WEBVTT

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Previously on Life. This is a
specific (inaudible), anemia,

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gross underdevelopment, and many things.
Most of the pregnant women

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here they are suffering from anemia…

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Literacy of women, education, hygiene,

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availability of food, the whole
situation is really socio-economic.

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Bazma(ph) is anemic. She is one of over

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two billion people worldwide who
suffer from this exhausting condition.

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She has no appetite, she is
tired, and she can\'t concentrate.

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There is not enough iron in her blood
to allow it to carry sufficient oxygen

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to her body and her brain.

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Without treatment, the disorder will have
long term effects on Bazma\'s(ph) health

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and she could even die.

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Iron deficiency anemia

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is the most widespread nutritional disorder in the
world. It is particularly severe in the middle-east

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and it affects the rich as well as poor.

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It is often a hidden disease and young
children and women of childbearing age

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suffer the most. Children can
suffer irreversible mental

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and physical damage. Women with
severe anemia can die in childbirth

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and miscarry their unborn children.

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People live with anemia
but they can\'t work well.

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People live with anemia but
they can\'t think well,

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and if you can\'t think well, how you
can make a better life? We can\'t.

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[sil.]

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Bazma is getting specialist
treatment from Dr. Ibrahim,

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a nutritional expert, at a clinic in Cairo.

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Young children are especially vulnerable to
iron deficiency. They need a constant supply

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of iron to grow properly.

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Here we are facing many problems of anemia. I find
that she is very pale from the conjunctiva of her eye

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and her pallor of the lip, okay,

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and also in the nail.

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Her weight is 18 kilogram which is not

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that suitable for her age, which she is five
years and eleven months and also her height

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is 109 cm

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which is not also suitable for her age.

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This child is not growing well,
even physical or mental.

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And this is will affect her school age
when the starting school age is next year,

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okay? She will get some educational
problems if she is not well treated now.

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[sil.]

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The cause is complex social
and cultural issues.

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Over 50% of the population of some countries in the
Middle-East suffer from iron deficiency anemia.

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It stunts the health of entire populations

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and slows down productivity. The
economic consequences of a tired, weak,

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and iron deficient workforce can
run into billions of dollars.

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Now when you translate iron deficiency, this
lack of productivity to actual money terms,

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you come up with amounts of up to $428

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per capita per year. Now,
times 60 million inhabitants,

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for instance, that\'s a huge amount of money
and that\'s really to be taken very seriously.

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[sil.]

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One of the most effective ways
to combat iron deficiency anemia

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is to add iron to staple foods that everybody
eats, a process known as iron fortification.

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Here bread

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is the staple food. Western
countries have been fortifying

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bread and cereals for the last 50 years but in
the Middle-East the idea is still quite new

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and the process has thrown
up a number of problems.

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The idea is to add iron to flour

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so that everybody will get their recommended
dose of iron when they eat their daily bread.

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[music]

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It was in Egypt, the ancient land of the Pharaohs
that legend says bread-making was invented

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many thousands of years ago. Loaves
were often buried with the dead

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to provide them with sustenance on
their journey to the afterlife.

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Ancient hieroglyphics from over 5,000
years ago show that bread was even then

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the staple food.

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Possessing a great number of
loaves meant great wealth.

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Bread was the currency of the kingdom
used to pay priests and pyramid builders.

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The Pharaoh was the lord
of all wheat and flour.

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In present day Egypt,

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bread is in abundance everywhere,
eaten at least four times a day,

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there is said to be over 100
different types of bread here.

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The most common is Baladi bread.

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In Egypt,

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bread is known as Aish.
The word Aish means life.

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[non-English narration]

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This bread means everything to us…
everything. This bread is the best.

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That old man over there
refuses to eat anything else.

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[sil.]

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Ramdam Fawzy is one of many
thousands of bakers in Egypt.

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He inherited this bakery from his father
who inherited it from his father.

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Everyday he bakes at least 5,000 loaves.

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Of course, I\'m proud of what I do.

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I feed everyone, from
politicians to poor people.

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It\'s a service that I provide to the whole
community when I bake bread, Inshallah.

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Because bread

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is so important to Egyptians, any government
policy on fortifying bread flour with iron

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needs careful management.
People are anxious

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of the thought of interfering
with something so natural.

