american sha, kerry richardson will not be competing in 100 meters and the total impacts. also sending drugs, test. richardson tested positive for cannabis at the us olympic trials last month and has been 100 a one month suspension. the ban is backdated, meaning her qualifying was out for 100 meters has been wiped out. so she'll miss that event but could still be selected for real events at the gains. richardson says she used marijuana as a way of coping with the death of her biological mother, and has apologized to her fans. ah, hi there. this is al jazeera and these are the headlines. indonesia has improved additional current of ice restrictions in the capital casa, across the main islands of java, and the tourists have the bali, as you can see here, the streets of downtown, she goes to raul, the quieter than usual. right now. the highly infectious delta variance is driving record numbers of death in cases. jessica washington has

a nice us from the indonesian capital. i'm in the dakota city center and the city is uncharacteristically quiet. as these restrictions take effect and they will be in place until at least the 20th of july, but authorities warned that they may be extended if the situation does not improve to some of these restrictions include 100 percent work from home policy for non essential sectors the closure of move restaurant galleries and all the public sites as well as road closures and limits on who can travel. passengers now have to show a vaccination card before they can travel domestically. when they bring malaysia is also tightening pandemic restrictions and applies to quite a long war and some surrounding areas. the country is under a national lockdown and reported more than $6000.00 new cases on friday. meanwhile, new job data from the u. s. shows a major increase in the number of people going back to work. 850000 jobs were added

in june, better than many analysts were expecting. the u. s. economy has been searching since the start of this year. the united nation says 400000 people in ethiopia are suffering famine and 1800000 more are facing starvation and warns the government and crime rebel fighters to obey a sci fi to stop the humanitarian crisis from getting was if you, if you government declared a hold to military operations this week, right before the a major bridge and t guy was destroyed, cutting off a crucial aid suppliers. the us military has told us about kinda sounds a bug room at the epicenter of its water, top of the taliban, and hunt down. i'll kinda after the $911.00 attacks afghan forces now control the base us president joe biden has set september deadline for a full withdrawal and says that paul out is on track. well, those are the headlines. i'll be back with more here, off the talk to al jazeera and stay with us. there's a wave of sentiment around the world. you will actually want accountability from

the people who are running their countries. and i think often people's voice is not heard because it's not part of the mainstream news narrative. obviously we cover the big stories and report on the big events going on. but we also tell a story that people generally don't have a voice. i'm in one of the child that never be afraid to hand up knock a question and i think that's what they were when he does the all the questions for people who should be accountable. and also we get people to give them view of what's going on. the death for many is something to be feared. while for others, it's simply a part of life. but regardless of how we perceive it, if something inevitable, more than 50000000 people die every year from natural causes or different medical conditions. and the covert, 900 pandemic has pushed the numbers even further. its estimated to 2020 ended with

the deaths of nearly 60000000 people. philosophers and doctors have studied the process of dying for centuries, and perhaps the discipline that his best understood this is palliative care. according to the world health organization, how you'd have care is a crucial part of integrated people, centered health services, relieving serious health related suffering, be a physical, psychological, social, or spiritual. and the agency says it's a global ethical responsibility. but is this ethical responsibility being observed? our health services worldwide providing patients and their families with the right care and services. we'll put that to the chair of the board of directors of the international association for hospice and palliative care. doctor lucas rog talks to al jazeera ah dr. lucas rod brook chair of the board of directors of the international association

for hospice and palliative care. thank you for talking to al jazeera. thank you for having me. look at, let me ask you 1st palliative care is not just a type of medical care for patients living with a serious illness. it's also a philosophy of care. so i want to ask you, what is that overall philosophy? well, 1st of all, it's really patient oriend, so it's not only strict guidelines on symptoms, but it's also about asking people what they really want. because you know there's a broad range of priorities that patients may have. some of them cling to lives and may want to prolong as much as possible. others possibly will. you know, i just talked to patient care what was that, that she's actually waiting to die. and the sooner the better, because she says business, in spite of all the benefit of care she's getting,

is not going to be well again. why not? and this rather sooner than later. so accepting that, i'm not doing any life prolonging treatment, giving her good symptom relief, not hastening death on the other side. all that's part of the program. it's also a philosophy about change from deficits to resources and in medicine. usually we look at things that will not work and often fail symptoms that are their suffering that is abundant and imperative care will also look at resources at the caregivers that are still there at the things that patients still can do at the family that support them and all these things that give the patients strength and meaning in spite of their sometimes when you're worrying situation. so i think that of the 2 main differences. and i think that in, in consequence also necessitates a lot of different things. for example, we talk

