purpose is to extend health care coverage to millions of uninsured Americans.  Non-Americans who are here illegally are still out of luck.  Here’s The World’s Alex Gallafent on what that could mean for the nation’s health care system.

ALEX GALLAFENT:  Health care plus immigration equals political combustion.  Indeed, undocumented immigrants are not covered by the health care reform bill.  But even without Joe Wilson-style interjections, the fact remains that the problems of health care and immigration are related.  So says Ira Mehlman.

IRA MEHLMAN:  The growth of immigration in the United States over the past several decades has had a direct impact on the growth of the medically uninsured in the United States.

GALLAFENT: Mehlman is with the Federation for American Immigration Reform, a group devoted to capping immigration levels and stopping illegal immigration.  He says it’s correct that he health care reform bill doesn’t extend coverage to illegal immigrants.

MEHLMAN: Number one, it is costly to the tax payers.  Number two it bestows recognition and benefits on people who should not be in the country in the first place.

GALLAFENT: But in a place like New York City, thousands of undocumented immigrants are a present and immediate concern.  Alan Aviles should know, he’s President of the city’s Health and Hospitals Corporation.  He runs a network of 11 hospitals in the city, including six level one trauma centers.

ALAN AVILES:  So in New York City we have an estimated 500,000 undocumented immigrants.  The New York City public hospital system, which is the largest in the nation, has been the principal safety net for new immigrant communities across New York for decades.

GALLAFENT: That hospital system treated about 450,000 uninsured patients last year.  Aviles says a very large percentage of that number were undocumented, or illegal immigrants.  They didn’t have insurance, but they needed care, and so they went, more often than not, to places like this.  Emergency rooms.  The problem for Aviles, he says, is that the health care reform bill funds expanded coverage for Americans partly by limiting federal funding for public hospitals like his.

AVILES: And this is being done under the assumption that the uninsured that we currently serve will largely become insured and that will replace those dollars that are now being taken off the table.  But the reality in urban centers like New York, particularly gateway cities like New York, who have so many undocumented immigrants among the city’s residents, that will not necessarily play out as predicted.

GALLAFENT: So Aviles is concerned about a funding gap.  Less money from the federal government and not much more money from newly insured patients.  Aviles is especially galled by the fact that undocumented immigrants, many of whom do work and pay taxes, won’t be able to buy insurance from the new government run exchange, even at full cost.  When they’re sick, someone, somewhere is still going to have to pay for their care.  Aviles says there is a glimmer of hope.  The federal government might end up taking less money away from states with large numbers of illegal immigrants, keeping those emergency rooms going.  But that wouldn’t amount to a real fix, says Ira Mehlman at the Federation for American Immigration Reform.  Cities like New York, he says, should be doing more to limit illegal immigration in the first place.

MEHLMAN: We shouldn’t be dealing with this at the emergency room door.  We should be dealing with this far earlier in the process by seeing to it that fewer and fewer people come and remain in the United States illegally, and therefore draw less on our vital social services.

GALLAFENT: That means immigration reform.  And for Sonal Ambegaokar it could be an opportunity to deal with unfinished health care business.  She’s health policy attorney with the National Immigration Law Center.

SONAL AMBEGAOKAR:  So right now, newly arrived legal immigrants, immigrants who have their green card, have to wait 5 years before they can be eligible to enroll in what we call the Medicaid program, which serves the lowest income folks.

GALLAFENT: Maybe that’s fair, maybe that’s unfair.  At the very least Ambegaokar hopes it will be considered as lawmakers turn to immigration.  New York hospital administrator Alan Aviles also sees immigration reform as a necessary step in expanding health care.  If undocumented immigrants are allowed to earn citizenship, he says, health benefits will follow.  Now that doesn’t square with Ira Mehlman, although he is hoping for a sober discussion on what all agree is an emotive topic.

MEHLMAN: Respecting people and understanding why they come here doesn’t mean that we should not enforce laws, that doesn’t mean that we shouldn’t set restrictions.  We need to be able to deal with immigration policy just like we deal with any other public policy in the United States.

GALLAFENT: Given the tone of the recent health care debate, that should be fun.  For The World, I’m Alex Gallafent in New York.

Copyright ©2009 PRI’s THE WORLD. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to PRI’s THE WORLD. This transcript may not be reproduced, in whole or in part, without prior written permission. For further information, please email The World’s Permissions Coordinator at theworld@pri.org.

• BBC coverage
• Reporting US health care reform abroad
• Health coverage on The World

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This text below is a phonetic transcript of a radio story broadcast by PRI’s THE WORLD. It has been created on deadline by a contractor for PRI. The transcript is included here to facilitate internet searches for audio content. Please report any transcribing errors to theworld@pri.org. This transcript may not be in its final form, and it may be updated. Please be aware that the authoritative record of material distributed by PRI’s THE WORLD is the program audio.