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We shouldn\'t put anything into our flour.

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It will affect the bread. Any small
changes will affect our work.

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We shouldn\'t play around with
things that God gave us.

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Changing nature will give
us a lot of problems.

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Dr. Farouk and his colleagues are working with
the government and international agencies

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to encourage the fortification
of bread flour with iron

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but he knows that he has to
take things one step at a time.

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Baladi bread, we can say, out of the whole
bread in Egypt it is the staple food like rice

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in far east but in Egypt it is very
precious for… the bread is very precious

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and sacred since ancient, ancient times

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and we are keen that the
fortification of the bread,

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the process would be thoroughly studied
and done in a very cautious way so

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that\'s why we decided that it
must be… it had been decided

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that we have to do a pilot study
in one of the (inaudible)

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not universal for the whole nation.

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As part of the pilot study, Dr. Ibrahim

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is helping people to understand that the
fortification of the flour is safe and necessary.

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We are planning for social marketing
campaign for the flour fortification project

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because people must know
that we are getting

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the bread what is must be

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(inaudible) you know,

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as a whole flour contain iron but when we milling it
we execute(ph) a lot of iron so if we return it back,

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just return it back, okay, and
this is in a dose which is safe,

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in a dose which is not harm, you
know, which is under control.

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Dr. Ibrahim takes his work
to the eastern region,

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Al-Fahyoom(ph) where a new project to fortify bread
flour with iron is scheduled for the near future.

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Here he works with local nutritional
educators like Afaf(ph)

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who help him talk to people and
discuss any concerns they might have.

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Today they are visiting Sabah(ph)
who is eight months pregnant.

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Because of this, she needs more iron
than usual to feed her growing baby.

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In our social marketing
campaign it is a very good idea

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that the social educator come to the mother at home
we will use nutrition educators like Afaf(ph),

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we will teach her (inaudible) providers

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so that they can visit the home.
We cannot visit all homes.

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We will also train them help educate
the people about fortification.

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[non-English narration]

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Home visits aren\'t just an opportunity
to talk about flour fortification.

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They are also a good way to teach people about
the importance of eating iron-rich foods.

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[sil.]

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A few kilometers from Sabah\'s house
is the Al-Fahnoum(ph) flour mill.

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One of five hundred mills in
Egypt, it was the first to install

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a simple flour fortification system.
For the last two years,

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they\'ve been adding iron to flour used
to bake biscuits for school children.

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[sil.]

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In a few months\' time they also
plan to add iron to bread flour.

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The iron is added in the form of
ferrous sulfate in small doses.

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The process is carefully
monitored at every stage.

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In this test the darker color
means the flour now contains

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the recommended dosage of iron.

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Dr. Ibrahim wants to help
people like Bazma(ph)

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and her mother understand why iron
is so important to their diet

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and how their eating habits
can affect their iron intake.

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There are many natural sources of
iron given to us by God like spinach,

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parsley, cabbage, all of them

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which are rich in iron. The thing
is that we need to be careful

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what we eat with what. We shouldn\'t
drink tea with our meals.

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And we need to eat our meals fresh.

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[non-English narration]

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The problem is exactly we make food which
is rich in iron, not rich in iron.

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Some of the problem of iron is absorption.

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Iron is an element which has to be in
suitable circumstances to be absorbed.

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We must have some vitamin
C or fruits or vegetable

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which contains vitamin C to absorb iron.

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Here in Egypt, we are taking tea
with lunch – not after lunch,

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not before lunch – we are taking it with
lunch so the iron content of that food

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is not well absorbed. So I take
iron but I can\'t absorb it.

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[non-English narration]

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Bazma is lucky. As well as eating an iron
rich diet, she is receiving iron supplements.

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[non-English narration]

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Her prognosis is good. With luck she
won\'t suffer any long-term damage.

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[sil.]

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Across the Red Sea to the South-East, Yemen is also
launching a national flour fortification program

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in the near future. In
some areas of the country,

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up to 80% of the population suffers
from iron deficiency anemia.

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Yemen, a country the size of France,

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but with a population of just 18
million, Yemen has only recently emerged

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from centuries of isolation
and the ravages of civil war.

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As in Egypt, bread is Yemen\'s staple food.

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But here the challenges are different.

