Medical cannabis could soon get the green light in France after unprecedented trial

During a years-long experiment that ended on Tuesday, French health authorities gave patients suffering from serious illnesses the chance to use prescribed medical cannabis. As France prepares to put cannabis-based medicines on the market, patients look back at their experience of the trial.

Patience is a virtue. But when faced with indescribable pain on a daily basis, being virtuous is not the priority. At least it isn’t for Valérie Vedere, who was diagnosed with HIV in 1992 and then throat cancer in 2012.

“To appease the burning sensation I get from radiotherapy, I use cannabis therapeutically,” the 58-year-old living in Bordeaux says. “But I also experience pain from antiretroviral treatments for HIV.”

“It’s as if my hands and feet are being squeezed in a vice, which can lead to extreme burning and tingling sensations. I also have muscle spasms that generally take place at the end of the day,” Vedere explains. Her chronic pain is something that can’t be treated with painkillers like tramadol or other opioids. “It’s not suitable for the long-term,” she says.

When France launched a nationwide experiment to test the use of medical cannabis for patients with serious illnesses three years ago, Vedere was determined to participate.

“I had already been using cannabis to ease my symptoms illegally. Now, I would be able to use it legally and have consistent follow-ups with my doctor,” she says. After persuading her doctor that she was a perfect candidate for the trial, she finally became a participant in May 2021 – two months after the experiment was launched.

A leap in the direction of legal medical cannabis

The first results of the trial came trickling in two years later, in 2023. Patients felt their symptoms had improved significantly, with no unexpected side effects. No cases of substance abuse or addiction had been reported.

“Our evaluations show that between 30 and 40 percent of symptoms like pain, spasms, quality of life or epileptic seizures for example, have improved significantly,” says Nicolas Authier, a doctor specialised in pharmacology, addiction and pain who is also the president of the scientific committee tasked with monitoring the medical cannabis trial.

Preparations to make prescribed cannabis-based medicines more readily available, including in pharmacies, are now under way for 2025.

Read moreFrance launches public consultation on legalising cannabis

“Cannabis-based medicines are currently dispensed in hospitals or in hospital pharmacies, but in the long-run, most of them will become available in regular pharmacies much like any other drug,” says Authier.

The French National Agency for the Safety of Medicines and Health Products (ANSM) has until the end of the year to authorise approved cannabis-based products for medicinal use. Those products will then be granted temporary approval for five years – with scope for them be renewed indefinitely – pending a decision by European authorities to market the drugs.

Until then, the patients who were part of the trial will continue to have access to cannabis-based medicines. But as of Wednesday March 27, no new participants are able to join the trial.  

A total of 3,035 people took part in the unprecedented experiment and 1,842 are still receiving treatment today.

An unprecedented experiment

Before the trial was first launched across 275 health facilities in the country, a committee of interdisciplinary scientists – consisting mostly of healthcare professionals and patients – was set up. Together, they defined the conditions under which the experiment would be rolled out, what medicines would be used, the training pharmacists and doctors would receive, how patients would be monitored and the information they would receive.

Health authorities then allowed limited prescriptions for people suffering from five specific conditions: neuropathic pain, some drug-resistant forms of epilepsy, intense oncology symptoms related to cancer or cancer treatment, palliative situations and pathologies that affect the nervous system, like multiple sclerosis.

Patients were only prescribed cannabis-based medicines if available treatment was found to be insufficient, or if they presented an aversion to existing drugs.

Mylène, who is 26 and lives in Paris, has tried a cocktail of medications to combat her cephalgia – a condition that results in recurring and extremely painful headaches. “They are brutal. The pain is permanent, seven days a week. I haven’t had a break since they started in 2014,” she says. “And sometimes I get a particularly painful attack, and it’s as if two cinder blocks are being pressed against my head.”

“I tried all kinds of treatment. Paracetamol, ibuprofen, opioids like tramadol and even morphine. Either the medicine wouldn’t have an effect on me or the side effects were too intense,” the young radiologist explains. “I joined the trial in late December 2023 and started taking medical cannabis droplets morning and night. It’s almost been three months and I am already starting to feel relief. I feel a change that’s really starting to take effect.”

Depending on their condition, patients were given medical cannabis either in oil or dried flower form. Oil droplets were generally taken orally, while dried flowers were inhaled in vaporisers to prevent the potential health risks from burning the plant.

Cannabis-based medicines can have varying degrees of THC and CBD, the two main compounds unique to the cannabis plant, known as cannabinoids. While THC is its primary psychoactive compound, responsible for the typical weed high consumers can feel, it is most efficient in tackling pain. CBD, the second most prevalent compound in cannabis or cannabinoid, is still psychoactive but doesn’t have the same intoxicating effect as THC.

“The majority of patients were given cannabis-based medicines in oil form, which is the treatment that has the longest lasting effect,” Authier explains. “But oil droplets don’t prevent peaks of severe pain that can only be relieved by fast-acting medication … so sometimes we added dried cannabis flowers that patients could inhale using a vape. The effects don’t last very long but are very rapid.”  

However, in February 2024 the ANSM decided to stop prescribing medical cannabis in flower form.

“I wasn’t at the mediation meeting when the decision was taken so I can’t say for certain why,” says Authier. “It seems that the medical cannabis flower looks too similar to the illicit cannabis flower consumed for [recreational] purposes. So that could cause confusion and perhaps spark fears of a potential black market.”

“It’s all very debatable,” Authier adds, unconvinced.

For Vedere, both the oils and flowers are “indispensable”. Angered with the decision to stop prescribing medical cannabis in this form, she wrote an open letter to the French health ministry demanding an explanation.

“I don’t want to take opioids. And when I have sudden attacks of pain, the flowers are the only thing that relieve me,” says Vedere. “So I will just have to continue using the oil that I’m prescribed. As for the flowers, I’ll buy them illegally.”

Based on the five medical conditions that warrant this type of treatment, Authier estimates that between 150,000 and 300,000 people in France could be prescribed cannabis-based medicines, meaning that an entire industry has been holding its breath for the roll-out of the drugs.

While suppliers of the cannabis-based medicines used in the years-long trial were Israeli, Australian and German companies – those tasked with distribution were French.

Along with Germany, France could become the biggest market for medical cannabis in Europe, according to French daily Le Monde.

But despite the promise of a booming market, introducing these drugs to the French market and even getting the trial off the ground has been anything but a bed of roses.

The bad rep of cannabis in France

A few days ago, while attending a Senate hearing on the impact of drug trafficking in France, Finance Minister Bruno le Maire reiterated his position that the decriminalisation of cannabis was a no-go.

“Cannabis is cool and cocaine is chic. That is the social representation of drugs,” he said. “But in reality, the two are poisons. They are both destructive and contribute to the undermining of French society as a whole.”

Despite France being one of the biggest cannabis consumers in Europe, it also has some of the toughest laws against the drug. THC is still classified as a narcotic in France, with the maximum level permitted in any cannabis plant limited to 0.3 percent. CBD is legal as long as the cannabis plant does not exceed the permitted levels of THC.

There is still a lot of stigma around cannabis in France, even though public opinion on its medical use is hugely encouraging. According to a 2019 survey by the national Observatory for Drugs and Addictive Tendencies, 91 percent of French people say they are in favour of doctors prescribing cannabis-based medicines “for certain serious or chronic illnesses”.

Read moreCannabis in France: Weeding out the facts from the fiction

Still, attitudes around the plant are difficult to shift. “It’s impossible to completely shake off the stigma attached to the word cannabis, which is associated with narcotics. So we had to make a real effort to reassure [the medical community] throughout the experiment,” says Authier.

When it comes to medicinal cannabis, politicians and public health officials in France have expressed their concerns through two key arguments. First, that the roll-out of these medicines would be too expensive. And second, that the legalisation of medicinal cannabis will inevitably lead to the legalisation of its recreational use.

“Our objective has always been accessibility. Ensuring that patients have access to these medicines and that doctors prescribe them,” Authier counters. “It was never, as some like to believe, a Trojan horse move to then legalise recreational cannabis. That has absolutely nothing to do with our trial. Opium-based medicines exist without heroin being legalised.”

“We had to deal with some rather dogmatic opinions and deconstruct a lot of beliefs or language to be taken seriously,” he confesses.

