Fall From Grace

"He acted like a kid. He didn't act like a man."
"Nobody from the board or [connected to] the school gave him any money [for tuition of $12,700]. The board got paid its tuition."
"The first question he asked was can he drink the water?"
"He'd get up in the morning, I'd make him breakfast, pack him a lunch and he'd come to school with me. After school he practised and we'd come home. Sometimes we'd go back in the evening to do more work [on his basketball skills]."
"He struggled in school. He had gaps in his education. He'd been in and out of school there [South Sudan], so that was normal."
"But every one of his teachers came to see me. They'd say what a nice boy he was. He's trying so hard."
Peter Cusumano, basketball coach, Windsor, Ontario

"He was a good guy, he had a big heart. We're good friends."
"Every time we went out to eat, if a teammate didn't have enough money he'd spot him. He'd sometimes pay for people. He was just a really good guy."
Ramkel Wal, 17, Catholic Central Comets team player, Windsor, Ontario

Jonathan Nicola, right, of the Catholic Central Comets catches his breath during a game against the Kennedy Clippers January 5, 2016. Nick Brancaccio / Windsor Star

Desperate people do surprising, bold and desperate things to try to help themselves. And certainly Jonathan Nicola, from South Sudan, has surprised many people who have discovered he is not a 17-year-old kid seeking haven from extreme poverty, conflict and social disadvantage, coming to Canada as a starving waif of 6-foot-9-inches, a high school kid, looking for a break and finding one through the Canada Homestay Network.

That's a program that aids in finding homes for international students, among willing host families. South Sudanese Jonathan Nicola found a home living with Comets basketball coach Peter Cusumano, last November. Two government agencies had looked into Nicola's background before he was permitted to enter Canada. He was in possession of a passport, birth certificate, student visa and immunization records. Everything he needed to present himself as a 17-year-old qualifying for entry to Canada as a high school student.

Mr. Cusumano spoke of his experiences with the young man, how life in Canada so pleased Jonathan Nicola, initially malnourished; amazingly tall but skin and bones. "He put on 25 pounds staying with us in five months", Cusumano remarked. The young man had little difficulty establishing a routine of attending school, practising basketball and diligently applying himself to homework. Shy initially, the young man soon became integrated comfortably with Cusumano's family.

He was teenager-uncharacteristically amenable about helping with daily domestic chores. And in time he began to divulge stories of his homeland, speaking of dreadful violence, poverty, and his heartfelt gratitude to have escaped all of that miserable dysfunction. His father was in Saudi Arabia, his mother in South Sudan. He had six or seven full siblings, and numerous half-siblings, he explained. The coach would provide Nicola with spending money, and life was good, life was 'normal'.

Cusumano describes how much Nicola enjoyed being on the basketball court. Slowly learning the game, working his way into the lineup. People stood up, took notice in the high school basketball community. "I went up against him a couple times. He was very aggressive. He had such size and strength", recounts, a player from another team, Mitch Zimmerman, of the teen who had never played organized basketball before arriving in Canada.

 
Catholic Central Comets Jonathan Nicola, centre, defends against Kennedy Clippers Omer Sulliman, left, in senior boys’ basketball action at Catholic Central on Jan. 5, 2016. Nick Brancaccio / Windsor Star

A national scout watched him at a tournament in London and was impressed with his "raw, uncoordinated" talent. He was subsequently ranked as one of the Top 15 prospects in the country. And where is he now? In a detention centre, a third hearing in the offing before the Immigration and Refugee Board, to take place in May. In mid-April the Canada Border Services Agency appeared at Catholic Central to take him into custody.

Jonathan Nicola admitted readily that he had falsified his age. His fingerprints were matched with those of a person who had unsuccessfully applied for a U.S. visitor visa in 2015. On the application was a birth date of November 1, 1985, making Nicola 29 years of age. "What he did wasn't right. To portray him as a criminal is not fair either", remarked Mr. Cusumano of the young man who had lived with his family for six months.

Who truly can find fault with the deception that Jonathan Nicola resorted to? Unfair is the very least of what his incarceration and pending deportation represents.

Catholic Central Comets Jonathan Nicola, centre, during warm-ups with teammates Caleb Akinsanya, left, and Ramkel Wah on Jan. 5, 2016. Nick Brancaccio / Windsor Star

Regret There Is None

"They definitely, definitely loved their son but as stated in our closing arguments, unfortunately sometimes love just isn't enough."
"Parents still have to follow a standard of care as set by criminal law."
Crown prosecutor Lisa Welch, Lethbridge courthouse, Alberta

"It's like a religion to them [naturopathy]. Studies have shown that some people are more likely to believe these kinds of things [all things natural trump science]."
"They're more likely to believe in the supernatural. They're more likely to be religious and they're more likely to buy the entire package of complementary and alternative practices."
Tim Caulfield, Health Law and Science Policy Group, University of Alberta

"Our doctors are required to understand their limitations of their practice and as such, when the situation arises where a naturopathic doctor recognizes the patient care is beyond their scope of practice, or beyond their limitations, that they would refer to an appropriate health-care provider."
Beverly Huang, president, College of Naturopathic Doctors of Alberta

David and Collet Stephan leave the courthouse on Tuesday, April 26, 2016, in Lethbridge, Alta. The Stephans were on trial, charged with failing to provide the necessaries of life to their son Ezekiel in 2012. (David Rossiter/Canadian Press)

The science-nature dichotomy pits that part of a population believing in natural healing remedies against people who place their faith in medical science. This polarization comes to the fore from time to time when those who have trust in the potency of natural and/or traditional medications derived from plant sources without the interference of modern pharmacological strains held by science to be superior and specifically formulated to respond to particular medical conditions adhere to their beliefs and in so doing bypass medical science to the detriment of a patient, usually a child, who succumbs to a dire illness that would have responded positively to medical treatment.

