Latest from San Francisco Chronicle
San Francisco Chronicle
an hour ago
- Health
- San Francisco Chronicle
In Uganda, a tougher bicycle offers hope for better health coverage in rural areas
LIRA, Uganda (AP) — The bicycle parked in Lucy Abalo's compound doesn't belong to her. Any one of the hundreds of people in her village can show up and ask to use it. A man might wish to take his pregnant wife for a checkup. A woman might need transport to pick up HIV medication. An injured child might need a trip to a hospital. 'The goodness about this bike,' Abalo said, is its availability to all. She is one of dozens of 'village doctors' in rural Uganda who recently were supplied with the Buffalo Bicycle, so called because its steel parts are reinforced to perform in areas with bad roads. World Bicycle Relief, a Chicago-based nonprofit, promotes the Buffalo Bicycle in remote parts of Africa. It collaborates with governments, non-governmental groups and others who use the bikes to improve access to health services. In Uganda, an east African country of 45 million people, efforts to market the bicycle have focused on supporting health workers like Abalo, who visits people's homes and reports any issues to authorities. As a community health extension worker, or CHEW, she has gained the trust of villagers, who can knock on her door in emergency situations. She said she helps to look after about 8,000 people in the area. And at least twice a week, she is required to report to a government-run health center about 5 kilometers (3 miles) away and assist with triaging patients. Ugandan health authorities acknowledge that one challenge for CHEWs is transportation, part of a larger burden of poverty that can leave health facilities lacking ambulances or even gas to move them. World Bicycle Relief, operating locally as Buffalo Bicycles Uganda, has collaborated with Ugandan health authorities since 2023 to equip 331 CHEWs in two of the country's 146 districts. One is Lira, 442 kilometers (274 miles) north of the capital, Kampala. Bicycles have long been ubiquitous, and many families tend to have one. Cultural norms in northern Uganda don't prohibit women from riding. While the roads in Lira town are paved, dirt paths lead into the heart of the district where farming is the main economic activity. The Buffalo Bicycle is a recent arrival. Many have never heard of it, or can't afford it. Retailing for roughly $200, it is three times more expensive than the cheapest regular bicycle — otherwise out of reach for many CHEWs, who do not yet earn a salary. The bike's promoters cite its durability in rough terrain, needing fewer trips to the mechanic as a way to save money. The Buffalo Bicycle's heavy-gauge steel frame is so strong that it comes with a five-year warranty, said Amuza Ali, a monitoring officer in Lira for Buffalo Bicycles Uganda. Abalo and others told the AP the Buffalo Bicycle felt uncomfortable to use in the beginning, with a braking system that doesn't permit carefree backpedaling. 'When I climbed on it, it wasn't that easy as I thought,' Abalo said. 'I was like, 'I am trying again to learn how to ride.'' CHEWs using the bicycles reported a 108% increase in households reached each week, and the time to reach health facilities dropped by nearly half, according to a study published in May by World Bicycle Relief. The study shows that 'mobility is not a luxury in healthcare' but a lifeline, CEO Dave Neiswander said in a statement released for the report. Diana Atwine, permanent secretary at the Ministry of Health, has urged the distribution of bicycles to more CHEWs across Uganda, saying front-line health workers save an unknown number of lives each year. Abalo received her Buffalo Bicycle from the health minister last year. One of her neighbors, Babra Akello, said she has used the bicycle at least six times already. The first was for transport to an antenatal checkup. She praised Abalo's willingness to help. The bike has also been used for emergencies. One evening earlier this year, a neighbor's 4-year-old child suffered a deep cut while playing in the dirt. With the child's parents away, Abalo transported the bleeding boy to a facility where he briefly lost consciousness before being revived. 'That bike, not me, saved the life of that child,' Abalo said. 'If that bike hadn't been there, I don't know what would have happened.' ___
San Francisco Chronicle
an hour ago
- Sport
- San Francisco Chronicle
Bogaerts homers among 4 hits as Padres beat Dodgers 5-3 to avoid four-game sweep
