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Our World — 11 November 2006


This transcript is provided as a service; there may be some variation between it and the program as broadcast.

MUSIC: "Our World" theme

Straight ahead on "Our World" ... New promise for an old malaria drug ... Aircraft flight recorders — are the black boxes really black? ... and a Website of the Week Veterans Day special...

LONCARIC: "And we were so hurt at what happened to these people that all the fellows there, even the infantry, we took our spare clothing and gave it to these guys."

Those stories, a life-saving approach to reducing hospital infections, and more. I'm Art Chimes. Welcome to VOA's science and technology magazine, "Our World."

An important and inexpensive malaria drug is making a strong comeback in the southern African nation of Malawi. Chloroquine had become ineffective as the malaria parasite developed resistance to it. A new study shows that the drug has regained its effectiveness, a decade after Malawi health officials stopped using it. But as we hear from VOA's David McAlary, the researchers are not yet recommending that chloroquine become a treatment mainstay once again.

McALARY: Public health experts consider chloroquine, introduced widely in the 1950s, to be the most important modern anti-malarial drug. It is inexpensive at about 10 cents per treatment, simple to administer, and in the beginning was highly effective in only a few doses. It helped control malaria and even eradicate the disease in some places during the global campaign of that decade.

But by the end of the 1950s, resistance had begun to emerge in the deadly form of malaria. Resistant forms of the parasite spread around the world and reached eastern Africa by the late 1970s.

University of Maryland physician Miriam Laufer says in many places, chloroquine's effectiveness dropped below 50 percent.

LAUFER: "By the 1980s, the resistance was so bad that people noticed that there were increased cases of malaria and increased deaths due to malaria. That was attributed to the failure of chloroquine to treat the disease."

McALARY: In 1993, Malawi become the first African country to shift from chloroquine therapy to a combination of sulfadoxine and pyrimethamine. But these drugs fell to parasite resistance even faster than chloroquine, so nations are switching to the new, but more expensive combination treatments based on the Chinese herb artemisinin.

Now, a team led by Dr. Laufer has shown that the layoff in use has been good for chloroquine, making it a potential candidate for re-introduction. In a trial of 210 Malawian children, chloroquine was 99 percent effective, compared to only 21 percent effectiveness in the group that got sulfadoxine-pyrimethamine.

LAUFER: "Chloroquine worked remarkably well. There was only one case of chloroquine treatment failure."

McALARY: The study, published in the New England Journal of Medicine, attributes chloroquine's renewed success to the disappearance of a genetic mutation in the parasite as a result of the drug's disuse. The mutation had developed to protect the parasite against the compound.

Is this good news for public health?

WHITE: "It is good news, but I do not think we can go back to our reliable old chloroquine as it once was."

McALARY: Physician Nicholas White is an infectious diseases expert at Mahidol University in Bangkok, Thailand. He, like Miriam Laufer's group, points out that chloroquine should not be re-introduced as a single therapy against malaria in places like Malawi where parasite resistance to it has faded.

WHITE: "The problem is that although resistance can go away, the reality is that Malawi is surrounded by a sea of resistance in other countries and it would come back rapidly in people."

McALARY: White says that, instead, chloroquine should be completely removed from use to allow resistance to it to die everywhere before the drug makes a comeback, and then it should be only as part of a combination of compounds.

The currently recommended combinations use artemisinin, and, presumably, chloroquine could join it. But Nicholas White says that if these new mixtures are to have an impact on malaria, they must be made more affordable and available, requiring an international funding and distribution plan to help countries acquire them. David McAlary, VOA News, Washington.

Six years ago, on the cusp of the 21st century, United Nations member states adopted a package of development goals for the new millennium. The goals ranged from eradicating hunger and poverty to halting the spread of HIV/AIDS. The agenda also included a commitment to cut in half the number of people without access to clean water and sanitation by 2015. On Thursday, the United Nations Development Program released a report on the global water crisis, which concludes that development goals cannot be met unless a global water action plan is put in place.

VOA's Rosanne Skirble has the details:

SKIRBLE: Each year two million children die from diseases caused by contaminated water. Kevin Watkins is lead author and director of the U.N. office that wrote the report. He says these deaths could be prevented with clean water and a toilet.