And such was the case with David Stephan and his wife Collet, found guilty of failing to provide the necessities of life for their 19-month old child Ezekiel, who died in 2012 of meningitis, a condition which they treated with a 'potent' echinacea formulation obtained from a naturopathic clinic. The child's father is employed at a company called Truehope Nutritional Support, in Raymond, Alberta. In 2004 Health Canada had attempted to launch a court case to stop the distribution of the company's supplement Empowerplus.

The company had laid claims that its product could empower people using it to manage mental illnesses like bipolar disorder. Health Canada issued warnings to the public about the product. But in 2006 the company was found not guilty in court, of distributing Empowerplus without a drug identification number. The trial in Lethbridge against David and Collet Stephan heard evidence that the parents of the toddler Ezekiel had attempted to treat his illness with Empowerplus.

The child was so ill that days before he was finally rushed to hospital his parents had been giving him fluids through an eye-dropper because he was so debilitated and incapable of responding that he would not or could not eat or drink. Collet Stephan, the jury heard, had researched treatments for viral meningitis online before she obtained an echinacea mixture from the Lethbridge naturopath, Tracey Tannis.

"I will be ... gathering information about Dr. Tannis's involvement in this matter", Kristen Tanaka, the College of Naturopathic Doctors of Alberta's complaints director advised, responding to a complaint by Dr. Michelle Cohen, a Brighton, Ontario family physician who collected signatures of doctors from across Canada, protesting against the health practise of naturopathy that placed Ezekiel Stephan's life at risk. Dr. Tannis testified in court that she had instructed the child's mother to take him directly to hospital.

Ezekiel Stephan died in March 2012. An autopsy shows he had meningitis. (Stephan family)

Found guilty of the charges laid against them, the parents of little Ezekiel will now face jail time. At the present time both are out on bail. And they remain convinced they did nothing wrong, that they are the victims of a vengeful medical community and an oblivious society that misplaces its trust in conventional medical science. Ezekiel was their  youngest child, they have other, older children upon whom they can practise naturopathy when they too become ill.

"I only wish that you could've seen how you [the jury] were being played by the Crown's deception, drama and trickery that not only led to our key witnesses being muzzled, but has also now led to a dangerous precedent being set in Canada."
"The floodgates have now been opened and if we do not fall in line with parenting as seen fit by the government, we all stand in risk of criminal prosecution."
"May heaven help us all!"
"It was just definitely heart wrenching to see the direction that it [the trial] went. There's the Crown's version of our story, then there's our story of us who actually lived it."
"Not so much for ourselves [considering appealing the verdict], but for the fact this sets a tremendous precedent for the Canadian populace. It would have been easier for us just to take a plea bargain a long time ago and just basically keep living our lives, but we didn't want this precedent being set. That's why we proceeded forward in the first place."
"I don't know yet whether we're going to throw in the towel."
David Stephen, father of Ezekiel Stephan

Patient or Profit-Oriented Medicine?

"The patients knew they were being manipulated. They were being used as billing numbers. Pharmacy and medicine are separate ... and there's good reason for that. If the physician has a vested interest in the drugs, then obviously that will influence how he prescribes."
"It's a way of transferring the profitability of the pharmacy to the doctors." 
William Brown, pharmacist, Brantford, Ontario

 

Glenn Lowson / National Post     Bill Brown filed a complaint against Dr. Dhillon alleging that the doctor is pressuring and intimidating methadone patients to fill their prescriptions at the pharmacy in the building he owns

"[Some doctors deliver excellent service focusing on providing methadone treatment, while others are] set up just to roll patients through."
"It's a way to make a lot more money than their peers in family medicine do."
Dr. Philip Berger, medical director, Inner-City Health Program, St.Michael's Hospital, Toronto 

Canada has its share of drug addicts, and among them are people who have been prescribed opioids post-surgery, or for pain management by their physicians who may fail to adequately monitor their use of the drugs, leaving patients to become addicted. The fact is that Canada is facing an epidemic of prescription-opioid abuse. And that's additional to the heroin addicts for whom the use of methadone has become a way to wean them away from their deadly addiction.

Methadone treatment is prescribed as well for those patients who have become addicted to prescription drugs.

And, it would seem, as Dr. Berger of Toronto's St. Michael's Hospital remarked, that many doctors have abandoned their broad practise of medicine as a service to the public through a patient workload, and have decided instead to focus their medical diagnostic and health skills on methadone treatment for recovering addicts. Clearly this is done for distinct reasons; some medical practitioners may feel their profession requires doctors dedicated to aiding addicts shed their self-destructive habit.

While others, lured by simplifying their practise -- shifting it away from the grind of testing their diagnostic skills on a multitude of patients presenting with a wide range of symptoms, arranging protocols to help them recover health, and monitoring their progress -- have chosen a preferential single-focus practise, much in demand, and becoming singularly profitable. One of those profiteers is a doctor from Brantford, Ontario.

Dr. Jatinder Dhillon established a company in Brantford, Ontario, JRD Corp. specializing in methadone treatment for patient-addicts. He also established a pharmacy as part of his business model, and once he diagnosed a patient's needs, prescribed medication, he also steered them to procure their medication at the pharmacy he has sole interest in. It's a kind of profitable double-dipping, that is morally and ethically unsound.

A complaint was brought against Dr. Dhillon by pharmacist William Brown because of their shared history. Dr. Dhillon bought the building that Mr. Brown's pharmacy was located in, as a home for his business, and he presented Mr. Brown with a rental renewal that was significantly increased from what he had been paying; effectively evicting the pharmacy so he could set up his own, Hope Pharmacy. And then Dr. Dhillon's staff was directed to steer patients to Hope Pharmacy.

Colborne Street Clinic and Hope Pharmacy in Brantford on April 22, 2016.
Glenn Lowson / National Post

Ontario's College of Physicians and Surgeons examined the allegations of conflict-of-interest, then cleared Dr. Dhillon of any wrong-doing. This, despite there was evidence that Dr. Dhillon made use of intimidation, threats and gifts to encourage methadone patients to use the pharmacy linked with his clinic. The background of all of this is the booming multimillion-dollar industry represented by the needs of methadone patients.