LOS ANGELES (AP) — Xander Bogaerts homered among his four hits and scored three runs, and the San Diego Padres beat the Los Angeles Dodgers 5-3 on Thursday night to avoid a four-game sweep. Rookie Ryan Bergert gave up three hits in 4 2/3 scoreless innings in his fourth career start, and Adrian Morejon (4-3) followed with four consecutive outs. Jake Cronenworth had three hits. After Dodgers right-hander Jack Little — making his major league debut — hit Fernando Tatis Jr. with a pitch in the ninth inning, both benches emptied behind home plate but no punches were thrown. Dodgers manager Dave Roberts and Padres manager Mike Shildt were ejected. Padres reliever Robert Suarez hit Shohei Ohtani with a pitch in the bottom of the ninth and was ejected. Tatis and Ohtani were each hit by pitches twice in the series. Right-hander Yoshinobu Yamamoto (6-6) gave up three runs and seven hits over 6 1/3 innings as Los Angeles snapped a five-game winning streak. Bogaerts gave the Padres a 1-0 lead in the second inning with his fourth home run and first since May 14. They went up 2-0 in the fifth inning on Jose Iglesias had a sacrifice fly in the fifth, and Cronenworth an RBI double in the seventh. Gavin Sheets added an RBI single and Iglesias drew a bases-loaded walk to make it 5-0 in the eighth. The Dodgers ended the shutout bid with three runs in the ninth and had the tying run at second base before rookie Dalton Rushing struck out against Yuki Matsui, who picked up his first save. Key moment Up 2-0, Morejon replaced Bergert in the fifth inning with runners on the corners and two outs and retired Ohtani on a comebacker. Key stat Two of Bergert's four career starts since June 3 have been scoreless, with Wednesday's outing the shortest. Up next Dodgers LHP Clayton Kershaw (2-0, 3.25 ERA) will start against Nationals LHP MacKenzie Gore (3-6, 2.89) on Friday. Padres RHP Nick Pivetta (7-2, 3.40) starts Royals RHP Michael Lorenzen (4-7, 4.91). ___
San Francisco Chronicle
an hour ago
- Health
- San Francisco Chronicle
UK lawmakers to vote on allowing terminally ill adults to end their lives
LONDON (AP) — British lawmakers are set to vote Friday on whether to back a bill to help terminally ill adults end their lives in England and Wales, in what could be one of the most consequential social policy decisions they will ever make. Members of Parliament supported legalizing assisted dying when they first debated the issue in November by 330 votes to 275. Since then, the Terminally Ill Adults (End of Life) Bill has undergone months of scrutiny leading to some changes in the proposed legislation, which is being shepherded through Parliament by Labour lawmaker Kim Leadbeater rather than the government. Leadbeater is confident lawmakers will back the bill. 'We have the most robust piece of legislation in the world in front of us tomorrow, and I know that many colleagues have engaged very closely with the legislation and will make their decision based on those facts and that evidence, and that cannot be disputed," Leadbeater said Thursday on the eve of the vote alongside bereaved and terminally ill people. Proponents of the bill argue those with a terminal diagnosis must be given a choice at the end of their lives. However, opponents say the disabled and elderly could be at risk of being coerced, directly or indirectly, to end their lives to save money or relieve the burden on family members. Others have called for the improvement of palliative care to ease suffering as an alternative. The vote is potentially the biggest change to social policy since abortion was legalized in 1967. What lawmakers are voting on The Terminally Ill Adults (End of Life) Bill would allow terminally ill adults aged over 18 in England and Wales, who are deemed to have less than six months to live, to apply for an assisted death. The terminally ill person would have to be capable of taking the fatal drugs themselves. Proponents of the bill say wealthy individuals can travel to Switzerland, which allows foreigners to legally end their lives, while others have to face possible prosecution for helping their loves ones die. How the vote may go The outcome of the vote is unclear, as some lawmakers who backed the bill in the fall only did so on the proviso there would be changes made. Some who backed the bill then have voiced disappointment at the changes, while others have indicated Parliament has not been given enough time to debate the issues. The vote is a free one, meaning lawmakers vote according to their conscience rather than on party lines. Alliances have formed across the political divide. If 28 members switched directly from backing the bill to opposing it, while others voted exactly the same way, the legislation would fail. Timeline if the bill passes Friday's vote is not the end of the matter. The legislation would then go to the unelected House of Lords, which has the power to delay and amend policy, though it can't overrule the lower chamber. Since assisted dying was not in the governing Labour Party's election manifesto last year, the House of Lords has more room to maneuver. Any amendments would then go back to the House of Commons. If the bill is passed, backers