:00:00. > :00:00.headlines. That is it from me. Here on BBC, it is time the health
:00:00. > :00:21.check. Dr Ayan Panja gives you the best of the month's health stories.
:00:22. > :00:30.Hello and welcome to health check. Your monthly dose of health
:00:31. > :00:35.stories. This month we're looking at health on the move. Coming up.
:00:36. > :00:40.Getting people moving by keeping prosthetics free in Cambodia. How
:00:41. > :00:45.social mobility in Brazil is changing the face of healthcare.
:00:46. > :00:51.Going evidence for a new ways to prevent the spread of HIV in Kenny.
:00:52. > :00:57.And a novel way opening healthcare closer to those who need it in
:00:58. > :01:03.Bangladesh. First two-day to a disease on the move. It is estimated
:01:04. > :01:06.that 37 million people around the world I hate to be positive. While
:01:07. > :01:11.drugs can keep the virus to a minimum in the body, once somebody
:01:12. > :01:17.is infected, the disease will beware them for life. Testing and condom
:01:18. > :01:20.use can help stop the spread of the disease. Now there is growing
:01:21. > :01:29.evidence for another way of doing it. There are over a quarter of a
:01:30. > :01:38.million couples in Kenny where only one partner is positive and the
:01:39. > :01:43.other is negative. -- Kenya. A new generation of drugs that can block
:01:44. > :01:55.HIV transmission has recently been trialled. This man is HIV positive
:01:56. > :02:01.and lives with her HIV-negative partner John. Throughout the trial
:02:02. > :02:08.John took the drugs which act as a barrier to the disease. And I find
:02:09. > :02:21.out that I was HIV-positive in the year 2007. Being in a situation like
:02:22. > :02:32.that we'll partner is HIV positive, sometimes many people would find it
:02:33. > :02:39.ethical. -- difficult. A condom is sometimes cumbersome to use
:02:40. > :02:44.throughout your life. So if there was another solution, maybe like the
:02:45. > :02:51.one we are looking for with the drug. So how does it work Australia
:02:52. > :02:54.what's inside your body the virus represented by the red sweets height
:02:55. > :03:02.in inaccessible areas around the body creating reservoirs meaning
:03:03. > :03:07.never be flushed out. The drugs represented by the blue sweet attack
:03:08. > :03:11.the virus. Research shows that if a non- infective dose and has a drugs
:03:12. > :03:17.when the virus enters the system it gets killed. This means it does not
:03:18. > :03:23.have a chance to hide in reservoirs. To that person does not get
:03:24. > :03:26.infected. The team behind the trial monitor the couple's progress
:03:27. > :03:33.topping together with a number of other case studies. It was one of
:03:34. > :03:36.many studies. It was conducted in Uganda and we were very excited
:03:37. > :03:42.about our results. In that study we were able to demonstrate a 75% load
:03:43. > :03:46.of risk of acquiring HIV amongst those who took the drug compared to
:03:47. > :03:51.those who did not take the drug. This year the pharmacy board
:03:52. > :04:03.approved the use of the drug full three -- preexposure. We're hoping
:04:04. > :04:08.that the next step will be the government taking it up. The couples
:04:09. > :04:18.achievement of such attempts offer a ray of hope for living healthier
:04:19. > :04:25.lives. That was Michael reporting from Kenya on the partner's prep
:04:26. > :04:28.study. It looked at a study where one person was infected and the
:04:29. > :04:32.other person was not. Another study in the UK is looking at whether prep
:04:33. > :04:40.might work in a different community for people who are at a higher risk
:04:41. > :04:47.of contracting HIV. Could you tell us a bit about the background to
:04:48. > :04:52.your study? We looked to recruit with men who has sex with men and
:04:53. > :04:55.transgender women and followed them in a way that is as close to our
:04:56. > :04:58.real world as possible. We're looking at people who were not using
:04:59. > :05:05.condoms at least some of the time. At half of the artist spends were
:05:06. > :05:11.allocated not to start at four a year. That is how we started a prep
:05:12. > :05:17.versus no prep scenario. It was like a real-world study if this was
:05:18. > :05:21.actually happening. There were two groups who start immediately and one
:05:22. > :05:27.who was delayed after a year. What did you find? We found that it was
:05:28. > :05:30.true that our participants were very motivated to take their prep if they
:05:31. > :05:36.had it straightaway. What was found there was most shocking with those
:05:37. > :05:42.who did not have prep, how the rate of new infections was. And those who
:05:43. > :05:48.were taking prep, we saw an 86% reduction. That is profound and we
:05:49. > :05:55.would expect that to make a very big impact on our epidemic if it was
:05:56. > :05:58.rolled out more widely. And quite striking, very impressive results,
:05:59. > :06:05.as a public health Doctor, how do you keep the prevention message
:06:06. > :06:12.going because surely that is the most important thing? Absolutely.