The first place to ever legalise medical cannabis was California, in 1996. Colorado followed suit four years later in 2000, then Canada in 2001, the Netherlands in 2003, Israel in 2006, Italy in 2013 and Germany in 2017. To date, around 20 countries in Europe have joined the list, each with their own set of rules and restrictions.

In France, it wasn’t until 2018 that serious discussions around medical cannabis emerged in the public sphere. And it took another three years before the trial began, in 2021.

Now that it looks like medical cannabis is here to stay in France, at least for the next five years, Mylène feels relieved.

“When I was accepted as a participant a few months ago, I thought ‘finally’,” she sighs. “I can see a real step forward and I hope it continues. I hope that it can become more readily available so that as many people as possible can be treated.”



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‘Things have not been easy for us’: My sister is a hoarder and procrastinator. She is delaying probate of our parents’ estate. What can I do?

I am in my early 50s, divorced and working full time, and have been raising my only child, a teenage daughter, alone for the past 12 years. My daughter is estranged from her father, who pays child support. We live in Connecticut.

My parents are both deceased as of last year. I moved out of the family home 34 years ago. I have one sibling: a slightly older sister who never moved out of the family home, never went to college, never married, never had a driver’s license, and has no children. I don’t believe she has ever had to pay rent.  

My parents, my sister and I are civil servants with pensions. My sister has done quite well with a high-school degree, and is already eligible to retire. Her job gives her a lot of time off, including holidays and the entire summer. 

When our last parent became ill, she became their caretaker. There was plenty of money between pensions and retirement accounts that she was able to use for home healthcare, medical expenses, household expenses and eventually funeral expenses.

‘She never stopped working’

She never stopped working through all of this, and had power of attorney on all their accounts. She was evasive with me about the amount of money she was overseeing, and I never pushed the issue.  

My parents’ house has been paid off for several years now and both parents’ names are on the deed. They had no will, but named us both as equal beneficiaries on all accounts. Those funds have been distributed.

My sister has been avoiding the issue of probate for several months. She continues to be evasive about the continuing costs associated with the house, but assures me everything is being paid. She has a history of procrastination and has been hoarding for decades. As time goes on, there is noticeably less space to stand inside the house. 

Through probate, the house and our parents’ belongings are due to be split between the two of us. Since I can’t envision my sister ever finding the wherewithal to move out or prepare the house for sale, I would want her to buy out my half of the house so that my daughter and I can live a more secure life.

Finished paying off loans

We rent, and things have not been easy for us. I paid my own way through college and finished paying all my loans off three years ago. I plan to send my daughter to college in a few years and have a 529 plan for her that’s only worth about $15,000. I’ve been sacrificing a lot to put aside retirement money for a long time, but I will probably never feel confident that it’s enough. 

My sister has been busying herself with many activities that she claims are the reason we can’t get this probate process started now. People around me are urging me to be more assertive. I’ve called the appropriate town offices, and I have a certified copy of the deed to the house and some of the applications in hand, but I don’t feel qualified to do this correctly on my own.

I know there are mediators and lawyers that can help, but I don’t know the best way to take control of this situation without spending a ton of money. What do you suggest would be the fairest and fastest way to get this going when one person is passively resisting?

Feeling Stuck

Related: My mom had a trust, so why do we still need probate to settle her estate?

“The good news is that all of the lawyer’s fees will likely be paid out of your parents’ estate, so you will have no upfront legal costs.”


MarketWatch illustration

Dear Stuck,

It’s time to call a lawyer. Delaying this process could cost you dearly.

In Connecticut, you have up to 30 days to file for probate; after that, you could incur fines. “Probate fees are established by statute and are uniform throughout the state,” according to the Connecticut probate-court system. “Interest at the rate of 0.5% per month accrues on all unpaid fees on decedents’ estates beginning 30 days after the date of the invoice, or, if a Connecticut estate tax return has not been filed within the time required, beginning 30 days after the return was due.” You can access an online calculator to estimate probate-court fees here

The good news is that all of the lawyer’s fees will likely be paid out of your parents’ estate, so you will have no upfront legal costs. The executor should have been chosen by the person who wrote the will; if your sister is unable to take on these responsibilities, talk to a trust-and-estate attorney about petitioning the court to remove your sister as executor. It may be that you decide to keep your sister as executor but, after explaining to her the financial implications, you proceed with the help of your attorney.

Your sister has proven herself to be a hard worker, by your own account, but she needs help with this process, and she needs help with the other aspects of her life. Removing her as executor would be time consuming and onerous. Possible reasons for removing an executor include egregious behavior like stealing from or wasting the assets of the estate, or lack of cooperation with the administration of the estate. Removal of an executor can be a complicated and costly process, and one that risks squandering even more money from your parents’ estate.

Personal issues

The legal aspect to your story has, perhaps inevitably, become intertwined with your personal histories. You identify your sister in your letter primarily by what she does not have: a husband, children, a driver’s license, etc. But she has also proven herself to be capable and have many other positive qualities: She was a caregiver, and worked hard as a civil servant to build up a pension to enable her to retire. What she lacks now is support, which both you and an attorney can provide. The nature of that support is legal, practical and also emotional. Providing the latter may be the key to the rest. 

Hoarding disorder is recognized as a mental-health condition by the medical profession. An outsider may see dust and dirt, in addition to cramped and possibly dangerous living conditions, but they don’t always see what lies beneath: fear, pain and potentially other neuropsychiatric disorders, including obsessive-compulsive disorder. Your sister would, of course, need to be diagnosed by a medical professional. Procrastination is also positively correlated with anxiety. Again, outsiders may mistake this for being uninterested or lazy.

It may be that being frustrated with your sister is a familiar feeling, and one you are willing to endure. But just as your sister should not be allowed to let her very significant issues interfere with probating your parents’ estate, you also should not let your relationship with your sister stop you from taking action. First, you will have the legal process, which will unfold if you seek help from an attorney. After that, you will have the equally important task of encouraging your sister to seek the support of a therapist who may be able to help her move forward.

Your probate stalemate shows that no one problem exists in isolation. 

You can email The Moneyist with any financial and ethical questions at [email protected], and follow Quentin Fottrell on X, the platform formerly known as Twitter. 

The Moneyist regrets he cannot reply to questions individually.

Previous columns by Quentin Fottrell:

I have $1.5 million in stocks and bonds. I asked my broker to convert my bonds to cash. He didn’t and my portfolio fell by $100,000. Can I sue?

‘She was very special to me’: My late 98-year-old cousin was targeted by grifters. They stole $800,000. Do I have any recourse?

‘It was a mistake’: My father set up a revocable trust, leaving everything to my stepmother. She’s cutting me out completely. What can I do?

Check out the Moneyist private Facebook group, where we look for answers to life’s thorniest money issues. Post your questions, or weigh in on the latest Moneyist columns.

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France’s foreign doctors suffer insecurity as understaffed hospitals struggle to function

The situation for several thousand foreign doctors working in French hospitals has become more complicated since the end of the exemption scheme put into place during the Covid-19 pandemic. Nearly 1,900 of these practitioners have now lost their right to practise, a great loss for French hospitals already struggling with shortages of medical staff. FRANCE 24 spoke to some of them.

Karima*’s last visit to the prefecture was a complete nightmare, as her residence permit was not renewed. “All I have is a receipt”, she says. This is despite the fact that she has been working as a paediatric orthopaedic surgeon – including in the emergency department, where she is on call at least four nights a month – for the past two years in a hospital in the Parisian suburbs. “My colleagues in general surgery asked me to come help out,” says the surgeon, who is originally from a country in North Africa*. “I’m not going to let them down,” she says, although she doesn’t know how much longer she will be able to practise.

Even though the hospital has agreed to let her work, Karima is concerned that her contract, which is renewed every six months, will be allowed to expire. She is one of some 4,000 medical practitioners with qualifications from outside the European Union known as “Padhue” (for the acronym of praticiens diplômés en dehors de l’Union européenne) who have been working in French hospitals for years in precarious positions such as “acting intern”.