Mr. Brown appealed that ruling. And presented new evidence; signed statements from patients and pharmacy workers, to have that ruling re-assessed. Mr. Brown noted that dozens of Dr. Dhillon's patients claimed to have been coerced to bring their prescriptions to Hope Pharmacy. The doctor threatened to cut off the doses of methadone he would permit patients to take home with them, rather than having to attend the clinic daily to have methadone administered at the clinic.

An appeal board of the Health Professions Appeal and Review Board is taking another look at the complaint and the circumstances. "He denied doing anything immoral or unethical", the ruling had stated. To further complicate things, an investigative journalist uncovered a study by five addictions experts suggesting that some patients are placed on methadone on an indiscriminate basis resulting from incentives for doctors to recruit additional patients in a lucrative business.

A number of physicians involved in this field of drug addiction remediation have been billing the Ontario government over $900,000 each yearly. The government had established a $150-million-a-year program to deal with the soaring numbers of addicted patients. An obvious allure to many professionals whose principles are somewhat compromised, to say the least. The appeal board cited charges that Dr. Dhillon emailed prescriptions automatically from his clinic to his associated Hope Pharmacy.

The charges, if proven to be true, would be "very serious and unethical, in particular considering the vulnerability of the methadone-patient population", stated the Ontario College of Physicians and Surgeons committee reviewing the original claims with the added evidence. According to the appeal board the college should have investigated the complaint more thoroughly to begin with. With the new evidence to consider it will approach the matter from a fuller perspective.

Heedless Consequences; Curing Acne ... Birth Defects

"Poor adherence with the Canadian prevention guidelines means that Canada, inadvertently, is using pregnancy termination rather than pregnancy prevention to manage fetal risk from isotretinoin."
"First of all it [Accutane] works. There is nothing quite as effective as it. [Doctors] are aware that when they've used it, patients have been really pleased with the results."
"Acne can be quite nasty and scarring [and can have psychological effects on young people]. It can deeply affect their psyche and cause depression."
"It might be a young man using it and someone comments at a party, 'Your acne is really clearing up'. And he says, 'I'm on this new treatment, I've got it with me, do you want to try it?' And he gives a few to a female friend, who unbeknownst is pregnant, or becomes pregnant."
"It just needs one dose at a vulnerable period."
"This information [birth defects caused by Accutane] is widely available and widely known and doctors and pharmacists are taught that this drug is highly teratogenic."
"We know that it does [cause birth defects]; we were looking at the safety of the system, looking at how many became pregnant while on it."
Dr. David Henry, senior scientist, Institute for Clinical Evaluative Sciences, Toronto

iStock

Researchers estimate that between four and six women of every thousand prescribed isotretinoin will conceive during the time frame they are taking a three-month course of the powerful drug meant to clear up their acne. Of all drug formulations, this is the one that has the highest success rate by far. Which means it will be the first choice by doctors since its use comes with such a high degree of success. Most unfortunately, use of the drug also comes with a high potential for disaster for pregnant women.

Fetuses exposed to isotretinoin within the first trimester of a pregnancy have a high potential to physical abnormalities, from elongated or conical skulls, wide-set eyes, low-set ears, cleft palates, or life-threatening heart problems. Those babies born with all of these symptoms of a drug having disrupted normal development of a fetus for a healthy baby to be born, present as a dire warning to both women and their physicians.

The problem appears to be that doctors knowing full well the potential of the drug's developmental interference of a fetus do not appear to exercise due caution. And women are not fully aware of what they can be gambling with when during pregnancy they use the acne medication. A new study involving some 60,000 women for whom the drug was prescribed in British Columbia, Saskatchewan, Manitoba and Ontario indicates that reducing fetal exposure to Accutane through a pregnancy-avoidance program has had minimal effect.

Sun Media Archive   Despite grave risks, many Canadian women are still becoming pregnant while taking the drug

Of the 1,473 pregnancies that were recorded over the 15-year life of the study, of which Dr. Henry was the lead author, 1,041 resulted in medically induced abortions while 290 were "spontaneous losses"; miscarriages in other words. Of the 118 live births eleven cases, representing 9.3 percent, resulted in congenital malformations, according to the research team that reported on the study outcome, in the Canadian Medical Association Journal.

The active ingredient in Accutane, isotretinoin, as well as in the genetic versions of the product is simply one of the most toxic of drugs in its effect on a developing fetus. In theory women are meant to have two negative pregnancy tests before they begin using isotretinoin. They are meant to sign a consent form indicating they are fully knowledgeable of the risk of birth defects. And they are supposed to use two forms of birth control while treatment is ongoing, and for a month after the use of the drug is completed.

The use of Accutane has rapidly grown in popularity, with greater numbers of doctors prescribing it for even mild acne cases. Approved in 1983 as a drug of last-resort in response to scarring cystic acne failing to respond positively to less powerful treatments, the marketing of generic versions appears to have boosted its popularity. Half of all prescriptions for Accutane are written for female patients with the average age of 24.

A Roche Holding AG's Accutane acne pill package.  (TANNEN MAURY/BLOOMBERG NEWS)

Based on their interpretation of the search of records of use in the demographic of girls and women aged 12 to 48 in all four provinces during 1996 to 2001, of pregnancies occurring during treatment, the researchers estimate that one or two children are born with congenital anomalies each year in Canada through exposure to isotretinoin in the womb.

While doctors are meant to recommend less-restricted, safe drugs before "graduating" to Accutane or a generic formulation, only 45 to 72 percent of isotretinoin users, it was found, had received a prescription for a less-potent medication before being prescribed Accutane.

The researchers conclude that pregnancy is entirely preventable, and mores strenuous efforts should be made to ensure that while patients are on the isotretinoin protocol they avoid becoming pregnant for obvious enough reasons. "We've got the means to do it. Really doctors and pharmacists need to step up to the plate on this one and do a lot more than they have done", insists Dr. Henry; warning women of the risks, persuading them to take the required precautions.

And obviously enough women themselves need to be more informed and certainly more responsible.