:06:13. > :06:17.You have to really dig in to why people put themselves at risk.
:06:18. > :06:24.Change it takes time. It will only happen if the person wanted to
:06:25. > :06:28.happen. At least this is a way to engage people and hope they have
:06:29. > :06:37.access to that support. Thank you for joining us and it is absolutely
:06:38. > :06:39.fascinating. A -- HIV is an infectious disease and can spread
:06:40. > :06:44.very quickly impacting a large number of people very shortly in
:06:45. > :06:51.time. It is important to pin down where they begin. Sometimes, a
:06:52. > :06:56.little helpers needed. -- a little help is. Enter the disease
:06:57. > :07:02.detectives. Like the investigators of the scene of the crime they begin
:07:03. > :07:05.I looking at clue. They look at what is causing the illness and see how
:07:06. > :07:10.it is transmitted. Many funky travel through the air. Bacteria often
:07:11. > :07:21.relying on water. Some viruses need more intimate contact. They also
:07:22. > :07:26.Kerkow infectious diseases. A very infectious disease like measles can
:07:27. > :07:37.have a founder of up to 18. That hate IT is lower with a number of
:07:38. > :07:42.around two. -- but HIV. Detectives find out where patients had to track
:07:43. > :07:45.the source. This is not as always as simple as it sounds. Weather
:07:46. > :07:50.patterns are changing the way that illness spreads and increase travel
:07:51. > :07:55.means it can spread quickly around the world. Despite these challenges,
:07:56. > :08:02.disease detectives are often successful. American detectives
:08:03. > :08:12.found that a frog breeding ground was response will first am another
:08:13. > :08:15.outbreak five years ago. Infectious diseases can cause serious
:08:16. > :08:19.disability and even death. As countries get richer, the number of
:08:20. > :08:25.people with these illnesses tend to fall. In countries like Brazil,
:08:26. > :08:36.social mobility and changing habits bring other diseases instead, such
:08:37. > :08:40.as diabetes. This family have benefited from was ill's rise to be
:08:41. > :08:43.a leading global colony. Like 40 million other Brazilians they have
:08:44. > :08:51.left poverty behind and entered the middle class. -- economy. They are
:08:52. > :08:57.warning that the changes are leading to new health problems TRANSLATION:
:08:58. > :09:03.My dad used to swim in the river and play football when he was a child.
:09:04. > :09:11.We still use to go outside and ride bikes. Today it is all about the
:09:12. > :09:15.TV, mobile phones and social media. I encourage my son to go outside
:09:16. > :09:22.when I realise he has been in front of the TV too long. He gets a far
:09:23. > :09:26.better start in life but easy access to fact and sugary foods is pushing
:09:27. > :09:30.up obesity rates and not just in young people. The senior citizens
:09:31. > :09:37.are also starting to be affected wide the conditions that their
:09:38. > :09:41.ancestors never worried about. I went to the doctors for some routine
:09:42. > :09:46.tests and they found that I had type 2 diabetes. Now I have to take
:09:47. > :09:51.tablets and my diet has changed tragically. I had to eat less and
:09:52. > :10:07.restrict sweeping. I'm also doing more exercise. 40 million adults
:10:08. > :10:11.have diabetes here. It has managed to lift many people into the middle
:10:12. > :10:14.classes. That has come at a price and now Brazil's doctors and nurses
:10:15. > :10:21.are treating more people with first world issues. Diabetes and heart
:10:22. > :10:25.issues at the top of the list. This doctor is a specialist in chronic
:10:26. > :10:30.diseases and is trying to change his patients over the past few years.