MARCO WERMAN:  Democracy here in the U.S. can be a messy business.  The health care reform debate is but the latest example.  Today President Obama held a televised ceremony to sign the health care overhaul bill into law.  Mr. Obama told lawmakers and others at the White House that the bill marked the start of a new season for the country.

PRESIDENT BARACK OBAMA:  Here in this country we shape our own destiny.  That is what we do.  That is who we are.  That is what makes us the United States of America.  And we have now just enshrined, as soon as I sign this bill, the core principle that everybody should have some basic security when it comes to their health care.  And it is an extraordinary achievement that has happened because of all of you and all the advocates all across the country.  So thank you.  Thank you.  God bless you and may God bless the United States of America.

WERMAN: The rest of the world has been watching closely and we’ve been bringing you a variety of international perspectives on the U.S. health care debate.  Today we get that from Justin Webb.  He was based in the U.S. for the BBC for eight years before moving back to Britain last year.  Webb now anchors the BBC’s main morning news radio broadcast, the Today Programme.

JUSTIN WEBB:  The big picture viewed from here in Europe is that America has taken a really important step, not towards a British style NHS, but a step in the direction of every American has a right having some kind of health coverage.  And that to really the rest of the rich world to be honest, but certainly to Europe, just looks to most people including senior conservatives here in the U.K., and I was talking to one the other day, it just looks like America joining the normal world as it were.

WERMAN: And for you Justin, issues of health care came right into the spotlight of your life just before Christmas in 2008.  You were living in Washington at the time and your son Sam got ill.  What happened?

WEBB: He was diagnosed with Type I diabetes, which is a horrible life-threatening illness.  It’s not brought on by any kind of lifestyle thing, it’s an auto-immune disease actually that just comes in youngsters and lots of people will know people with it if not have experience of it themselves.  And it was fascinating for us once we sort of got over the shock and the sadness about it all, to see how the American health care system coped and then really not much more than six months later to move back to Britain and see how the British system coped.  And as you’d expect there are strengths in each.  I think in a way, people in each country don’t fully understand the strengths of the other country.  That’s what I brought away from this.  So in the United States we were very well treated.  Sam was wonderfully well treated.  He had access to fantastic medicine and fantastic technology as an insulin pump that was made available very quickly under the American system.  Now there are all sorts of co-pays and things, it’s not as if it was free and our insurance certainly paid a lot of money, but we were well insured, so everything went rather well. So that was the situation in America.  We came back to Britain and lo and behold everything’s free.  You know, the test strips, a lot of people with Type II diabetes will know what I’m talking about now.  There’s test strips that you test your blood with.  You go to a British doctor and you say I’d like some more please and they say yes, how many?  And they just give them to you.  To be honest, it was an extraordinary sort of change.  I was really used to the American system where everything is accounted for and paid for by someone and quite often by you.  So here in Britain all these thing are handed out, but, although the medicine is just as good, and there’s no question in my mind that Sam is as well treated as he is here in America, I have to say that the technology, in particular that pump that pumps insulin into him is a very state of the art thing.  It is not, at the moment, available in the U.K., the particular pump that Sam uses.  And that is, at least in part because, the pump makers can make money in America and they can’t make it under the British NHS.

WERMAN: I’m wondering when you went back to the U.K., how much health care actually kind of showed up in your calculations about getting back to the U.K .and finding something that was perhaps better?

WEBB: Well that’s an interesting thing.  We would not have moved back here for the health care.  There’s no question at all that we were perfectly happy in America and we were well insured and had no prospect of losing it.  But I have to say that my son would be in the category of those people who would go along to a health insurer in years to come, and he wants to be a film director in Hollywood at the moment, he’s 10 years old so he can still have those dreams, what would he do for health insurance had the Obama bill not passed?  Now of course, American health insurance companies would have turned him down because he has a serious pre-existing condition.  If that genuinely does change, which it seems that it is going to now, then that for someone like my son, is a major plus.  It means that for him there is a possibility of working on either side of the Atlantic.  Of course it just means for American as well, and for everyone who has a pre-existing condition, it’s a greater freedom for that group of people.

WERMAN: The BBC’s Justin Webb, thanks very much for sharing your views and experiences with us.  I greatly appreciate it.

WEBB: Pleasure.  Nice to talk to you.

Copyright ©2009 PRI’s THE WORLD. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to PRI’s THE WORLD. This transcript may not be reproduced, in whole or in part, without prior written permission. For further information, please email The World’s Permissions Coordinator at theworld@pri.org.

• Gregor Peter Schmitz: “US Health Care – Good for America, Bad for the World?”
• BBC coverage
• Video of President Obama’s reaction
• Health coverage on The World

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This text below is a phonetic transcript of a radio story broadcast by PRI’s THE WORLD. It has been created on deadline by a contractor for PRI. The transcript is included here to facilitate internet searches for audio content. Please report any transcribing errors to theworld@pri.org. This transcript may not be in its final form, and it may be updated. Please be aware that the authoritative record of material distributed by PRI’s THE WORLD is the program audio.