“The work I do is real work, the work of a practitioner, even though I’m on an intern contract for which I get paid 1,400 euros net and which has to be renewed every six months. The prefecture refused to renew my residence permit because of these breaches of contract,” says the doctor, who is constantly going back and forth with the authorities to try and stabilise her situation. “This time, the prefecture is asking me for a work permit provided by the regional health agency, which no longer wants to provide it, as the law has changed.” 

On December 31, 2023, the exemption scheme that allowed establishments to employ Padhue staff under a variety of precarious arrangements expired, making it impossible for them to continue working. As of January 1, these doctors must sit highly selective and competitive examinations known as “knowledge verification tests” (épreuves de vérification des connaissances, or EVC) before they can be reinstated. Posts under the scheme are hard to come by, with 2,700 available for over 8,000 applicants in 2023, some of whom try their luck from abroad. As a result, the majority of the Padhue doctors found themselves out of the running this year.

After an outcry from French unions, the government finally promised to “regularise a number of foreign doctors” and renewed their temporary work permits another year so that they can sit the 2024 EVC.

‘I don’t understand why I’m not being judged on my experience here’

However, Karima’s problems are far from over, as she tried to sit the EVC in paediatric orthopaedic surgery in 2023 but her application was rejected. “They tell me that I don’t have the right diploma, that I need one in paediatric orthopaedics, but my country doesn’t offer this type of diploma! I don’t understand why I’m not being judged on my experience here. I operate on my own, I consult, I have my own patients,” she says. 

When she arrived in France in 2020, she did not have long-term plans to live on this side of the Mediterranean. “I had been sent to France for further training in orthopaedic surgery because I had noticed shortcomings in the department where I was working in North Africa,” she says. But after almost two years as an associate trainee at a university hospital in Nice, Karima found herself stuck in France because of the Covid-19 pandemic and the closure of her country’s borders. She also lost her job in North Africa. 

While in Nice, she worked on the front lines during the Covid-19 pandemic alongside French medical staff, lending a hand in intensive care. “We saved lives. And we’ll continue to do so. It’s what we do. Sometimes in the emergency department, I find myself in a situation where I have to react in a split second, do the right thing and make the right decision to save someone.”

‘I regularly pack my bags’

Sometimes Karima thinks about returning to North Africa. “I ask myself the question if I can go on in this situation. But I have a job that I love, especially the children. I’m attached to my patients. When I see in their eyes that they’re satisfied, I feel useful.” However, she is thinking more and more about leaving, as she wants a life where she can plan beyond a day-to-day basis. “I regularly find myself packing my bags. I hesitate to order new furniture.” Those close to her have suggested that she apply for a job in Germany “Some of my colleagues have gone there. They were accepted on the basis of their applications and took German language courses,” she says.

Against the backdrop of its overwhelmed healthcare system, France is in desperate need of additional medical staff, but risks losing thousands of these doctors to other European countries.  

Watch moreA country short of doctors: Exploring France’s ‘medical deserts’

 


Dr Aristide Yayi, originally from Burkina Faso, came to demonstrate in front of the health ministry in Paris, France to defend the rights of foreign doctors working in France on February 15, 2024. © Bahar Makooi, FRANCE 24

Dr Aristide Yayi is originally from Burkina Faso and qualified in forensic medicine in Dakar, Senegal. He has been working for three years as a general practitioner at the only residential care home for senior citizens (“Ehpads”, in France) in Commercy, a small town in the northeastern Meuse department. France’s elder care sector is in desperate need of doctors. “My contract runs until July 2024. After that, I don’t know what’s going to happen,” says Yayi. He wants to develop a pain management service for the Ehpad residents, but this project may never see the light of day if his situation does not become more stable. “I’ve been on one training course after another, with six-month contracts as an ‘acting intern’. It’s always uncertain and precarious. I feel like I’m being treated like a junior doctor,” he says.

Hospital services under threat without foreign doctors

Several hospital department heads, particularly in the Paris region, have warned that they will be “forced to close” if no more foreign doctors are hired. At his January 16 press conference, President Emmanuel Macron admitted that France needed these practitioners, saying he wanted to “regularise a number of foreign doctors, who help to hold our system together”. This promise was reiterated by newly-appointed Prime Minister Gabriel Attal in his general policy speech at the end of January. 

French unions are now demanding that this rhetoric be followed by action. At a meeting with the health ministry on February 15, they welcomed the previous day’s publication of the decree renewing temporary work permits for foreign doctors who undertake to sit the 2024 EVC. However, Olivier Varnet, general secretary of the National Union of Hospital Doctors FO, criticised the decree, saying it was “a first step” that “merely postpones the problem for a year”.

Meanwhile, foreign doctors are suffering, as almost 1,900 of them are unable to work at the moment. “My old department is desperately looking for someone to replace me. They’re really struggling. I was in charge of two units with 20 patients each. It’s absurd,” says Mostapha, who worked in a follow-up care and rehabilitation unit in Normandy. His contract as an “associate practitioner” was suspended on January 1, as he was not permitted to sit the knowledge verification tests. “The hospital wanted to keep me, but the regional health authority didn’t authorise it,” he says.

‘Some candidates failed, even with top marks’

A graduate of the Faculty of Physical Medicine and Rehabilitation in Algiers, he followed his wife, a French national, to France three years ago. “I don’t have any problems with my papers – I have a 10-year residence permit,” he says.

Mostapha joined his fellow doctors and a French union delegation received on February 16, 2024 by the Ministry of Health in Paris, France.
Mostapha joined his fellow doctors and a French union delegation in a meeting at the French health ministry on February 16, 2024. © Bahar Makooi, FRANCE 24

Mostapha hopes that his case will be examined more closely and that the new decree will enable him to return to work. However, he doesn’t really believe that taking the exam will help him get his career back on track: “I’m planning to take it again because for the moment there’s no other solution, although the chances of passing it are getting smaller and smaller because of the number of posts. It’s worse than selective.”

Many unions believe that the exam is more reflective of a quota system than an actual “verification of knowledge”. “Some candidates failed with an average of more than 15 [out of 20, a highly competitive result],” says Laurent Laporte, general secretary of the CGT’s Federal Union of Doctors, Engineers, Managers and Technicians. The unions say the test is “too academic”, “random”, “opaque” and “discriminatory for doctors working more than 60 hours a week”. The health ministry promised on February 15 to “reformulate the EVC” by making it more practical. 

*This person wishes to remain anonymous

This article has been translated from the original in French

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Sounding the alarm: France sees explosion in syphilis cases

In the past few years, France has seen a steep rise in sexually transmitted infections, but there is one in particular that is rising at an alarming rate: syphilis. Experts are worried. Due to the ongoing fight against HIV, syphilis has long been relegated to a much less talked about second place in French public health policy. In the meantime, the number of syphilis cases has exploded, soaring by 110 percent between 2020 and 2022.

On the eve of Valentine’s Day, Martin* received a piece of particularly bad news from a friend: “I’ve just been tested, and you’re the only person I have had unprotected sex with. Voilà, I have syphilis now.”

Martin rushed off to get tested: He tested positive. Once he had gotten over the shock, he quickly went through his list of sexual partners and remembered a recent encounter with a woman with whom he had not used protection. After a brief exchange, she confirmed she had syphilis and had been a carrier for some time. But just like Martin, she had preferred taking the risk rather than having protected sex.

Martin’s case is not unique. According to a report issued by the French health authority Santé Publique in December, sexually transmitted bacterial infections (namely, chlamydia, gonorrhoea and syphilis, as opposed to HIV, which is a virus) rose sharply in mainland France between 2020 and 2022.

Although chlamydia remains the most recurring sexually transmitted infection (STI) in absolute terms, up 16 percent from 2020 with 102 cases per 100,000 inhabitants, experts are alarmed by the sharp rise in gonococcal infections, and especially the huge increase in syphilis. The number of gonococcal infections jumped by 91 percent (44 cases per 100,000 inhabitants) in the two-year period while syphilis soared 110 percent, to 21 cases per 100,000 inhabitants.

Syphilis first appeared in the Middle Ages and was nearly eliminated in the second half of the 20th century, but in recent years it has resurfaced in most Western countries, particularly in the United States. According to the US Centers for Disease Control and Prevention, syphilis has now reached its highest infection rate since the 1950s, the New York Times reported in a January article.