WATKINS: "Now that to me is a fairly powerful indictment of what governments are doing and what the international community is doing. Water and sanitation — this huge road block for human development and for human progress — is really not figuring on the domestic policy agenda for many countries."

SKIRBLE: Watkins says the problem has a lot to do with how water is governed and managed.

WATKINS: "The problem is the governments in the world do not treat it as a precious resource and they do not treat it as a finite resource. They treat it as a resource that is infinitely available to be diverted, to be used for the generation of power and to be used to provide water for cities, to be pumped into agriculture, often without any regard to economic efficiency."

SKIRBLE: The report finds that almost half the people in developing countries at any given time suffer from health problems due to unclean water and poor sanitation. This crisis in health care also holds back economic growth. The U.N. says Sub-Saharan Africa, for example, loses five percent of its Gross Domestic Product [GDP] a year, which is more than the region receives annually in debt relief and foreign aid.

The U.N. Human Development report calls for a Global Action Plan to mobilize resources and focus political action on water and sanitation problems. The U.N's Kevin Watkins says one important step toward ending the water crisis is the recognition of water as a basic human right.

WATKINS: "And they need to mean it, and mean it in the sense of national legislation which provides citizens with an entitlement of 20 liters of water a day as a right of citizenship."

SKIRBLE: South Africa could be a model. The nation already has a law that establishes a water entitlement.

SKIRBLE: The Global plan calls for increased international aid to bring the UN water and sanitation goals within reach. Watkins says that would require an extra $4 billion a year. or double what donor countries now contribute.

WATKINS: "We are talking about three or four days worth of global military spending to address a problem that is claiming two million lives a year. I don't think that is too much to ask."

SKIRBLE: Kevin Watkins, who heads the U.N. Human Development Report Office, says getting water and sanitation on the international development agenda calls for greater leadership by G8 nations or those with the greatest resources, technology and political power to end the crisis that largely affects the world's poorest people. I'm Rosanne Skirble.

Time again for our Website of the Week, when we showcase interesting and innovative online destinations.

November 11 is Veterans Day in the United States, when we honor those who have served our country in uniform. The holiday is only one day a year, but every day our Website of the Week recalls the personal stories of those men and women.

PATRICK: "We are currently the largest oral history in the country. The Veterans History Project contains a little bit over 45,000 collections. That includes interviews, both audio and video. And in addition to those 45,000, we have tens of thousands of letters, photographs, diaries that people have submitted to the Library of Congress here for inclusion."

Bob Patrick heads the Veterans History Project at the Library of Congress, online at loc.gov/vets, where you can experience many of those first-person interviews.

A few of the participants are well-known to Americans, but most are not, such as World War II veteran William Loncaric, who was with the American troops who liberated the Nazi Dachau concentration camp near Munich.

LONCARIC: "I've never seen anything like this in my life. And we must have had about 2,000 people who were ambulatory, and we were so hurt at what happened to these people that all the fellows there, even the infantry, we took our spare clothing and gave it to these guys."

If you studied history in school, you might have learned about a couple of big battles, or who won a war. The Veterans History Project goes deeper, adding a soldier's-eye view of military experience. Some of the interviews are conducted by professional historians. Others are family projects, and Bob Patrick says doing the interview is itself an important part of the legacy.

PATRICK: "I think they also help to inspire future generations. One very important part of this project is the intergenerational part of it: the granddaughter that sits down with her grandfather who fought in World War II, say, and hear his story. And that's another part of it that these veterans and these people who did serve have the opportunity to enlighten their families and also to enlighten the nation."

Experience wartime without getting mud on your boots, through the stories of the men and women who were there. Our Website of the Week is the Veterans History Project of the Library of Congress at loc.gov/vets, or get the link from our site, voanews.com/ourworld.

MUSIC - Moe Denham - When Johnny Come marching Home Again

And we serve with pride at VOA's science and technology magazine, Our World. I'm Art Chimes in Washington.

Every time a commercial airliner crashes, investigators move quickly to recover the aircraft flight recorder, which brings us to an email we recently received from listener Vincent Maloba in Kenya. He asks a number of good questions about these devices, and for the answer we turned to a company that makes them, the venerable American aviation firm Curtiss Wright, which referred us to business development manager Nick Kidd.