Cancer Life-Sentence Reprieve

"It means that this protein is a key piece of the puzzle and could be a possible target for future treatments."
"If we block the function of this Achilles heel [Oncostatin M Receptor], the tumor can't grow and disappears.  This is all done in a mouse of course."
"Within our lifetime if it's all successful, but it's a long difficult path to bring these treatments to clinic."
Dr. Mijchael Rudnicki, Director, Regenerative Medicine Program, The Ottawa Hospital

"[Glioblastoma] is really heartbreaking. These patients don't have a lot of hope right now. That is what drives me to study this."
Dr. Arezu Jahani-Asil, assistant professor, department of oncology, McGill University, Jewish General Hospital, Montreal

"It is very exciting to have not only these new findings, but the possibility of new treatments. This is a very devastating disease. I am one of the lucky few who have made it to the three-year [survival] mark. Only a small percentage of patients do."
"When people are in my situation, it is very much day-to-day living. For me, being a three-year survivor is phenomenal. I am finally in a place that I can look at next year."
Denis Raymond, 29, Ottawa teacher

Diagnosed with brain cancer in 2013, Denis Raymond is a living anomaly among people with similar diagnoses; glioblastoma, the deadliest form of brain cancer. He took part in the medical trial of an experimental therapy in the field of electromagnetic therapy. And the research, to block Oncostatin M Receptor (OSMR), in his excited and hopeful opinion holds out great promise as an effective treatment for glioblastoma.

Now, a team of Ottawa researchers has published the findings resulting from their research into a treatment for glioblastoma, published in the journal Nature Neuroscience. Led by Dr. Jahani-Asl while she was a post-doctoral fellow under Dr. Rudnicki in Ottawa, the discovery was that a protein called OSMR is the handmaiden of bioblastoma; without that protein's presence the cancer tumours cannot form.

It was obvious to the research team that blocking the OSMR activity in brain stem cells should be their target. Blocking OSMR served to prevent them from forming tumours in laboratory mice. The research findings offer a new perspective on treatment of this difficult and deadly cancer, offering the hope that OSMR-targeted therapies might improve the prognosis for glioblastoma patients.

And glioblastoma patients need all the help they can get from medical science, to prolong their lives.

The diagnosis of glioblastoma is a grim one. Patients receiving that information soon learn that treatments currently available are limited in their efficacy. The condition is resistant both to radiation and therapy. And it is extremely difficult to surgically remove. Most people given that diagnosis survive a mere sixteen months.

"To finally be free of the constant worrying and constant thought of being faced with my own mortality, it's very exciting, very exciting", understated Denis Raymond.

29-year-old Denis Raymond at Ottawa Cancer Centre.

 Humankind : Threat to all Living Creatures

"Thirty years ago, two things happened at once. The whole area was contaminated with radiation, and the human population vanished. That gives us a unique opportunity."
"We're not saying that radiation is not as dangerous as we thought. Rather it is possible that in the absence of humans, the stress of radioactive contamination is a manageable one for wildlife populations."
Dr. Mike Wood, British naturalist

"You could say that the overall effect was positive."
"Radiation is a matter of increased potential risk. But when humans are around, animals are simply shot or lose their habitat."
Professor Nick Beresford, Chernobyl expert, Centre for Ecology and Hydrology, Lancaster, England

© Vasily Fedosenko / Reuters

When the Chernobyl reactor number four exploded thirty years ago, a huge area around the nuclear installation became contaminated by radiation, and a wasteland remained. Radioactive toxins spread from the April 26, 1986 explosion at Chernobyl across Europe. Thousands of people died as a result of radiation-related illnesses and cancers. The lingering effects of the catastrophe remain the cause of birth defects in Belarus, Russia and Ukraine.

Scientists believe that the area around the power station will exclude human habitation for hundreds and quite conceivably for thousands of years, as a result of the dreadful depth penetration of the toxic cloud of radioactive material that was released on that date. The area population of 120,000 souls was evacuated expeditiously, leaving a 4,500 square-kilometre region between Ukraine and Belarus a ghost area.

The town of Chernobyl which had hosted residents for its 800-year-history was totally evacuated, along with dozens of villages. Also abandoned was a secret Soviet military base. To remain would be to surrender to a gradual debilitation onset, morbid illness and certain death. The food that was grown for centuries to feed the local population would be grown on deadly soil. Potable water would be unavailable; everything was malignantly befouled.

A radiation sign is seen in the 30 km (19 miles) exclusion zone around the Chernobyl nuclear reactor in the abandoned village of Dronki, Belarus. © Vasily Fedosenko / Reuters

 

What was left was a dead "zone". A place where only emergency workers were dispatched to for brief intervals and even with all safety procedures in place, they would succumb as additional victims to a world-shattering nuclear disaster, the product of human error. Void now of people living where they had traditionally as long as memory could recount and history validate, nature has turned the "zone" over to its other more deserving creatures who could never create a disaster of such magnitude.

The dead "zone" created by the Chernobyl blast has become one of Europe's largest wildlife reserves by default, where wild boar, wolves, elk and deer thrive throughout the forested region and the grasslands that make up the landscape. The presence of wolves, of feral horses and bison are known because cameras set up to record their presence provide their images. The wild species called Przewalski's horses introduced to the area in the 1990s, is proliferating.

And scientists are studying the "zone" and its new residents. Three areas of the "zone" are set up with cameras to reflect the presence of free-ranging and carefree-from-human-presence animals. The three areas represent high, medium and low contamination-designated regions. The issue of ecological-system health, one in comparison to the other and judging soil samples and animal droppings help the naturalists understand the situation in the round.

Terrain horribly compromised and remaining a long-term threat to human life, has become a refuge for animals who appear to have adjusted to the "zone", finding it a place of comfort and haven where they can roam freely without fear of being trapped or shot at as prey, stalked by hunters. Drs. Wood and Beresford are part of a contingent of British scientists who have converged on the "zone" to interpret the evidence they are studying.