say implementation will take four years, rather than the initially suggested two. That means it could become law in 2029, around the time the next general election must be held. Changes to the bill Plenty of revisions have been made to the measure, but not enough for some. Perhaps the most important change was to drop the requirement that a judge sign off on any decision. Many in the legal profession had objected. Now any request would be subject to approval by two doctors and a panel featuring a social worker, senior legal figure and psychiatrist. Changes also were made to ensure the establishment of independent advocates to support people with learning disabilities, autism or mental health conditions and the creation of a disability advisory board. No involvement of health care practitioners It was already the case that doctors would not be required to take part, but lawmakers have since voted to insert a new clause into the bill extending the provision to anyone. The wording means 'no person,' including social care workers and pharmacists, is obliged to take part in assisted dying and can therefore opt out. The government's stance There is clear no consensus in the cabinet about the measure. Prime Minister Keir Starmer has indicated he will back the bill on Friday. His health secretary, Wes Streeting, is opposed but said he will respect the outcome. There are also questions about how it would impact the U.K.'s state-funded National Health Service, hospice care and the legal system. Nations where assisted dying is legal Other countries that have legalized assisted suicide include Australia, Belgium, Canada and parts of the United States, with regulations on who is eligible varying by jurisdiction.
San Francisco Chronicle
2 hours ago
- Health
- San Francisco Chronicle
'I was terrified I was going to die.' Rape victims in Brazil struggle to access legal abortions
RIO DE JANEIRO (AP) — A 27-year-old Brazilian woman, who said she became pregnant after being raped in March during Carnival in Brasilia, should have been granted access to a legal abortion. But when she sought to terminate the pregnancy at a hospital around a month later, she was told she needed a police report to access the service, despite it not being a legal requirement. She decided to abort at home with medication she bought on the black market, with only a few friends on site to help. 'I fainted several times because of the pain. I was terrified I was going to die,' she said. The Associated Press does not identify people without their permission if they say they have been sexually assaulted. In Brazil, abortion is legally restricted to cases of rape, life-threatening risks to the pregnant woman or if the fetus has no functioning brain. Theoretically, when a pregnancy results from sexual violence, the victim's word should suffice for access to the procedure. 'The law doesn't require judicial authorization or anything like that,' explained Ivanilda Figueiredo, a professor of law at the State University of Rio de Janeiro. 'A woman seeking an abortion recounts the situation to a multi-disciplinary team at the healthcare clinic and, in theory, that should be enough.' In practice, however, advocates, activists and health experts say women encounter significant barriers to ending a pregnancy even under the limited conditions provided for by the law. This is due to factors including lack of facilities, disparities between clinic protocols and even resistance from medical personnel. 'Healthcare professionals, citing religious or moral convictions, often refuse to provide legal abortions, even when working in clinics authorized to perform them,' said Carla de Castro Gomes, a sociologist who studies abortion and associate researcher at the Federal University of Rio de Janeiro. Women in Brazil also face geographical barriers to legal abortions. Only 290 facilities in a mere 3.6% of municipalities around the country of approximately 213 million people provide the service, according to a 2021 study from scientific journal Reports in Public Health. In June 2022, four nonprofits filed a legal challenge with the Supreme Court, arguing that restrictions on abortion access violate women's constitutional rights. The case is currently under review. 'Still a taboo' A 35-year-old cashier from a small city in the interior of Rio de Janeiro state also said she became pregnant as a result of a rape. But, unlike the woman in Brasilia, she chose to pursue an abortion through legal means, fearing the risks that come with a clandestine procedure. Although Brazil's Health Ministry mandates that, in the case of a pregnancy resulting from rape, healthcare professionals must present women with their rights and support them in their decision, the woman said a hospital committee refused to terminate the pregnancy. They claimed she was too far along, despite Brazilian law not stipulating a time limit for such procedures. She eventually found help through the Sao Paulo-based Women Alive Project, a nonprofit specializing in helping victims of sexual violence access legal abortions. The organization helped her locate a hospital in another state, an 18-hour drive, willing to carry out the procedure. Thanks to a fundraising campaign, the woman was able to travel and undergo the operation at 30 weeks of pregnancy in late April. 