:10:31. > :10:37.You think that changes the lifestyle of the people. We became more
:10:38. > :10:42.sedentary and began to eat worse. The consequences of this is an
:10:43. > :10:47.increasing number of diseases such as diabetes, high blood pressure,
:10:48. > :10:52.high cholesterol and the consequences of these diseases, such
:10:53. > :10:58.as heart failure, kidney failure and arthritis. All of Brazil's
:10:59. > :11:02.generation has piled on the pounds but with nearly one in five adults
:11:03. > :11:09.are obese, some believe it could be the fattest nation in the world by
:11:10. > :11:15.2030. They've introduced lessons in how to improve their lifestyle. The
:11:16. > :11:21.grandmother has made pudding for the family. Doctors orders means that
:11:22. > :11:25.she is not having any. Family keeps an eye on her diet and make sure
:11:26. > :11:29.that she takes a medicine at the right time. But not everybody had
:11:30. > :11:42.this level of help so ending Brazil's love affair with fatty
:11:43. > :11:44.foods could prove tricky. The coastal cities of southern
:11:45. > :11:49.Bangladesh are mostly found on the banks of rivers that flow into the
:11:50. > :11:58.Bay of Bengal. Infrastructure is poor in the area is prone to
:11:59. > :12:04.disasters such as tidal surges. One charity is using a novel approach to
:12:05. > :12:10.bring healthcare to the region. This man lives in a remote region in
:12:11. > :12:16.southern Bangladesh. For a long time he has needed to see a doctor. I
:12:17. > :12:23.have become old and I cannot see things properly. I hope I will get
:12:24. > :12:28.well soon. I can see only with one eye and my other eye has lost its
:12:29. > :12:38.vision. I can't walk properly and cannot read anything. I can't even
:12:39. > :12:42.go to the mosque and offer prayers. In this rural area many live in the
:12:43. > :12:47.banks of rivers or low-lying coastal areas where there is few medical
:12:48. > :12:53.facilities. The rivers are the lifeblood of Bangladesh. But the
:12:54. > :12:57.rivers are not constant in their shifting all of the time. You cannot
:12:58. > :13:02.have a land hospital on the river banks, and yet, it is the people on
:13:03. > :13:07.the river banks who are the most hard to reach. To tackle this, her
:13:08. > :13:14.colleagues have turned to the water. They have transformed a
:13:15. > :13:19.former Greenpeace ship into a floating hospital to bring free
:13:20. > :13:25.healthcare to those in need. The river is going into the most from
:13:26. > :13:29.it, the poorest, the most unaddressed communities. Is on the
:13:30. > :13:34.roads do not go to. The objective of friendship is to reach the poorest
:13:35. > :13:38.of poor and the most hard to reach and the river is the best means or
:13:39. > :13:49.tools by which we can carry out to the people. Hence, hospital ships.
:13:50. > :13:55.They offer it right to the doorstep of these remote communities. They
:13:56. > :14:03.offer simple medicines to surgery. It is a fully equipped hospital and
:14:04. > :14:09.it has Doctor's rooms, paediatric, general doctors, dentistry, a fully
:14:10. > :14:13.equipped pathological centre, a Ward and where we have too many people,
:14:14. > :14:18.they are on the deck. The medical staff on the ship carry out
:14:19. > :14:26.countless procedures helping up to 45,000 people every year. Ago
:14:27. > :14:27.treatment is this man. Today that cataract in his right eye will be
:14:28. > :14:37.removed. A short time later his cataract is
:14:38. > :14:42.gone and his vision should improve soon. TRANSLATION: I am feeling good
:14:43. > :14:49.after the surgery. It was a smooth operation. I like this hospital. Now
:14:50. > :14:53.I think they will be able to regain my vision. It was unthinkable in my
:14:54. > :15:01.life. I feel like getting a second life. This ship can spend a few
:15:02. > :15:08.months in each location before moving on. Along with two other
:15:09. > :15:11.ships, this hospital will continue to use Bangladesh's waterways to
:15:12. > :15:15.improve the health of hard to reach communities.
