over exploited their natural resources, they would die of hunger, which is what happened to the native americans in the united states when the white men exterminated the buffalo. these days, the concept of living in harmony with nature is actually becoming mainstream. so much so that many chileans who long regarded them. i put you with contempt for believing that people should take from nature only one needs are beginning to understand the need for all to do the same. lucy and ulan al jazeera loki, my chile for francis, is recovering from scheduled call on surgery. the vatican says he's alerts and breathing without assistance. the h for you upon says, is expected to stay in hospital for 7 days. suppose this was the this is al jazeera and these are the headlines, ethiopia,

prime minister of the meds is defending the decisions for rebels and the northern tiguan region. he described them as a danger to the country on sunday t guys regional government said it was ready for see far books with key conditions . with significant time, they prepared an army that they didn't stop there. they started encroaching on the rest of ethiopia and started to destabilize the entire nation in all sorts of ways . this is quite dangerous and at the end of the day it would endanger the existence of the nation. it's considered as a threat. you can. taliban is advancing in northern districts forcing hundreds of government. so just to flee across the border to take his son for the safety group has taken a key district in kandahar emergency teams and thailand or baffling to contain a fire factory near bank of airport. it was caused by a large explosion. at least one person is confirmed, have been killed. thousands more have been injured. so they can learn for in cuba

is being store width of the 95 kilometers in our and heavy rain. also fast at several other caribbean islands killing you please. 3 people. 11 days after an apartment building and florida partially collapsed, what was left of the structure. that's not the pool sign, the floors, he say the demolition of the surf side apartments will help search and recovery efforts. 24 bodies were phones, but 121. people are still missing to destroy the remains of the building brought forwards as the reach of braces for tropical storm l firm and a very public rest is opened up between saudi arabia and its m rossi allies over a crucial oil deal. the opec plus alliance of oil producing countries is meeting again on monday. the u. e poses a push by the others to raise. the production has been in showing up since the slash last year, when the pandemic crushed the man. i'm not here today. talk to al jazeera is next

for some, a robot is a mechanical or even that self driving train of the apple. but androids today can be over the humanoid. robots, like me, will be everywhere. options 0 documentaries. next lead on the weird and wonderful world of robot that learn, think, feel, and even trust. i feel like i'm alive, but i know i am a machine origins of this species on our 20 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, it's something inevitable. more than 50000000 people die every year from natural

causes or different medical conditions. and the covert, 1900 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 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 it's 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 how you took care. dr. lucas rad

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 life 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 period of cash she's getting, it is 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, an organ that fail symptoms that are their suffering that is abundant and intended to care. we'll also look at resources at the caregivers that are still there at the things that patients still can do at the family that supports them. and all these things that give the patients strength and meaning in spite of their sometimes when

the 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 them, a period of care team would include not only physicians and if possible,

from different disciplines. so in my team here in germany and a high resort 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 specialist 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 palliative care present, therapist agathor, so that we have the team meeting and people are sitting that 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 health care 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. advocate,

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 the 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 severely patients into the field of medicine. whereas palliative 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? yes, you know, some time ago there was the feeling that relative care only start 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 then, 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 chemo therapy, but actually, it's quite important that it is care restarted much earlier. does this slogan of early integration care, meaning that 10 already start with corrective treatment at the same time and we know that them, but it is tell when not taught lives as many fear. you know,

when you don't do things and it is kept 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 empowering to correct his treatment. because sometimes the treatment is more aggressive than that, the seeds, and then if a 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 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 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 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 their 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 with 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 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 in western society, 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 terrifying about needing care from other people. not being able to care for yourself is something that the d test. and we even have patients asking for assisted suicide or other life ending measures because they comp beer do in 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 society is 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 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 relative care is not allowed say that curative 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 arguments that everybody agrees that hospice and politic care has to be extended in the country. but what we see and we lives them in the congress that have allowed assisted suicide, or even us navia 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 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'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, or lacking in compassion? difficult step is 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 used in an area. so make the most with the budget you have

and that often means that it's not the optimal treatment that patients receive as 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 religious 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 patients

. so by and large, i would say that the system's black and compassionate, even though the professional and 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 paramount 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 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 will help 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 populates, are available for palliative care whether needed has been highlighting the needs that 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 haven't done 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. now there are some really good of public private partnerships for example and malay, the where 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. 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 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 o also says that each year, an 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 do 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 c. and the overall cost of care would not be that grapes and it would provide benefits because for example, when you 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 bias 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 settings. 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 care unit. warranty or services has been stopped because of the and they, and 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 was 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 palliative care considerably because resources are going. and another way right now, even though we know that it's even more needed right now than was before the panoramic, we are right not the bearing. one on one m, w h o has already something about it is care in emergencies and monetary 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 his 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 di and 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. rog, 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

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a year long delay, japan, hudson. and unlike any the world have seen before. my son, bob, re showcase his personal story, offering a fresh look at the changes and challenges. but the bob way face today, just by growing tension with egypt and sudan, ethiopia reset for the next phase of filling it down on the blue nile. july on i'll just eat up. i me. this is al jazeera. ah, hello, i'm sammy's a than this is the news out live from dell. how coming up in the next 60 minutes? hundreds of afghan government through fleet the neighboring jacob stan is out of time to capture more districts across the country. here's prime minister.