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On a map, a border is a solid black line. On the ground it can feel like a fiction. I'm standing on the edge of a shallow stream through the forest that separates two West African countries: Ivory Coast and Liberia. Here there is no fence. No sign. No border guard to prevent my crossing.

On either side of this stream people speak the same local language, Yokuba, a language incomprehensible to most of their countrymen. They share the same currency, the West African CFA franc, as well as a currency of trust built up over generations of intermarriage and communal life. There's even one tribal king who can settle disputes on both sides.

Ebola changed all that.

The arrival of Ebola on the Liberian side of the border, Nimba County, with more than 100 cases, turned this border-straddling community into a security risk.

"They know that their relatives are suffering over there," says Dr Boni Aman, Regional Health Director in the town of Danan, 15 miles inland in Ivory Coast. "They're making attempts to cross the border to bring them food. Or, they're making attempts to come to Ivory Coast to buy what they need."

In June, the government shut down all local markets along the border villages, hoping that stopping trade would stop traffic. Even today the scaffolding of abandoned stalls sit unused by the roadside. Commerce within this frontier community, even on the ebola-free side, has ground to a halt.

But in August the government went a step further: it announced the official border was closed. Along the 800-mile border with Liberia and Guinea, local villagers were organized in volunteer committees to guard the unofficial border crossings, like this babbling stream through the forest.

Standing with me on the Ivory Coast side of the stream, are two men from the nearby village of Gahapleu. The village chief, Gueu Denis, and a local carpenter, Tan Benjamin, are both volunteers on the watch committee. They are not armed. They have no gloves or masks. They say they keep watch over this path night and day. Chief Denis says he is terrified of getting ebola from this work.

But the men are also afraid of something else. They say the provincial deputy authority warned them if one person in their village gets ebola, then the entire village will be burnt to the ground. They believe they'll be quarantined and left to die. And so they've decided to send anyone they see - even their own relatives or friends - back across the border to face Ebola alone.

Tan Benjamin, the local carpenter, says this applies even to his younger sister, Sabine, living with her three children in Liberia.

"Because of the closure of the border, she can no more come here," says Benjamin. "It's very painful, but as ebola is a threat for everybody, what can you do?"

He was sitting in a clinic. Waiting. And waiting. And waiting for his grandparents' HIV medicine.

Sizwe Nzima was a high school student in Cape Town, South Africa, when he would pick up the medicine for his HIV-positive grandparents, who had difficulty traveling to the clinic themselves. Because of the long lines, Nzima usually waited hours and often made multiple trips to the clinic before and after school. He tried to bribe the pharmacists to get the medication sooner. But it didn't work.

So there he was, sitting on a hard wooden bench at the clinic one day about four years ago, when he had an idea: Why not start an HIV medicine delivery service?

He did some research and found that plenty of companies in Cape Town delivered medication to people's homes. But none were operating in the city's low-income townships, where unemployment levels are high and most people live in wooden or metal shacks. The companies told Nzima it wasn't that they were discriminating against poor people. They just couldn't find the houses.

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As a teenager, Sizwe Nzima was frustrated by long waits at pharmacies dispensing HIV medications. So he began a medicine delivery service, now serving 930 patients. Anders Kelto for NPR hide caption

itoggle caption Anders Kelto for NPR

As a teenager, Sizwe Nzima was frustrated by long waits at pharmacies dispensing HIV medications. So he began a medicine delivery service, now serving 930 patients.

Anders Kelto for NPR

"You punch [an address] into Google, Google won't find it," Nzima agrees. "It needs local knowledge."

Nzima might be onto something. The problem of wait times in sub-Saharan African is epic. In South Africa alone, one in eight people – more than six million – are HIV-positive. Across the continent, tens of millions are infected with the virus. The result is overcrowded health clinics, and patients who travel great distances to get their HIV medicine.

For poor people, long waits are more than just an annoyance. Suhair Solomon, an HIV expert with the international health organization Doctors Without Borders, says spending all day in line means lost income and lost opportunities to look for work. As a result, many poor people don't show up.

Across sub-Saharan Africa, millions fail to take their HIV medication consistently, leading to easily preventable sickness and death. Long lines are part of the reason.

South Africa has come up with some solutions. Doctors Without Borders has created HIV "adherence clubs" – basically, support groups that often meet at patients' houses. At the end of each meeting, a health worker distributes HIV medicine to the attendees. Solomon says the entire process takes 45 minutes to one hour.

There's also a new pharmacy in South Africa that utilizes electronic prescriptions and dispenses HIV medicine almost immediately.

And then there's Nzima's business, which might be the first of its kind: a bicycle-based, HIV medicine delivery service. It's called Iyeza Express.

On a recent afternoon, Nzima pedaled his bike — which is partially powered by an electric motor — along a narrow road, past rows of shacks. Motorcycles and buses whizzed by. He rounded a corner and was chased by an angry dog. Of the many dangers he faces — cars, robbers, vandals — he says dogs are the biggest hazard.

He eventually arrived at a small brick home and knocked on the door. Loyce Peko, a 63-year-old man with gray hair, answered. Nzima handed him a white plastic bag of HIV medicine and collected a delivery fee of about 90 cents. The two chatted inside Peko's house for a few minutes.

Peko said this delivery service, which brings his medicine one day each month, is wonderful. "Because my wife and me, we are elderlies, and without my medication, I'm nothing."

