The fields grow shoulder-high with weeds out the window of Bob Fitzgerald’s Ford pickup. The drive through Fitzgerald’s neighborhood in Princess Anne, Maryland, is a tour of dying forests and abandoned cropland.

“A few years ago, all of this was a good farm,” he said. “And it’s gone, as a farm.”

The land along the shores of the Chesapeake Bay has been sinking for centuries. But climate change is adding a second whammy. As the sea level rises, salt water is seeping into the water table, deeper and deeper inland. The ground is becoming too salty for crops to grow. 

Maryland’s Eastern Shore is home to some of the oldest farms in America. Fitzgerald’s dates back to 1666. He’s seen big changes in his lifetime.

“You just can’t believe how it’s taking things over in the last 15 or 20 years,” Fitzgerald said. “I can show you land around here that people raised tomatoes on when I was a little boy. And now it’s gone.”

Around the world, scientists warn that coastal farms are under threat from rising seas and encroaching salt water. A World Bank report estimates rice yields in coastal areas of Bangladesh may fall by more than 15 percent by 2050. Another report found that hundreds of millions of people will likely be displaced by rising waters.

Kate Tully aims to help keep Eastern Shore farmers in business as the seas rise. 

The University of Maryland agroecologist had seen the “ghost forests” of dying pine trees killed by the increasingly salty soil. When she started looking at maps, she said, “I realized that a lot of the land that was upslope wasn’t just forests, it was farms. And so I started poking around and talking to people and asking if this was an issue on farms.”

It was. But “a lot of people hadn’t really been talking about it” outside their own communities, she said. 

With a new $1.1 million research grant from the U.S. Department of Agriculture, Tully and her colleagues are aiming to give farmers options.

Test plots scattered around the Eastern Shore are trying out different crops.

“One thing that I’m very pleasantly surprised about is how well the sorghum does,” Tully said. The grain crop may be a good choice to feed the roughly 600 million chickens raised in the region each year. It’s a hardy crop that can handle salt, drought and heavy rains.

Tully’s group is also testing barley to supply the growing microbrew industry; the oilseed canola; switchgrass, a possible biofuel crop; and salt-tolerant soybeans. 

Just being able to grow a crop isn’t enough, though. It also has to be profitable. An economist on the team will be running the numbers.

“I never want to recommend something that would make farmers go out of business,” Tully said.

But farming the land may not be the best option. Another choice is to give in to nature and turn fields into wetlands. 

Wetlands attract waterfowl. Waterfowl attract hunters.

“There’s money in duck hunting,” Tully said. Hunting clubs will pay farmers for exclusive access to wetlands on their property. “It can be a lucrative pathway.”

Tully and her colleagues are just getting started. It will be a few years before they have recommendations for what will sustain communities that have been farming this land for centuries. 

“There’s a lot of history there. And as these seas rise, some of that history is going underwater,” Tully said. “And I find that to be a pretty moving, pretty motivating reason to try to figure out what we can do for these farmers.”
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As climate change raises sea levels, salty ocean water is pushing its way inland. That’s ruining valuable farmland around the world. On Maryland’s Eastern Shore, once-productive fields are succumbing to the saline waters. So researchers are looking for ways to keep farmers in business as the land changes. VOA’s Steve Baragona has more.
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Insurance shoppers likely will have several choices for individual health coverage this fall. The bad news? There’s no guarantee they will cover certain doctors or prescriptions.

Health insurers have stopped fleeing the Affordable Care Act’s marketplaces and they’ve toned down premium hikes that gouged consumers in recent years. Some are even dropping prices for 2019. But the market will still be far from ideal for many customers when open enrollment starts Thursday.

Much of the insurance left on the marketplaces limits patients to narrow networks of hospitals or doctors and provides no coverage outside those networks.

Plus these plans can still be unaffordable for people who don’t receive help from the ACA’s income-based tax credits, and they often require patients to pay several thousand dollars toward their care before most coverage starts.

“People understand that things are kind of screwed up,” said Chicago-area broker Robert Slayton. “My objective is to give them what reality is, to give them options. Their job is to choose what may work.”

The ACA expanded coverage to millions of Americans when it established state-based marketplaces where people can buy a plan if they don’t get insurance through work or qualify for government programs like Medicaid. But the expansion has been rough.

Several insurers pulled back from these markets after being swamped with higher-than-expected costs. Many that remained jacked up prices or started limiting the hospitals and doctors included in their coverage networks.

Those narrow networks give insurers leverage to negotiate better rates that can lead to lower coverage prices, and the consulting firm McKinsey & Co. has found that the quality of their hospitals is comparable to broader networks.

Plans with narrow networks will cover necessary specialists like cardiologists, but they often exclude out-of-state care providers or academic medical centers, which tend to be more expensive.

They can pose problems for patients who have more than one physician or want to keep a doctor covered under a previous plan.

