last about 7 hours, it's only the 2nd time a chinese crew has entered the vacuum of space. the last pace walk in 2008 lasted just 20 minutes. that young her station should be completed next year. cool that the, the crew members will spend 3 months helping build the station, conducting experiments small at the same time, maintaining their fitness. they'll also be capturing views that chinese astronauts had been unable to see for themselves since the us lock them out of the international space station 10 years ago. and her chappelle al jazeera. ah, this is algebra, these top stories for miss south african president, jacob's duma has defied a deadline set by the supreme court surrender to police. you found guilty of contempt of court last week. we're fighting to appear before corruption inquiry, but continues to deny anyone doing a demolition team as preparing to bring

down what's left of a parsley collapse apartment building in the us state of florida. the operation was brought forward a head of a tropical storm expected to land on tuesday. 24 people confirmed dead and a 121 missing ought to be collapse 10 days ago. or will be moving forward with the demolition as soon as it's safe to do so. between 10 pm and 3 am tonight, bringing the building down in a controlled manner is critical to expanding our scope of search. as you know in the pile and allowing us to search in the area closest to the buildings which has currently not been accessible to the team, given the great risk to our 1st responders due to the instability of the building. under 80000 people are being evacuated. as tropical storm elsa makes land for in eastern cuba is 4 winds of nearly 95 kilometers per hour and heavy rain. full cost

is a warning, a flash flooding and month slides. storm has already battered several caribbean islands, killing at least 3 people. the philippine military says all 96 people on board, one of its planes that crashed on some they have been accounted for. 47 personnel died when the aircraft went down in soon province. 49 others survived. the crash and assembly elected after months of protest in chile as begun. meeting to draft a new constitution an indigenous month, which a woman was elected to lead the process. candidates military is on stand by to help with evacuations as well. 5 threatened towns in the west of the country, at least $178.00 fires burning in the province of british columbia. canada has been enduring a record heat wave with temperatures approaching 50 degrees south. okay

. as you headlines talks out there coming up next. mm mm. mm mm

i 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. it's 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 to 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 in palliative care. dr. lucas rodro 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 oriented. 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 patients that it was, was that, that she's actually waiting to die. and the sooner the better, because she says this is, in spite of all the benefit of cash he's getting. but he's not going to be well again. why not? and this rather sooner than later, so accepting that, i'm not doing any life prolong and treatment, giving her good symptom relief. not hastening debts on the other side. all that's part of the program. that's also a philosophy about change from deficits to resources, you know,

in medicine. usually we look at things that do 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 need a period of care team, what include not only physicians and if possible, from different disciplines. so in my team here in germany and a highly sought setting, what we have are really physicians working in our team will come from general medicine from family medicine, from internal medicine, neurology and the ology. so from all seals 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 of the special training and care present, therapist agather, a bist, so that we have the team meeting and people are sitting there discussing patients paces and sometimes 15 people around the table. mind you 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 patient, the way i see the, the ne p has with somebody else, reflect on that. and then discuss whether i really have, you know, whether i am 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 herself. and even then, we would think that having experienced relative care service nearby, where she can phone in and when there are problems as of the utmost importance. dr . address, 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 of care. quite often it's 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 bring the hospice idea of the company dying and civilian patients in the field of medicine. whereas period care sort of sorry, les hot springs that can knowledge into the general community, can palliative care also be given along with curative treatment for patients yet, 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 then care may come them and we still have quite often, this kind of barrier that other physician tell me, you know, this is not a patients, are you, we still do chemo therapy, but actually, it's quite important that it is care restarted much earlier. does this slogan of early integration of care, meaning that 10 already start with corrected treatment at the same time. and we know that them, but it is tell when not taught in life as many fear, you know, when you don't do things and it is the feeling we sometimes encountered but, but there is good research showing that quite often patients live longer when they receive care early on, even in parallel to curative treatment because sometimes the treatment is more aggressive than that, the seeds and then the pallet of care comes in and you will discuss with patients what they need, what they want,

