It tears every part of your life away: the truth about male infertility

Men are facing a fertility crisis, so why is most practical and emotional support offered to couples struggling to conceive aimed at women?

James and Davina DSouza met and fell in love in their early 20s. They got married five years later, and three years afterwards had saved enough to buy a family home in a quiet cul-de-sac in London. Then, when Davina was 29 and James 33, they started trying for a baby.

I knew that the moment we bought a home, wed start a family, Davina tells me in their living room, beside shelves crammed with framed photos of nieces, nephews, cousins and siblings. My parents live down the road, and if I needed help to raise a child, my mum would be here.

We thought about all of that stuff, James adds. The job, the future, the house, the home: we make things happen.

But after a year of trying, nothing had happened. Davina went to their GP, who referred her for the kind of invasive tests that have become the norm for women who experience problems conceiving: she had an internal, transvaginal scan to check her womb for fibroids, and an HSG test, where dye was pushed into her fallopian tubes to see if they were blocked. Everything looked normal.

It was only then that anyone suggested testing James. He had his semen analysed, and was told that only 1% of his sperm were formed normally. Still, it only takes one, the consultant said. She told them not to worry and to carry on trying. Two years after Davina came off the pill, James was tested again. This time, he had no normally formed sperm at all.

My first thought was, Oh, its my fault, James says, quietly. He stares at the coffee table through his thick-framed glasses. I felt helpless. No one was talking about this stuff. Youd go online and there was no male conversation. Id Google problems having a baby or fertility issues, and the websites that came up were all pink. Id post in a forum and women would respond on behalf of their husbands. There was nothing for men.

Though he may have felt it, James is not alone. Across the western world, men are facing a fertility crisis. A landmark study by the Hebrew University of Jerusalem, published in July, showed that among men from Europe, North America and Australia, sperm counts have declined by almost 60% in less than 40 years. Fertility specialists have described it as the most robust study of its kind (the researchers came to their conclusions after reviewing 185 previous studies involving 43,000 men from across the globe) and the findings are stark. Such a significant decline in male reproductive health over a relatively short period in such a specific population suggests theres something in the way we live now that means its much harder for men to become fathers than a generation ago.

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Until recently, the focus of both fertility experts and research scientists has been overwhelmingly on womens bodies, while male reproductive health has been almost ignored. For decades, the average age of both fathers and mothers has been increasing, but its women who have felt the pressure of balancing the need to invest in their careers with the so-called timebomb of their own declining fertility. They have been encouraged to put family first and to change their lifestyles if they want to become mothers, at the same time as male fertility appears to have fallen off a cliff.

Davina says the consultant gynaecologist who was treating her and James had no hesitation about next steps. She said, Jamess sperm results are in, and we think you should go for IVF. That was it. The NHS didnt have any other options for us. Indeed, the NHS couldnt even fund any IVF in their area at that time, so they had to scrape the money together to go private. They spent more than 12,000 on two rounds of IVF, and were finally offered a third round on the NHS this year. But after nearly seven years of trying for a baby, they are still childless.

IVF takes a huge physical, hormonal and emotional toll on a woman, James tells me. Sometimes I felt totally powerless, ineffective. I questioned my masculinity, my sense of myself as a man, through those rounds of IVF. During consultations, James felt the conversations were always directed at Davina. I felt like I had to say, Im here. Id deliberately ask a question to make my presence felt.

On their first round of IVF, someone at the clinic recommended James take a vitamin supplement. It was the first time lifestyle factors had been mentioned. That was when I realised, maybe there is something I can do, he says between slurps of his own blend of bulletproof coffee (made with grass-fed butter, coconut oil and egg yolk). James, head of sixth form at a local school, is a fan of self-help books. Hes been on a high-fat, low-carbohydrate ketogenic diet for months and says its done him good: hes slim and spry, but says he wasnt always this way. Hes wearing a digital fitness tracker. But as someone who rarely drinks, has never smoked and doesnt ride a bike, there were few lifestyle changes he could make, beyond taking colder showers and wearing looser underwear. Still, his sperm quality has improved.

At the moment, the couples fertility problems are unexplained. They decided against adoption when social workers said theyd have to use contraception during the process, because it wouldnt be fair on an adopted child to move into a home with a new baby, and they arent prepared to stop trying just yet.

Weve talked about when were going to call it a day, James says.

Davina glances at him with wet eyes. It makes me sad to think well be putting a cap on it.

But it regularly comes up, he says. We did actually say at the end of this year well stop. Ive been asking, Why do we want to have children? Weve decided it isnt going to define us.

There is treatment for male infertility, but its certainly not in the fertility clinic, says Sheryl Homa, scientific director of Andrology Solutions, the only clinic licensed by the Human Fertilisation & Embryology Authority to focus purely on male reproductive health in the UK. Men are channelled from their GP with a semen analysis and sent straight to a gynaecologist in an IVF clinic. But gynaecologists are interested in the female reproductive tract.

A former clinical embryologist, Homa once led IVF laboratories in both the private and public sectors. I was quite horrified by the lack of investigation and appropriate management of male infertility, she says, so I decided to start my own clinic specifically to focus on male fertility diagnosis and investigation. Male reproductive health is being assessed through semen analysis, which she argues has a very poor correlation with fertility. Instead of having their detailed medical history taken and a full physical examination, men are being given a cup and asked to produce a sample.

Homa says the leading cause of male infertility (around 40%) is varicocele (a clump of varicose veins in the testes). It can be determined from a physical exam, and can certainly be ruled out by an ultrasound scan. All women get ultrasound scans; why arent men getting them?

Varicoceles can be repaired by fairly simple surgery under local or general anaesthetic, leading to a significant improvement in a couples chances of successful natural or assisted conception. But many are going undiagnosed. The NHS is carrying out far too many IVF treatments when they could be saving money by doing proper investigations in men.

Homa says there is also some evidence linking silent infections those with no symptoms, such as chlamydia in men with delayed conception and an increased risk of miscarriage. But if a man is judged by his semen sample alone, there would be no way of addressing these hidden concerns.

Apart from saving the NHS money, there are important medical reasons why men should be thoroughly examined, Homa argues. Semen parameters are a marker of underlying systemic illness: they might have diabetes, they might have kidney disease, they might have cardiac problems. It could be something much more serious thats contributing to the problem.

As for the possible reasons for falling sperm counts across the west, Homa mentions all the chemicals and pesticides that we are exposed to in our environment, as well as smoking, rising levels of obesity and increasingly sedentary lifestyles. But at the moment, ideas such as these including hormones in the water and BPA in plastics that might mimic the effect of oestrogen inside the body are just theories that make intuitive sense. In the absence of widespread research over time, no one can pinpoint exactly which factor or combination of factors is making the difference.

In the 10 years her clinic has been operating, Homa has seen demand for her services steadily rise. She says she gets the fallout from men whove been sent by their GP for multiple rounds of fertility treatments that fail, when IVF should be the last resort. But at the moment, National Institute for Health and Care Excellence (Nice) guidelines give GPs no option but to refer men with fertility problems to IVF clinics. If theres a female problem, the GP will refer them to a gynaecology clinic. If theres a male problem, they need to be referring to a consultant urologist who deals with male infertility. But its just not happening.

Gareth
Gareth Down and his wife, Natalie, went through 10 rounds of IVF before their son, Reece, was born. Photograph: Harry Borden for the Guardian

In some ways, Gareth Down and his wife, Natalie, were lucky: they knew from the start that their problems conceiving were probably down to Gareth, because he had had surgery to remove benign lumps on his testes as a teenager, and always feared they might interfere with his chances of becoming a father. But after 10 cycles of IVF that cost them tens of thousands of pounds, and several miscarriages, lucky doesnt feel like the right word.

I always wanted kids, says Gareth, 31. My mum was a childminder, and I was brought up looking after kids, so from as young as I can remember, weve had a house full of them. He and Natalie started trying for a baby six months before their wedding in 2010, and went to the GP a year later, when nothing had happened. Gareth was referred to a urologist, who confirmed that the surgery hed had as a teen had affected his sperm production, and that he had azoospermia: a zero sperm count.

The Downs were determined to have children, but trying almost broke them. It invades every part of your life, Gareth says. On a personal level, you have to confront the fact that you might not have a family. It affects you financially, as you try and save to fund the treatment. We had family fallouts because we couldnt see newborn nieces and nephews we just couldnt be around babies. We changed jobs because time off with certain employers was difficult. I had quite a customer-facing job at one point, and when they were telling me about their problems, I was thinking, You aint got problems. He pauses. I dont think there was any part of who we were that we held on to by the end. It tears just about every part of your life away.

Gareth has just put his 16-month-old son, Reece, to bed while Natalie is still at work. Reece was conceived with donor sperm, on their 10th round of IVF, when Natalie had had enough of the heartache of fertility treatment and was convinced they should give up. After going through so much to have him, their first feeling when Reece was finally born was not joy, but disbelief. It was surreal, says Gareth. I dont think either of us could accept it was real and going to last. Wed had so many ups and downs that we couldnt believe nothing bad was going to happen. We kept checking the cot to see if he was still there. It was weeks before we realised he was not going to be taken away from us.

It was during their final attempt to have a baby that Gareth set up his closed, men-only Facebook group, Mens Fertility Support. Over the years, Natalie had found a lot of comfort online, from forums and support pages to Facebook groups, and was surrounded by an international community of women going through the same experience. Gareth had tried to contribute in the same places, but never stuck around long. There were no other men there to relate to what you were saying, or make you feel you could say what you meant and that it wouldnt be taken the wrong way by an audience that vastly outnumbered you.

The 300 or so members of his group are a diverse mix of men, mostly from the UK. Some are just beginning to have problems with conception, others went through it decades ago; some never had a happy ending and are there to share their experiences that a life beyond trying to have a family is possible. Many members say its the only place they can be totally honest: the belief that the ability to father children is a marker of masculinity has left many unwilling to talk about their issues anywhere else.

We do get women wanting to join, Gareth tells me with a smile, but we want a degree of privacy. Its about having freedom to talk, to say, yes, those [IVF] hormones really do screw her up and its really tough. You need to be able to vent somewhere without causing offence to anyone you know.