Jodi Smith Lemacks is nervous about changing or losing her job because that could mean cutting off her 15-year-old son Joshua from heart specialists he’s seen his entire life. The Richmond, Virginia, resident said she looked last year for options on the ACA’s marketplace to trim the coverage bill she pays through work.

She didn’t find any plans that would cover his current doctors, including some at the Children’s Hospital of Philadelphia, who treat his congenital heart disease.

“The issue with kids like Joshua is, it really matters, it’s life or death where you go,” she said.

Plans with some form of a limited network made up more than half of the choices offered for 2017 on the ACA’s marketplaces, according to the latest numbers from McKinsey. That coverage was particularly common in the price range where most consumers shop, which is within 10 percent of the lowest-priced plan.

These plans grew more common from 2014 to 2017, especially in cities where insurers could choose between competing hospital networks. But that trend has since stabilized, said McKinsey’s Jim Oatman.

Even so, brokers aren’t expecting narrow networks to go away. In some markets like St. Louis, they were the only option shoppers had among 10 plan choices for this year.

The narrow networks are grouped by hospital systems, and broker Kelly Rector has several customers who see doctors in different systems. She advises them to pick their coverage based on which doctor is most important and drop the others for in-network options.

Plans with narrow networks can make it harder to simply get to the doctor, especially if it’s a specialist.

Wichita Falls, Texas, residents with individual coverage have to drive nearly two hours to see an in-network neurologist, insurance agent Kelly Fristoe said. That can be stunning to customers who buy an individual plan after having coverage through work, which tends to come with wider networks.

“They don’t like it,” Fristoe said. “They’re forced to make a change, and they have to go establish themselves with a new specialist.”

Debbie Dean lives 15 minutes from a suburban Chicago hospital, but she’ll have to travel about an hour to an in-network location if she wants surgery on her injured shoulder. Dean couldn’t find affordable coverage that included the nearby hospital when she bought her 2018 plan.

Instead, she settled on insurance that comes with a $6,000 annual deductible she has to pay before most coverage starts. That, plus the travel distance, keeps her from seeking help.

“I’m grateful that I have coverage, but it’s really cruddy coverage,” she said. “I sit here with my shoulder killing me every day.”

Narrow-network plans with their lower prices can be good for shoppers who aren’t tied to a doctor and just want protection from big medical bills, said Paul Rooney, a vice president with the online insurance broker eHealth.

“They’re younger and they’re healthier and they’re thinking, ‘I’m going to get this coverage in case I hurt my knee playing basketball,’” he said.

But it can be tough for consumers when shopping to know if there’s a decent selection of doctors nearby until they need one.

People who “have the most to lose from having a narrow-network plan are those who have something unexpected happen to them,” said Daniel Polsky, a University of Pennsylvania economist.
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Children in eastern Democratic Republic of Congo are dying from Ebola at an unprecedented rate due largely to poor sanitary practices at clinics run by traditional healers, the health ministry said on Sunday.

The impact on children has been felt acutely in the city of Beni, which has emerged as the outbreak’s new epicenter. Of 120 confirmed Ebola cases in Beni, at least 30 are under 10-years-old, and 27 of them have died, according to health ministry data.

Many children affected by an unrelated malaria outbreak near Beni are thought to have contracted Ebola at clinics run by traditional healers who have also treated Ebola patients, said Jessica Ilunga, a spokeswoman for the health ministry.

“There is an abnormally high number of children who have contracted and died of Ebola in Beni. Normally, in every Ebola epidemic, children are not as affected,” Ilunga told Reuters.

“Traditional healers use the same tools to treat everyone. And the child who has entered a traditional healer’s clinic with malaria comes out with Ebola and dies several days later,” she said.

The rate of new cases in eastern Congo has accelerated in recent weeks. An emergency World Health Organization committee said earlier this month that the outbreak was likely to worsen significantly unless the response was stepped up.

The health ministry reported nine new confirmed cases late on Saturday — seven in Beni and two in the city of Butembo — the biggest one-day day jump since the outbreak was declared on Aug. 1.

The hemorrhagic fever is believed to have killed 168 people and infected another 98 in North Kivu and Ituri provinces, where attacks by armed groups and community resistance to health officials have complicated the response.

Congo has suffered 10 Ebola outbreaks since the virus was discovered near its eponymous Ebola River in 1976. The current one now ranks third in terms of number of confirmed cases.

 
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The Ebola outbreak in eastern Democratic Republic of the Congo has led to 164 deaths, health authorities said. 

In mid-October, Congolese authorities said they were facing a “second wave” of the outbreak centered on Beni, a town in North Kivu near the border with Uganda. 

The epicenter had earlier been focused on Mangina, a town about 20 kilometers (12 miles) from Beni. 

In total, 257 cases had been recorded in the region, of which 222 were confirmed and 35 were probable, since the start of the outbreak at the beginning of August, the Congolese Health Ministry said in a bulletin dated Friday. 