As yet it is largely unknown whether or how much the animals are impacted by the radiation suffusing the atmosphere and the environment. It is assumed that there is some measure of deleterious fallout to their health from the corrupted land, but its extent can only for the present, be a matter of speculation. One thing seems clear, however, and that is that animals can better cope in the absence of man, even in dreadfully compromised landscapes, than they are able to in pristine forests stalked by man.

Wolves walk in the 30 km (19 miles) exclusion zone around the Chernobyl nuclear reactor in the abandoned village of Orevichi, Belarus. © Vasily Fedosenko / Reuters

Oceanic Biodiversity

"The entire reef is covered with a red-brown fuzz. It is otherworldly. It is algae that has grown over dead coral."
"It was devastating."
"The worst has happened. This shows how climate change and temperature stresses are affecting these reefs over the long haul. This reef may not ever be the same."
Kim Cobb, Marine scientist, Georgia Institute of Technology

"We are currently experiencing the longest global coral bleaching event ever observed."
"We are going to lose a lot of the world's reefs during this event."
"A lot of bleaching happened due to climate change, before the El Nino had even kicked in."
C. Mark Eakin, Coral Reef Watch coordinator, National Oceanic and Atmospheric Administration, Maryland

Corals bleaching at Loomis Reef, Lizard Island, during mass coral bleaching of 2016 Photograph: CoralWatch

In 2015 the most powerful El Nino climate cycle in a century blasted torrid heat through the tropical and southern Pacific. Reefs from Kiritamati to Indonesia, and from the Indian Ocean to Reunion and Tanzania on Africa's east cost were bleached. Centuries of reef formation destroyed in a matter of weeks. Marine scientists are in the dark over the duration of the ongoing bleaching let alone when the next such episode will arise.

What they do know from observation and the fallout of those catastrophic events is that they are occurring with greater frequency and ferocity. Bleachings that took place in 2010 and 1998, although destructive and worrisome, were not nearly as extensive or as prolonged as the current one. Around 15 percent of the world's coral was destroyed in 1998.

Australia's Great Barrier Reef

Then in 2014 reefs in the Florida Keys and the Caribbean, suffering from previous bleaching events were unable to regenerate before another thermal stress from El Nino last year devastated them. The health of reefs worldwide hangs in the balance since El Nino warms the equatorial waters around Kiritimati Island to a greater extent than anywhere else on the globe. It is a harbinger of what is to come worldwide.

The Kiritimati Island reefs are washed by a nearly constant 24-degree ocean temperature, but the upwelling of deep, cold water usually expected, failed to arise, leaving water in the atoll 6.5 degrees warmer than normal, not cool enough to allow the damaged coral to recover. Global bleaching has resulted from a rare confluence of events raising water temperatures which have been already compromised through climate change.

In the northeastern Pacific an underwater heat wave stretched along the west coast of North America from Baja California to the Bering Sea. This wave was two degrees Celsius warmer than the waters surrounding it and it has caused hungry sea lions to be beached, and tropical skipjack tuna to be sighted off Alaska. A strong high-pressure cell had blocked normal southward flow of polar air in 2013 from the North Atlantic, causing the underwater heat wave, named the "Blob".

XL CATLIN SEAVIEW SURVEY / AFP/GETTY IMAGES

Australia's iconic Great Barrier Reef is suffering its worst coral bleaching ever recorded with 93 per cent of the reef ecosystems affected, scientists said this week.

The Great Barrier Reef off Australia was discovered by Australia's National Coral Bleaching Task force to have been struck with almost a thousand kilometres of reef bleaching. Half of the coral in a survey of 520 individual reefs making up the northern section of the Great Barrier Reef have died.
Kill the reefs and you kill the incubators of the oceanic ecosystem that provides food and shelter to 25 percent of all marine species.

In turn fish stocks that feed over a billion people are supported by the ecosystem and creatures that thrive in healthy reefs. Countless millions of tiny animals, polyps, form symbiotic relations with algae, capturing sunlight and carbon dioxide to produce sugars that feed the polyps. Small-scale fishermen and women estimated to be around 30 million in number are hugely dependent on reefs' productivity.

"This is a huge, looming planetary crisis and we are sticking our heads in the sand about it", commented Justin Marshall of Coral Watch at Australia's University of Queensland, of the metabolism of the algae bleaching when high heat and bright sunlight begin creating toxins, killing the polyps.

Australia's Great Barrier Reef

21st Century Uplift in Rwanda

"The concept of drone ports is something that a very small decision-making unit in the country decided they were going to do."
"It took a very short time. It's something that America could learn from."
Michael Fairbanks, Rwanda presidential advisory council

In 2014 Keller Rinaudo and William Hetzler had a visit with a young public health worker in Dar es Salaam, Tanzania. They were impressed with that worker's vision and initiative for having created a text-messaging system capable of helping hospital workers to use it as an emergency communication to request medical supplies in life-or-death situations.

"The public health worker showed me the database that had entries every time someone texted, and it was thousands of names long. It was mostly infants, and there was no response", explained Mr. Rinaudo. And it was at that moment that he understood the reality of what he was observing. That database with its entries that had never received a response was in fact a long list of death sentences.

That realization acted as a powerful spur, sending Keller Rinaudo and his business partner William Hetzler to find a solution. They looked for an airborne alternative to enable the automation of a supply chain. Their meeting with Keenan Wyrobek, a roboticist trained at Standford University set them on track to assemble an engineering team with background in the aerospace industry.

The close collaboration with roboticists and aerospace engineers led to a rapid engineering feat where a highly automated system was developed to be operated by a staff of five to eight people. That ground-breaking automated system was in fact a drone service. And now one is to be based in a city close by the Rwandan capital of Kigali.

In a story of modern technology uplifting and aiding one of the world's poorest nations, putting it way ahead of wealthier more technologically advanced countries of the world, Rwanda is on schedule to be the first to establish a commercial network of drone deliveries. "Rwanda has a vision to become a technology hub for East Africa and ultimately the whole continent of Africa", explained Mr. Hetzler.