'We are already victims of violence and are forced to suffer even more,' she said in a phone interview. 'It's a right guaranteed by law, but unfortunately still seen as taboo.' Legal uncertainty Brazil's abortion laws are among the most constrictive in Latin America, where several countries — including Mexico, Argentina and Colombia — have enacted sweeping reforms to legalize or broadly decriminalize abortion. This legislative environment is exacerbated by a political landscape in which far-right politicians, supported by Catholic and Evangelical voters who make up a majority in the country, regularly seek to further restrict the limited provisions within the country's penal code. In 2020, the government of far-right former President Jair Bolsonaro issued an ordinance requiring doctors to report rape victims seeking abortions to the police. Current President Luiz Inácio Lula da Silva revoked the measure in his first month in office in 2023. But the measure left lasting effects. 'These changes end up generating a lot of legal uncertainty among health professionals, who fear prosecution for performing legal abortions,' Castro Gomes said. Last year, conservative lawmaker Sóstenes Cavalcante proposed a bill to equate the termination of a pregnancy after 22 weeks with homicide, sparking widespread protests by feminist groups across Brazil. The protests ultimately led to the proposal being shelved. But in November, a committee of the Chamber of Deputies approved a proposed constitutional amendment that would effectively outlaw all abortions by determining the 'inviolability of the right to life from conception.' The bill is currently on hold, awaiting the formation of a commission. Earlier this month, Rio Mayor Eduardo Paes, a Lula ally, came under fire after sanctioning a bill mandating anti-abortion messages on posters in municipal hospitals and other health establishments. 'Doctors don't tell you' Advocates say access to abortion highlights significant disparities: women with financial means dodge legal restrictions by traveling abroad for the procedure, while children, poor women and Black women face greater obstacles. According to the Brazilian Forum on Public Safety, 61.6% of the 83,988 rape victims in 2023 were under the age of 14. A statistical analysis that year by investigative outlet The Intercept estimated less than 4% of girls aged 10 to 14 who became pregnant as a result of rape accessed a legal abortion between 2015 and 2020. In Rio de Janeiro's Mare favela, one of the city's largest low-income communities, the nonprofit Networks of Mare's House of Women provides women with information regarding their reproductive rights, including legal provisions for abortions. It was there, during a recent workshop, that Karina Braga de Souza, a 41-year-old mother of five, found out abortion is legal in certain cases in Brazil. 'We don't have access (to information). Doctors don't tell you,' she said. Cross-border connections Feminist groups in Brazil are campaigning at a federal level for enhanced access to legal abortion services. Last year, 'A Child Is Not a Mother,' a campaign by feminist groups, successfully advocated for the National Council for the Rights of Children and Adolescents to adopt a resolution detailing how to handle cases of pregnant child rape victims. The body, jointly made up of government ministries and civil society organizations, approved the resolution by a slim majority in December. Brazilian activists also are seeking to improve access to abortion by forging links with organizations abroad. In May, members of feminist groups in Brazil including Neither in Prison, Nor Dead and Criola met with a delegation of mostly Black U.S. state legislators. The meeting, organized by the Washington, D.C.-based Women's Equality Center, aimed to foster collaboration on strategies to defend reproductive rights, especially in light of the U.S. Supreme Court 2022 decision to strip away the constitutional right to abortion. In the meantime, the consequences for women who struggle to access their rights run deep. The woman in Brasilia who underwent an abortion at home said she is coping thanks to therapy and the support of other women, but has been traumatized by recent events. By being denied access to a legal abortion, 'our bodies feel much more pain than they should,' she said. 'Whenever I remember, I feel very angry.'
