Month: February 2018

The fishing industry has long been hard to monitor. Its global footprint is difficult even to visualize. Much fishing takes place unobserved, far from land, and once the boats move on, they leave behind few visible traces of their activity.

But this week, the journal Science published some remarkable maps that help fill that gap. John Amos, president of an organization called SkyTruth, which helped produce them, issued a statement calling the maps “a stunning illustration of the vast scope of exploitation of the ocean.”

SkyTruth and its collaborators tracked most of the world’s fishing vessels through an entire year by monitoring radio transmissions that most vessels now emit automatically in order to avoid collisions with each other. The researchers were able to distinguish between different kinds of vessels — trawlers that drag nets behind them, for instance, versus vessels that deploy drifting “longlines” that are often used to catch tuna.

The maps show the most intense fishing activity along the coasts of heavily populated areas like Europe and southern China. But fishing also covered much of the high seas. According to the researchers, commercial fishing operations covered at last 55 percent of the world’s oceans. That area, it calculates, is four times larger than the area devoted to agriculture on land.

The researchers also were able to distinguish between fishing vessels from different countries. According to the study, five countries — China, Spain, Taiwan, Japan, and South Korea — accounted for 85 percent of all high-seas fishing.

In addition to SkyTruth, researchers from Global Fishing Watch, the National Geographic Society’s Pristine Seas project, University of California Santa Barbara, Dalhousie University, Google, and Stanford University collaborated on the study.

For the hundreds of thousands of Rohingya Muslims who have fled Myanmar and what authorities describe as a brutal campaign of ethnic cleansing, the prospect of returning to their home villages might be more than just daunting. As satellite photographs show, a return home might be simply impossible.

The images released by DigitalGlobe reveal what appears to be a systematic bulldozing operation by Myanmar authorities, with the remains of dozens of predominantly Rohingya villages razed to the ground in a matter of months.

“Many of these villages were scenes of atrocities against Rohingya and should be preserved so that the experts appointed by the UN to document these abuses can properly evaluate the evidence to identify those responsible,” Brad Adams, Asia director of Human Rights Watch, said in a statement released Friday.

The international human rights organization said at least 55 villages have been leveled and stripped of all their buildings, plant life and distinguishing features since last November. Most of these villages had already been at least partially burned to the ground since August, when Myanmar’s crackdown against the stateless minority population erupted in response to an attack by Rohingya insurgents.

Since then, some 688,000 Rohingya have escaped Myanmar to neighboring Bangladesh, where they live in massive makeshift camps bearing horrific accounts of widespread murder, rape and torture conducted by Myanmar’s military. Earlier this month, The Associated Press reported evidence of at least five mass graves at just one location; others, including two Reuters reporters who were arrested by Myanmar officials, have also reported evidence mass graves in Rakhine state, where most of the atrocities have been reported.

Adams said Friday the bulldozing operation apparently underway there is tantamount to a cover-up destroying dozens of crime scenes.

The operation not only “threatens to erase both the memory and the legal claims of the Rohingya who lived there,” he said. “Deliberately demolishing villages to destroy evidence of grave crimes is obstruction of justice.”

Myanmar’s government, for its part, says the Rohingya — whom it calls “Bengalis” — burned their own homes as they left their villages. Officials say their activities in Rakhine state are related to rebuilding efforts, conducted partly with the intention of repatriating the Rohingya refugees who escaped to Bangladesh.

Authorities are “making continuous and unremitting efforts” to support “the socioeconomic development and creation of employment opportunities in Rakhine State” and enable the closure of the region’s internally displaced person camps, the government said in a lengthy statement about the construction project posted earlier this week.

The AP reported some reasons to doubt the assertion that construction efforts were intended to help the Rohingya, who “fear authorities are seizing land they’ve lived on for generations.” Of the 787 houses planned in the effort, the news service says, only 22 have been reserved for the Rohingya.

Earlier this month the U.N. high commissioner for refugees, Filippo Grandi, urged caution on a controversial plan to repatriate the Rohingya refugess, which was put on hold due to logistical concerns last month.

“Let me be clear. Conditions are not yet conducive to the voluntary repatriation of Rohingya refugees,” Grandi told members of the Security Council. “The causes of their flight have not been addressed, and we have yet to see substantive progress on addressing the exclusion and denial of rights that has deepened over the last decades, rooted in their lack of citizenship.”

The refugees want to return, Grandi said, so long as their protection and freedom of movement are assured. But as satellite images continue to filter out, showing their homes leveled and their farms bare of crops, it is unclear now just what it is they will be returning to.

“All the memories that I had there are gone,” one 18-year-old refugee told the AP. “They’ve been erased.”