Everyone Gareth and Natalie told about their problems conceiving assumed the issue must be hers. Every step of the way it was, Poor Nat whats going on with her? But he hopes that men are starting to seek help. If it was any other part of your body that wasnt working properly, youd seek advice. Slowly, those barriers are beginning to come down a bit.

He wonders whether the new figures on declining sperm counts could have been coloured by this growth in awareness: fertility treatments are more in demand than ever, so more men are having their fertility investigated. Are we just testing more, looking into things more? he asks. If you had fertility problems 40 years ago, you wouldnt have wanted to confront it or had anywhere to go with it.

Dr Xiao-Ping Zhai, the fertility specialist behind the Zhai Clinic, agrees. We never really tested men in the past, and if you use the word decline, you have to have something to compare it to. In the past, people probably had problems, didnt want to say they had problems, and didnt have children. Even though the Hebrew University of Jerusalem study is the best piece of research weve had so far, she points out, the data from 40 years ago is still very thin.

Trained both in western and traditional Chinese medicine, Zhai has a unique perspective on fertility treatment and, since she opened her Harley Street clinic more than 20 years ago, claims shes had a great deal of success in helping couples conceive even though many patients come to her out of desperation rather than faith in traditional medicine. Its mainly women who call to make the appointments. Eighty per cent of the time, the partner doesnt even want to come along. They dont think they have a problem.

Rather than look at sperm counts, Zhai takes a full health MOT of all her patients, using diagnostics from Chinese medicine to find out which part of the body needs to be addressed: You find that a lot of people have something that cant be discovered on a scan or through mechanical investigation what wed call a functional problem. Zhai offers a range of treatments according to the patients specific constitution, including acupuncture, herbal supplements and advice on lifestyle changes and diet. None of this is cheap: an initial consultation costs 250, and a four-week course of bespoke herbal supplements can cost up to 350.

But IVF treatment on Harley Street costs even more, and Zhai says many of her patients arrive in the consulting room having already spent lots of money. Its to do with the culture here: in the UK, if a man has a problem, then the woman needs IVF. IVF clinics can offer only what they specialise in.

In 2014, Zhai launched a national campaign to end the stigma attached to male infertility and improve the treatment choices offered to men. She called for a full parliamentary debate on male fertility issues, and on health secretary Jeremy Hunt to work with doctors to improve practice and treatment pathways for men within the NHS. But there has been no debate and no change in NHS strategy. There are too few options for infertile patients, Zhai says. It will take a long, long time to overcome this culture.

Gary
The doctor who rang with Gary Parsons sperm count results simply said it was game over. Photograph: Harry Borden for the Guardian

Gary and Kim Parsons went to their GP two years after Kim stopped taking the pill, when there was still no sign of pregnancy. She went through all the regular tests blood tests and then more invasive examinations and everything came back A-OK, says Gary, 36, from his home in Burnham-on-Sea. Then it was my turn. Like James, Gary had no physical examination and was asked only to produce a sample to check his sperm count. That came back as a big fat zero. There was nothing to count.

When the doctor rang to deliver the results, he said it was game over. Gary blinks in disbelief when he tells me this. I really didnt need any encouragement to feel more down about things, so that was an unfortunate turn of phrase. Gary thinks this may have been because it was a conversation between men. That extreme, direct way of communicating might have been the only way he thought he could get me to understand that this is not something where I could drink a kale smoothie and everything would be OK.

Still, thats what Gary tried, at first. Or, rather, he turned to vitamin supplements and a high-protein diet in the hope they could help. Im a vegetarian, so for a second I thought, Oh no, Im one of these anaemic, lentil-based stereotypes. But, ultimately, he knew this probably wouldnt help because his count wasnt low it was zero. There was nothing to improve. Thats the thing Ive found hardest. Most problems Ive had in my life Ive overcome with either bloody-mindedness or effort, and thats not this, he says, shaking his head. Thats not this.

Garys infertility remains unexplained. The next step is for him to have a testicular sperm extraction procedure, to find out if hes producing sperm that are being blocked, which could potentially be extracted for use in assisted conception. Three years after they started trying for a baby, this will be the first time he will be examined beyond blood tests and semen samples.

Without Gareth Downs Facebook group, it would have been hard to find someone to talk to. Gary is a counsellor, and when he looked at who was registered with the British Infertility Counselling Association, the professional body for fertility counsellors in the UK, he found that the 46 registered practitioners were all women. Emotional support provision for men is glaring in its absence, he says. Its just a case of, On your bike, son. Get on with it.

The way that men are treated as the secondary partner in infertility treatment could have worrying consequences, he says. All the paperwork goes through the female. Everything is done through my wife. In meetings, its been very rare that Ive even been able to get any eye contact from a consultant so far. It occurred to me that, should my wife leave me, I would have no mechanism for resolving this, or getting any questions answered, and that would have an impact in terms of maybe meeting someone new, or even knowing if Im able to be a parent one day.

Edinburgh University professor Richard Sharpe, an expert in sperm count and male fertility, believes the University of Jerusalem studys findings should be taken very seriously. If something is having that big an effect something in our environment, diet, lifestyle, and we dont know what it is what else might it be doing to us? We think of sperm counts as a fairly crude barometer of overall male health. Its a warning shot across our bows.

Sharpe has been specialising in male infertility for 25 years, but even he can offer only general hypotheses about what could have made sperm counts fall by 60% in little over a generation. He thinks diet and lifestyle are much more likely to be contributory factors than environmental chemicals such as pesticides, plastics and hormones in the water, because the evidence that they could induce such striking effects at low levels of exposure is unconvincing. But our understanding of the normal process of sperm production is very poor, completely superficial, he says. Its a much more complex process to understand than the menstrual cycle, and we havent done enough research.

There is a chance that women might ultimately be behind the sudden drop in sperm count, Sharpe believes. His work has looked at the link between rates of maternal smoking and the use of painkillers during pregnancy, and the reduced sperm counts of sons in adulthood. A baby boys testes are formed during the first trimester, when many women dont know theyre pregnant, and the period immediately after their formation is critical for the production of testosterone. What we are seeing now could be the expression of a generational problem: the fact that, since the 1970s, women are more likely than ever to smoke and take over-the-counter painkillers.

But, again, the evidence isnt strong enough. There are four studies that all show a significant association between maternal smoking and reduction in sperm counts in male offspring, so its plausible, he says, but it cant explain the 60% fall, because not so many women smoke and smoke heavily. A longitudinal study, over 20 years, would be needed to demonstrate the effects of maternal lifestyle on male fertility, but long-term research projects are inherently difficult to get funding for, unless public bodies think the issue is critically important. Male fertility is not considered a high-priority issue, partly because theres this perception that its a problem solved by assisted reproduction. Thats not treatment of the underlying issue behind male infertility. Its simply ignoring it.

We may be sleepwalking into a future where we become increasingly dependent on assisted reproduction, Sharpe argues, without fully understanding the long-term consequences of the technologies were relying upon. Researchers have already demonstrated in animals that its possible to make sperm out of other kinds of cell. People are going to do this in humans not in the UK, initially, but they will somewhere in the world. Those techniques are going to be applied in the fertility clinic, but we dont have the knowledge to do it in a truly informed way, to know that its all safe, that there are no consequences.

Whatever the reasons for our underinvestment in male fertility lack of funding and research, male pride or the overemphasis on women in fertility treatment it has huge implications for both men and women. Were flying blind to a large extent, and so far weve been ridiculously lucky, Sharpe says. Its a perfect storm, at every level.

Commenting on this piece? If you would like your comment to be considered for inclusion on Weekend magazines letters page in print, please email weekend@theguardian.com, including your name and address (not for publication).

Read more: https://www.theguardian.com/lifeandstyle/2017/nov/18/tears-every-part-life-truth-male-infertility-ivf

Dyslexia: scientists claim cause of condition may lie in the eyes

In people with the condition, light receptor cells are arranged in matching patterns in both eyes, which may confuse the brain

French scientists claim they may have found a physiological, and seemingly treatable, cause for dyslexia hidden in tiny light-receptor cells in the human eye.

In people with the condition, the cells were arranged in matching patterns in both eyes, which may be to blame for confusing the brain by producing mirror images, the co-authors wrote in the journal Proceedings of the Royal Society B.

In non-dyslexic people, the cells are arranged asymmetrically, allowing signals from the one eye to be overridden by the other to create a single image in the brain.

Our observations lead us to believe that we indeed found a potential cause of dyslexia, said the studys co-author, Guy Ropars, of the University of Rennes.

It offers a relatively simple method of diagnosis, he added, by simply looking into a subjects eyes.

Furthermore, the discovery of a delay (of about 10 thousandths of a second) between the primary image and the mirror image in the opposing hemispheres of the brain, allowed us to develop a method to erase the mirror image that is so confusing for dyslexic people using an LED lamp.

Like being left- or right-handed, human beings also have a dominant eye. As most of us have two eyes, which record slightly different versions of the same image, the brain has to select one of the two, creating a non-symmetry.

Many more people are right-eyed than left, and the dominant eye has more neural connections to the brain than the weaker one. Image signals are captured with rods and cones in the eye the cones being responsible for colour.

The majority of cones, which come in red, green and blue variants, are found in a small spot at the centre of the retina of the eye known as the fovea. But there is a small hole (about 0.1-0.15 millimetres in diameter) with no blue cones.

In the newstudy, Ropars and colleague Albert le Floch spotted a major difference between the arrangement of cones between the eyes of dyslexic and non-dyslexic people enrolled in an experiment.

In non-dyslexic people, the blue cone-free spot in one eye the dominant one, was round and in the other eye unevenly shaped. In dyslexic people, both eyes have the same, round spot, which translates into neither eye being dominant, they found.

The lack of asymmetry might be the biological and anatomical basis of reading and spelling disabilities, said the studys authors.

Dyslexic people make so-called mirror errors in reading, for example confusing the letters b and d.

For dyslexic students their two eyes are equivalent and their brain has to successively rely on the two slightly different versions of a given visual scene, they added.