He began with an answer to Mr. Maloba's first question, whether the so-called "black box" really is black.

KIDD: "They are. in fact. bright orange. The reason they're bright orange is to aid with the location of them after an accident. If an aircraft goes down in the sea there's also an ultrasonic underwater location beacon fitted, which, when it gets seawater on it, it pulses and ultrasonic pulse out which lasts for about 30 days, and with a hydrophone the accident investigators can home in on the location of that recorder."

Miniaturization and advanced materials have made today's flight recorders more survivable than ever, and they are routinely recovered from scenes of such utter destruction that you have to wonder how they — and the critical data they contain — could possibly have survived. Nick Kidd explained it's all about the packaging.

KIDD: "The outer case of the unit is a very hard system designed to withstand the impact and any metalwork crushing or spikes that may try and impinge in it, and typically those are either stainless steel or titanium cases. Within there, most of the space is taken up with thermal insulation, because the unit has to survive some pretty severe fire tests."

Today, the flight recorders weigh just three or four kilos. There are actually two separate devices, although they are sometimes combined in one box. One records sound from the cockpit - not just the voices of the crew, but also the sound of the engines, of switches being toggled, and so on. The other records a wide range of flight information.

KIDD: "Typically there is altitude and airspeed and time references, latitude, longitude, vertical accelerations, stick positions, flight control surface positions, position of the undercarriage and things like that."

The information, which used to be recorded on magnetic tape, is now stored in solid state modules, like the flash memory cards used in digital cameras. Investigators use the information stored on flight recorders to try to reconstruct the cause of an accident. And that information helps improve aviation safety.

Thanks to Nick Kidd of Curtiss Wright Integrated Sensing for the answers, and especially to Vincent Maloba in Kenya, for the questions. He's earned a special VOA gift as our way of saying thanks.

If you've got a question about science, technology, health or the environment, send it in. If we choose your question and answer it on the show, we'll be sending you a VOA gift, too. You can email us at ourworld@voanews.com, or listen for our postal address at the end of the show.

An estimated one million people worldwide are diagnosed with lung cancer each year. In too many cases, patients die because the cancer is not diagnosed until it has progressed to a point where treatment is ineffective.

Now, a recent report in the New England Journal of Medicine finds that it's possible to identify lung cancer before symptoms, substantially improving survival rates.

The Early Lung Cancer Action Program — affiliated with 38 institutions in 8 countries — studied more than 31,000 men and women at high risk of lung cancer. Among the smokers or former smokers in the study, CT scans identified 484 with lung cancer.

Lead author Claudia Henschke of Cornell University says the results confirm that computerized x-ray scans can be effective tools for early diagnosis of lung cancer.

HENSCHKE: "If you're found to be in Stage I [lung cancer] — and 85 percent [of participants] were found to be in that stage — and you had prompt treatment, the 10-year survival rate was 92 percent."

Henschke says that unlike a conventional chest x-ray, the CT scan can pick up very tiny growths in the lung.

HENSCHKE: "Smaller than even a pea, maybe the size of a grain of rice. So you see it much earlier when it's much smaller and you simply can't see it on the chest x-ray. Whereas if you find it early where it is still confined to that part of the lung, and you cut out that part of the lung, then you are potentially cured."

Henschke urges those at greatest risk - especially smokers or former smokers around age 50 - to consult their doctors about the procedure. She says 15 percent of those scanned will require a follow up test to determine the appropriate course of action.

Finally, today: Hospitals are supposed to heal the sick, but too often infections and medical errors leave patients worse off than they were when they checked in.

Some 3,000 U.S. hospitals are taking part in a program to change that. The Hundred Thousand Lives Campaign is the first national initiative to help patients survive their hospital stays.

One small facility in Minnesota, St. Peter Community Hospital, has become a model after cutting its patient death rate by 60 percent in just 18 months.

Our report was written and reported by Faiza Elmasry in Minnesota and read in the studio by Susan Logue.