One of the most common reasons patients head to an emergency room is pain. In response, doctors may try something simple at first, like ibuprofen or acetaminophen. And, at least up until recently, if that isn’t effective, the second line of attack has been the big guns.

“Percocet or Vicodin,” says Dr. Peter Bakes, an emergency medicine specialist at Swedish Medical Center in Englewood, Colo. “Medications that certainly have contributed to the rising opioid epidemic.”

Now though, physicians are looking for alternatives to help reduce opioid use and curtail potential abuse. Ten Colorado hospitals, including Swedish, participated in a six-month pilot project called the Colorado Opioid Safety Collaborative, aimed at cutting their use of the prescription painkillers. Launched by the Colorado Hospital Association, the project is believed to be the first in the nation to include this many hospitals in such an effort.

The collaborating ERs hoped to reduce their opioid use by 15 percent. Instead, Dr. Don Stader, an emergency physician at Swedish who helped develop and lead the study, says the institutions did much better — cutting their use of the drugs by 36 percent, on average.

“It’s really a revolution in how we approach patients and approach pain,” Stader says, “and I think it’s a revolution in pain management that’s going to help us end the opioid epidemic.”

The overall decrease amounted to 35,000 fewer opioid doses than were prescribed during the same period in 2016.

Their strategy calls for coordination across providers, pharmacies, clinical staff and administrators. And it introduces alternative procedures — using nonopioid patches for pain, for example. Another innovation, Stader says, is using ultrasound to help guide targeted injections of nonopioid pain medicines.

Rather than opioids, such as oxycodone, hydrocodone or fentanyl, Stader says, the doctors now try to use safer and less addictive alternative medicines, like ketamine and lidocaine, an anesthetic commonly used by dentists.

Lidocaine was by far the leading alternative; its use in the project’s ERs rose 451 percent. Ketamine use was up 144 percent.

Meanwhile, the use of methadone dropped by about 51 percent and oxycodone prescriptions dropped 43 percent. The use of codeine was cut 35 percent and fentanyl’s use dropped by roughly 11 percent.

“We all see the carnage that this opioid epidemic has brought,” Stader says. “We all see how dangerous it’s been for patients, and how damaging it’s been for our communities. And we know that we have to do something radically different.”

Claire Duncan, a clinical nurse coordinator in the ER at Swedish, says the new approach has required intensive training of health care providers. She says she was surprised by the pushback from patients.

“They say ‘only narcotics work for me, only narcotics work for me,’ ” says Duncan. “Because they haven’t had the experience of that multifaceted care, they don’t expect that ibuprofen is going to work, or that ibuprofen plus Tylenol, plus a heating pad plus stretching measures — they don’t expect that to work.”

Dr. Peter Bakes is an emergency medicine doctor at Swedish Medical Center. Rather than reaching first for opioids for their patients who have severe pain, doctors in his ER have been trained to turn more often now to safer and less addictive alternative medicines, like ketamine and lidocaine.

John Daley / CPR News

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John Daley / CPR News

Dr. Peter Bakes is an emergency medicine doctor at Swedish Medical Center. Rather than reaching first for opioids for their patients who have severe pain, doctors in his ER have been trained to turn more often now to safer and less addictive alternative medicines, like ketamine and lidocaine.

John Daley / CPR News

The program requires a big culture change, Duncan says, encouraging staff to change the conversation from pain medication only, to ways to treat pain that help patients better understand and cope with it.

Emergency medical workers are all too familiar with the ravages of the opioid epidemic. They see patients struggling with the consequences every day. But Bakes, the ER doctor at Swedish, says this project has changed many minds, empowering health care professionals to combat an opioid crisis they unwittingly helped create.

“I think that any thinking person — or any thinking physician, or provider of patient care — really felt to some extent guilty, but powerless to enact meaningful change,” Bakes says.

The pilot project has proven so successful that Swedish and the other emergency departments involved will continue the new protocols and share what they’ve learned. Stader says the Colorado Hospital Association plans to help spread the word about opioid safety, too; he expects to see the new strategies adopted statewide by year’s end.

“And I think if we did put this into practice in Colorado, and showed our success,” he says, “this would spread like wildfire across the country.”

The 10 hospitals that took part in the Colorado collaboration were scattered all over the state — Boulder Community Health; Gunnison Valley Health; Sedgwick County Health Center; Sky Ridge Medical Center; Swedish Medical Center; UCHealth Greeley Emergency and Surgical Center; UCHealth Harmony Campus; UCHealth Medical Center of the Rockies; UCHealth Poudre Valley Hospital and UCHealth Yampa Valley Medical Center.

This story is part of NPR’s reporting partnership with Colorado Public Radio and Kaiser Health News. John Daley can be found on Twitter @CODaleyNews.