DAVID BARON:  Passage of President Obama’s health care overhaul made headlines around the globe.  The foreign reports who covered the debate and last night’s vote, include the Washington Bureau Chief for the Toronto Star, Mitch Potter, and Gregor Schmitz, he’s the U.S. Correspondent for German’s news magazine, Der Spiegel.  Both are in Washington.  Mitch Potter, to you first, how are Canadians reading the story of health care reform in America today?

MITCH POTTER:  Well it’s a bit of a paradox.  Canadians have been fascinated by this all along.  On one hand I think Canadians in large part are sort of cheering on Americans.  It in a sense validates the system we have.  We know that what President Obama has brought forward here is not a Canadian style system, but it’s moving in that direction and I think Canadians feel validated by the fact that the United States is moving in our direction, if you will.

BARON:  Right, well it would be interesting to point out that among some groups, Canada has been a bit of a punching bag.  People have said this is what we don’t want to become.  We don’t want Canada’s health care system.

POTTER: It’s true and it’s really been a political piñata.  Time and again the Canadian system has been cherry picked with isolate horror stories being conflated into something to scare away Americans.  And that, truly, has annoyed Canadians.  A lot of Canadians have taken offense as they have watched this play out.

BARON: Now Gregor Schmitz, you had an opinion piece in Der Spiegel today and the headline reads “U.S. Health Care Good for America, Bad for the World”.  Now what do you mean by that?

GREGOR SCHMITZ:  Well I think if you look at the more recent debates you see there is a real risk that Obama might become a one issue President.  And I think if you look more closely at his speeches over the past weeks or months, there was basically no reference to other conflicts, or say other challenges, let’s say Afghanistan, even though soldiers are fighting there increasingly there now in recent weeks or months.

BARON: Because he’s been so wrapped up in health care.

SCHMITZ: Exactly he has been so wrapped up in health care and I don’t think anyone has predicted for this to drag out for so long.  So I think there is a real risk.  If you look at other parts of the world, particularly Europe, they are becoming a little disillusioned by a lack of interest.  He had to cancel the trip to Asia which I think was understandable in the context of the health care debate.  But still, it sent a signal to the rest of the world that this is the most important issue to us, understandably, and we don’t really care about the other challenges.  So I think there is a real risk for him to become a one issue President.

BARON: Well something I would like both of you to address is the way that Barack Obama is perceived around the world.  We know that when he was elected President in 2008 he was extremely popular in other countries.  How popular is Barack Obama in your countries now and I wonder to what extent have people in your countries been cheering on health care reform in the U.S. because they wanted to see President Obama succeed.  Mitch Potter, let’s start with you from Canada.

POTTER: Well I think that’s largely the case with Canadians.  There’s a recognition that we may not have a force in this health care fight, but if anybody is looking to see an Obama administration assert itself on other foreign files, they recognize that he needs a victory.  You can debate the wisdom of whether to have invested do much political capital to make health care his signature project was the right thing to do, but imagine how politically ham strung he would be in trying to pursue the rest of his agenda if this had all fallen apart on him and he would be approaching these mid-term elections with absolutely nothing to show for this first period of his Presidency.

BARON: But bottom line he is still popular in Canada?

POTTER: Definitely.

BARON: And in Germany Gregor Schmitz?  What is President Obama’s approval rating over there these days?

SCHMITZ: It probably has slipped from 99% to 97%.  I think overall he is still very popular in Europe and I think it is true in this regard when you look at health care that it is not about Obama.  It is about America.  Mitch has already alluded to that.  Europeans are cheering on the Americans because for them it’s just beyond imagination that the richest country on earth hasn’t been able, for so long, to provide basic health care coverage to every citizen.  So for Europeans that is more of a moral issue.  Frankly, they just don’t get it.  And I think on this specific issue, Obama is getting a pass.  I think they look at Washington and they basically blame the Republicans for blocking everything.  But one thing that I think is missing in the European debate that makes it harder for us to explain the debates here in the U.S. is the fact that many Americans are actually happy with the health care system.  When Europeans look at the American health care system, they don’t fully understand that the people who are a part of the system now, who have coverage, who have insurance are often very happy with the way they are being treated and with their options.  So I think that is something we need to explain to our readers that these debates are so fierce because it is the question of whether they want to extend that coverage or an offer of more solidarity to other Americans and whether they want to include the people that are left out right now.

BARON: Well gentlemen I expect you didn’t get all that much sleep last night.  Thank you for coming in.  It was good to talk to you.  Mitch Potter is the Washington Bureau Chief for the Toronto Star, thank you Mitch.

POTTER: Thank you very much.

BARON: And Gregor Schmitz is U. S. Correspondent for Der Spiegel in Germany, thank you.

SCHMITZ: Thanks for having me.

Copyright ©2009 PRI’s THE WORLD. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to PRI’s THE WORLD. This transcript may not be reproduced, in whole or in part, without prior written permission. For further information, please email The World’s Permissions Coordinator at theworld@pri.org.