a lot to patients, we lose use, often really very little medicines, very little technique. but we use a lot of communication, a lot of teamwork, and a lot of discussions with patients and families. you know, you mentioned teamwork. and since palliative care focuses on so much more than just physical suffering, i've read that oftentimes, or if not, in most cases, that there is an interdisciplinary team of physicians that is involved in palliative care. could you expand on that? what type of team are we talking about? what kind of specialists are we talking about? so in a good setting, when you really have what you need them, a better care team, what include not only physicians and if possible, from different disciplines. so in my team here in germany and a high result setting what we have our really physicians working in our team will

come from general medicine from family medicine, from internal medicine, neurology and the ology. so from all field of medicine. but we also have specialists not this who have special tentative care training, who have special knowledge and wound dressings. for example, we do have spiritual caregivers. we do have social workers and psychologists, all the special training and care present therapist agather bist. so that we have the team meeting and people are sitting there discussing patients paces and sometimes 15 people around the table minute that that isn't a high resource setting and a tertiary kansas and them. and other places you would probably have only a physician and a nurse, or maybe even only some nurses and some volunteers. but still it's so important that you have more than one person. that for example, as a, as a healthcare professional, i am able to discuss the, the way i see the patients,

the way i see that the need has with somebody else, reflect on that. and then discuss whether i really have, you know, whether i'm not blind, whether i don't have a blind spot on something. when i really have seen everything that's important for the patient. so it must not be the complete team with 15 people, but at least not working on your own is very helpful. and a lot of settings in the world, you don't have that, that, you know, there's a lot of places, especially in developing countries, whether it is one community we're not working on ourselves. and even then, we would think that having experienced relative care serve as nearby where she can phone in and when there are problems is of the utmost importance. doctor admiral, there does seem to be a lot of confusion when it comes to palliative care. what is the difference between palliative care and hospice care? could you explain the difference between the 2?

well, it depends a little bit on where you are, for example. so in the u. s, for example, preventive care quite often is delivered by hospice programs, which are mostly outpatient services, on our home care services. in the okay, the hospice would be a free standing building, not the 6th to a hospital, whether a specialist masters and physicians and other caregivers. and in germany, hospice would be rather end of life. care by volunteer care would be done by a much larger disciplinary team. in general, there's a lot of overlap. and if you want to simplify them, i could say that care sort of brings the hospice idea of the company dying and civilian patients into the field of medicine. whereas period is care sort of sorry, les hot springs can knowledge into the general community. can palliative care also

be given along with curative treatment for patients? yes, you know, some time ago there was the feeling that relative care only starts once the patient has been diagnosed as incurable. the, you know, cancer treatment has failed and the patient will suddenly deteriorate and finally die. and them care may come in and we still have quite often this kind of barrier that other physician tell me, you know, this is not a patient or you, we still do chemotherapy, but actually it's quite important that period of care is started much earlier. does this slogan of early integration. i didn't care meaning that all ready start with corrective treatment at the same time and we know that them, but it is tell when not taught life as many fear. you know, when you don't do things and it is the feeling we sometimes encountered. but there

is good research showing that quite often patients live longer when they receive care early on, even empowering to correct his treatment. because sometimes the treatment is more aggress system that the seeds and then if it of care comes in and you will discuss with patients what they need, what they want, what is good for them. sometimes aggressive treatments may be left out or maybe delayed and then patients may live even longer, in addition to having better quality of life and less stuff, right. you talked about that feeling of fear that so many patients encounter. obviously, many people around the world are fearful of death and dying is the way that a patient perceived death or their perception of the process of dying linked to the type of palliative care that they might receive. and i'm not just talking about for the person dying. i'm also asking about those who are around the patient. other

caregivers, perhaps members of the family, is that taken into account when palliative care is given? definitely because we do have large group ro, influences in the well, the way that but it of care, but all kinds of health care i received by patients by patients, by their families and by their communities. so quite often, in some cultural settings, you would not explicitly talk about prognosis with the patient. would probably discuss treatment decisions with the family and not only what the patients, because they are not involved and the patients will not accept treatment options. you will sometimes pursue chemotherapy, even even though many of the treating physicians know that it's futile just because you know that patient and family when not accept mot, getting it or stopping it. having said that, we know that if you do good sensible period of care,

and if you have communication skills, then quite often you can discuss even these cultural settings with the patient and with families that does not a good way to pursue that. it may be much better to focus on symptom control and not on proven gauge of life, which often assume that it's much better to spend resources on palliative care and not on some kind of radio or chemo therapy that does not work. and then patients will be very accepting of that. what we do quite often is that we use volunteers from the community to help the professional caregivers because the volunteers from the community quite off know how to approach patients and the barriers much lower for the volunteers than for us. what are some of the more significant cultural and social barriers that palliative care health givers encounter? well, one thing is that in western societies,