:15:16. > :15:22.That was reported at an ingenious moving medical facility. -- a report
:15:23. > :15:25.about. You have been to one of these floating hospitals? There's another
:15:26. > :15:28.one in the north of Bangladesh that I went to and it was remarkable. We
:15:29. > :15:32.got there early in the morning and there were people camped out all
:15:33. > :15:37.along the banks, waiting to get onto the ship. You got onto it via a
:15:38. > :15:41.rather rickety gangway and then people were queueing up to have
:15:42. > :15:45.cataract operations, operations on their hands, children often fall
:15:46. > :15:49.into fires and if their hands have been burned and it hasn't been
:15:50. > :15:52.treated properly it curls up and they can't use them properly. At the
:15:53. > :15:57.cataract operations were really amazing. One little girl had her
:15:58. > :16:02.operation done and the next morning she was having the baggage taken off
:16:03. > :16:06.and we saw her see for the first time in her life. Unfortunately what
:16:07. > :16:11.she saw was me with a microphone, but she saw for the first time in
:16:12. > :16:16.her life. Amazing. Next to Cambodia, where people injured in landmines
:16:17. > :16:21.often need to use prosthetics to keep them on the move. Devote years
:16:22. > :16:25.ago a British charity set up a clinic to give artificial limbs to
:16:26. > :16:29.the people who need it the most. -- 35 years ago. But as the number of
:16:30. > :16:34.landmines have decreased, so has the funding, is another clinic has found
:16:35. > :16:40.a new way of raising its own funds. This man has had his pathetic leg
:16:41. > :16:44.for more years than he can remember. -- prosthetic leg. A soldier during
:16:45. > :16:48.the Civil War, he stepped on one of the millions of landmines that once
:16:49. > :16:52.deterred the countryside. TRANSLATION: It changed my life when
:16:53. > :16:57.I got the slim. I was able to walk again, to live my life and support
:16:58. > :17:03.my family. -- this limb. I am so grateful for getting this prosthetic
:17:04. > :17:09.leg and it has lasted a long time. The school in Cambodia provides this
:17:10. > :17:13.life changing limbs free of charge but times are changing. Cambodia
:17:14. > :17:16.still has a significant problems with landmines, but it is the longer
:17:17. > :17:22.the mine infested country it was what -- once was. The funding has
:17:23. > :17:27.decreased, threatening their ability to offer this free prosthetics. But,
:17:28. > :17:31.as a wealthier middle class and mergers, the school has set its
:17:32. > :17:37.sights on attracting a client ace who wants and wants to afford more
:17:38. > :17:40.than the standard was that equally. Offering these top of the range
:17:41. > :17:43.devices, for those clients who can afford them the school can still
:17:44. > :17:48.make its free prosthetics service available to those most in need. We
:17:49. > :17:53.have to find an innovative way to secure the funding and we explain to
:17:54. > :18:00.our client that we have this initiative, the private clinic, that
:18:01. > :18:04.we would be able to use the advanced technology and the profit from this
:18:05. > :18:11.clinic would be put back to the free care that we provide.