The team used an LED lamp, flashing so fast that it is invisible to the naked eye, to cancel one of the images in the brains of dyslexic trial participants while reading. In initial experiments, dyslexic study participants called it the magic lamp, said Ropars, but further tests are required to confirm the technique really works.

About 700 million people worldwide are known to have from dyslexia about one in 10 of the global population.

Read more: https://www.theguardian.com/society/2017/oct/18/dyslexia-scientists-claim-cause-of-condition-may-lie-in-the-eyes

Reality shrivels. This is your life now: 88 days trapped in bed to save a pregnancy

The long read: Months before she was due to give birth, disaster struck for Katherine Heiny. Doctors ordered her to lie on her side in bed and not move and gave her a 1% chance of carrying her baby to term

When I was five years old, my parents decided they could no longer watch the nightly news. Or rather, they could no longer watch it if I was in earshot. The coverage of the attack at the Munich Olympics had caused me to have such an intense fear of being killed by gorillas that I couldnt sleep. No matter how many times my parents explained the difference between terrorist guerrillas and primate gorillas and that there were no gorillas in Michigan anyway I remained sleepless with worry late into the night for weeks. My parents eventually gave up and subscribed to the afternoon paper as well as the morning one.

The problem is not just that I am a champion worrier. Its that I court worry I seek it out, I invite it into my home, never remembering how hard it is too dislodge it from its comfortable chair by the fire. I watch true-crime documentaries when Im alone. I Google photos of black widow spider bites. I know the statistics about paracetamol overdoses. I have memorised the beaches with dangerous riptides. I have installed a carbon monoxide detector in every house I have ever lived in. And when I got pregnant with my first child, I bought What to Expect When Youre Expecting and the chapter titled What Can Go Wrong was the one I read first.

Retained placenta; umbilical cord prolapse; foetal arrhythmia; toxoplasmosis; preeclampsia; placental abruption; gestational diabetes; cytomegalovirus: I read about all of them, and learned the warning signs. Perhaps to other women, these complications remain obscure, shadowy threats during pregnancy, but to me they were hard, clear, immediate dangers. When my obstetrician told me that mine was a perfectly normal pregnancy, the very first thing I said was: Are you sure?

And yet I was surprised when disaster struck. The things you worry about arent supposed to happen thats what worry does. Its a preventative. And my disaster happened quickly, without fanfare or drama. One second, I was a nice, normal, happy pregnant married woman of 32, walking across my bedroom to my desk while my husband made lunch downstairs. And then the warm fluid gushed out of me, soaking my clothing and leaving a little wet spot on the pale green carpet.

I yanked down my jeans and pants, expecting blood, but there was only wetness. I knew it was very likely that my waters had broken, but I was barely 26 weeks pregnant. It didnt seem possible. I stepped out of my clothes and went to the top of the stairs to call my husband. He stood on the landing with his hands all sticky from making hamburgers, and I told him what had happened. We discussed it for a surprisingly long time. Was it really so bad? How much fluid? Maybe a cup? Was there blood? Was the baby still kicking? Should I call my doctor? Yes, we decided.

I wrapped a towel around my waist and called my obstetrician. He was a man in his late 50s with a perpetual hangdog expression, and for this reason, my husband and I called him Doggie B. I loved Doggie B. Nothing ever surprised him, nothing ever alarmed him. I could not picture him giving me bad news, and because I could not imagine it, I felt it wouldnt happen.

I want you to meet me at the hospital, Doggie B said. Go to the maternity ward. And I want you at Georgetown Hospital where they have the neonatal unit.

I put on fresh pants and jeans and my husband and I drove to the hospital. It was 29 January 2000, and an ice storm was just beginning. Something happened to me on the way to the hospital: my mind split in two. One half was convinced that that this trip was unnecessary, that, of course, my water hadnt broken, that I was just fine. The other half was just as sure my waters had broken and that I would almost certainly go into labour and give birth to a baby too young to live. The two halves of my mind rotated inside my head like the lights of a lighthouse, the worried part flashing and then disappearing, replaced by the calm one.


At the hospital, a doctor who looked just like Andie MacDowell performed a pelvic exam and took vaginal swabs. A nitrate test was done on one of the swabs for the presence of amniotic fluid. (Its presence would have meant membranes containing the baby had ruptured three months prematurely and would most likely cause me to go, disastrously, into labour.) The other swab was for sent off to the lab to check for the presence of arborisation, otherwise known as ferning, because amniotic fluid produces a delicate, leafy pattern under the microscope. Both tests were negative, although they were running a repeat just in case. I began to feel a little ridiculous.

The Andie MacDowell doctor told us that there was no evidence that I was leaking amniotic fluid, but that they were going to admit me, she said, on the strength of my story.

The strength of my story! I was appalled. Im a writer of course I told a strong story. Maybe I didnt need to be here, I told my husband, as nurses wheeled my gurney into a private room. Maybe I should just tell an equally strong story about how nothing was wrong and go home.

The doctor came back. I just saw the ferns, she said. You have definitely ruptured. Well try to delay labour as long as possible.

Three months? I asked.

Yes, thats the hope, she said.

I wouldnt have been so scared if it werent for the look on her face.

Dom
Illustration: Dom Mckenzie

Nurses came into my room and began to bustle around me while the doctor explained that my condition was called preterm premature rupture of membranes, or pPROM. The two most dangerous (and most common) complications of pPROM are extreme pre-term birth and chorioamnionitis, a bacterial infection of the foetal membranes. Both are devastating for the foetus. I reached for my husbands hand.

The nurses put me in Trendelenburg, meaning my hospital bed was tilted so that my head was 20 degrees lower than my feet. (I thought it was some long German word that meant head below feet on the side of a mountain.) A nurse wrapped a foetal monitor to my belly with a thick strap, explaining that it could be read from the nurses station, and they would know immediately if I began having contractions. Another nurse slid a pair of puffy compression leggings on to my legs. They inflated and deflated every other minute with a whooshing sound. It was like having Darth Vader breathing at my bedside. I was told to lie on my side in order not to put pressure on my vena cava, which would lower the babys oxygen supply. Yet another nurse poked a needle into my arm to start a line for intravenous antibiotics.

The doctor gave me a shot of steroids to help develop the babys lungs, in case the baby would shortly be needing those lungs to breathe. Arent steroids counter-indicated in pregnancy? I asked.

Yes, but its more dangerous to go without, she said.

Doggie B called the hospital to stay that he couldnt make it in because of the ice storm. In his absence, the doctor ordered the nurses to give me a shot of terbutaline, a medication that can delay preterm labour for up to 48 hours.

Please, I begged. I dont want any more shots. Im not in labour. This could be so bad for the baby.

From the moment I learned I was pregnant, I had divided the world into things that were OK for the baby, and things that were bad for the baby. The first group included rice, poached chicken and yoga, The second group included alcohol, secondhand smoke, deli meat, smoked seafood, raw eggs, soft cheese, pt, caffeine, unwashed vegetables, diet soda, eggnog, x-rays, aspirin, ibuprofen, antihistamines, nasal decongestants, cough syrup, librium, valium, sleeping pills, castor oil, vitamin A supplements, paint fumes, insect repellent, acupuncture, cats, hair dye, altitude, saunas, reptiles, tick bites, microwaves, electric blankets, rollercoasters, bikini waxes, stiletto heels, hot dogs and tap water. I trusted no one but myself and Doggie B to categorise items, and certainly not a doctor I had met 10 minutes before.

They gave me the terbutaline anyway. It made me dizzy and cold, though it makes most people hot. They piled more blankets on top of me. My hands shook uncontrollably.

The neonatologist came to talk to us. He had thick glasses and he talked in percentages. It was clear that he was not interested in offering comfort; he was there to convey information. He told us that for babies born at 26 weeks, the survival rate is 50%. Of the surviving half, one-third had major disabilities, and are likely to be dependent on caregivers for ever. It was common for them to have breathing problems, cardiac disorders, brain bleeds, cerebral palsy. Brain damage, deafness, blindness. Another third had more moderate disabilities: spastic muscles, significant hearing loss, impaired vision without blindness. The final third (the best we could hope for, apparently) had milder learning disabilities, anemia and digestive complications.

I watched him dispassionately, not really listening. He was so stereotypically nerdy that I couldnt get over it. Why was he telling us all this scary shit anyway? I wasnt going to go into labour. The baby wasnt going to be born yet. Why couldnt anyone understand that?


The first night was longer than I would have believed possible. Visiting hours ended and the nurses chased my husband out. He drove home on streets that crackled and shifted with ice. I was not allowed to stand, or even sit. I was served a dinner that I was too nervous to eat. And I learned about bedpans. Peeing into something the size and shape of a casserole dish while lying in bed with your head angled toward the floor is messy and awkward.

But that is not the worst thing about bedpans. The worst thing is the other people involved. Having to ask someone to bring you a bedpan, having to make conversation with that person while you use it, having to apologise because your aim is a little off and now theres a wet spot on the sheets, having to ask that person to wipe you, having to ask her to wipe you again because you still feel damp and sticky, having to thank the person, and you do really thank her, you are so grateful, its just that two hours ago you were an upright person with a little dignity, and now youre not.

The hospital lowered the lights in the hall, just like on a transatlantic flight. Nurses went by on squeaky shoes. I lay on my side and gripped the metal railing of my bed. The lighthouse in my mind revolved, and for one instant the room was flooded with cold, bright, white fear for the baby. Then it was gone. Certainty that the baby would not be born early stole over me, and I gathered that certainty close. I lay awake and watched the sleet falling outside my window. It occurred to me that I could not see the ground.

Doggie B came to see me the next day.

Can you believe this? I said to him. Me, your most paranoid patient!

He didnt bother to deny that I was his most paranoid patient. When he spoke, his voice was mild and unconcerned. He said that I would remain on bed rest, and unless infection forced us to act sooner, he would deliver the baby at 33 weeks, when the greatest risk was over.