With more than 207,000 cases diagnosed in 2022, the last year for which data is available, the US now has an infection rate of 17 cases per 100,000 inhabitants – an increase of 80 percent since 2018.

PrEP, a false sense of safety?

So why is this happening? Doctors say scientific advances, especially in the fight against HIV, are partly to blame. “People are protecting themselves less and less, in part because they’re no longer afraid of AIDS, since the scientific advances mean that it is now possible to lead an uncomplicated life even you have HIV,” Pierre Tattevin, the head of the infectious diseases department at Rennes University Hospital, explained.

According to most doctors, people “relax” when they don’t have to fear HIV anymore. “That’s the negative effect of using PrEP,” said Jean-Paul Stahl, infectiologist and emeritus professor of infectious diseases at Grenoble University.

PrEP, a pre-exposure prophylaxis, is a retroviral drug that is taken before any potential exposure to the HIV virus in order to help prevent contamination. It has become extremely popular in the past few years, especially among gay and bisexual men who are single. The pill is routinely offered in public hospitals to anyone reporting to have had sex with more than 10 different partners in the past 12 months, regardless of whether they have had protected sex or not.

“PrEP gives users the impression that they are protected from everything, and they think they can have all kinds of risky sexual relations, but it only protects them against HIV,” Stahl warned.

The danger of dating apps

But according to Pierre Tattevin, there is also another reason for the steep rise in STIs. “It’s become extremely easy to find sexual partners via dating apps. You multiply partners without knowing who they are, what their habits are, or what their [sexual] history is,” Stahl, who also presides the French Infectious Diseases Society (SPILF), said.

According to the December report by Santé Publique, the men most at risk of contracting gonorrhoea or syphilis, representing nearly 80% of cases, have multiple partners and a history of STIs.

More generally, it is men who are most affected: they account for 77 percent of gonococcal cases and more than 90 percent of syphilis cases. For the majority of syphilis cases, men aged 50 and over are most affected. 

Chlamydia, on the other hand, affects women more, especially young women aged between 15 and 25.

Great risk to pregnant women

The public fear of syphilis has diminished in the past half century or so thanks to a safe and very effective treatment for it: antibiotics. “It’s a cure, of course, and once it’s cured, there are no further effects or complications if the infection is detected quickly,” Stahl said.

Except that, if left untreated, syphilis is a very serious disease. It can damage the heart, brain and eyesight, and could go as far as to cause deafness and paralysis. An infection during pregnancy can lead to miscarriage or stillbirth. Children who survive through birth may also suffer vision or hearing problems, and developmental delays.

While the number of syphilis cases only increased slightly among heterosexual women in 2021 and 2022, “around three quarters of syphilis cases involved MSM [men who have sex with men], regardless of the year surveyed”, the study said.

The researchers further warned that “STIs represent a major public health problem because of their transmissibility (to partners and mother and foetus), their frequency, the long-term complications they cause (chronic pelvic pain, upper genital infections, infertility, cancer, etc.) and their role in HIV transmissions”.

‘Can’t hand out condoms to everyone’

Doctors say that although the number of registered STI cases is on the rise in France, it is also a testament to the fact that the country has a well-functioning testing system, which is essential to stopping an epidemic.

“When you miss one case, you then end up with two more cases, and if you miss two cases, you then end up with four,” Dr Jay Varma, chief medical officer at Siga Technologies and a former deputy commissioner of health for New York City, said in an interview with the New York Times. “That’s how epidemics grow.”

Tattevin agreed. “Our different governments have pursued good policies in recent years, with free testing centres. We need to test even more, especially patients at risk,” he said.

In addition to information campaigns, Stahl insisted on  personal responsibility. “Those who use PrEP need to know what they’re risking. Because some know about the risks involved but decide to take them anyway,” he said. “Scientific information is always beneficial, but at the end of the day, the decision comes down to each and every individual.”

“The government can’t hand out condoms to everyone,” he said.

Martin, meanwhile, continues his conquests: sometimes protected, sometimes not, but for now, at least he is cured.

*The first name has been changed at the request of the person.

This article was adapted from the original in French.

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My brothers are co-owners on $1.9 million of our mother’s bank and brokerage accounts. She now has Alzheimer’s. How can I rectify this?

I have three adult siblings living in different states, and we are disputing the circumstances surrounding the joint accounts shared with our 85-year-old mother, who has early stage Alzheimer’s. Our mom has a net worth of around $2 million, which is spread across several different bank and brokerage accounts. Late in life, she added a different sibling as a co-owner on each of her accounts to help manage her money.  

My brother “Joe” is listed as the sole co-owner on the bulk of our mother’s brokerage accounts, totaling $1.3 million, while my brother “Andy” is the sole co-owner of a $600,000 bank account and I am the sole co-owner of a $100,000 brokerage account. I think our mom simply forgot to add my sister, “Sue,” as a co-owner on any account. Her intention has always been for the four of us to equally inherit her assets.

I suggested to my three siblings that we should change all the accounts to sole ownership under our mother’s name with four equal beneficiaries. I thought this could avoid many possible complications with gift taxes and distribution at the time of our mother’s death, since as it stands, each co-owner would have to divide the money from their co-ownership account and send it to the other siblings.

Sue is named as power of attorney and could manage our mother’s individual accounts as needed. However, Joe is adamant that the current setup of co-ownership of accounts is the best way to help our mother, especially to protect her against financial fraud in case she needs to move to a nursing home. He insists there will be no gift taxes with the eventual distribution and that this setup is straightforward and easy to co-manage.

This situation is causing a lot of stress and distrust among my siblings, which I hate. I suggested we change things in order to make our mother’s financial situation as simple as possible, especially at the time of death, and not because I don’t trust Joe. Right now, no one is touching our mother’s accounts, and I am paying most of her expenses, as she lives with me.

Please advise.

Frustrated Sibling

Also read: My wife and I sold our home to her son at a $100,000 discount. He’s now selling at a $250,000 profit. Do I ask for a cut?

“Sue, as power of attorney, should be able to withdraw money from your mother’s other accounts and/or set up a bank account with those funds in your mom’s name,” the Moneyist writes.


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Dear Frustrated,

Your brothers have every reason to act like white truffle butter wouldn’t melt in their mouths.

Between them, they have sewn up your mother’s largest bank accounts, and you are very likely dependent on the kindness of these brothers to either add you to the accounts as co-owners or distribute the funds between all four siblings after your mother passes away. 

I would not hold my breath for Joe or Andy to do either of these things. They can just as easily resist with politeness and smiles as with anger and resentment. I’m sorry to say that the most damaging actions — for you and your sister— have already been taken. 

We may never know the conversations that took place when your brothers were added as co-owners. But there is a very important difference between a “co-owner” and a “co-signer” on an account. The latter can withdraw money but does not own the money in the account.

If your mother was not of sound mind or her mental capacity was diminished when your brothers were added to these accounts, or if she had intended to add them as co-signers, there may be a case where you can contest your brothers’ ownership of these accounts.

The legal framework around such cases vary depending on the state, but it’s usually up to the estate of the original owner of the account to prove that there was elder abuse and/or undue influence taking place. As always, you should consult an attorney who specializes in elder law.

Limitations to power-of-attorney duties 

Sue, as power of attorney, should be able to withdraw money from your mother’s other accounts and/or set up a bank account with those funds in your mom’s name. She should preserve these funds for additional medical bills and long-term care as her condition progresses.

But the bottom line is that without the cooperation of your two brothers after your mother dies, failing any legal case to reverse matters, you will remain with the sole ownership of the $100,000 brokerage account, and the four of you will inherit whatever else is left in the estate. 

It’s virtually impossible to say without more information, but Sue, as power of attorney, is unlikely to have the ability to change the ownership of these accounts unless that is specified in the terms of her POA contract. That would also depend on the laws of your state.

“The power of attorney permits the agent to access their parent’s bank accounts, make deposits and write checks,” Jupiter, Fla.-based Welch Law says in this POA overview. “However, it doesn’t create any ownership interest in the bank accounts. It allows access and signing authority.”

The law firm continues: “If the person’s parent wants to add them to the account, they become a joint owner of the account. When this happens, the person has the same authority as the parent, accessing the account and making deposits and withdrawals.”