San Francisco Chronicle
2 hours ago
- Automotive
- San Francisco Chronicle
S.F. cyclist ‘doored' by driverless Waymo sues, claiming safety tech failed
Jenifer Hanki was cycling down Seventh Street in February when an autonomous Waymo pulled into her marked bike lane and a passenger popped open a back door, colliding with her bike and ejecting her into the side of a second Waymo also pulling into the bicycle pathway, according to a lawsuit. Hanki alleges the company's Safe Exit system, aimed at warning passengers of such incoming hazards, failed. She sued Mountain View-based Waymo and its parent company Alphabet earlier this month in San Francisco County Superior Court alleging battery, emotional distress and negligence while seeking unspecified damages. 'Unlike Uber, Lyft, or taxis, where drivers actively monitor traffic and often lock doors or guide passengers to exit safely, Waymo's system fell short significantly,' Hanki said in a released statement. 'There was no alert issued in the illegally parked car as according to the passengers. Human drivers prevent accidents every day by assessing real-time risks, something Waymo's 'Safe Exit' system clearly cannot handle.' A request for comment from Waymo was not immediately returned Thursday. The crash happened on Feb. 16, just after noon, as Hanki pedaled to her apartment, traveling northwest on Seventh Street between Stevenson and Market streets in a marked bike lane, the lawsuit said. A Waymo carrying four passengers pulled over to the right side curb on the one-way street next to a no-stopping sign, the suit said. 'The curb-side Waymo's left passenger door suddenly swung open directly in the bike lane,' Hanki said. 'I had no room or time to swerve. With no room or time to react, I crashed violently into the door and interior.' The 26-year-old said she flew into a second Waymo and landed on the ground 'disoriented and overwhelmed.' 'As there were no human drivers in Waymo's vehicles, it exacerbated the chaos,' she said. 'The passengers were visibly confused, the two Waymos remained as they were, obstructing both the bike lane and regular oncoming traffic.' Hanki said the passengers told her it was their first Waymo ride, and they were unsure how to report the incident. They shrugged and left the scene after a few minutes, she said. Other witnesses called 911. An ambulance took Hanki to a hospital with 'serious bodily injuries,' the suit said. Among the safety systems marketed by Waymo is its Safe Exit, the suit alleges, which is 'supposed to be designed to detect nearby cyclists and pedestrians and notify disembarking passengers to avoid collisions.' Hanki claimed the system failed and that the company long knew its cars were 'dooring' cyclists. 'As technology moves forward, we believe it is crucial for all autonomous car companies to not move forward too quickly,' said Michael Stephenson, Hanki's attorney. 'In the interest of public safety, they must make sure they are adequately testing and refining their technology before subjecting the public to these cars.' Hanki said she's not against self-driving technology, but believes there's a 'gap in accountability.' She said she suffered a brain injury, along with spine and soft tissue damage, and the crash has kept her out of work and off bikes. 'I have yet to touch a bicycle because I am afraid of revisiting the same experience,' she said. 'I feel anxious, stressed, and unsafe. Before the crash, cycling was a source of joy and freedom; now how it feels like I've lost that part of myself.' The incident has subtle similarities to an accident involving a driverless Cruise robotaxi on Market Street in 2023. In that incident, a car driven by a human struck a jaywalking pedestrian, causing the person to ricochet into the path of an oncoming Cruise car, which dragged the person before stopping. Cruise has not operated its driverless vehicles in the city since the accident.