I didnt want to have the baby at 33 weeks. I wanted to have the baby at 40 weeks, like everyone else. I knew the risks. But I had also been told the risks of preterm infection: a baby born with brain damage, cardiac defects, limb abnormalities, microcephaly, hydrocephalus, paralysis, bone lesions, eye lesions or possibly no live baby at all. I refused to weigh the risks; I would simply not go into labour, nor would I develop an infection. That was all there was to it.

I frowned at Doggie B. Why 33 weeks? Why not go to May 10? That was my due date.

He shrugged. OK, May 10.

He was a much better liar than the Andie MacDowell doctor.

After Doggie B left, the nerdy neonatology doctor came to my room again. He wanted me to go down to the neonatal intensive care unit (NICU). You need to see what a preemie looks like, he said, pushing his glasses up his nose. You need to prepare yourself.

The Andie MacDowell doctor was there, too. A three-pound baby takes some getting used to, she said. You dont want to see one for the first time in the delivery room.

To both of them, I turned a deaf ear and a sullen face. I was not going into labour. I was not going to go to the NICU and no one could make me. Conversation was cut short when another nurse came in and told me that my monitor had showed slight disturbances, and gave me another shot of terbutaline.

I cant believe terbutaline makes you cold, this nurse said as she took blankets from the blanket-warmer and I shivered beneath them. Out in the hall I heard her say to someone: That one is so contrary.

I could see remotely that all these doctors and nurses knew something I didnt. I found out much later that what they knew were the odds. Fifty per cent of women with pPROM go into labour within 48 hours, and 95% deliver within one week of rupture. Four of the remaining 5% deliver within two weeks. One percent of women with pPROM experience spontaneous resealment of the membranes and go on to carry the baby to term.

One per cent.


Do you knit or crochet? one of the nurses asked me early on. Lots of bed rest patients find that helps them pass the time. No, I read and I write, I answered, pretentiously. And untruthfully, because I have always watched a great deal of TV.

I couldnt write because I couldnt sit up. I also couldnt write because if I focused too much on my situation, the lighthouse in my mind would revolve and the worried, scared part of me would rush out, gibbering with alarm, baying, screaming, howling that the baby was going to be born too soon, the baby was coming now, the baby was going to die. How could I write with that going on?

I had a headache from being in Trendelenburg. I couldnt remember what it was like to look someone in the eye, so long had I now spent gazing up at everyone from thigh-level. When I ate, it was one wobbly, precarious forkful at time. After a while, I just gave up and if I couldnt eat it with my fingers, I didnt eat at all. I drank through a straw, until everything tasted the same: like the plastic of the straws.

I couldnt write, so instead I read. Constantly. Ceaselessly. I had to hold the book open in front of me sideways, like someone gripping a large steering wheel. My husband brought me books and I stacked them on my overbed table, and as I read each book, I held the next book in my free hand, with my finger marking the start of the first chapter so that as soon I finished one book, I could immediately start another. I must have read dozens of books while I was in hospital, and I can only remember one of them.

Only one book held my interest. I told my husband exactly where to find it on the bookshelf near my desk and he brought it to me: Steven Callahans Adrift, a memoir of the 76 days in 1982 during which Callahan had survived in an inflatable life raft after his sailboat sank. I had fallen in love with the book when it was first published, in 1986. It seems like a strange choice of reading for a teenage girl, especially one as studious and non-athletic and seasickness-prone as I was. But I have always been drawn to survival stories: they dovetail nicely with my chronic fear of disasters.

Callahan spent more than two months in a rubber raft in the middle of the Atlantic, spearing fish to eat raw, using solar stills to distil water, and making endless, desperate makeshift repairs to his patched and leaking vessel. I had read Adrift many times over the years, but now I read it again, and was inspired by his suffering and ingenuity in a new way. I was in a hospital bed where nurses brought me meals three times a day, and I slept in a bed on clean sheets and was in no danger of drowning. I could do this. I could.


You dont sleep in hospital. You cant sleep. Too many people coming and going. A nurse comes every four hours to check your vitals: temperature, pulse rate, blood pressure, babys heartbeat. Another nurse comes in every two hours to make sure you are doing your kick-counts. Meals come three times a day, plus a night-time snack for pregnant women, which means four times someone comes into your room to deliver a meal, and four more times someone comes back to collect the tray. A nurse comes every time you need to use the bedpan. An orderly comes every morning to take you for an ultrasound. Your obstetrician comes by every day to check on you, and you dont want to miss his visit, because he is the only one who tells you what you want to hear no, theres no sign of infection; yes, Im sure youll carry to term. The hospital chaplain stops by once a day. She was a mousy woman with a perpetually scared expression. Its not a good look on a hospital chaplain.

So thats more than 30 people coming to your room and interrupting your sleep. And then theres the physical part of it. If you are confined to bed, after you lie on your side for a few days, it begins to feel as if your hip sockets are lined with metal shavings, as if the sheets are covered with shattered glass. Before long, red, rough, scaly patches the size of saucers appear on your hips and your shoulders the beginnings of bedsores. The compression leggings chafe your thighs.

You forget how to sleep. The line between waking and sleeping used to be as clear and sharp as the line down the middle of a road, but after two weeks, that line has blurred and is almost invisible. You stagger back and forth across it like a shambling drunk, until there is no more sleeping and waking; there is just this dim, dull, soupy consciousness. Your reality shrivels down into one long, hazy, beige-tiled tunnel. You used to worry, but it has gone beyond that now. Worry used to be inside you, but now you are inside it. Worry is a dome that has descended over you and trapped you. This is your life now. This is your world.

Every day about 10am, an orderly arrived with a gurney and I carefully scooted on to it and then the orderly pushed the gurney through the hospital halls to the prenatal department.

Two weeks had gone by, and I hadnt gone into labour. This seemed to surprise everyone but me and Doggie B, who began, cautiously, to speak of resealment. The nerdy doctor came by and gave me a whole bunch of new statistics about what the babys chances were at 28 weeks, at 30 weeks. He didnt go beyond 30 weeks, though. They removed my IV. Everyone talked about something called BP as though they were speaking of the Rapture. (Bathroom Privileges.) The atmosphere in my room became positively springlike, despite the snow outside.

Doggie B said the first step would be for me to get up and take a shower. A shower! Nothing could have been more tempting. He gave me a date. Now it was something to look forward to. I had my husband bring in a bottle of my favourite shampoo and a bar of coconut soap. The day finally came. A nurse removed my circulation leggings. I sat up slowly and swung my feet to the floor. The nurse took my arm and helped me to stand. I stood there, swaying. Amniotic fluid poured out of me and splashed to the floor. The nurse let go of my arm in surprise. I lay back down and turned my face to the wall.

It took me a while to regain my strange equilibrium, especially considering that the doctors now suspected I had been leaking continuously since the first rupture. Rupture of the membranes is considered prolonged (and therefore dangerous) when more than 24 hours passes between the rupture and the onset of labour. My waters had broken more than 300 hours ago. The risk of sepsis was very high.

Katherine
Katherine Heiny. Photograph: Leila Barbaro

But still, two days maybe three and the stubbornly optimistic side of my personality fought its way to the forefront and re-planted its battle flag. The Andie McDowell doctor wrote in my chart: Patient needs to understand that resealment is highly unlikely at this time and that preterm birth is almost a certainty. Yeah, well, thats what she thought. This baby was not coming early. I simply wouldnt allow it.

Another week in bed went by. Every once in a while, they had me stand up, and every time I leaked amniotic fluid. But still I didnt go into labour. Nor did I have a fever or abdominal pain, the two greatest indicators of infection. Life as I now knew it went on.

After I had been on bed rest in the hospital for 25 days, there came a time when I stood up and no fluid gushed out of me to splatter on the floor. The nurse and I looked at each other in amazement. Go take a shower, quick! she said. Ill change the sheets on your bed.

It was not the slow, luxurious shower I had dreamed of, but I can tell you this: it was pretty fucking nice. They didnt allow me out of bed again that day, but I was finally taken out of Trendelenburg. I stood up the next day and again there was no leak. I took another shower.

When Doggie B came to see me next, I was sitting in a chair to greet him, radiant, both my pride and my belly enormous.

I had done it. I had resealed. I was in the 1%.


Doggie B wanted to send me home. I fought him. I had been in the hospital for almost a month at this point, and I was pretty much institutionalised. Go home? Without the foetal monitor? With no nurses to listen for the babys heartbeat every four hours? No daily ultrasound? Uh-uh. He was crazy if he thought I could handle that much responsibility. I told him that I needed to be in the hospital near the NICU. I pointed to my chart where it said Severe Risk Pregnancy in big scary letters. Doggie B stood firm. He discharged me and my husband drove me home.

Steven Callahan writes of seeing the first food after his rescue a cake of chipped coconut topped with a dot of red sugar and how he looked at it in wonder and thought: Red! That was exactly how I felt when I saw my house again. Green! Blue! Lilac! My hospital room had been unrelentingly beige.

I was still on almost total bed rest, allowed up for 15 minutes twice a day. A shower in the morning and dinner at night. Out of the hospital, the lighthouse in my mind revolved faster and faster, unchecked by the nurses reassurance. I counted constantly how often the baby kicked, and took my temperature five times a day. The amniotic sac had resealed, but the rupture had been extremely prolonged, greatly increasing the chances of an infection reaching the baby. Even feeling the babys movements could not quell my worry. Doggie Bs receptionist learned to put me straight through to him when I called.

Time ground slowly by. My husband brought me breakfast in the morning before he left for work. Our housekeeper brought me lunch. My husband brought me dinner and we ate at the card table he had set up in the corner of our bedroom. Then I crawled back into bed and worried until I fell asleep, woke up, and started another day. That was my routine, and I never varied from it. I dont mean I never varied from it significantly; I mean I never varied from it at all.

Thirty-one weeks. Thirty-two weeks. Thirty-three. Still I didnt go into labour. I lay in bed and stroked my abdomen with my fingertips. Thirty-four weeks. Thirty-five. March ended and April began. A blizzard of cherry blossoms replaced the snow outside my bedroom window. Thirty-six weeks. Thirty-seven weeks. I no longer watched TV or pretended to read books. I knew nothing but my belly and the endless waiting. Time had softened and stretched like taffy, pulling itself into long, gooey ribbons. Thirty-eight weeks. Thirty-nine. I was certain that the baby would be born on 21 April, the same day Steven Callahan was rescued. But 21 April came and went. And then one day I got up to take my morning shower and felt the slightest trickle of fluid run down my leg. My waters had broken for the last time.