you do have the concept autonomy of self determination, which is really power. amanda, and many people lose control of something that is absolutely terrify, meeting care from other people, not being able to care for yourself is something that they detest. and we even have patients asking for assisted suicide or other life ending measures because they can't beer losing control. and you have long discussions how to find meaningful sense of lice in, in a situation where you need physical care for yourself. in other societies that quite often much less prominent and african agent societies, you have much more community spirit where patients do not have to have that high degree of autonomy and contrast. and some settings proverbial the mediterranean

setting on the middle east setting. where you do have much less acceptance of an open prognosis if it's life threatening life limiting disease. and patients and families will quite often not accept that they will not accept stopping at his treatment trials. that sometimes they say it's a religious issue. but actually neither islam nor any other major religion say the period of care is not allowed say that corrective treatment must be pursued . so in our experience, it's much more often a cultural issue and the religious one. you just mentioned, assisted suicide. i want to ask you, as assisted dying laws are passed in more parts of the world and more countries around the world, does that create more difficulties for those like yourself who are trying to expand palliative care initiatives around the world? yes or no?

so one thing is that if a country discusses assisted suicide, quite often linked to discussion on hospice and palliative care. and quite often the, the argument that everybody agrees that hospice and political care has to be extended in the country. but what we see and we live them in the congress that have allowed assisted suicide, or even the, the navy is that there is a tendency, slow change in society. so what happens is that this kind assist, the dying becomes more accepted. and in contrast, people start asking, why should you even try and just care? you know, if the easy way out is just letting the patient die. and sometimes we'll also see that there is a slow increasing pressure on patients. that this may be the option that they should pursue, instead of sticking on,

and maybe using relative care. so what we see, what we are afraid of the rather the change in society than the immediate pressure on individual patients. you know, dr. rug, one of the things i've encountered most when reading about palliative care, i come across physicians who say that it's really expanded their understanding. and that when it comes to palliative care, it's more about understanding the patient or the person they're treating rather than treating the disease. from your perspective, do you believe that health systems by enlarge around the world are lacking in compassion? so that's a really difficult question. so i think that health care systems actually do lack of compassion because if you look at the philosophy behind health care systems, quite often it has to be utilitarian. so make the most with the budget you have. and that often means that it's not the optimal treatment that patients received was

the one that the society kind of thought health care system kind of thought. having said that, i think that most of the health care professionals really try to be compassionate. there are a few bad apples, but by and large i think everybody really tries to help patients that may not always be real compassionate care because many health care professionals have not really learned to listen to patients to communicate good to communicate well with patients. that's something we start teaching students for a few years now and notice how different that is to the rest of medicine. we do have guidelines on the latest care on symptom control, for example. but we always say that it's more important to listen to the patient mentally guideline. and that also is not usually medicine medicine in most countries goes by guideline and guidelines become more important than the individual patient setting. so by and large, i would say that the systems let them compassionate,

even though the professionals tried to keep it up. so with that in mind, how important is training in palliative care to the development of a physician? i think it's per mom's that at least some basic knowledge is really taught to every medical student, other students, and probably every other health professional in the making. and that's pretty basic . what is the next step in ensuring that more people around the world actually have access to palliative care? that's also the problem on the policy level. is that implementation is always a big issue. and once you manage to get something through on an international organization like health organization that really does something, but it takes a long time to the trickles down to the country level. so actually in the last decade we have seen the world health organization and the international control board and the united nations office of control, all of them working on ensuring balance,

making sure that really popular are available for valid care whether needed. they have been highlighting the needs staff and put out guidance with either concrete guidelines or policy papers. there has been a w, h world health assembly resolution and 2014, stating the need for palliative care with the 4 pillars that i just missed it. and still so many countries have that. we do notice that some countries really use the guidance by world health organization and they thought of the health minister get interest. they stopped thinking about this. they set up services. there are some really good examples of public private partnerships. for example, in my life the, where the government pays for the task. if the hospice as n g o managers to find a place for it. so if they say we, you know,

we've got this place without this house, then the government will pay for something like that where you combine forces. all this very encouraging is examples. but still, it's a long ways from the guideline of the international organization to the national government level and even down to the service provider level. and quite often them after a few years of implementation work advocacy work by look, apply on the as you will have the 1st service in the capital of the country. but then again, this will not help people in the rural areas who are not even able to access any physician and will not be able to accessibility care at all. i mean, you talk about it being a long road and the w. h will also says that each year and estimated 40000000 people are in need of palliative care, 78 percent of whom live in low and middle income countries worldwide. only about 14 percent of people who need palliative care currently receive it. what kind of