But those with power of attorney cannot self-deal when it comes to their parent’s finances. “As a POA, they are a fiduciary, which means they have a legally enforceable responsibility to put their parent’s benefits above their own,” Welch Law adds.

You should not have to pay for your mother’s care out of your own bank account. Your sister, as power of attorney, should be managing that. Talk to your siblings about your mother’s Alzheimer’s and how the four of you plan to manage her care in the months and years ahead.

Will your brothers fulfill their promise and make you and your sister whole? Only time will tell.

You can email The Moneyist with any financial and ethical questions at [email protected], and follow Quentin Fottrell on X, the platform formerly known as Twitter.

Check out the Moneyist private Facebook group, where we look for answers to life’s thorniest money issues. Post your questions, tell me what you want to know more about, or weigh in on the latest Moneyist columns.

The Moneyist regrets he cannot reply to questions individually.

Previous columns by Quentin Fottrell:

‘I don’t like the idea of dying alone’: I’m 54, twice divorced and have $2.3 million. My girlfriend wants to get married. How do I protect myself?

‘If I say the sky is blue, she’ll tell me it’s green’: My daughter, 19, will inherit $800,000. How can she invest in her future?

‘They have no running water’: Our neighbors constantly hit us up for money. My husband gave them $400. Is it selfish to say no?



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Air pollution a factor in spiking cancer cases, report says

New estimates from the World Health Organization (WHO) predict a 77% increase in cancer cases globally by 2050. The report points to air pollution as one of the factors driving the expected increase in cancer rates, even though it does not have the same effect on everyone.

As a global health watchdog, the WHO rarely has good news. It stayed true to its mission ahead of World Cancer Day, when its International Agency for Research on Cancer released a report on February 1 predicting an increase of some 35 million new cases of cancer by 2050. This represents an increase of 77% compared to 2022, noted WHO.  

Among the factors driving the expected increase in cancer rates was air pollution.

Fine particles lead to cell dysfunction

“This mainly concerns fine particle pollution”, said Dr Emmanuel Ricard, a spokesperson for the French League Against Cancer.

Diesel exhaust is one of the main sources of these particles, he said. The finest of these particles can descend into the lungs, all the way down to the alveoli. These are the tiny air sacs located at the end of the respiratory tree-like structure of the lung, where the blood exchanges oxygen and carbon dioxide during the process of breathing in and breathing out.

The body’s defence cells will “want” to remove these particles, and inflammation follows. This ends up disrupting the cells which, instead of continuing to replicate in a healthy way, will begin to “dysfunction”, becoming cancerous. “These cancer cells will multiply, and form a tumour,” Ricard said.

More people, and older 

At least several factors indicated by the study are unrelated to pollution. The rapidly growing global cancer rate reflects population growth: as the number of human beings on the planet continues to increase, the total number of cancer cases will also increase.

And while humans are becoming more numerous, the species is also living longer. “Cancer is a problem of immunity, and immunity declines the older we get. As a result, the longer the population’s life expectancy, the more it will be at risk of getting cancer,” said Ricard.

Another classic illusion in the epidemiological data is linked to the improvement of cancer diagnosis itself. These are cases that already existed in the past, but which escaped medical radars. Now, as they are being detected, they contribute to an increase in overall cancer cases.

There are also situations of “overdiagnosis”, in which the presence of cancer cells is confused with cancer as such, said Catherine Hill, a French epidemiologist.

A classic case is prostate cancer. According to the French Institute for Public Health Surveillance (InVs), 30% of 30-year-old men and 80% of 80-year-old men have cancer cells in their prostate. “This is extremely common. It’s obvious that not all of these cancer cells give rise to symptomatic cancers,” said Hill.

Mental health

More and more studies are establishing – although it has yet to be confirmed – a link between pollution and the deterioration of health, including mental health. Pollution even supposedly aggravates depression.

These are “trends” full of scientific estimations, said Hill. After tobacco, alcohol consumption is the leading cause of cancer in France according to WHO, said Hill. “Pollution causes 50 times less cancer in France than tobacco, and 20 times less than alcohol,” she added, quoting a study by WHO’s International Agency for Research on Cancer.

Yet it would be wrong to consider the factors of cancer as isolated, said Ricard. An individual exposed to several factors will have a higher risk of getting cancer. The knowledge that exists on the effect that tobacco and alcohol together can have on cancer rates can be applied elsewhere, he said. “We were thus able to find, in the case of lung cancer, genes that were just as impacted by cigarettes as by atmospheric pollution,” said Ricard.  

The dangers of the world’s ‘dumping ground’

Yet the pollution factor is not the same for everyone, since humans do not breathe the same air. “In the big cities of China, India, South America, Antananarivo [in Madagascar], and even Cairo, clouds of particles form out of the pollution. Under this ‘smog’, people develop lung cancer, just like in England during the industrial revolution,” said Ricard.

There is now a transfer of pollution towards the “South”, which is used as a “dumping ground for the world”, Ricard added. “Besides the ‘at-risk’ factories that industrialized countries prefer to relocate, developing economies are sold low-cost oil derivatives of inferior quality.”

Those who have visited the megacities of developing countries will agree: the pollution seems stronger there. This is indeed because it is more aggressive: “The diesel fuels used there are even richer in sulphur and nitrogen than those emitted in Europe,” said Ricard.

For Richard, WHO’s report highlights an epidemiological transition. The countries previously impacted by infectious diseases, which are declining, will soon face a surge of diseases, like cancer, common to Western countries.

An ecological wake-up call?

In France, for instance, air quality has improved over the past 30 years. In the Toulouse metropolitan area, the presence of fine particles and nitrogen oxide fell respectively by 40% and 17% between 2009 and 2019. This has had a positive impact on cardiovascular diseases, strokes, heart attacks and cancers, said Ricard.

Less encouraging is the study carried out in the Toulouse region, which concludes that the economically disadvantaged population is more exposed to air pollution, and more concerned by deaths attributable to long-term exposure.

Beyond these socio-economic disparities, Xavier Briffault, a researcher working in social sciences and epistemology of mental health at the French National Centre for Scientific Research (CNRS) saw potential for an ecological wake-up call. By demonstrating a direct correlation between health and environmental degradation, science could take us from environmental protection, driven by ethics, to ecological awareness, driven by public health concerns. 

Health is not an end in itself but also a means in our fight for a greener world, said Briffault. By mobilizing our fears, the health issue also allows citizens to put pressure on politicians with the message: “Not only are you killing the planet, but you are killing us.”

The rallying cry that “polluting is bad” is bound to disappear, to be replaced by a new logic: Pollution is killing us.

This article was translated from the original in French.

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An unspoken pain: Tackling France’s infertility problem

French President Emmanuel Macron this week announced a plan to revive France’s sluggish birth rate and tackle the country’s growing infertility problem. More than three million people in France suffer from what Macron described as “the taboo of the century”, making it one of the country’s biggest public health issues. So why has it never been treated as such? 

Macron promised steps to boost France’s declining birth rate during a televised press conference on Tuesday, calling for a “demographic rearmament” of the country. The call came after France recorded its lowest annual birth rate since World War II, with 678,000 births registered in 2023 – a sharp 6.6 percent drop from the previous year. Despite Macron’s “announcement”, the plan has actually been long in the making, and is part of a bioethics law that the French parliament approved in 2021. 

France has long been proud of its comparatively high birth rate, described as a “French exception” in Europe. But recent trends have undermined the country’s status as the continent’s baby-making champion – and highlighted a growing fertility problem.  

A 2022 report commissioned by the government showed that as many as one in every four French couples who have tried to conceive naturally for 12 months or longer are unable to do so. The World Health Organization (WHO) defines this as infertility – a condition that currently affects as many as 3.3 million people in France. 


FRENCH CONNECTIONS © FRANCE 24

Among them is Virginie Rio, the president and co-founder of the infertility support group Collectif Bamp!, which advocates better treatment for infertility. 

After trying but failing to conceive naturally for several years, Rio sought help through Medically Assisted Procreation (MAP) and managed to get pregnant. But her long journey was fraught with challenges and mistreatment, not least because of a lack of understanding and compassion from doctors. 