The two thanked each other and Nzima got back on his bike to head to the next client's house.

When Nzima started this business a few years ago, he had just two customers — his grandma and his grandpa. He slowly started to expand, but ran into a problem. His arrival at someone's doorstep – clad in a fluorescent green vest, with the Iyeza Express logo – felt like a pronouncement: The person who lives here is HIV-positive. He says this deterred many potential customers.

So Nzima diversified. He began delivering other medications, too – for chronic illnesses like diabetes and epilepsy. That's when his business really took off. He now has 930 clients and a staff of six riders, some of whom work full-time. He says no staff members are getting rich, but they're making a decent living.

Iyeza Express also gets support from a local business incubation program that provides free office space, including a telephone, computer and WiFi. Nzima says if it weren't for this support, he wouldn't be able to offer the service at such a low cost.

He may soon be branching out even further. Earlier this year, Nzima, now 23, was contacted by an international shipping company that hopes to offer package delivery to Cape Town's urban townships.

They want Nzima and his crew to be the deliverymen.

BICYCLE

South Africa

HIV/AIDS

The wheels of drug research grind slowly, but they can grind exceedingly fine.

Merck said Monday that its cholesterol drug Vytorin was vindicated by a nine-year-long clinical study that aimed to find out if adding a drug that blocked the absorption of cholesterol to a statin, long the gold standard for cholesterol care, would help patients at a high risk of heart attack and stroke.

Previous research had raised doubts about Vytorin's effectiveness. In a bit of a surprise, the study, known by the acronym IMPROVE-IT, showed that the drug worked. Still, the effects were modest.

Researchers found that when people took Vytorin (a combination of the statin simvastatin and ezetimibe, the cholesterol blocker) for seven years, their risk of heart attack and stroke was about 2 percentage points lower than patients taking only simvastatin.

All told, 32.7 percent of patients taking Vytorin experienced a heart attack or stroke compared with 34.7 percent of those taking simvastatin alone. In relative terms, Vytorin reduced the chances of a heart attack or stroke by 6.4 percent over seven years. As for side effects, they were about the same for both groups.

"This is a reminder to everybody that all the stuff they've heard about cholesterol is true," Dr. Christopher Cannon, the principal investigator for the study, told Shots in an interview. "Lowering the cholesterol to even lower levels than we had in the past looks to be beneficial," he said.

Shots - Health News

More Squash, Less Bacon: Calculating Your Real-Life Heart Risk

The results were presented Monday in Chicago at a scientific meeting of the American Heart Association.

Vytorin and Zetia, which is the brand name for ezetimibe alone, have been on the market for years. In approving them, the Food and Drug Administration relied mainly on data that showed the drugs reduced bad cholesterol rather than on whether the drugs led to fewer heart attacks and strokes among people who took them.

"There's still some uncertainty, but overall it's good news," Yale cardiologist Harlan Krumholz told Shots. "It means that there's another option for treatment that has some evidence behind it."

Using a laboratory measurement, such as bad cholesterol, as a shortcut in clinical research is common.

But a previous study that looked at thickening of the arteries that carry blood to the brain raised doubts about Vytorin and Zetia. The extra drug didn't appear to reduce thickening compared with simvastatin alone. Merck, which bought Vytorin's maker Schering-Plough in 2009, agreed to pay $688 million last year to settle a suit brought by investors who claimed the companies had harmed them by withholding those unflattering data.

IMPROVE-IT looked at patients at a high risk of heart attack and stroke. Would Vytorin and Zetia help patients at lower risk? Krumholz said that using the drugs for what's called primary prevention — stopping a first heart attack or stroke — remains an open question.

Doctors and patients also don't know for sure how effective Zetia is when added to more potent statins, such as atorvastatin (the generic form of Lipitor) and Crestor.

It's unlikely that a study like this one will be extended to those other drugs.

The IMPROVE-IT trial was huge — more than 18,000 patients. And it was expensive. "The exact costs of a trial like IMPROVE-IT are difficult to calculate but are on the order of hundreds of millions of dollars," a Merck spokeswoman said in an email to Shots.

And, speaking of cost, Vytorin isn't cheap. A 30-day supply costs more than $200 at Costco. Atorvastatin, or generic Lipitor, runs $20 or less, depending on the dose.

Merck

cholesterol

Heart Disease & Stroke

Pharmaceuticals

Airbus has filed a patent for a new plane that looks decidedly more Star Trek Enterprise than airplane.

The Financial Times dubbed it "flying doughnuts."

According to the patent application, the craft would address a long-standing problem for plane designers — pressurized cabins, which stress planes on the front and back ends and require heavy, reinforced frames.

The patent says the new design would distribute that pressure in a way that would be more "economic and efficient."

Airbus says the design also has an additional benefit: Seating passengers in a circle, doughnut-style, allows for more fliers than the old-fashioned paper-towel-holder-with-two-wings.

"An approximately cylindrical geometry limits possibilities for increasing the passenger carrying capacity of the aircraft," the patent says.

Airbus spokesman Justin Dubon, though, told NPR that the design is not currently in production — and may never be. Dubon says the company files more than 600 patents every year.

"Some of these become the seed for other ideas with practical use," he says.

Still, Dubon says, "There are some very clever people here that have fantastic ideas. And who knows? Maybe one day they will come to light."

In the meantime, Airbus may want to start redesigning the drink carts to handle curves.

flying

Travel

Airbus

airplanes

donuts