barriers need to be overcome significantly and immediately in order to better address the needs for palliative care and also what kind of costs are we talking about? and when i talk about cost, also our insurance companies on board. i mean, is the insurance system in the health care systems in various countries on board with palliative care? so the main barriers are mostly on the national level. so as i said, the, all this lack of training of physicians. so right now, physicians are not prescribing the medicine, such as more that are needed for these patients because they don't prescribe them. the government sees no need to import more of these medicines. so the medicines are not available in the country. there's quite often there's not a budget because the companies are struggling to meet other health care needs. the budgets are restricted and they say they can't spend money on the latest care. and there's often a lack of policy. so physicians to not even know that there's something they should

know about actually providing an essential package for bell. it is not that difficult. there was a commission from the medical journal, the lancet, which describes such an essential package saying that it's about 20 medicines and a few other things like wheelchairs which you would need and the cost of that the central package, equipment medicine and stamps isn't actually that high you can calculate that are low income country, foreign, middle income country and for a high income country. and you will find that all these settings would probably be able to afford that. i was a bit astonished when we produce that report because we thought that in low income countries that really wouldn't be too expensive. but because the tests are so low and that thing they could actually even embed setting the part it, it would be only a minor part of the health care budget. it would calculated per capita. and the

overall cost of care would not be that grapes. and that would provide benefits because for example, when you really suffering, when a patient is not an acronym anymore, is not prying out of pain all day. does not need a caregiver and a family member as a caregiver buyer's side for the whole day. then for example, the family caregiver can go out and back to work again and con, on some family income again. so, but it's care does actually also relieve some of the burden on society that is taken up by informal caregivers, by the cost a day and group. we found some stages and some specific settings. for example, children that the costs are really so low that you probably would get that together quite easily. and the problem then is not costs, but rather provide training and disseminate the knowledge and the medicine once you have them. so as i said, i think it's

a combined problem of lack of training, lack of awareness, lack of access to medicines, and you would have to tackle all of those at the same time in order to start giving good relative care. my final question dr. rod brook, how much has the coven 19 pandemic been a disruption to palliative care around the world? its various depending on country and setting. so in some countries that has been a major disruption. patients have not assessed care because they have been isolated and then nursing homes, for example, or at home. and i have been afraid to go to the hospital even if it's a palliative care unit. one of your services has been stopped because of the and they infection, danger and other countries. additional resources have been required for better care because patients are not able to accept intensive care. and you would give them at least some good symptom management of the relief of breathlessness,

for example. so we see all kinds, but it certainly is a major brain on the health care resources, at least the weaker economy settings. and the danger is that not only right now, but also in the long run, this will weaken the latest care considerably because resources are going. and another way right now, even though we know that it's even more needed right now and was before the panoramic, we are right not the bearing on one of the w h o has already something about it as care in emergencies and monetary and emergencies, such as damage and in specific settings, such as here in germany for example. we are also describing the need for condemning preparedness from appellate cap respective saying that there should be special regulations. just one easy example. when hospitals and nothing homes are locked

down, independent mac patients are dying alone. without seeing that family members, we had cases where the family for about 4 weeks was not able to see their sick family member and hospital until he died alone. in an intensive care unit, and that's absolutely not necessary. you can prevent that by clarifying that oscillation, measures are not valid for dying patients. and the family members should be allowed to see di, even an intensive care units even. and if and damage provided you have adequate protective equipment. dr. lucas. rog, brooke, chair of the board of directors of the international association for hospice and palliative care. thank you for talking child here. thank you very much. i

have a great the damage caused to the precious grove plants a chilly. it's being reversed with one of the world's biggest ada conservation projects. they're pretty emblematic of the patagonia and if they're plentiful and they're calm like this one is, then you know that the system is going back and that they feel no threat. and that's why you know, i, for re wilding pass, go on al jazeera july on. i was just the can to festival return to the delight of fans and an industry hit hard by curve at 19, but will travel restrictions and social distance in off the shadow on the glitz and glamour across the globe generation change. we young activists, spicing injustices and demanding radical change after a year long delay, japan, hudson. and unlike any the world has seen before, my son, bob way, showcase his personal story, offering the fresh look of the changes and challenges. but the bob way face today,

despite grow intention to the agency, dance e p o p, a reset for the next phase of filling them on the blue nile july on a just i me additional kind of 19 restrictions come into force on the indonesian islands of java and bali and neighboring malaysia, titan's cabs and true regions, including the capital of the delta ovarian spreads across se, asia ah, hello there, uninstalled the hey, this is out there, like from durham, also coming up the un wounds of a deteriorating situation and more than 400000 people are suffering from famine

despite the government si size. wildfire has been across western canada.