“I was told that women had psychological problems, and that I needed to relax more,” she said, pointing to sexist prejudice surrounding the issue of infertility. “The discourse makes women feel very guilty. They’re made to feel as if it’s their fault that they can’t have children,” Rio explained. 

The underlying causes  

Multiple studies have shown that a woman’s age plays a key role in her ability to conceive. A study published in the Upsala Journal of Medical Sciences in May 2020 showed that a woman under the age of 30 had an 85 percent chance of getting pregnant within a year, while a woman aged 30 had a 75 percent chance. At 35, her chances dropped even further, to 66 percent, and at 40 to 44 percent. 

But these types of statistics are guilt-tripping and hardly show the full picture.

“The stigma that women are the only ones responsible for infertility is deeply rooted in peoples’ minds,” said Élise de La Rochebrochard, a researcher at the French Institute for Demographic Studies (INED). “We shouldn’t reinforce this belief, making women the only ones responsible for reproduction – since it’s also an issue for men,” she said. 

There are many reasons why a growing number women wait until later in life before trying to have a child. Sociologists point to women making up a much larger part of the workforce and to widespread access to contraceptives. Many young adults put their family creation plans on hold as they seek professional and emotional stability, or  wait until they have struck the right work-life balance. But the longer people wait to seek help for an infertility problem, the more difficult it gets for them. 

Medical conditions, such as endometriosis, polycystic ovary syndrome (PCOS) and sperm production disorders, are also to blame for the uptick in infertility rates. 

Read moreFighting endometriosis: ‘I don’t know what it means to be free from pain’

A meta-analysis published in 2017 showed that the average concentration of gametes in sperm had dropped by 50 percent between 1973 and 2011. Several reasons have been cited for the sharp reduction, including smoking, alcohol consumption and obesity, but also the exposure to pollution and endocrine disruptors, which can be found in many plastics and which interfere with the body’s hormones. 

“The decline in sperm quality is a worrying issue, but there’s no need to panic,” said Micheline Misrahi-Abadou, a professor of biochemistry and molecular biology at the University of Paris-Saclay. She said today’s gamete concentration average of 40 to 50 million gametes per millilitre of sperm is still more than enough to impregnate a woman. 

So what are the remedies?  

When medical conditions stand in the way of a pregnancy, hormone treatments can help. In France, Medically Assisted Procreation, or MAP, has been available to all women since 2021 and no longer requires them to fulfil the medical criteria of infertility. But many doctors say hormonal treatments are not always necessary and, in some cases, not even the best route to pregnancy. 

“A part of the three million people who are estimated to suffer from infertility may be due to couples going straight for MAP,” said Misrahi-Abadou, adding that she understood why some do not want to take the risk of waiting to become parents. 

“Infertility is a terrible suffering, and is experienced as a tragedy, especially when the cause is unknown. But MAP can be an additional source of suffering, with an average failure rate of 40 percent,” she said. 

Couples who choose MAP treatment have to undergo a multitude of tests and treatments that can be both expensive and stressful. But infertility is not only a social challenge, it is also a professional one. 

“MAP protocols are often time-consuming and unsuccessful, which can make it difficult for people to reconcile their work with the treatment they are getting,” Rio explained.  

“Employers often expect their employees to be productive and present, but MAP treatments can require taking time off work.”

The authors of the 2022 infertility report recommended better public information, starting from secondary school, as well as targeted consultations in a bid to identify the factors affecting fertility. They also stressed the need to label food products containing phytoestrogens – which can cause infertility problems. Finally, they suggested more training on the issue for doctors and other health professionals. 

Neglected issues  

Meanwhile, researchers are trying to pin down the underlying factors of infertility.

“Identifying the causes of infertility is an essential prerequisite to improve treatments,” said Misrahi-Abadou, adding that genetics is an especially important tool to do so. “Like in all medical specialty fields, it’s possible to use DNA analysis to look for the causes of infertility,” she said. “The ultimate goal is to define a targeted therapy with medication that can act directly,” said Misrahi-Abadou, who heads the first reference laboratory for genetic infertility at the Bicêtre Hospital in Paris.    

The experts interviewed by FRANCE 24 agreed that infertility has not been taken seriously enough in France. They hope Macron’s announcements will be followed up by action.  

“Infertility is still an issue that is mistreated by society, and the people concerned are mistreated too,” said Rio, adding that her advocacy group’s calls for action have long been ignored. Misrahi-Abadou added: “Infertility is not a fatal disease and so it’s considered less serious than other pathologies.”  

Taking Macron’s ambitions into account, does this mean that the “taboo of the century” will now finally be broken in France? The experts are not so sure. “Infertility is a taboo, but it’s not the only reproductive health issue that remains difficult to talk about,” de La Rochebrochard said. “Menstruation and abortion are both topics that are still not talked about enough.” 

Infertility, sterility and reduced fertility are three different concepts.

  • The WHO defines infertility as the inability to conceive after one year or more of regular unprotected sex.  
  • Sterility is the total inability to conceive or impregnate, regardless if the woman or man undergoes treatment. 
  • Reduced fertility is a drop in the number of estimated births per woman. In France, the fertility rate came to 1.68 children per woman last year, compared with 1.79 in 2022, according to the national statistics office INSEE. This can partly be explained by a general drop in the number of women of child-bearing age (between 20 and 40 years old), but also other factors, including lifestyle choices.
     

This article was translated from the original in French.

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Tracy’s triumphant fitness consistency

Wellness & Fitness

Tracy’s triumphant fitness consistency


Tracy Wagasa Shirao poses for a picture while holding dumbbells at Thabiti Fitness and Health Center in Syokimau on January 5, 2024. PHOTO | BONFACE BOGITA | NMG

Tracy Wagasa was reluctant to give up her version of a healthy meal plan. But her coach convinced her to ditch intermittent fasting and other methods that promise weight loss within weeks.

The 30-year-old switched to portion control and calorie deficit eating, but never misses a meal.

“I am conscious of what I eat. Instead of having French fries every lunch time, I changed to eating them once a week,’’ she says.

Ms Wagasa’s weight loss journey was inspired by her sister when she left for Australia to study for a Master’s degree.

“We were very close. Coming home every day without her presence left a void that I had to fill.’’

At the same time, she was uncomfortable with the way she looked in the photos she took. She had previously started going to the gym in 2019, intending only to lose a few kilos, but instead, she says, “I kept gaining, which demotivated and finally stopped going altogether.’

Read: How we achieved 2023 fitness goals

When Covid-19 broke out, she had even more reason not to go to the gym.

But since resuming last year, the advocate of the High Court of Kenya says she has lost more than 20 kilo.

weights

Tracy Wagasa Shirao does renegade row workout exercise at Thabiti Fitness and Health Center in Syokimau on January 5, 2024. PHOTO | BONFACE BOGITA | NMG

“I was so curious to see if it could work for me because I have several friends whose transformation journeys I had witnessed.’’

She recalls going to her local gym after work and paying for a membership to get started.

“I was fortunate to have a coach who has been with me all the way. Simon Mwangi (the coach) is the building block of my consistencies,’’ she adds.

Imposter syndrome

It is better said than done, Ms Wagasa says of her early experiences.

“The first day at the gym was strange, I looked at myself in the mirror and wondered what I was doing there. It did not look achievable, I felt discouraged, especially when they did my body composition analysis.’’

She goes on, “I was so intimidated when I walked into the gym and saw other fit women still working on what I can only call their perfect bodies. I had no sense of belonging, I had no idea of where to start.’’

But her trainer would not let her wallow in her self-pity.

“Simon reminded me to always show up. I have always been consistent, trying my best to just show up and do what I can, even on the days when I don’t feel like it.’’

Read: Claire finds sweet relief at the gym

Hours of cardio sessions helped her loose the excess fats.

“I feel more confident than ever,’’ she laughs. “Honestly, if I had known this is what confidence looks like, I would have started working out long before this. It has become a lifestyle. It’s almost like breathing for me,’’ she sighs.

For Ms Wagasa, being fit means more than just looking good, “the mental benefits are exciting, I did not expect to see the gym as a therapy facility and not necessarily because I am going through something.’’

The benefits have grounded her in the journey, ultimately allowing her to release frustrations and gain clarity on things she needs.

Lifestyle change

She has also had to change her perception about weight lifting.

