
'Shock' at closure of eye clinic in St Austell as services move
All glaucoma patients who attended Wheal Northey are being told that treatment has moved to the Royal Cornwall Hospital, with the rest of the clinic's services understood to be transferring within the next few weeks.
Mrs Bristow lives near Bodmin and has been receiving injections for macular degeneration at the clinic.She said: "It's a horrific thought that you've got to have injections directly into your eyes, but I actually look forward to going to Wheal Northey because they are so friendly."Her husband George said he felt the same way as "they put you at ease there". He added: "It's a horrendous process. "Jill's got used to the people there and is confident to go there because they are so friendly. "In a bigger hospital, that's not going to happen."The change means she will have to travel nearly 20 miles (32km) to attend appointments every seven weeks."They keep wanting to get services into the community, yet this is doing the opposite," Mr Bristow concluded.The clinic's closure comes after the NHS said the minor injuries unit in Launceston would remain closed until staff could be trained.Bosses have also asked holidaymakers to stay away from the Truro emergency department.
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Last summer, temperatures reached 47.8C (118F) in Najafgarh, making it the hottest area in the capital. "I've never experienced anything like this in my last pregnancies," Kumari says. "I often feel lightheaded and find myself getting irritated easily." In Delhi, Karan and hundreds of other ASHAs are helping thousands of pregnant women navigate the growing risks that heat poses to maternal health in a warming world. Extreme heat poses a risk to the majority of India's population, according to a recent report by the International Institute for Environment and Development. Delhi recorded 4,222 days with temperatures above 35C (95F) over the past three decades, more than any other of the world's 20 most populous capital cities. India is expected to be among the first countries where temperatures exceed safe limits for healthy people by 2050, even while resting in the shade, which could impact labour productivity, economic growth and the quality of life for 310 to 480 million people. 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"So pregnant women are more likely to get heat-related illnesses than those who are not [pregnant]," she says. Each 1C (1.8F) rise in temperature is associated with a 5% increase in the risk of preterm birth and stillbirth. With Earth's average temperature projected to rise by nearly 3C by the end of the century compared to pre-industrial levels, the World Health Organization has warned of "an existential threat to all of us", with pregnant women facing "some of the gravest consequences". Despite the increasing evidence of the danger heat poses to pregnant women, scientists and physicians still lack a comprehensive understanding of the physiological mechanisms involved, says Adithya Pradyumna, an environmental health researcher at Azim Premji University in Bangalore. A report by the United Nations Population Fund found that only 20% of the 119 countries that have made climate change pledges include maternal and foetal health in their plans. There is no universal threshold for what constitutes dangerous heat levels for pregnant women, nor is there international guidance on how to protect these women, particularly those working in extreme heat. More like this:• Why white paint could cool India• How sponges help Zanzibar women• The ancient Mexican techniques to save water Karan was working as a primary school teacher when she realised that expectant mothers in her area were struggling with oppressive heat. She decided to educate herself through YouTube videos about heat-related dangers and signed up as an ASHA worker in 2019. Launched in 2005 as part of the Indian government's National Rural Health Mission (NHRM), the ASHA programme has become a vital service in India's rural and suburban healthcare system as this army of one million women connect a vast majority of India's 1.4 billion people to its public health services. Over the past two decades, ASHA workers have taken on many responsibilities. These include supporting pregnant women during pre- and post-natal check-ups, administering immunisations, and educating communities on nutrition and sanitation. They counsel women on safe childbirth, breastfeeding, contraception and provide guidance to teenage girls on menstruation, while working to prevent common infections in mothers and children. The ASHA workers also file daily reports, conduct surveys and collate health-related data. Karan provides antenatal care to about 24 women in her area, 15 of whom have high-risk pregnancies. To support women like Kumari, she has created a list of dos and don'ts for pregnant women, advising them how to stay cool and hydrated, both indoors and outdoors. This includes simple tips to stay hydrated, such as drinking homemade beverages like lime water, buttermilk, lassi (a