:18:12. > :18:15.This man lost his left leg in a motorbike accident almost ten years
:18:16. > :18:19.ago. But with money to pay for a state-of-the-art titanium
:18:20. > :18:24.prosthesis, he has come to this new clinic. TRANSLATION: I am very happy
:18:25. > :18:30.to be able to have a choice of prosthesis now in Cambodia. This new
:18:31. > :18:38.titanium limb is much better. It is much the poor -- it is much more
:18:39. > :18:43.renewable. Anti-Gaddafi, it is much easier to use. Demand for both their
:18:44. > :18:48.free pathetic and this top of the range models is decreasing. People
:18:49. > :18:53.trust us and the quality we are producing. The poor who can't afford
:18:54. > :18:59.to pay can still get the service for free. Income we generate from the
:19:00. > :19:05.patients who pay for it comes back to this charity work. The school
:19:06. > :19:10.also welcomes students, local and international, which provides a
:19:11. > :19:15.further vital source of income. With the money earned from training in
:19:16. > :19:18.new generation of doctors and with its new clinic allowing people to
:19:19. > :19:26.pay for premium artificial limbs, the Cambodian school of prosthetics
:19:27. > :19:33.and are -- templating to support people like this for many years to
:19:34. > :19:38.come. Prosthetics are expensive all around
:19:39. > :19:43.the world, not just in Cambodia. That means millions of people who
:19:44. > :19:46.need them can't afford them. Organisations are doing their best
:19:47. > :19:57.to make them cheaper and easier to access and I am joined now by the
:19:58. > :20:02.managing director of 3D Life Prints. How important is it to get
:20:03. > :20:07.people access to prosthetic limbs? We first have to work out how many
:20:08. > :20:12.people have lost limbs in the world. It could be up to 15 million
:20:13. > :20:16.people who have amputations or are in need of prosthetics. Of that
:20:17. > :20:20.number we believe two thirds are on or beneath the property loan. That's
:20:21. > :20:24.very important you think about what could rate cut cycle of poverty.
:20:25. > :20:29.Correct prosthetic, provided you one of those individuals, can break that
:20:30. > :20:32.cycle and bring them back to the world of employment, so they can
:20:33. > :20:36.support themselves and their family. What kind of prosthesis has
:20:37. > :20:42.3D Life Prints come up with? We designed our own lower arm
:20:43. > :20:48.prosthetic, which is a 3D-printed semi flexible plastic pathetic.
:20:49. > :20:52.Importantly, it is purely mechanical, so it has no electronic
:20:53. > :20:58.parts, it is cheap to manufacture and is very hard wearing. You have
:20:59. > :21:01.some examples? The point about this, it is functional, so you can grasp
:21:02. > :21:09.with it, pick things up, hold things with it. What have we got here? A
:21:10. > :21:13.leak prosthesis? -- leg. You don't 3D-printed because of the stresses
:21:14. > :21:15.involved, what we work in partnership with a company that
:21:16. > :21:21.supplied lower limb extremity prosthetics. What we do is we print
:21:22. > :21:29.a cosmetic cover to those, so that the previously ugly limb looks more
:21:30. > :21:36.socially acceptable and we match the cover to the patient's skintone and
:21:37. > :21:39.shape. What are the benefits of 3D printing in a developing country?
:21:40. > :21:43.Specifically, you can create something that the spoke and in
:21:44. > :21:47.country. So rather than sitting in the Western world and sending stuff
:21:48. > :21:51.out there that would work, we can be on the ground in the country,
:21:52. > :21:53.finding out ways to solve these problems and carry out the
:21:54. > :21:57.operations there and then. We wish you the best of luck with the rest
:21:58. > :22:01.of your project. Thank you for joining us.
:22:02. > :22:08.Sadly that's all we've got time for this month. If you want more on
:22:09. > :22:13.health you will find it on BBC World News every Wednesday and Saturday
:22:14. > :22:16.and don't forget you can catch Claudia's radio programme on the BBC
:22:17. > :22:20.World Service. And you can follow up on these programmes online. If
:22:21. > :22:23.you've got any comments or ideas, do e-mail us at:
:22:24. > :22:30.for now, goodbye from us and the rest of the Health Check team.
:22:31. > :22:46.Goodbye! Across the Atlantic,
:22:47. > :22:50.in the north-east of the US, the