“For a very long time I was one of those people who were very sceptical about women lifting weights, so I had to get used to being comfortable as one of them. I had always been of the opinion that “you must be muscular”.’’

“I also had to adjust my daily routine where I cannot be lazy, I have to show up at the gym, it’s something that has become compulsory,’’ she adds.

Besides that, Ms Wagasa says she has made healthier choices. Even after a good weekend, she needs to balance and release the toxins in her body.

legwork

Tracy Wagasa Shirao does leg extension workout exercise at Thabiti Fitness and Health Center in Syokimau on January 5, 2024. PHOTO | BONFACE BOGITA | NMG

“I never thought drinking meant anything until my trainer occasionally challenged me when I came back after a good weekend out. The struggle was real,’’ she says clearing her throat.

Read: Calisthenics: I help women get strong, flexible and more aware of their bodies

“I am not just living; I am living consciously.’’

It’s never an easy task in any trail.

“I have had my fair share of indiscipline and a lot of mental dialogue as to why I have to do it. Everything about my lifestyle had to change.’’

Did weight gain affect her?

“Honestly, I have never received external shame or made uncomfortable. I was always the inflictor of body shaming to myself because I had a lot of self-doubt. I never felt good and beautiful enough even when no one gave me reasons to doubt myself,’’ she says.

Hoping on the Stair Master machine, she lets her twisted braids down.

“Even when you are working out, you can still look good. I will always put on lipstick, sometimes I wish I could have been born with red lips. You can trust me to have my mascara and my lipstick on. It’s almost like my identity,’’ she laughs.

Launching gym wear

Ms Wagasa also describes her gym attire as improved: “I started with promotional shirts. Then I didn’t see the need for proper gym sets because of my size.’’

Read: Exercising after thyroid disease

She is now almost ready to launch her line of gym wear. “The way you look does contribute to your attitude in the gym,’’ she says.

Her biggest concern now, she adds, “I don’t want to lose any more weight, it has become a trend.’’

Is she a morning person?

“I have respect for those who work out in the morning, I don’t like interfering with morning routine. My body takes time to adjust in the morning as opposed to evening when I have had a lot of movements,’’ she laughs.

Despite her success in fitness, Ms Wagasa insists, “I would strongly advise beginners to get a trainer who’s going to be with you all the way, it’s going to make a big difference. Find a trainer who can get you fit, not just lose weight.’’

“Having the right mindset is not easy. Choose a system that motivates you to stick with it. Make friends at the gym so you have accountability partners. Do the right things consciously to get the results. That means eating well, complaining less and actually doing what the programme tells you to do,’’ she advices.

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Women’s rights take centre stage in DR Congo election

from our special correspondent in Kinshasa – Ahead of Monday’s election in the Democratic Republic of Congo (DRC), women’s faces can be seen everywhere, pinned up on electoral posters throughout the country. During his five-year term, President Félix Tshisekedi demonstrated a commitment to women’s rights and better female representation in politics, but there is still a long way to go.

Days out from the DRC‘s presidential election, campaign clips play constantly on state broadcaster Congolese National Radio and Television (RTNC). One of the advertisements, from the campaign of President Félix Tshisekedi, known colloquially as “Fatshi béton”, highlights one of his flagship policies: free maternity care. 

Since being implemented in September 2023, the measure is gradually taking effect in public hospitals and health centres. At the Kinshasa General Hospital (still informally known as “Mama Yemo Hospital”, after the mother of ousted President Mobutu), Julie is receiving postnatal care after giving birth to her daughter, Yumi.

“This is my third child. I had a C-section. For the first two, I gave birth elsewhere and paid 40,000 Congolese francs, then 65,000 for the second (€14 and €22.60 at current exchange rates),” says Julie. “I am satisfied with the free maternity care because, this time, if I was made to pay for the C-section, I would have died. I couldn’t have afforded the operation (one million Congolese francs, or €340).”

Julie gave birth to a baby girl by Caesarean section and benefitted from free medical care for the first time. © David Gormezano, FRANCE 24

She still must pay for her painkillers and the medicine for her newborn’s fever, but the impact of the financial relief is evident. “Before free childbirth, if you didn’t pay, they kept you in the hospital until the bill was paid,” Julie says.

Women and hospitals alike

Still lying on her bed after giving birth to her son Vainqueur (“Winner”, in English), Pierrette Mayele Moseka praises the policy. “This is my sixth child. According to my husband, when I arrived, I was in agony. We came from very far away, and care was immediately provided at the hospital. We will all vote for President Fatshi.”

Despite its dilapidated buildings and very basic equipment, Kinshasa General has one of the best public maternity wards in Kinshasa. For doctors, the free care provided to mothers and their babies can mean the difference between the life and death of their patients.

The maternity ward at the
The maternity ward at the “Mama Yemo” general hospital in Kinshasa. © David Gormezano, FRANCE 24

“The measure allows us to free up beds more quickly. After two or three days, women can go home if there are no complications. It makes our job easier,” says Olenga Manga, one of the two medical interns, finishing his shift.

“Often, women would refuse C-sections because they couldn’t afford them. With the free service, maternal mortality has decreased. Today, we can intervene quickly. We no longer worry about whether a woman can pay. Infant mortality has also decreased,” he says, walking through the delivery room still under partial construction.

Progress or politics?

In his brand-new office, hospital director Dr Jean-Paul Divengi likewise praises President Tshisekedi’s policy but believes the responsibility to make effective use of the funding ultimately rests with care providers.

Indeed, the director explains that the free childbirth policy does not only affect the maternity ward. “This involves other departments: functional rehabilitation, resuscitation, anaesthesia, paediatric surgery, and also the morgue for unfortunate situations,” says Divengi. “It’s a significant step forward for women but also the hospital in general.”

Jean-Paul Divengi, medical director of the
Jean-Paul Divengi, medical director of the “Mama Yemo” general hospital. © David Gormezano, FRANCE 24

With free childbirth, instead of asking patients to front the bill, the hospitals invoice the health ministry for their care each month. This has put less pressure on finances, says Divengi.

“I was at the helm for three years [before the policy was implemented], and almost no bill was fully paid!” says Divengi. “For this program to develop successfully, technical and financial partners must also follow suit.”

However, not everyone is convinced. According to lawyer Arlette Ottia, a member of the party of former president Joseph Kabila (2001-2019), it is “a political and populist measure. In reality, you will hardly find women who have given birth for free. It’s only politicians who talk about it.”

Read moreNobel Prize winner Denis Mukwege unveils DR Congo presidential bid

After just three months, it is difficult to determine the status of the ambitious program. While several institutions in Kinshasa have implemented the initiative, few data are available to assess the DRC at large, with its more than 100 million inhabitants.

‘Feminist president’

At the presidential palace in Kinshasa situated on the banks of the Congo River, Tshisekedi is nowhere to be seen. With the election just days away, he is touring the enormous territory to rally support – from Katanga to Kivu to Kasaï.

Tina Salama, Tshisekedi’s spokesperson and a former journalist from respected outlet Radio Okapi, vehemently rejects accusations that the government’s promises are empty. “The president of the republic is a staunch defender of women’s rights. Under his presidency, the country has never done better.”

In the gardens of the Nation’s palace which has housed the “great men” of Congolese history, from Patrice Lumumba to Laurent-Désiré Kabila, Salama explains why she thinks her boss is a “feminist president”.

Tina Salama, former Okapi Radio journalist and spokesperson for President Félix Tshisekedi.
Tina Salama, former Okapi Radio journalist and spokesperson for President Félix Tshisekedi. © David Gormezano, FRANCE 24

“In 2019, we had 17 percent women in state administrations and public enterprises. In 2023, we have reached 32 percent,” says Salama. “It is the first time we see women in decision-making positions. We have a deputy chief of staff, and I am the first spokesperson. There is also a woman heading the Central Bank of Congo, a woman minister of the environment and another who is the minister of justice.”

Tshisekedi’s advocacy for women’s rights comes from his belief that female emancipation is key to social development in the DRC, Salama says. “Women have strongly influenced his life: his mother (Marthe Kasalu Jibikila, wife of Étienne Tshisekedi, a former prime minister under Mobutu known as an ‘eternal opposition figure’), his wife, and his four daughters. He says he takes great pleasure in being surrounded by all these women.”