yogurt-based drink) and shikanji (lemonade), while strictly advising them to avoid exposure to the Sun. "If they can't avoid it, I tell them to always carry an umbrella, cover themselves with a cotton scarf, wear light-coloured clothes, and carry water mixed with ORS. Sometimes I even ask them to send me a photo to check if they are following my instructions," Karan says playfully. In 2023, Karan created a WhatsApp group for expectant mothers in her area and began sharing informative, evidence-based videos on heat-related dangers in Hindi to help them understand the impact of heat on their bodies and learn how to cope with it. "That's how I discovered Kumari was struggling unusually with her current pregnancy. She often complained about feeling extremely hot and anxious. At first, I thought it was normal – until I realised it wasn't," Karan says. "I started by counselling Kumari, insisting that she increase her fluid intake, avoid going out in the Sun, and reduce exertion while working," Karan says. "I couldn't ask her to stop working altogether, even though it would have made a huge difference. It just was not practical. So, we discussed it and decided she would take up work as a house help in the early mornings and evenings to avoid the peak heat." Karan says she quickly learned her solutions had to align with her patients' priorities, which, for most, meant being able to work and earn money. For Kumari stopping work is not an option – she already struggles to feed her family with her monthly income of £85-90 ($114-121). Rana believes that these simple measures taken by ASHAs can significantly benefit pregnant women. "ASHAs have extensive on-the-ground experience and work closely with their patients. Solutions such as keeping patients hydrated, maintaining a nutritious diet and taking precautions in the sun can greatly reduce the risk of heat-related illnesses." "I think the efforts and potential of ASHAs, if properly harnessed, can contribute to the broader strategy for addressing the health impacts of climate change," she says. Indeed, studies show that the ASHA programme successfully connects marginalised communities to maternity health services. "Given the limited understanding of heat's impact, I believe we need more hyper-localised intelligence, like what ASHA workers bring through their work," says Ajay Chauhan, a physician at Delhi's Ram Manohar Lohia Hospital, one of the largest hospitals in Delhi. The hospital set up a special heat stroke unit in May 2024 after the general ward struggled to manage the influx of heat stroke patients. ASHA workers tell the BBC that challenges are abundant. Despite being expected to handle a staggering number of tasks daily, they are still called "volunteers" in official records and do not receive a fixed salary. In most Indian states, they are paid a small honorarium of 3,000 rupees ($35/£26) per month, along with task-based incentives. For years, ASHA workers and their unions have been advocating for better recognition and fair pay. "Our work demands that we are on call round-the-clock because illness or childbirth doesn't follow a schedule, and we can't refuse to help. But it's no secret that we are overworked, underpaid and unrecognised," says Dalal. Their demanding job involves frequent field visits, regardless of the weather, making them, too, vulnerable to heat. "I fainted from the heat last May while on my way to weigh a newborn," says Karan, adding that a passer-by recognised her by her uniform (a pink coat) and helped her get home. "Though we attend countless training sessions, we have never been taught how to protect ourselves from the heat, let alone how to safeguard pregnant women. We once requested umbrellas from the authorities, but I've never received one," she says. "Ambulances meant for pregnant women are supposed to have air conditioning, but in reality, they only have a small fan, which is barely enough for the patient. So, I always carry a hand fan when accompanying a woman in labour because we have no one to complain to," Dalal adds. India's Ministry of Health and Family Welfare and the National Health Mission, which leads the ASHA programme, did not respond to the BBC's request for comment. Back in Najafgarh, both Karan and Dalal remain committed to helping pregnant women cope with the dangers of extreme heat. "A safe and successful delivery – that's all I work for," Dalal says with a smile. Kumari safely gave birth to her fifth child last December and says she recovered faster than her previous pregnancies. "For the first time since I moved to Delhi, I had the support of an ASHA worker," she says. "I was able to return to work after four months of rest, and whenever there's a health issue with me or the baby, Kalyani didi is just a phone call away." -- For essential climate news and hopeful developments to your inbox, sign up to the Future Earth newsletter, while The Essential List delivers a handpicked selection of features and insights twice a week. For more science, technology, environment and health stories from the BBC, follow us on Facebook and Instagram.