Our son was born 12 hours later at Sibley Hospital in Washington DC. We named him Angus. And so my life changed again in another minute, another second. The two halves of my mind fused back together. I went from severe-risk pregnancy to healthy new mother. I was totally unprepared. For so long the goal had been to stay pregnant I had almost forgotten that a baby was the end result. I knew nothing about newborns, nothing about breastfeeding or burping or vaccinations. The nurses had to show me everything. One them said, in a careful voice: Ive heard about you, I think. I could tell that whatever she had heard was, at best, a mixed review. Didnt you rupture very early and do a lot of bed rest over at Georgetown?

I felt a stubborn thump of pride. Thirty days at Georgetown. Eighty-eight days altogether.

Wow, she said. I bet you never want to see a hospital again.

I didnt know how to tell her that almost the opposite was true. It wasnt just that I knew about hospitals now, and knew I could survive a long stay in one. I was a different person from the one who had been admitted all those weeks and months ago: a tried person, a changed person. Very few experiences transform your view of the world and yourself, but bed rest did that for me. I had beaten nearly unthinkable odds. All the things I have always meant to fix about myself but had never got around to my stubbornness, my hypochondria, my inflexible nature had turned out not to need fixing. Had, in fact, turned out to be survival skills.

Twenty-four hours went by, and I cried because I never wanted Angus to get any older. The impossible had happened: time had speeded up.

Six months later, I arranged to speak to Steven Callahan by phone. I told him how much his book had meant to me, how much he had inspired me. We discovered that we had both been obsessed with numbers, with calculating and re-calculating the days of our progress. I told him that my ordeal had altered me in some fundamental way, that sometimes I even missed the mind-bending, terrifying force of it. He agreed.

Sometimes I feel a loss, he said, in terms of the fact that few if any experiences I will ever have again can equal the intensity and importance of that one. You try to mine the precious elements of the experience, but they slip away from you, and thats another loss. You try to appreciate this enormous gift youve been given, but eventually you just get on with it.

The precious elements of my experience were fading, too. I took my bathroom privileges for granted now. I slept on my back again. I went for walks. I worried about traffic jams and deadlines and love handles, just like a normal person. I got on with it.

Angus is 17 now, taller than me, taller than my husband. He has the beginnings of a moustache and a voice as deep as James Earl Joness. He knows how to do laundry, and make spaghetti. He can take the Metro by himself, and he learned to drive this summer. Its possible he watches porn on the internet. (Its extremely possible.) I have new fears and worries, about teenagers. The bright, icy terror of the hospital is behind me, but it has taken a long time.

One day, when Angus was about three years old, I cleaned out a closet and unexpectedly found the plastic water pitcher that had been by my hospital bed. In an instant, the lighthouse in my head revolved, and everything went white and cold. I was certain that the baby was in danger so certain that I had to run to the bathroom and vomit. I dont know why this surprised me, or why I thought I would be different, immune to the after-effects of my ordeal. All survivors have scars.

Main illustration by Dom McKenzie

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Read more: https://www.theguardian.com/lifeandstyle/2017/oct/24/88-days-trapped-in-bed-to-save-a-pregnancy-bed-rest

Facing poverty, academics turn to sex work and sleeping in cars

Adjunct professors in America face low pay and long hours without the security of full-time faculty. Some, on the brink of homelessness, take desperate measures

There is nothing she would rather do than teach. But after supplementing her career with tutoring and proofreading, the university lecturer decided to go to remarkable lengths to make her career financially viable.

She first opted for her side gig during a particularly rough patch, several years ago, when her course load was suddenly cut in half and her income plunged, putting her on the brink of eviction. In my mind I was like, Ive had one-night stands, how bad can it be? she said. And it wasnt that bad.

The wry but weary-sounding middle-aged woman, who lives in a large US city and asked to remain anonymous to protect her reputation, is an adjunct instructor, meaning she is not a full-time faculty member at any one institution and strings together a living by teaching individual courses, in her case at multiple colleges.

about

I feel committed to being the person whos there to help millennials, the next generation, go on to become critical thinkers, she said. And Im really good at it, and I really like it. And its heartbreaking to me it doesnt pay what I feel it should.

Sex work is one of the more unusual ways that adjuncts have avoided living in poverty, and perhaps even homelessness. A quarter of part-time college academics (many of whom are adjuncts, though its not uncommon for adjuncts to work 40 hours a week or more) are said to be enrolled in public assistance programs such as Medicaid.

They resort to food banks and Goodwill, and there is even an adjuncts cookbook that shows how to turn items like beef scraps, chicken bones and orange peel into meals. And then there are those who are either on the streets or teetering on the edge of losing stable housing. The Guardian has spoken to several such academics, including an adjunct living in a shack north of Miami, and another sleeping in her car in Silicon Valley.

The adjunct who turned to sex work makes several thousand dollars per course, and teaches about six per semester. She estimates that she puts in 60 hours a week. But she struggles to make ends meet after paying $1,500 in monthly rent and with student loans that, including interest, amount to a few hundred thousand dollars. Her income from teaching comes to $40,000 a year. Thats significantly more than most adjuncts: a 2014 survey found that the median income for adjuncts is only $22,041 a year, whereas for full-time faculty it is $47,500.

We take a kind of vow of poverty

Recent reports have revealed the extent of poverty among professors, but the issue is longstanding. Several years ago, it was thrust into the headlines in dramatic fashion when Mary-Faith Cerasoli, an adjunct professor of Romance languages in her 50s, revealed she was homeless and protested outside the New York state education department.

We take a kind of vow of poverty to continue practicing our profession, Debra Leigh Scott, who is working on a documentary about adjuncts, said in an email. We do it because we are dedicated to scholarship, to learning, to our students and to our disciplines.

Adjuncting has grown as funding for public universities has fallen by more than a quarterbetween 1990 and 2009. Private institutions also recognize the allure of part-time professors: generally they are cheaper than full-time staff, dont receive benefits or support for their personal research, and their hours can be carefully limited so they do not teach enough to qualify for health insurance.

This is why adjuncts have been called the fast-food workers of the academic world: among labor experts adjuncting is defined as precarious employment, a growing category that includes temping and sharing-economy gigs such as driving for Uber. An American Sociological Association taskforce focusing on precarious academic jobs, meanwhile, has suggested that faculty employment is no longer a stable middle-class career.

Adjunct
Adjunct English professor Ellen James-Penney and her husband live in a car with their two dogs. They have developed a system. Keep nothing on the dash, nothing on the floor you cant look like youre homeless, you cant dress like youre homeless. Photograph: Talia Herman for the Guardian

The struggle to stay in housing can take many forms, and a second job is one way adjuncts seek to buoy their finances. The professor who turned to sex work said it helps her keep her toehold in the rental market.

This is something I chose to do, she said, adding that for her it is preferable to, say, a six-hour shift at a bar after teaching all day. I dont want it to come across as, Oh, I had no other choice, this is how hard my life is.

Advertising online, she makes about $200 an hour for sex work. She sees clients only a handful of times during the semester, and more often during the summer, when classes end and she receives no income.

Im terrified that a student is going to come walking in, she said. And the financial concerns have not ceased. I constantly have tension in my neck from gritting my teeth all night.

To keep their homes, some adjuncts are forced to compromise on their living space.

Caprice Lawless, 65, a teacher of English composition and a campaigner for better working conditions for adjuncts, resides in an 1100 sq ft brick house near Boulder, Colorado. She bought it following a divorce two decades ago. But because her $18,000 income from teaching almost full time is so meager, she has remortgaged the property several times, and has had to rent her home to three other female housemates.

I live paycheck to paycheck and Im deeply in debt, she said, including from car repairs and a hospitalization for food poisoning.

Like every other adjunct, she says, she opted for the role thinking it would be a path to full-time work. She is so dependent on her job to maintain her living situation that when her mother died this summer, she didnt take time off in part because she has no bereavement leave. She turned up for work at 8am the next day, taught in a blur and, despite the cane she has used since a hip replacement, fell over in the parking lot.

If she were to lose her home her only hope, she says, would be government-subsidized housing.

Most of my colleagues are unjustifiably ashamed, she said. They take this personally, as if theyve failed, and Im always telling them, you havent failed, the system has failed you.

A precarious situation

Even more desperate are those adjuncts in substandard living spaces who cannot afford to fix them. Mindy Percival, 61, a lecturer with a doctorate from Columbia, teaches history at a state college in Florida and, in her words, lives in a shack which is in the woods in middle of nowhere.

Lecturer
Lecturer Mindy Percivals mobile home in Stuart, Florida. Her oven, shower and water heater dont work. Photograph: Courtesy of Mindy Percival

The mobile home she inhabits, located in the town of Stuart, north of Miami, was donated to her about eight years ago. It looks tidyon the outside, but inside there are holes in the floor and the paneling is peeling off the walls. She has no washing machine, and the oven, shower and water heater dont work. Im on the verge of homelessness, constantly on the verge, she said.

Percival once had a tenure-track job but left to care for her elderly mother, not expecting it would be impossible to find a similar position. Now, two weeks after being paid, I might have a can with $5 in change in it. Her 18-year-old car broke down after Hurricane Irma, and she is driven to school by a former student, paying $20 a day for gas.

I am trying to get out so terribly hard, she said.

Homelessness is a genuine prospect for adjuncts. When Ellen Tara James-Penney finishes work, teaching English composition and critical thinking at San Jose State University in Silicon Valley, her husband, Jim, picks her up. They have dinner and drive to a local church, where Jim pitches a tent by the car and sleeps there with one of their rescue dogs. In the car, James-Penney puts the car seats down and sleeps with another dog. She grades papers using a headlamp.