On Oct. 17, the World Health Organization said the death toll was 139, although it said the outbreak did not yet merit being labeled a global health emergency. 

The second wave of the deadly virus has been attributed to community resistance to measures already taken to tackle the disease. 

On Thursday, about 1,000 students marched through the streets of Beni to launch a campaign to fight Ebola. 

Since a vaccination program began on Aug. 8, over 22,000 people have been inoculated, of whom about 11,000 were in Beni, the health ministry said. 

An Ebola treatment center in the city now has more than 60 beds, it added. 

The latest outbreak is the 10th in DRC since Ebola was first detected there in 1976. 
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When she was a young girl, Edna Adan Ismail’s mother and grandmother circumcised her in a traditional ceremony while her father, a doctor, was away.

That evening, he returned home, enraged at what had happened. “What have you done?” he asked Ismail’s mother and grandmother. Cutting the young girl, he said, was “haraam” — a sin.

She was only seven or eight, but Ismail knew what had happened was wrong. The event, and her father’s reaction, would have a lasting impact.

Medical trailblazer

Years later, Ismail followed in her father’s footsteps, pursuing a career in medicine. She studied abroad and became a pioneer in health care in Somaliland, an autonomous region of Somalia.

In 1965, the World Health Organization made Ismail the first Somali appointed to a senior civil servant position. She spent decades with the organization working in Somalia, Somaliland and Djibouti, and caring for patients from across the Horn of Africa, many of whom were refugees.

In 1976, Ismail attended a health conference in Sudan that changed her next steps. Ismail, then a director in Somaliland’s Ministry of Health, had traveled with a team of doctors to learn about developments in the field.

At the conference, Ismail heard, for the first time, people in a Muslim country openly discuss the harm caused by female circumcision, also called female genital mutilation, or FGM.

For Ismail, the discussions were a revelation. Back home, talking about FGM, let alone its harms, was taboo.

But Ismail knew there was another way. In England, where Ismail studied and practiced medicine, women weren’t subjected to FGM, and they gave birth with few complications.

But Ismail didn’t believe the practice could be stopped in Somaliland, where she had returned in 1961 as the country’s first qualified nurse and midwife.

“I saw the difficulties, and the tears, and the lacerations, and the fistulas,” Ismail said. “This created in me this anger about this damage.”

Ismail knew the practice was wrong. But she couldn’t break through the silence.

That changed after the Sudan conference, where doctors, nurses and midwives discussed the physical and psychological toll of the traditional practice. They shared steps that health care workers could take to lessen suffering. They made FGM defeatable.

Ismail knew she could do more. She returned home and co-founded a group to eradicate the procedure. She also began speaking up.

“I was the first person who publicly spoke about the harmful effects of female circumcision,” Ismail told VOA in a recent studio interview in Washington. The practice, she added, “is the most harmful thing that can happen to a girl.”

‘Little girls are still being cut’

Ismail retired in 1997 and built a hospital a year later in Hargeisa, Somaliland, with her personal savings. The facility opened in 2002. “It was a natural thing to do,” Ismail said.

Doctors and nurses at the facility, also a teaching hospital, treat patients from Somaliland, Somalia and Ethiopia. As a center for learning and caring, the hospital is “a symbol of what we need to do in our countries,” Ismail said. “I’m so privileged and so happy that I could also influence so many others and be an example for others to come back,” she added.

After retirement, Ismail contributed in other ways. In 2003, she became Somaliland’s foreign minister, a post she held until 2006. Now in her 80s, Ismail continues to direct the hospital.

But she knows there’s work left to do. “Little girls are still being cut,” she said.

Often, it’s women — mothers, grandmothers, aunts — directly responsible for FGM, which 200 million women and girls alive today have experienced, the World Health Organization estimates.

But men have a vital role to play in stopping the practice. “Fathers must come into it,” Ismail said, “the same way my father objected.”

Legal mechanisms must also be used, Ismail said. Countries where FGM rates remain high have, in some cases, passed laws banning at least the most severe forms of the procedure, but enforcement is key.

Fathers should be taken to court if their daughters are harmed, Ismail said, forcing all parts of society to face the issue. “It’s a battle that needs to be fought by both men and women — and communities and governments — together.”

At her own hospital, Ismail has seen progress. In 2002, 98 percent of the women who delivered babies had experienced FGM. That number had fallen to 76 percent several years later.

But Ismail isn’t satisfied. “Zero percent is what we want,” she said.
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A group of Chilean youths with Down syndrome are gaining important life skills as they learn to plant, grow and sell their own fresh vegetables, and create delicious marmalades and preserves, which they sell for profit. VOA’s Julie Taboh has more.
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It may surprise you that cement is responsible for 7 percent of the world’s carbon emissions. That’s because it takes a lot of heat to produce the basic powdery base of cement that eventually becomes concrete. But it turns out that simple fibers from carrots could not only reduce that carbon footprint but also make concrete stronger. VOA’s Kevin Enochs reports.
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