He, as it happens, along with Keller Rinaudo founded a new technology company named Zipline, in Half Moon Bay, California. They helped to design small fixed-wing drones designed to carry medical supplies to remote locations up to 65 kilometres distance from operational headquarters. And the government of Rwanda has signed onto their initiative.

The new system will be capable of 50 to 150 daily deliveries. Rwanda's 21 hospitals and clinics in the western half of the nation is set, from July of 2016 when the system will begin operation, to take advantage of this life-saving option that modern technology has pioneered. A fleet of 15 drones, each with twin electric motors, a 1.6 kilogram payload and a 1.5-meter wingspan describes the system's base.

Speed maintains a "cold chain" -- temperature-controlled supply chain required to convey blood and vaccines. The Zipline drones will make use of GPS to navigate, and communication will take place using the Rwandan cellular network. Rough weather flight with winds up to 50 kilometres per hour will be handled by the drones which will not land but instead drop small packages from low altitudes with the use of paper parachutes.

Extreme Caution : Abortion Alert

"There is no evidence in any jurisdiction that women would seek and obtain a mifepristone prescription, yet not use it."
"This requirement [that a doctor witness a woman taking the first dose] is medically unnecessary and demeaning to Canadian women."
"The single most important reason physicians from across the country are citing for not planning to offer mifepristone is the need for physician dispensing."
"The physicians we have polled -- particularly rural physicians -- have no infrastructure for this."
Dr. Wendy Norman, sexual and reproduction health researcher, University of British Columbia

"[The requirements for dispensing the new anti-abortion drug will effectively limit its availability] and its potential to transform abortion access in Canada."
"The women who call us are looking for a safe way to terminate their pregnancy that doesn't require a lot of travel to an abortion provider, and doesn't require a surgical procedure to be performed on them."
Sandeep Prasad, executive director, Action Canada for Sexual Health and Rights

"We're really trying to balance the use of the product with the potential risks and any of the adverse events that could come from it."
"You want to make sure the person prescribed the medication is [the one] taking the medication. You don't want that medication to go to somebody else."
"You don't want someone to take it at a later time where the risks can be greater."
Dr. Supriya Sharma, senior medical adviser, Health Canada

Mifeprex, a brand name of mifepristone, is available in the United States. A similar product is currently being reviewed by Health Canada. Photo, courtesy of Danco Laboratories.

Mifepristone is regarded as the "gold standard" in medical use for early-stage abortions. France and China have given access to the drug for over a quarter of a century. The drug has been available to American women in the United States since 2000. It is only now that Canadian women can look forward to being able to access this drug that blocks the hormone progesterone, a drug whose efficacy is well recognized and which is available for use in over 50 countries.

When progesterone is blocked its normal function in the preparation of the uterus lining for a pregnancy is disrupted. The lining breaks down and it sheds, a process similar to that which occurs during a woman's menstrual period. Misoprostol acts to cause the uterus to contract, expelling the pregnancy, in the second stage of the drug.

Health Canada has responded to criticism from women's groups that its guidelines for use are unnecessarily complex. They point to a single case of ectopic pregnancy reported in the United States which resulted in the death of a woman taking mifepristone and misoprostol, as well as a few instances of blood infections, including fatal sepsis. A single case of a non-fatal heart attack was also attributed to the use of the abortifactant.

Whether or not there is an actual direct cause-and-effect relationship between these health crises and the use of Mifepristone, however, is unknown. But those in the medical community calling for greater options to be available to women feel Health Canada's restrictions are unhelpful. Dr. Norman and her colleagues recently published a study showing that abortion facilities are located in large urban centres only for most jurisdictions, with the exception of British Columbia and Quebec.

This is a two-step regimen which pairs one drug, mifepristone, with a second, misoprostol. Used within 49 days of pregnancy, the combination induces abortion that is patterned similarly to a natural miscarriage. The drug will not be available over the counter, only through a physician's prescription, and that doctor must be prepared to carry through to witnessing the first dose being taken by the women he has prescribed it for.

Along with that dedication to following a patient's progress with the abortion pill whose convenience of use is obviously made complicated by Health Canada's prescribed regimen, the doctor would be responsible for ordering, stocking and taking payment for the pills, a process that normally goes through a pharmacy as intermediary. The cost is expected to be $270 per package.

And doctors are expected to be registered after completion of a certified, online training program that will entitle them to prescribe and dispense the medication; with Health Canada's protocol requirements: "the patient will not have the prescription in [her] hands". For the physician, an unnecessarily cumbersome process, for the patient a prime indignity.

As it is, women will be required to undergo an  ultrasound to determine gestational age, and ruling out ectopic pregnancy before the abortion pill can be confidently prescribed with safety uppermost in mind.

Inventor of the RU486 abortion drug, French Professor Emile-Etienne Beaulieu, holds the pills in this 1995 file photo. The pills, which have been available in France for 25 years, have been approved for use in Canada.   REMY DE LA MAUVINIERE/Associated Press)

Hoarding Disorder

"I don't see it as courage [to tackle hoarding]. I saw it more as desperation. I was so afraid of people finding out that I wanted to stop it before I lost control. Hoarding is an illusion of control. You believe you're the one who is controlling what you get rid of and what you collect. But in actuality, it controls you."
"It's a source of high anxiety for me. When I go into a [remediative] phase of cleaning, I can go for days without sleeping. We [she and her therapist/clutter coach] would pick things up and I would describe my feeling about getting rid of it or putting it away and that would help. I would shake, cry, have dry heaves. It was pretty intense."
Josie (last name withheld) Ottawa

"In the States, most of their intervention is based on enforcement. People are found out and then the enforcement agencies intervene. Easily, 70 percent of my referrals are self-referrals -- that's almost unheard of in the States."
"It [her hoarding counselling service] is not about cleaning up. It's not about getting rid of things. It's about getting that person to change their relationship to those things. That's when the cleaning up happens naturally. ... If you just throw out and they haven't come to terms with letting go, then you've just created a void and they will fill it."
Elaine Birchall, Ottawa therapist, "clutter coach", expert on hoarding