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Fortifying flour is just one part of the
need to address basic health issues

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compounded by extreme poverty,
primitive infrastructures,

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and inaccessible mountain ranges.

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Mountains cover over 60% of the country.

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We have to combat iron deficiency anemia

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at different level everywhere by all means

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and what I mean by that, that we
have to… to… to fortify flour

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to control parasites,

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anthelmintic, to control malaria
to combat and control malaria,

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to improve the obstetric care
under productive healthcare.

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[non-English narration]

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Hospital is a luxury reserved
for the few Yemenis who manage

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to make it into town.

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It can take days to travel to the nearest health center.
Once there, patients will still have to pay something

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towards the cost of their treatment
– a cost few of them can afford.

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Eight out of ten women are illiterate

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and only one in five receive any
medical assistance in childbirth.

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With little access to family planning,

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most families have at least seven children and
women who suffer from iron deficiency anemia

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are much more likely to die in childbirth.

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In this hospital

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in the Yemeni capital of Sana\'a, one out
of every ten women who go into labor die

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because of complications from anemia.

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I feel so sad

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and frustrated when I see how many women are
dying. The cases that we are unable to save.

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There is a lack of awareness and
education about family planning

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and also about general
health and nutrition issues.

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Health education in Yemen till
the moment is still limping

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and the only issue is preparation(ph)

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(inaudible) overcome this problem

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and to have the suitable training where they
can educate the population and the community.

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[sil.]

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Rachel Chandiru, a health specialist from Uganda
trains midwifes in the western region of Yemen.

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One of the poorest areas, it also has a high
malarial incidence which adds to the problems

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of iron deficiency anemia.

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The problem we have here with
anemia is mostly abortion,

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still birth,

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and also death of mothers during delivery.

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As part of her daily work, Rachel sees the basic
challenges that pregnant women and new mothers face.

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She teaches midwives to discuss primary health
care and nutrition with their patients.

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All these midwives here,

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they do home visits and she is the one supervising
successfully delivering in the house,

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so I was asking, uh… who is going to
help her during the time of delivery,

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successfully (inaudible) trained midwife.

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[non-English narration]

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Rachel accompanies the
midwives on their home visits.

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Anisa(ph) is 16. She has two children. She
gave birth to her second child two days ago.

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The baby she delivered today, the mother
here just in this place where we are.

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She delivered in the
floor here (inaudible).

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[non-English narration]

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Rachel emphasizes the key role
midwives can play in persuading women

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to take iron tablets during pregnancy.

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In Yemen, ignorance combined with
cultural misconceptions often

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exacerbates basic health problems.

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Yes. I was asking her as a midwife, she was
the one taking care of her during antenatal,

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did she give her iron tablets, she
said yes. That was the first things

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they told as when started giving iron
tablets, it will make our babies big

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and we shall have difficulty in delivery or these
kinds of things but we have to teach them,

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train them what iron tablets does
for the baby and for the mother.

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[non-English narration]

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Sixteen-year-old Anisa(ph) is (inaudible) couple of
years older than these girls in the same village.

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Many of them already suffer
from iron deficiency anemia.

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(inaudible) don\'t have the right foods at the
right time and the mothers need to be taught,

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in fact what to feed their children with.

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So most of them are really
small for their age.

00:20:05.000 --> 00:20:09.999
[non-English narration]

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She told me she has ten… nine children
and that\'s her ninth… uh, tenth child.

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I asked her why don\'t you visit the midwife

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because she is nearest to you she
says she doesn\'t want to visit her.

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I said why because it is important for
you to visit the antenatal clinic

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because if you have anemia or
anything like you have a swollen leg,

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the midwife would have detected
it earlier because this is anemia

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due to not taking iron
tablets and not eating well.

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[sil.]

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Half the population of Yemen
is under the age of 15.

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Many suffer from easily curable childhood diseases.
One in eleven children die before the age of five.

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Of course, when children have
deficiency of nutrition or nutritional

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deficiency they will not grow up well.
They will not perform well in school

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or they will not be active
among their peer groups

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or in their home to help their parents to do some
work. The eye… when we look at the eye, it is so pale

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and she has this swelling

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(inaudible)

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I think this is a sign of deficiency
and you can see the child is not happy

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so this must be one of the
signs for deficiency.

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[sil.]