TEXT: Although St. Peter Community Hospital is quite small — it has just 17 beds — Medical Director Dr. Benjamin Chaska says the suburban Minneapolis facility faces many of the same challenges as do larger, urban hospitals:

CHASKA: "It's so complex to take care of patients. With all the different caregivers, all the different diseases, all the different drugs, mistakes are made. That actually turns out to be quite challenging. So challenging that in the late 1990s, the Institute of Medicine published a report looking [at the problem] nationwide. There were tens of thousands of people in the United States [each year] that were harmed or even died from health care that wasn't delivered correctly."

TEXT: Dr. Chaska says that in order to improve its medical services and do a better job of saving patients' lives, St. Peter Hospital in 2004 joined the One Hundred Thousand Lives Campaign. That's an initiative, sponsored by the private Institute for Healthcare Improvement, which aims to save the lives of at least 100,000 hospital patients by reducing infections and medical errors. The initiative targeted several problem areas, from infections in heart patients to surgical mishaps:.

CHASKA: "We took on the issue of reducing the errors in the care of acute myocardial infarction for in-patients and emergency patients, preventing adverse drug reaction from occurring, responding rapidly with patients who are on the verge of becoming unstable or who have become unstable, and preventing surgical infections."

TEXT: In many cases, Dr. Chaska says, major improvements have required only minor changes. For example, the hospital stopped using razor blades to shave the skin around surgical sites and switched to electric shavers. They also started using surgical gowns equipped with air hoses that warm up patients before and during surgery. In other cases, the changes meant new hospital routines.

CHASKA: "For preventing adverse drug events, we really focused on 'medical reconciliation,' which is making sure that everybody involved with the patient care and the patient are all agreed and understand what the patient actually is taking as compared to what the doctor thinks they might be taking. And we set up a team to respond rapidly to patient urgencies. [For example] if the person's blood pressure went too high, we were able to intervene before they had a stroke. Or if their blood sugar went out of control, we were able to intervene before they got into trouble."

TEXT: Dr. Chaska says the changes instituted at St Peter during the Hundred Thousand Lives Campaign had an amazing impact:

CHASKA: "We were able to reduce the rate of infection tenfold. We eliminated over 90 percent of the infections. We've had no unexpected deaths in our hospital since January 1, 2005. So that means that everybody that came here expecting to go home alive did."

TEXT: St. Peter CEO Colleen Spike says joining the One Hundred Thousand Lives Campaign was a significant learning experience.

SPIKE: "There was a lot of education that went on for the nursing staff. It's the standardized approach, to making sure that the care is delivered all the time in the same manner and in the same way no matter who is delivering that care. It sounds easy, but when you look at the number of people that touch a patient's life once that patient enters your door, it's not always easy to achieve. And that's where it takes a lot of staff education to get to that point."

McCANNON: "I think that St. Peter is a great example of a smaller hospital that offers a model for other peer facilities."

TEXT: One Hundred Thousand Lives Campaign spokesman Joe McCannon says St. Peter Community Hospital is the smallest facility in the country to make the campaign's list of 100 "mentor hospitals." That's a title, McCannon says, that comes with responsibilities.

McCANNON: "Being a mentor hospital is voluntary. We ask for hospitals that have done good work to raise their hands and tell their stories, to make themselves available to others. We found that hospitals have been very generous. They know how it feels to be alone. They know what it feels like not to know the way forward. They are very willing to collaborate, to improve the quality of care."


TEXT: The original aim of the Hundred Thousand Campaign was to save 100,000 lives over a period of 18 months. Campaign spokesman Joe McCannon says that when this phase ended last June, 122,000 lives had actually been saved. Next month, he says, the Institute of Healthcare Improvement will launch the campaign's second phase. The hope is that St. Peter and other participating health facilities will continue their efforts to reduce infection and mortality rates and set a higher standard for hospitals across the nation.

MUSIC: "Our World" theme

That's our show for this week. If you'd like to get in touch, email us at ourworld@voanews.com. Or use the postal address —

Our World
Voice of America
Washington, DC 20237 USA.

Rob Sivak edited the program. Eva Nenicka is the technical director. And this is Art Chimes, inviting you to join us online at voanews.com/ourworld or on your radio next Saturday and Sunday as we check out the latest in science and technology...in Our World.

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