Elaine Birchall is an Ottawa psychologist who treats hoarding disorder. She is seen in a client's home in this 2010 file photo. Ashley Fraser / The Ottawa Citizen

"That inability to process information carefully and quickly contributes to the hoarding problem. People can't distinguish important from unimportant features. So they have difficulty deciding whether to keep it or discard it, and once they decide to keep it, they have difficulty organizing it, so it all ends up in the middle of the room."
"There's nothing here that is not the case with all of us. Our possessions are magical. They have an essence that goes beyond their physical characteristics. Like that favourite ticket stub from a concert. It's the same phenomena, but with these people, it just extends to more things."
Randy Frost, professor of psychology, Smith College, Massachusetts

This 2015 file photo shows an apartment in New York City surrounded by hoarded newspapers, clothes, books and other items. (Jack Sherratt/Associated Press)

The diagnostic-helpful handbook that psychologists depend on titled the Diagnostic and Statistical Manual of Mental Disorders lists hoarding as a condition that afflicts an estimated two to six percent of any population. A year-long study that took place in Ottawa by Montfort Renaissance and Options Bytown released the results of their investigation into the prevalence of hoarding in the hope that it could be better understood, its motivation and result, and the potential for intervention.

Hoarding can be dangerous. When living spaces are crammed full of objects accidents can occur. Fires can also occur and with so much combustible materials packed into tight spaces such fires can be difficult to control. Jamming all manner of objects from newspapers to bags of durable goods into a living space can also create an obvious hygiene problem leading to the risk of disease and illness. People who hoard know their habit is abnormal and they tend to be ashamed, and become isolated from society.

Moreover, if and when a landlord discovers that a tenant has packed rented space with a plethora of objects making that space both unlivable and potentially dangerous, eviction can follow, and from there homelessness. Hoarding is a pathology where people think of objects that most people will have discarded or feel to be unnecessary or redundant to their needs, as vital to their existence. Hoarders experience great difficulty in objectively considering the absurdity of owning multiple objects with the same function.

Hoarders are very often people who have suffered some kind of trauma in their lives. Hoarding takes their minds away from their pain and gives them something to look forward to. Possessing useless objects that clutter a living area beyond reason, offers a peculiar kind of comfort to hoarders. Depression and anxiety disorder may lead to placing great value on useless objects with little-to-no inherent value, collected in impossible-to-control quantities.

At one time hoarding was considered to reflect a type of obsessive compulsive disorder, but it has now been listed on its own in the reference manual. It was, in fact, an unknown or unrecognized phenomena until 1947 when police discovered a horror story in a three-storey mansion in Harlem. When they entered the building it was to discover that it was packed floor to ceiling with all manner of detritus. And among that junk was the bodies of the two owners of the mansion.

Police detectives examine the mansion of brothers Homer and Langley Collyer in this 1947 photo. The Collyer brothers hoard was a sensation at the time, one of the first cases of hoarding to hit the media. Anthony Camerano / AP

The Ottawa study reached the conclusion that forced cleanouts of "hoarder houses" rarely solve the problem. In fact, it seems to exacerbate the need of hoarders to continue collecting secretively and the problem becomes more difficult to deal with in its aftermath.

"Cleanouts aren't very effective. They are usually very traumatic for the person receiving the cleanout, and they have an almost 100 percent recidivism rate. The person gets very, very traumatized. We find that after three to six months the person is hoarding once again and the problem is worse than it used to be", explained Stephanie Yamin, a psychology professor at St.Paul University who researched the two-year pilot project on hoarding.

The study tracked fifteen people with the hoarding disorder, among them two men, the balance women, all with an average age of 53. Although officially hoarding is said to affect 5.3 percent of the population, researchers feel the actual incidence is higher. It is considered a "hidden disorder", isolating those who are impacted by it, through shame and embarrassment.

People with depression, schizophrenia, fetal alcohol spectrum disorder and developmental delays seem most vulnerable to the pathology. And among those studied, 75 percent had other members of their families who also were affected with hoarding disorder.

"We made a tool kit that's made for the people who work one-on-one with clients. They can use it to help make their environment a better place to live in, with less clutter and less risk around fire, infestations or public health issues. Most of our partners have clients who are struggling with these issues", explained Lise Girard, director of Montfort Renaissance.

Unmanned Aerial Devices

"People are starting to think of UAVs [unmanned aerial vehicles] as not just science fiction, but real-life tools. I wouldn't be surprised if, within two years, it's standard for every fire engine to have a UAV on board."
Philip Reece, CEO, InDro Robotics

UAV operator and paramedic James Power flies a drone in Renfrew Ontario Tuesday April 12, 2016. The Renfrew County paramedic department uses a drone to fly over crash scenes and natural disasters to check out whats going on. (Tony Caldwell/Postmedia Networks)

"What if it had been possible to know more about the situation on Calabogie Lake [where a snowmobiler crashed through the lake urgently requiring rescue]? Of if there was a technology that could, say, deliver a rope to the desperate man hanging on to that wafer of ice?"
"It [use of a drone] identifies the likely injuries [for first responders]. It lets  you prepare for a situation that otherwise would be in the moment."
Paramedic chief Michael Nolan, Renfrew, Ontario

The drone was used for aerial surveillance when OPP were investing the scene of a homicide in Foymount last September. Tony Caldwell/Postmedia Network

Infamously, drones have been used by the American military to target and dispatch to Kingdom Come the CEOs of Terrorism International. They have become weapons of distance-destruction, safeguarding the lives of their operators while eradicating those of the Islamist jihadis for whom non-Muslims have become a moving target in the death game they have become skilled at.

But there are other plans for the use of these UAVs, mostly in the field of commercial deliverables, and in due time we'll hear and see far more about them as they are deployed in the name of commerce. There are multiple uses for drones, however, as eyes in the sky capable of manoeuvring their way into spaces not given to larger airborne vehicles, and at far less cost to deploy.

Several years back Renfrew paramedic chief Michael Nolan thought there must be a way that people involved in rescue could bring modern technology to aid in the preliminary work of gathering data before the paramedics themselves become involved at the actual rescue, to prepare them for what they would find, and what they should bring to the effort.