Over the years, she said, they have developed a system. Keep nothing on the dash, nothing on the floor you cant look like youre homeless, you cant dress like youre homeless. Dont park anywhere too long so the cops dont stop you.

James-Penney, 54, has struggled with homelessness since 2007, when she began studying for her bachelors degree. Jim, 64, used to be a trucker but cannot work owing to a herniated disk. Ellen made $28,000 last year, a chunk of which goes to debt repayments. The remainder is not enough to afford Silicon Valley rent.

At night, instead of a toilet they must use cups or plastic bags and baby wipes. To get clean, they find restrooms and we have what we call the sink-shower, James-Penney said. The couple keep their belongings in the back of the car and a roof container. All the while they deal with the consequences of ageing James-Penney has osteoporosis in a space too small to even stand up.

James-Penney does not hide her situation from her class. If her students complain about the homeless people who can sometimes be seen on campus, she will say:Youre looking at someone who is homeless.

That generally stops any kind of sound in the room, she says. I tell them, your parents could very well be one paycheck away, one illness away, from homelessness, so it is not something to be ashamed of.

Ellen
Ellen James-Penney teaching an English class at San Jose State University in California. She tells her students, youre looking at someone who is homeless. Photograph: Talia Herman for the Guardian

I hung on to the dream

Many adjuncts are seeking to change their lot by unionizing, and have done so at dozens of schools in recent years. They are notching successes; some have seen annual pay increases of about 5% to almost 20%, according to Julie Schmid, executive director of the American Association of University Professors.

Schools are often opposed to such efforts and say unions will result in higher costs for students. And for certain adjuncts, any gains will come too late.

Mary-Faith Cerasoli, 56, the homeless adjunct who captured the publics attention with her protest in New York three years ago, said that in the aftermath little changed in termsof her living situation. Two generous people, a retiree and then a nurse, offered her temporary accommodation, but she subsequently ended up in a tent pitched at a campground and, after that, a broken sailboat docked in the Hudson river.

But there was, however, one shift. All the moving around made it hard for her to make teaching commitments, and in any case the pay remained terrible, so she gave it up. She currently lives in a subsidized room in a shared house in a wealthy county north of New York.

For Rebecca Snow, 51, another adjunct who quit teaching after a succession of appalling living situations, there is a sense of having been freed, even though finances continue to be stressful.

Author
Author Rebecca Snow, now retired from adjuncting, has moved to a small apartment just north of Spokane, Washington. Photograph: Rajah Bose for the Guardian

She began teaching English composition at a community college in the Denver area in 2005, but the poor conditions of the homes she could afford meant she had to move every year or two. She left one place because of bedbugs, another when raw sewage flowed into her bathtub and the landlord failed to properly fix the pipes.

Sometimes her teenage son would have to stay with her ex-husband when she couldnt provide a stable home. Snow even published a poem about adjuncts housing difficulties.

In the end she left the profession when the housing and job insecurity became too much, and her bills too daunting. Today she lives in a quiet apartment above the garage of a friends home, located 15 miles outside Spokane, Washington. She has a view of a lake and forested hills and, with one novel under her belt, is working on a second.

Teaching was the fantasy, she said, but life on the brink of homelessness was the reality.

I realized I hung on to the dream for too long.

  • Do you have an experience of homelessness to share with the Guardian? Get in touch

Read more: https://www.theguardian.com/us-news/2017/sep/28/adjunct-professors-homeless-sex-work-academia-poverty

Exclusive: footage shows young elephants being captured in Zimbabwe for Chinese zoos

Rare footage of the capture of wild young elephants in Zimbabwe shows rough treatment of the calves as they are sedated and taken away

The Guardian has been given exclusive footage which shows the capture of young, wild elephants in Zimbabwe in preparation, it is believed, for their legal sale to Chinese zoos.

In the early morning of 8 August, five elephants were caught in Hwange national park by officials at Zimbabwe Parks and Wildlife Management Authority (Zimparks).

These captures are usually kept as secret as possible. The Guardian understands that in this case the usual procedure was followed. First, a viable herd is identified. Then operatives in a helicopter pick off the younger elephants with a sedative fired from a rifle. As the elephant collapses, the pilot dive-bombs the immediate vicinity so the rest of the herd, attempting to come to the aid of the fallen animal, are kept at bay. When things quieten down, a ground-team approaches the sedated elephants on foot, bundles them up, and drags them on to trailers.

The footage, a series of isolated clips and photographs provided to the Guardian by an anonymous source associated with the operation, documents the moment that operatives are running into the bush, then shows them tying up one young elephant. The elephants are then seen herded together in a holding pen near the main tourist camp in Hwange.

Elephant
In this part of the footage, a young female elephant is seen being kicked in the head repeatedly by one of the captors. Photograph: The Guardian

Finally, in the most disturbing part of the footage, a small female elephant, likely around five years old, is seen standing in the trailer. Her body is tightly tied to the vehicle by two ropes. Only minutes after being taken from the wild, the animal, still groggy from the sedative, is unable to understand that the officials want her to back into the truck, so they smack her on her body, twist her trunk, pull her by her tail and repeatedly kick her in the head with their boots.

Altogether, 14 elephants were captured during this time period, according to the source, who asked to remain to anonymous for fear of reprisal. The intention was to take more elephants, but the helicopter crashed during one of the operations. It is estimated that 30-40 elephants were to be captured in total.

The elephants that were taken are now in holding pens at an off-limits facility within Hwange called Umtshibi, according to the source. One expert who reviewed the photographs, Joyce Poole, an expert on elephant behaviour and co-director of the Kenya-based organisation ElephantVoices, said the elephants were bunching huddling together because they are frightened.

The
The young elephants in their enclosure. According to experts, they are bunching, huddling together because they are frightened. Photograph: The Guardian

Audrey Delsink, an elephant behavioural ecologist and executive director for Executive Director for Humane Society International Africa, also reviewed the photos and footage. She believed that most of the elephants were aged between two and four. Basically, these calves have just been weaned or are a year or two into the weaning process. In the wild, elephants are completely dependent on their mothers milk until they are two, and are not fully weaned until the age of five.

A number of the calves, she said, were displaying temporal streaming a stress-induced activity. Many of the gestures indicate apprehensive and displacement behaviour trunk twisting, trunk curled under, face touching, foot swinging, head-shaking, ear-cocking, displacement feeding, amongst others. Zimparks were approached but did not make a comment.

The buyer for the young elephants is a Chinese national, according to inside sources who asked not to be named. Last year he was associated with a case involving 11 wild hyenas, who were discovered in a truck at Harare international airport that had been on the road for 24 hours without food or water and were reportedly in an extremely stressed condition, dehydrated and emaciated and, in some cases, badly injured.

One
One of the hyenas found in a consignment at Harare airport in Zimbabwe. Photograph: The Guardian

The legal live trade in wild animals

The capture of the baby elephants is just one of a number of operations that have taken place in Zimbabwe and across the continent over several decades. Nine elephants were reportedly exported from Namibia to Mexico in 2012, six from Namibia to Cuba in 2013, and more than 25 from Zimbabwe to China in 2015. In 2016, the US imported 17 elephants from Swaziland despite objections from the public and conservationists. From 1995-2015, more than 600 wild African elephants and 400 wild Asian elephants are reported to have been traded globally, according to a database kept by the Convention on International Trade in Endangered Species (Cites).

Under Cites, trading live elephants is legal, with a few stipulations. The destination must be appropriate and acceptable, and the sale must benefit conservation in the home country. But elephant conservationists and animal welfare advocates point out a number of flaws in the system. There are no criteria setting out what appropriate and acceptable means and what is really contributing to conservation, explained Daniela Freyer of Pro-Wildlife, a German-based organisation that seeks to improve international legislation protecting wildlife. Currently, it is entirely up to authorities in the importing countries to define and decide. There are no common rules and no monitoring of the conditions of the capture, the number of animals being traded, where they will end up or the conditions in which they will be kept at their destination. There is also no monitoring of the requirement that a sale benefit conservation.

For example, Zimbabwe and China are the biggest players in the live elephant trade, but Iris Ho, wildlife programme manager at Humane Society International (HSI), says they have found little information from the importing countries on the animals arrival. We dont know how many facilities in China have received the elephants imported from Zimbabwe during the last few years. We dont know the status of these animals.

Attempts to comply with the few Cites stipulations such as appropriate and acceptable destinations are sometimes dismissed. In 2016, a Zimbabwe delegation of Zimparks and ZNSPCA inspectors travelled to China to access the facilities, where they found that most of the zoos showed signs of poor treatment of the animals. But their recommendation that a shipment of 36 elephants remain in Zimbabwe until the holding facilities in China were completed and assessed for compliance by Zimbabwe, was ignored.

On September 16 Chinese papers announced in cheery headlines that three elephants two females and a male, aged approximately four years old had arrived at the Lehe Ledu wildlife zoo. Photographs of the elephants from Chinese media were analysed by Poole, who noted that the face one of the females looked pinched and stressed. The elephant appears to have begun to wear her tusks down on the bars, rubbing back and forth in frustration. Poole added that the sunken look, dark eyes and mottled skin are common for young, captured elephants. In the wild, you only see the pinched, sunken look in sick or orphaned elephants.

The zoo has said that it is providing more than 1,000 square metres of indoor space and 3,000 sq metres outdoors. The animals have six full-time babysitters and every meal is prepared carefully, based on scientific recommendation.

A video posted on YouTube celebrating the arrival of the elephants at Lehe Ledu zoo.

Finally, questions have been asked about whether Zimbabwe is complying with the Cites stipulation that the sale of the elephants must benefit their conservation in the wild. The environment minister, Oppah Muchinguri-Kashiri, was reported in the Guardian last year as saying the sale of the elephants was necessary to raise funds to take care of national parks in Zimbabwe, which have been ravaged by drought and poaching. But in the past, there have been unconfirmed reports of Grace Mugabe, the presidents wife, using funds from the sales of elephants to pay off a military debt to the Democratic Republic of the Congo.