what is good for them. sometimes aggressive treatment 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 perceives death or their perception of the process of dying linked to the type of palliative care that they might receive. and i'm not 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 role in influences in the well, the way that but i need to care about all kinds of health care i received by patients by patients, by the families and by their communities. so quite often,

in some quote, role 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 patient will not accept treatment options. you will sometimes pursue chemotherapy, even though many of the treating physicians know that it's futile just because you know that patient and family one 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 of the few time 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 asian and to 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, and wisdom society is you do have the concept of autonomy of self determination, which is really power, amman, and many people. so losing control is something that is absolutely terrify, needing care from other people. not being able to care for yourself is something that they detest. and we even have patients asking for assistance, suicide,

or other life ending measures, because they can't beer losing control. and you have long discussion 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. patients do not have to have that high degree of autonomy and contrast. and some settings proverbial the mediterranean setting or 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 palliative 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 want. you know, 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 the country discusses assisted suicide, quite often just 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,

and the congress that have allowed assisted suicide, or even the navia is that there is a tendency, a 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 you instead of sticking on, and maybe using palliative care. so what we see, what we are afraid of this rather the change in society than the immediate credit on individual patients. you know, dr. rug, one of the things i have 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 and large around the world are lacking in compassion certificate? 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 in an area. so make the most with the budget you have. and that also means that it's not the optimal treatment that patients received was the one that the society kind of thought alca 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 patients than to eat the died 9. and that also is not usual in medicine medicine in most countries, goes by guideline and guidelines become more important than the individual, the patient. so by and large, i would say that the system's lack of compassion, even though the professionals and try 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 paramount that at least some basic knowledge is really taught to every medical student, nothing 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 the problem on the policy level. is that implementation is always a big issue. and once you've managed to get something through on an international organization like well, 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 proc control, all of them working on ensuring balance, making sure that really popular are available for care whether needed that has been highlighting the needs that's been 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 just missed it. and still so many countries have done that. we do notice that some countries really use the guidance by world health organization. and they thought of the health minister got interested. they start thinking about this, they set up services. there are some really good of public private partnerships. for example, in malawi, we're, the government pays for this test. if the hospice n g o managers to find a place for it. so if they say we, you know, we got this place without this house, then the government will pay for something like that where you combine forces. now, all this very encouraging is examples. but still, it's a long way 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 us. 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 in the w. h o 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 before, this lack of training of physicians. so right now, physicians are not prescribing the medicine such as mar, in 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 pell 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 steph 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 congress that really wouldn't be too expensive. but because the tests are so low in that thing, they could actually even in that setting before that 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 it would provide benefits because for example, when you are really suffering when a patient is not an acronym anymore is not prying out for pain. all day. does not need a caregiver and family member as a caregiver by your side for the whole day. then for example,

the family caregiver can go out and back to work again and come on some family income again. so, but it 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 that the 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 brooke, how much has the coven 19 pandemic been

a disruption to palliative care around the world? various, depending on country and setting. so in some countries that has been a major disruption. patients have not assessed the latest care because they have been isolated in the nursing homes for example, or at home. and they 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 palliative 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, 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 is 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 is 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 isolation

measures are not valid for diet nations and the family members should be allowed to see di patients, even an intensive care units even and if and damage providers you have adequate protective equipment. dr. lucas, rod brooke, chair of the board of directors of the international association for hospice and palliative care. thank you for talking to help, sir. thank you very much. i believe your company onto the pitch is a special moment for any football to do. it is a pallet. the woman is a remarkable achievement. footballing legend added canton introduces honey soldier who broke through social and political barriers to inspire a generation of female players across the middle east. football rebels. let's do it

on algae 0. something was going to change. anything really changed. this is systemic violence that needs to be addressed at its core. we are in a race against the barrier and know what to say. we are all say we're looking at the world as it is right now, not the world. we like it to be. the devil is always going to be in the house. the bottom line, when i was just there on i me a partially collapse building in the us state of florida has been demolished before a tropical storm makes land full. ah, hello, i'm down, jordan, this is out there. a lie from joe also coming up doesn't survive and military plane

crash in the philippines will have an update on the casualty.