00:22:00.000 --> 00:22:04.999
Here women are not allowed
to go outside (inaudible)

00:22:05.000 --> 00:22:09.999
it\'s the men who go outside to buy food.

00:22:10.000 --> 00:22:14.999
So this causes anemia to women
because market day is only once

00:22:15.000 --> 00:22:19.999
and then you have to get food and they don\'t
have storage, good storage, so it\'s difficult

00:22:20.000 --> 00:22:24.999
to buy fresh foods, maybe
which can last for one week.

00:22:25.000 --> 00:22:29.999
They talk about fortification and I
think that probably would be the best…

00:22:30.000 --> 00:22:34.999
the best solution here where there
is in fact no food for the community

00:22:35.000 --> 00:22:39.999
and they have no access to
market and they are very poor.

00:22:40.000 --> 00:22:44.999
I think that could be the best thing.

00:22:45.000 --> 00:22:49.999
[sil.]

00:22:50.000 --> 00:22:54.999
The Red Sea Flour Mill in Yemen is the
third biggest flour mill in the world.

00:22:55.000 --> 00:22:59.999
I think that people will accept it

00:23:00.000 --> 00:23:04.999
because since they know the benefit
of this for the health of the people

00:23:05.000 --> 00:23:09.999
and especially their
mothers and the children,

00:23:10.000 --> 00:23:14.999
I think they will accept it willingly.

00:23:15.000 --> 00:23:19.999
[sil.]

00:23:20.000 --> 00:23:24.999
Fortifying flour for bread

00:23:25.000 --> 00:23:29.999
means people across Yemen from mountain village to
bustling town can now receive a daily dose of iron

00:23:30.000 --> 00:23:34.999
as part of their diet.

00:23:35.000 --> 00:23:39.999
According to World Health Organization
studies, it costs just $2 per person

00:23:40.000 --> 00:23:44.999
for a lifetime to tackle the
problem of iron deficiency anemia.

00:23:45.000 --> 00:23:53.000
[sil.]

00:24:05.000 --> 00:24:09.999
Flour fortification is one way of ensuring

00:24:10.000 --> 00:24:14.999
that with every meal they eat,
every piece of bread they consume,

00:24:15.000 --> 00:24:19.999
people will now get the iron they need to create a
nation of physically and mentally healthy people.

00:24:20.000 --> 00:24:24.999
[sil.]

00:24:25.000 --> 00:24:29.999
Flour fortification is
such a great opportunity

00:24:30.000 --> 00:24:34.999
and I feel that if you have this bread, people eat bread,
they say this is the bread of life, it is life itself,

00:24:35.000 --> 00:24:39.999
and I think that life should be healthy and
life should be prosperous so if we can add iron

00:24:40.000 --> 00:24:44.999
and make sure that this bread enhances
the iron status of the individual person

00:24:45.000 --> 00:24:49.999
and, therefore, improves the economy of the
country, I think we have done a great job.

00:24:50.000 --> 00:24:54.999
Just yesterday the prime minister
of the Republic of Yemen

00:24:55.000 --> 00:24:59.999
and the minister of public
health have issued a decree,

00:25:00.000 --> 00:25:04.999
a law to fortify all flours,

00:25:05.000 --> 00:25:09.999
consumed flours, in Yemen
and the challenge now is

00:25:10.000 --> 00:25:14.999
to how to enforce this law.
Bread is a sacred food

00:25:15.000 --> 00:25:19.999
to the whole Egypt (inaudible) in Egypt.

00:25:20.000 --> 00:25:24.999
We eat bread in breakfast, we eat bread
in lunch, and we eat bread in dinner.

00:25:25.000 --> 00:25:33.000
[sil.]

00:25:35.000 --> 00:25:39.999
I was lucky because I have a
mother who is illiterate,

00:25:40.000 --> 00:25:44.999
she gave me all foods which I now
find that it was very rich in iron

00:25:45.000 --> 00:25:49.999
and it was very healthy food.

00:25:50.000 --> 00:25:54.999
Anemia is a very dangerous disease.

00:25:55.000 --> 00:25:59.999
It affects our health.
It affects our future,

00:26:00.000 --> 00:26:04.999
it affects our children. We have
to combat iron deficiency anemia.

00:26:05.000 --> 00:26:10.000
We have to prevent iron deficiency anemia
and we have to be more healthy (inaudible).