A long road to emancipation

At the other end of Kinshasa, in the offices of the Jema’h Association, an organisation that promotes women’s rights through access to education and the labour market, a group of young girls record a podcast about the dangers of social media.

Despite the lack of air conditioning in the studio, the young panellists discuss the harassment women can face and the potential toxicity of trending influencers.

For Tolsaint Vangu, 23, the project is about “influencing women who are ignorant of their rights, their duties, telling them about what they can do with their lives. I would like to influence them to be independent.”

Marie-Joséphine Ntshaykolo, who led the Carter Center program which funded the creation of the recording studio, says there has been “significant progress” in women’s rights in the DRC. She does say, however, that the women’s conditions vary by province or whether they live in cities or rural areas.

“The obstacles to women’s emancipation, especially in public affairs, are primarily cultural. In Congo, there is generally male domination. Women are discriminated against due to customs, norms that are not favourable to them,” she says. “But there are more and more women candidates at the legislative level. In the government, there are more women.”

“There is a change. Today, we are heard, and what we have to say is considered,” says Ronie Kaniba, another participant in the podcast.

Women in office

As the Congolese prepare to head to the polls on December 20, Kaniba, who works as a nutritionist for a UNICEF program, tries to keep her distance from politics. “We avoid [discussing political subjects] because it can be dangerous. But there are things we can do. For example, I am an observer (for an independent election watchdog). You observe, you note, and you report. You don’t need to disclose you have done the job because it can be dangerous.” 

Ronny Kaniba, 29, during the recording of
Ronny Kaniba, 29, during the recording of her podcast “A toi la parole” in Kinshasa. © David Gormezano, FRANCE 24

In addition to the next president, the elections will also determine the national and provincial deputies as well as municipal councillors.

According to a report by UN Women, 29,096 women are candidates for these positions (compared to 71,273 men). The percentage of successful female candidates is expected to be revealed by the Independent National Electoral Commission (CENI) on December 31, a result that will indicate the progress of women’s representation in Congolese public life.

The last time the country went to the polls, in 2018, conditions were disastrous and the results were contested. A repeat would be bad news for both women and democracy in central Africa’s largest and most populous country.

This article was translated from the original in French.

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French doctors vow to ‘disobey’ bill stripping undocumented migrants of healthcare rights

A push by France’s conservative-led Senate to strip undocumented migrants of their access to free healthcare has sparked a public outcry among workers across the medical profession, many of whom have pledged to ignore a measure they describe as an ethical, sanitary and financial aberration.

Medical practitioners voiced their dismay in a flurry of media statements after senators from the right-wing Les Républicains amended a government-sponsored immigration bill last week to axe a scheme known as State Medical Aid (AME) – which provides free healthcare to undocumented migrants who have settled in France.

The amended bill, which will be examined by the National Assembly next month, was swiftly panned by health officials, who warned that it would present a threat to public health and that long-term costs would far exceed any initial savings.

The head of the Paris hospital consortium AP-HP said scrapping the AME would allow diseases to spread undected and ultimately increase the burden on France’s health system. The Federation of French Hospitals (FHF) described it as “humanitarian, sanitary and financial heresy”.

On Saturday, some 3,500 health workers signed a letter pledging to “continue to treat undocumented patients free of charge and based on their needs, in accordance with the Hippocratic Oath” they took. “Patients from here and elsewhere, our doors are open to you. And will remain so,” they added.

That would effectively mean working for free, said Antoine Pelissolo, a psychiatrist at a hospital east of Paris who co-authored the letter. “If they see a patient who is not covered (by health insurance), they will not be paid,” Pelissolo told AFP. “It’s a very strong stand.”

‘Guided by ideology rather than medical concern’

Set up in 2000, the AME gives undocumented migrants access to the free healthcare provided under France’s health insurance scheme. Beneficiaries must prove they have resided in France for at least three months and have a monthly income of less than €810 ($860).


The scheme has long been a favourite punching bag for critics on the right and far right, who accuse it of inciting illegal immigration – at a growing cost to French taxpayers.  

Last year, the AME counted 411,364 beneficiaries for a total cost of €1.2 billion, up from €900 million in 2018, according to the Inspection Générale des Affaires Sociales (IGAS), a government auditor.  

During debates in the Senate last week, Bruno Retailleau, the head of Les Républicains’ delegation, flagged the “steady increase in recent years, both in the number of AME beneficiaries and its total cost”. He added: “It is only natural that we look for ways to cut certain costs.”

In its amended bill, Retailleau’s party replaced the scheme with a more restrictive “emergency medical assistance” (AMU), which would cover only cases of “severe illness and acute pain”.

Read moreUndocumented workers left in limbo as French immigration bill delayed

The move betrays a sketchy understanding of healthcare, said Professor Pierre Tattevin, the deputy head of the French Infectious Diseases Society (SPILF), noting that the aim for medical workers is precisely to treat diseases before they become severe and acutely painful.

“It’s called prevention: if you treat something early, it will cost you less in the long run,” he explained, arguing that the debate over AME was “guided by ideology rather than medical concern”.

Cost of reform set to outweigh savings

While AME spending has increased in recent years, in line with immigration numbers, it still accounts for just 0.5% of France’s public health spending. According to an IGAS report from 2019, the scheme’s beneficiaries have lower healthcare costs than the general public, averaging around €2,600 per year – against a national average of roughly €3,000.

“The idea that AME costs us money is completely misguided,” said Tattevin. “Scrapping it would cost us a lot dearer than any savings it might generate.”

Earlier this month, some 3,000 health workers signed an op-ed in Le Monde warning that AME’s abolition “would lead to a deterioration in the health of undocumented workers, and more generally that of the population as a whole”.

 


Signatories included Françoise Barré-Sinoussi, the 2008 Nobel Prize laureate who helped discover HIV/AIDS, and Jean-François Delfraissy, the head of the scientific council that advised the French government during the Covid-19 pandemic.

They pointed to a recent precedent in Spain, where a 2012 law “restricting access to healthcare for illegal immigrants led to an increase in the incidence of infectious diseases and higher mortality rates”. The reform was finally repealed in 2018.

“If you bar part of the population from access to care, it will necessarily have repercussions,” said Tattevin, who also signed the Le Monde op-ed. “It could take months or years to show, but we would end up with hidden epidemics that eventually affect the wider public too,” he added.

A negotiating ploy?

Experts have largely debunked another criticism levelled at State Medical Aid: that its purported generosity induces migrants to choose France over other destinations.

In 2019, France’s former Human Rights Ombudsman, Jacques Toubon, lamented the “false idea that the ‘generosity’ of a scheme such as the AME would lead to an increase in illegal migratory flows by creating a ‘pull effect’”. Instead, he argued, “studies show that the need for care is a completely marginal cause of immigration”.

A 2022 study by France’s National Centre for Scientific Research (CNRS) found that fewer than 10% of France’s undocumented migrants cited healthcare as a factor in their decision to move to the country. A separate survey by the IRDES healthcare research institute found that only half of those eligible for AME actually benefit from the scheme, owing to administrative obstacles and a lack of information.

Read moreMost migrants eligible for French state medical aid have not accessed their rights

Prime Minister Élisabeth Borne echoed Toubon’s words in a speech to the National Assembly in December 2022, aiming to “dispel misconceptions” about AME.

“No, state medical aid does not fuel illegal immigration. It’s a question of protection and public health,” she told lawmakers at the time. “No plans to migrate to France are motivated solely by the existence of this scheme.”

While Borne reiterated her stance last week, France’s hardline Interior Minister Gérald Darmanin, the immigration bill’s chief sponsor, has previously voiced support for a reform of AME in a bid to win over support from the right – only to backtrack in recent days.

On Sunday, Health Minister Aurélien Rousseau pledged to defend the scheme, saying he “understood” the doctors’ complaints. “The government will fight to ensure that they do not have to exercise civil disobedience,” he told France Info radio.

“One has the impression that it’s all part of a negotiation, that EMA’s abolition has been thrown in the mix only to be removed at the last minute,” said Tattevin. “That way they can say they’re open to compromise and argue that their law isn’t as harsh as critics say.”

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