It often is, after all, a matter of life and death when people find themselves in desperately threatening situations and time is of the essence to help them find their way back to safety and security. The geographic area representing chief Nolan's jurisdiction is vast, stretching over ten thousand square kilometres. When he became aware that one of his crew had military experience with drones he began considering how his unit might procure one of their own and deploy it for life-saving purposes.

The video images that a drone could send back to aid first responders be more effectively efficient was of tremendous interest to Mr. Nolan. So he and paramedic James Power, took eventual possession of a modified drone reflecting in particular what paramedics would profit by having. Their drone was modified for their use by InDro Robotics and Technology of British Columbia. And not only has the drone proven to be indispensable for the Renfrew paramedic services but others as well.

The drone was seconded by the Ontario Provincial Police to obtain a bird's-eye view of a homicide scene in Foymount. Police were tracking the path of a killer of three women. There were unknowns to be dealt with: was the armed intruder still in the house? ...where were the exits? ... where was the victim's 20-year-old son? The use of the drone helped to clarify these issues and expedited the work of the police.

During a forest fire near Eganville in the spring of last year, the drone aided in identification of hot spots for the firefighters. A month ago the drone was used to film the scene of a landslide that had succeeded in plunging several hectares of Leda clay and the trees standing on it into the Bonnechere River. The difficult-to-access area was accessed by the drone, enabling responders to view a natural dam that the slide had created, giving the location and the extent of the ensuing damage.

The regulatory framework imposed by Transport Canada for the use of drones mandates they can be used only within the operator's range of vision. The Renfrew paramedics have requested an exemption to permit them to deploy the drone any time, anywhere that appropriate conditions apply. Weapons-mounted drones have taken away life, Mr. Nolan foresees a time when drones can be used for the delivery of life-saving medications such as an EpiPen to rescue someone in anaphylactic shock.

The Forest Speaks

"These trees are friends. You see how the thick branches point away from each other? That's so they don't block their buddy's light."
"Scientific language removes all the emotion, and people don't understand it anymore. When I say, 'Trees suckle their children', everyone knows immediately what I mean."
"For a forester, this tree is ugly, because it is crooked, which means you can’t get very much money for the wood. It really surprised me, walking through the forest when people called a tree like this one [tree with a curved trunk] beautiful. They said, 'My life hasn't always run in a straight line, either'. And I began to see things with new eyes."
"I kept thinking, 'Ah! You only have 20 years, and you still have to accomplish this, and this, and that.' I learned to be happy about what I’ve done so far. With a forest, you have to think in terms of 200 or 300 years. I learned to accept that I can’t do everything. Nobody can."
Peter Wohlleben, German forest ranger

“When I say, ‘Trees suckle their children,’ everyone knows immediately what I mean.” PETER WOHLLEBEN Credit Gordon Welters for The New York Times

For people who love nature and feel a kinship to all within nature in a natural surrounding, trees in a forest are almost representative of a natural cathedral. They are tall, towering over us, broad and elderly, and their canopy shelters us. Their life span is far longer than that of the human species and they are beautiful to look at and to contemplate. Resting under a canopy of old trees, looking at their massive trunks, the sky above, hearing the birds that shelter in them, seeing the moss and lichen growing on their trunks, gives us a sense of peaceful repose.

Mr. Wohlleben was a forest ranger living in Germany where he was born. He began to think of trees and the presence of trees in the natural world somewhat differently than the detached way in which many of us regard a forest. In the forest he was familiar with he recognized trees as individuals of their species and he found them to be social creatures, with a regard for their neighbours' well-being. This is not the kind of fey thought that might occur to those who fancy elves living in a forest. But it is the realization of someone who comes to understand that nature is even more complex than we imagine it to be.

Living creatures like animals have sentience, the ability to think and to be aware and to act. Without quite anthropomorphizing trees, it is conceivable that they have developed over aeons of time their own social networks where consideration for the welfare of the other denizens of a forest is a type of survival mechanism that nature has imprinted trees with, as improbable as that may seem to those of us who imagine only human beings to be capable of such thoughts and considerations.

Peter Wohlleben found himself much quoted and admired on the publication of his book The Hidden Life of Trees: What they Feel,  How They Communicate -- Discoveries From a Secret World. He hypothesizes and he also presents research along with his own observations of trees and how a forest represents an interconnected network of socialization and practical survival. Some of his ideas may not be entirely original since botanists often consider forest trees to exist within a social network.

Trees and other plants are linked underground (Credit: All Canada Photos / Alamy)

Sending electrical signals throughout a forest-floor's buried fungal network known as the "Wood Wide Web", trees convey messages  to one another, their communications warning of danger, and through the network nursing ill neighbours, and remembering what they have learned. Mr. Wohlleben read extensively about the behaviour of trees, concluding from his own observations and what he had read that trees in a forest habitat behave as communal entities. He realized that the forestry he had studied was not beneficial to those trees.

That reforestation -- for example, where trees are spaced too wide apart when they are planted while ensuring trees have more exposure to sunlight enabling them to speed up growth -- naturalists point out that too much space is capable of disconnecting trees from their natural networks so that their resilience mechanisms are impaired. In the Eifel forest the idea occurred to Mr. Wohilleben that heavy logging machinery damages forest soil, and that by substituting them with horses the soil and the trees would benefit. When his idea was dismissed by authorities he decided it was time to retire.

The Eifel municipality a decade ago was intrigued with this forester's plans, however, and a decade ago failed to renew its contract with the state forestry authority and and moved instead to hire Mr. Wohlleben and his ideas directly. By eliminating expensive machinery and chemicals the forest was better managed, going from loss to a profit margin, and his theory was  validated. This is an extension of respect by mankind toward the natural order of things, recognizing special qualities that exist within other species.

Nearly all forest trees live in symbiosis with underground fungi, and the type of fungus in a forest location can now be identified in satellite images. Credit: Malene Thyssen/CC BY-SA 3.0