The international body governing the trade, Cites, is increasingly coming under fire for its role. The scientific literature states that captive facilities continue to fall far short of meeting elephants natural needs for movement, space and extended social networks, with negative effects on health, behavior and reproduction, said Anna Mul, a legal adviser on animal law at Fondation Franz Weber, an organisation that is lobbying Cites to end the trade of live elephants.

A spokesman for CITES said: The triennial CITES conference held last year (CoP17) agreed that appropriate and acceptable destinations was defined as destinations where the importing State is satisfied that the recipient of the live animals is suitably equipped to house and care for them. CoP17 also agreed on a process to assess if additional guidance on this matter is required. Further, both the importing and exporting countries are now required to be satisfied that any trade in live elephants should promote the conservation of elephants in the wild. In addition, the exporting Party must also be satisfied that animals are prepared and shipped so as to minimize the risk of injury, damage to health or cruel treatment of live elephants in trade… CITES does not address the way in which the animals are captured or stored prior to export.

But for now, China continues to import the vulnerable elephants at almost conveyor-belt speed. According to Ho, some pressure to stop the practice is beginning to be felt, but the country is influenced by the view that breeding is conservation. And then, of course, there is a willing partner in Zimbabwe and the thrill of seeing African elephants by the visitors.

Its a win-win, she said, for those who are financially profiting from the legal trade in the calves. But its a lose-lose for the animals, both imported and left behind.

Read more: https://www.theguardian.com/environment/2017/oct/03/exclusive-footage-shows-young-elephants-being-captured-in-zimbabwe-for-chinese-zoos

The ‘vampire breast lift’: just another grotesque beauty boob | Van Badham

A procedure that draws blood from a womans arm and extracts the platelets to pump into her breasts has doubled in popularity

Through conquest, Alexander the Great established one of the most vast land empires of the classical age. It stretched from the Mediterranean, through North Africa and on to Asia. He was undefeated in battle, awash with the trophies of victories, self-anointed as a god. Yet a popular quote describes the young conquerer-king viewing the magnificence of his achievements with despair: And when Alexander saw the breadth of his domain, he wept for there were no more worlds to conquer. Most people know these words from when Alan Rickman says them in Die Hard.

Its a shame that Alexanders lifespan pre-dated the modern beauty industry. Because if you desire territorial conquest opportunities that are limitless, you dont need to bother with the satrapies of Asia Minor, the kings of Persia or a shoeless Bruce Willis anymore. Just grab the nearest female body and slash, slice, stab, burn and pillage away. No phalanxes of Macedonian foot-soldiers are necessary merely gather an Instagram account, a willing celebrity endorsement and the kind of prevailing external culture of misogyny that wont let any human female rest her own self-hatred for a single minute. Actually, you dont even need the celebrity or the Instagram account. Just the last one although it never hurts to shove a freebie into the Oscars showbag.

My assessment is based on how last years Oscar treat is todays latest abomination masquerading as self-improvement. Its a breast plumping procedure adapted from the equally grotesque vampire facial innovation of some years back. You may remember Kim Kardashians blood-smeared face promoting it in 2014 as if summoned to do so by human sacrifice and Satanic ritual.

This week News.com.au reports that the popularity of vampire breast lifts has doubled in the past year. Over the course of two 60-minute sessions, the plot of every body horror movie in existence is spun together for the procedure: blood is drawn from the patient/victims arm, then whorled through a centrifuge then platelet-rich plasma is sucked from the blood, which is pumped into human boobs, with needles.

You dont go up a cup size, regain lost years of youth or achieve dominion over the ancient subcontinent, but apparently it gives the cleavage a fuller look.

Full disclosure: I watch a lot of genre movies and whenever a woman shares a context with blood and centrifuges, nothing good happens next. Human females are actually being encouraged to pay about $2000 for an experience that rationally one would hire a therapist or many to forget.

Dr Herbert Hooi, the man owning the dubious honour of being the one of the worlds pioneer cleavage-enhancing breast-embloodeners, advocates the procedure for those seeking shapelier breasts, which is a thoroughly objective, scientific criteria for wilful bodily trauma if ever there was one. It seems an appropriate punishment for women who have dared to saggen their breasts with the self-indulgence of nursing children or growing older to oblige them into redness, swelling and possible bruising after getting their tits re-pumped with fresh blood.

Dr Hooi says his vampire boob-needles are not for everyone, so, please, be assured that makes everything OK. Tattooing a penis on your face is not for everyone but people do that, too. Ramming your face full of nails to more resemble the bubbly side of a pancake can also be niche activity, kind of like more of a hobby than anything else, pfft, whatever, live and let live, people can do what they want, there are no broader social implications, Yolo.

Yes, of course some women choose to do these things to themselves. But how rarified and elusive has the standard for the optics of female humanity become that mere shapelierness of boobs is now in competitive play? Ive listed the non-invasive procedures advertised to women before. How is it now possible the radical arc of breast enhancements, liposuction, chemical peels, eyelifts, browlifts, backlifts, grin lifts, butt implants, jawline advancements, bellybutton inversions, eyelash transplants, areola reductions, vaginal canal tightening and hacking off ones labia is still not enough?

An industry-wide business model understands that as long as female beauty has greater cultural value than female achievement, it doesnt matter how gruesome, barbaric, cruel or painful the new treatment to improve beauty may be. It doesnt matter to which part of the body its targeted or what it does. You just need to convince a viable market share of women that theyll be deficient without it, and as a sense of deficiency is admitted and shared among women, it will spread like aesthetic contagion. The size of your empire surely will double in a year.

The quote about Alexander the Great that they use in Die Hardis actually bastardised from dramatist William Congreve. The context of it is relevant: Having only that one hope, the accomplishment of it must put an end to all my hopes; and what a wretch is he who must survive his hopes!

It doesnt seem much blessing for women pursuing what society deems most to be beautiful that this particular wretchedness is one theyre unlikely, ever, to know.

  • Van Badham is a Guardian Australia columnist

Read more: https://www.theguardian.com/commentisfree/2017/oct/10/the-vampire-breast-lift-just-another-grotesque-beauty-boob

Sixth mass extinction of wildlife also threatens global food supplies

Plant and animal species that are the foundation of our food supplies are as endangered as wildlife but get almost no attention, a new report reveals

The sixth mass extinction of global wildlife already under way is seriously threatening the worlds food supplies, according to experts.

Huge proportions of the plant and animal species that form the foundation of our food supply are just as endangered [as wildlife] and are getting almost no attention, said Ann Tutwiler, director general of Bioversity International, a research group that published a new report on Tuesday.

If there is one thing we cannot allow to become extinct, it is the species that provide the food that sustains each and every one of the seven billion people on our planet, she said in an article for the Guardian. This agrobiodiversity is a precious resource that we are losing, and yet it can also help solve or mitigate many challenges the world is facing. It has a critical yet overlooked role in helping us improve global nutrition, reduce our impact on the environment and adapt to climate change.

Three-quarters of the worlds food today comes from just 12 crops and five animal species and this leaves supplies very vulnerable to disease and pests that can sweep through large areas of monocultures, as happened in the Irish potato famine when a million people starved to death. Reliance on only a few strains also means the worlds fast changing climate will cut yields just as the demand from a growing global population is rising.

There are tens of thousands of wild or rarely cultivated species that could provide a richly varied range of nutritious foods, resistant to disease and tolerant of the changing environment. But the destruction of wild areas, pollution and overhunting has started a mass extinction of species on Earth. The focus to date has been on wild animals half of which have been lost in the last 40 years but the new report reveals that the same pressures are endangering humanitys food supply, with at least 1,000 cultivated species already endangered.

Tutwiler said saving the worlds agrobiodiversity is also vital in tackling the number one cause of human death and disability in the world poor diet, which includes both too much and too little food. We are not winning the battle against obesity and undernutrition, she said. Poor diets are in large part because we have very unified diets based on a narrow set of commodities and we are not consuming enough diversity.

The new report sets out how both governments and companies can protect, enhance and use the huge variety of little-known food crops. It highlights examples including the gac, a fiery red fruit from Vietnam, and the orange-fleshed Asupina banana. Both have extremely high levels of beta-carotene that the body converts to vitamin A and could help the many millions of people suffering deficiency of that vitamin.

Quinoa has become popular in some rich nations but only a few of the thousands of varieties native to South America are cultivated. The report shows how support has enabled farmers in Peru to grow a tough, nutritious variety that will protect them from future diseases or extreme weather.

Mainstream crops can also benefit from diversity and earlier in 2017 in Ethiopia researchers found two varieties of durum wheat that produce excellent yields even in dry areas. Fish diversity is also very valuable, with a local Bangladeshi species now shown to be extremely nutritious.

Read more: https://www.theguardian.com/environment/2017/sep/26/sixth-mass-extinction-of-wildlife-also-threatens-global-food-supplies

Revealed: Johnson & Johnson’s ‘irresponsible’ actions over vaginal mesh implant

Woman awarded record $57m damages over implant launched with no clinical trial and marketed despite higher failure rate

A vaginal mesh implant made by Johnson & Johnson (J&J) was launched without a clinical trial, and then marketed for five years after the company learned that it had a higher failure rate than their two earlier devices.

Internal company emails disclosed in a US court case, in which a 51-year-old woman was awarded a record $57m in damages this month, also show that senior executives even briefly considered suppressing unfavourable data that could compromise the future of the device.

J&Js Ethicon unit was found by a US court to be liable for the serious injuries Ella Ebaugh suffered after receiving a mesh implant to treat urinary incontinence. The mother of five said she was left with a mangled urethra, bladder spasms and continual pelvic pain after an unsuccessful procedure that led to three revision surgeries to remove mesh that had cut into her urethra and migrated to her bladder.

But documents submitted to the court show J&J staff had raised concerns about the spinning of data in emails and male executives are seen bantering about a suggestion that sex with an earlier patient with mesh complications must be like screwing a wire brush.

Ella
Ella Ebaugh, who was awarded $57m after a court ruled that Johnson & Johnsons Ethicon unit were liable for the serious injuries she suffered. Photograph: CBS

When it emerged from initial data that the success rates for a new device looked to be way below those seen for previous products, Ethicons director of sales, Xavier Buchon, suggested in an email stop[ping] for a while such publications that could compromise the future.

The J&J implant, used to treat urinary incontinence, was launched in 2006. Despite the early indications of a high failure rate, it was only withdrawn in 2012 after being used in thousands of operations in the US, the UK and Australia. The documents raise uncomfortable questions for the manufacturers of vaginal mesh products, which are the subject of growing controversy.

The implants, which reinforce tissue around the urethra, are widely used to treat incontinence, and for the majority of women the procedure is quick and successful. However, some women have suffered debilitating complications, including severe pelvic pain, the mesh eroding through the vaginal wall or perforating organs.

Class action law suits are underway in Australia and the US, where lawyers claim that patients have been exposed to unacceptable risks; in England, NHS data suggests as many as one in fifteen women later requires full or partial removal of the implant.

Vaginal mesh implant

Ebaugh, whose case was heard in Philadelphia, said that her complications have left her with constant pelvic pain, meaning for example, that although she attended her daughters recent wedding, she was unable to enjoy it. I feel like Im on fire down there, she said in an interview with CBS.

The tranche of documents, revealed during the trial, places a spotlight on tensions between Ethicons commercial and clinical divisions at the time it launched its miniature mesh product, called the TVT-Secur, in 2006.

The company hoped that the new device, which was smaller and required fewer incisions, would reduce complications seen with its earlier devices. But getting to market ahead competitors, who had similar offerings in the pipeline, was described as priceless in company documents. It was approved for use without a trial under US and European equivalence rules, which allow this when a new device is similar to existing ones.

Carl Heneghan, professor of evidence-based medicine at the University of Oxford who has called for a public inquiry into the use of mesh, condemned the decision to launch a device before a trial, saying this had led to direct patient harms. It has made it impossible to provide informed choice to women, and points to a regulatory system that is failing patients, he added.

Prof Bernard Jacquetin, an eminent French gynaecologist whose early study on TVT-Secur had led to misgivings among J&J management, told the Guardian the company had acted irresponsibly by launching the device without adaquate evidence.

Ahead of the devices original launch, Jacquetin was invited to the US to give advice on the new design, but was taken aback when he was presented with a boxed-up product ready for release. Jacquetin and colleagues later carried out a study in 40 patients, which found success rates of 77% two months after surgery, compared to the roughly 85-90% success rate commonly reported for Ethicons original TVT mesh device.

On learning that Jacquetins results did not look promising (though not referring to the eventual 77% figure), marketing manager, Fabrice Degeneve emailed his superiors to ask: How should we handle this without compromising the use of this new technique?

Ethicons director of sales, Xavier Buchon, replied: This is for sure a big concern, before suggesting withholding results while the company reviewed the patients to be included in the analysis. No way to hide the truth but to make sure it has been done correctly in terms of procedure and inclusion, he added.

In the event, the findings were presented at a major international conference and Jacquetin said he never felt pressure to bury unfavourable results. But he adds: I was really disappointed. I told many people at Ethicon it was not [a good device].

In 2012, TVT-Secur was withdrawn from the market, along with three other mesh products. J&J declined to provide exact figures on how many women had received the implants.

In other emails, J&J staff complain of colleagues constantly spinning data and of a dangerous blurring of the lines between commercial and research divisions. I am continually amazed and surprised at our need to push back, wrote Judi Gauld, Ethicons former clinical director in Scotland.

Other emails show a blas attitude to distressing complications. In one, dated from 2003, a surgeon sought advice on treating a patient with a 2cm stretch of mesh poking through her vaginal wall. Sex is like screwing a wire brush according to her spouse, the doctor wrote. Martin Weisberg, Ethicons medical director, replied: Ive never tried the wire brush thing so I wont comment.

Following the trial, Ebaughs lawyer, Kila Baldwin, said in a statement: I am pleased the jury recognised the recklessness of J&J and I hope the company takes notice of the verdict and adjusts its practices accordingly.

Johnson & Johnson said they plan to appeal the verdict. In a statement, the company said: We believe the evidence in the Ebaugh trial showed Ethicons TVT and TVT-Secur devices were properly designed, Ethicon acted appropriately and responsibly in the research, development and marketing of the products, and the products were not the cause of the plaintiffs continuing medical problems.

Over two and a half million documents have been provided to plaintiff attorneys by Ethicon as part of the pelvic mesh litigation in the United States, and selective disclosure of certain sentences or documents without proper context can be extremely misleading.

Read more: https://www.theguardian.com/society/2017/sep/29/revealed-johnson-johnsons-irresponsible-actions-over-vaginal-mesh-implant

Poor diet is a factor in one in five deaths, global disease study reveals

Study compiling data from every country finds people are living longer but millions are eating wrong foods for their health

Poor diet is a factor in one in five deaths around the world, according to the most comprehensive study ever carried out on the subject.

Millions of people are eating the wrong sorts of food for good health. Eating a diet that is low in whole grains, fruit, nuts and seeds and fish oils and high in salt raises the risk of an early death, according to the huge and ongoing study Global Burden of Disease.

The study, based at the Institute of Health Metrics and Evaluation at the University of Washington, compiles data from every country in the world and makes informed estimates where there are gaps. Five papers on life expectancy and the causes and risk factors of death and ill health have been published by the Lancet medical journal.

It finds that people are living longer. Life expectancy in 2016 worldwide was 75.3 years for women and 69.8 for men. Japan has the highest life expectancy at 84 years and the Central African Republic has the lowest at just over 50. In the UK, life expectancy for a man born in 2016 is 79, and for a woman 82.9.

Diet is the second highest risk factor for early death after smoking. Other high risks are high blood glucose which can lead to diabetes, high blood pressure, high body mass index (BMI) which is a measure of obesity, and high total cholesterol. All of these can be related to eating the wrong foods, although there are also other causes.

causes of death graphic

This is really large, Dr Christopher Murray, IHMEs director, told the Guardian. It is amongst the really big problems in the world. It is a cluster that is getting worse. While obesity gets attention, he was not sure policymakers were as focused on the area of diet and health as they needed to be. That constellation is a really, really big challenge for health and health systems, he said.

The problem is often seen as the spread of western diets, taking over from traditional foods in the developing world. But it is not that simple, says Murray. Take fruit. It has lots of health benefits but only very wealthy people eat a lot of fruit, with some exceptions.

Sugary drinks are harmful to health but eating a lot of red meat, the study finds, is not as big a risk to health as failing to eat whole grains. We need to look really carefully at what are the healthy compounds in diets that provide protection, he said.

undernourishment graphic

Prof John Newton, director of health improvement at Public Health England, said the studies show how quickly diet and obesity-related disease is spreading around the world. I dont think people realise how quickly the focus is shifting towards non-communicable disease [such as cancer, heart disease and stroke] and diseases that come with development, in particular related to poor diet. The numbers are quite shocking in my view, he said.

The UK tracks childhood obesity through the school measurement programme and has brought in measures to try to tackle it. But no country in the world has been able to solve the problem and it is a concern that we really need to think about tackling globally, he said.

Today, 72% of deaths are from non-communicable diseases for which obesity and diet are among the risk factors, with ischaemic heart disease as the leading cause worldwide of early deaths, including in the UK. Lung cancer, stroke, lung disease (chronic obstructive pulmonary disorder) and Alzheimers are the other main causes in the UK.

The success story is children under five. In 2016, for the first time in modern history, fewer than 5 million children under five died in one year a significant fall compared with 1990, when 11 million died. Increased education for women, less poverty, having fewer children, vaccinations, anti-malaria bed-nets, improved water and sanitation are among the changes in low-income countries that have brought the death rate down, thanks to development aid.

People are living longer but spending more years in ill health. Obesity is one of the major reasons. More than a billion people worldwide are living with mental health and substance misuse disorders. Depression features in the top 10 causes of ill health in all but four countries.

Our findings indicate people are living longer and, over the past decade, we identified substantial progress in driving down death rates from some of the worlds most pernicious diseases and conditions, such as under age-five mortality and malaria, said Murray Yet, despite this progress, we are facing a triad of trouble holding back many nations and communities obesity, conflict, and mental illness, including substance use disorders.

In the UK, the concern is particularly about the increase in ill-health that prevents people from working or having a fulfilling life, said Newton. A man in the UK born in 2016 can expect only 69 years in good health and a woman 71 years.

This is yet another reminder that while were living longer, much of that extra time is spent in ill-health. It underlines the importance of preventing the conditions that keep people out of work and put their long term health in jeopardy, like musculoskeletal problems, poor hearing and mental ill health. Our priority is to help people, including during the crucial early years of life and in middle age, to give them the best chance of a long and healthy later life, he said.

Read more: https://www.theguardian.com/society/2017/sep/14/poor-diet-is-a-factor-in-one-in-five-deaths-global-disease-study-reveals

Fran works six days a week in fast food, and yet she’s homeless: ‘It’s economic slavery’

Fran Marion and Bridget Hughes are leading voices in Stand Up Kansas City, part of the Fight for $15 movement that aims raise the minimum wage across the US

Once a customer has barked their order into the microphone at the Popeyes drive-thru on Prospect Avenue, Kansas City, the clock starts. Staff have a company-mandated 180 seconds to take the order, cook the order, bag the order and deliver it to the drive-thru window.

The restaurant is on short shift at the moment, which means it has about half the usual staff, so Fran Marion often has to do all those jobs herself. On the day we met, she estimates she processed 187 orders roughly one every two minutes. Those orders grossed about $950 for the company. Marion went home with $76.

Despite working six days a week, Marion, 37, a single mother of two, cant make ends meet on the $9.50 an hour she gets at Popeyes (no apostrophe founder Al Copeland joked he was too poor to afford one). A fast food worker for 22 years, Marion has almost always had a second job. Until recently, she had been working 9am-4pm at Popeyes, without a break, then crossing town to a janitorial job at Bartle Hall, the convention center, where she would work from 5pm- to 1.30am for $11 an hour. She didnt take breaks there either, although they were allowed.

Read more: https://www.theguardian.com/us-news/2017/aug/21/missouri-fast-food-workers-better-pay-popeyes-economics