Born Twice

An experimental – and controversial – procedure for treating a crippling birth defect in the womb offered Trish and Mike Switzer the only chance that their daughter would walk like other children. But the fetal surgery posed a fatal dilemma: Their baby could die before she was born.

Photographer Max Aguilera said about this photo: “During a spina bifida corrective procedure at twenty-one weeks in utero, Samuel thrusts his tiny hand out of the surgical opening of his mother’s uterus. As the doctor lifts his hand, Samuel reacts to the touch and squeezes the doctor’s finger. As if testing for strength, the doctor shakes the tiny fist. Samuel held firm. At that moment, I took this 'Fetal Hand Grasp' photo. As a photojournalist, my job is to tell stories through pictures. The experience of taking this photograph has had a profound effect on me, and I’m proud to share this moment with you”

The image accompanying the text quoted above is real in the sense that it is indeed a photograph taken during a revolutionary fetal procedure undertaken on 19 August 1999 to fix the spina bifida lesion of a 21-week-old fetus in the womb. The operation was performed by a surgical team at Vanderbilt University in Nashville which developed a technique for correcting fetal problems in mid-pregnancy by temporarily removing the uterus, draining the amniotic fluid, performing surgery on the tiny fetus, then restoring the uterus back inside the mother. The patient shown above, Samuel Armas, was the 54th fetus operated on by the surgical team; Dr. Joseph Bruner, the surgeon whose hands are pictured above, alleviated the effects of the opening in Samuel's spine caused by the spina bifida, a congenital disease that often leads to paralysis and other problems. Pictures from the surgery were printed in a number of newspapers in the U.S. and around the world, including USA Today, and thanks to the remarkable surgical procedure performed by the Nashville team little Samuel was born healthy on 2 December 1999.

However, it is not true, as described in the accompanying text, that these photographs were taken as Samuel's hand "emerged from the mother's uterus to grasp the finger of Dr. Joseph Bruner as if thanking the doctor for the gift of life," or that Dr. Bruner said "when his finger was grasped, it was the most emotional moment of his life." This misinformation has been propagated by many different sources, including the Michael Clancy, the photographer who snapped the pictures: "As a doctor asked me what speed of film I was using, out of the corner of my eye I saw the uterus shake, but no one's hands were near it. It was shaking from within. Suddenly, an entire arm thrust out of the opening, then pulled back until just a little hand was showing. The doctor reached over and lifted the hand, which reacted and squeezed the doctor's finger. As if testing for strength, the doctor shook the tiny fist. Samuel held firm. I took the picture! Wow! It happened so fast that the nurse standing next to me asked, 'What happened'?" "The child reached out," I said. "Oh. They do that all the time," she responded.

What actually took place, as described in news reports of the surgery, was that: Just as surgeon Dr. Joseph Bruner was closing the incision in Julie Armas' uterus, Samuel's thumbnail-sized hand flopped out. Bruner lifted it gently and tucked it back in.

(The dubious veracity of the photographer's version of events is highlighted by the disclaimer he appended to it on his web site, stating that it represented his "opinion of the events as they took place during the surgery for Samuel.")

The surgeon, Dr. Bruner, later elaborated on some of the exaggerated and false claims made about the photograph:
"It has become an urban legend," says Bruner, the Vanderbilt University surgeon who fixed the spina bifida lesion on Samuel. Many people he hears from wonder whether it's a fake.

"One person said the photo had been reviewed by a team of medical experts and they had determined that it was a hoax," Bruner says with a laugh.

More commonly, people want to know how the photo came to be. Some opponents of abortion have claimed that the baby reached through the womb and grabbed the doctor's hand. Not true, Bruner says. Samuel and his mother, Julie, were under anesthesia and could not move. "The baby did not reach out," Bruner says. "The baby was anesthetized. The baby was not aware of what was going on.

Google Finds New Way to Give

Searching for solutions

Google.org aspires to use the power of information and technology to address the global challenges of our age: climate change, poverty and emerging disease. In collaboration with experienced partners working in each of these fields, we will invest our resources and tap the strengths of Google’s employees and global operations to advance five major initiatives.


Plug into a Greener Grid: RE

A significant amount of global greenhouse gas emissions are generated by coal-fired power plants and vehicles. To slow global warming, we must radically – and quickly – cut these emissions. Plug-in vehicles offer a major opportunity to reduce oil use and corresponding emissions while renewable energy sources – solar, wind, geothermal and others – could supplant a major portion of the planet's electricity generated from coal.

Google.org is confronting the climate crisis on two fronts: We're working on developing utility scale renewable energy cheaper than coal (RERechargeIT
Through our RechargeIT initiative, Google.org is working to accelerate mass commercialization of plug-in vehicles by seeding innovation, demonstrating technology, informing the debate, and stimulating market demand. In June 2007, we officially launched this initiative by unveiling our plug-in demonstration fleet, debuting Google's 1.6 megawatt solar installation, and announcing over $1 million in grants to support plug-in vehicle adoption. We also teamed up with PG&E to demonstrate vehicle-to-grid technology to show how electricity might be transmitted back and forth between plug-in vehicles and the grid.


Recharge a Car, Recharge the Grid, Recharge the Planet

RechargeIT is a Google.org initiative that aims to reduce CO2 emissions, cut oil use and stabilize the electrical grid by accelerating the adoption of plug-in hybrid electric vehicles and vehicle-to-grid technology.

By demonstrating the technology using our own fleet and supporting others through grants and investments, together we will drive toward a plug-in revolution. See for yourself how our plug-in hybrids are performing in real world conditions.


Predict and Prevent

Rapid ecological and social changes are increasing the risk of emerging threats, from infectious diseases to drought and other environmental disasters. This initiative will use information and technology to empower communities to predict and prevent emerging threats before they become local, regional, or global crises.

Google.org's initial focus will be on emerging infectious diseases, which are on the rise worldwide. Climate change, urbanization, and rising international travel and trade all contribute to this threat. Moreover, humans and animals are coming into closer contact because of environmental degradation and increased demand for animal products. Nearly three out of four new diseases in the last three decades have spread from animals to humans. While everyone faces increasing risk from emerging infectious diseases, the world's poor – who have minimal or no access to health care and may live with and depend on animals for their livelihood – are exceptionally vulnerable and stand to suffer the most.

This initiative supports two inter-related pathways from prediction to prevention. The first is vulnerability mapping and identification of "hot spots." The second, creating systems to better detect threats to provide early warning and enable a rapid response.

Identify Hot Spots

Understanding the complex drivers that lead to emerging threats can help communities anticipate surprises and reduce vulnerability. Google.org is initially focusing on:
+ Sharing knowledge across human, animal, and environmental health sectors
+ Improving data collection, sharing, and analysis for enhanced vulnerability mapping and modeling
+ Contributing to enhanced resilience of communities to withstand threats and adapt to changes

Enable Rapid Response

Timely, accurate, and accessible information can help prevent localized health crises from becoming regional or global threats. Google.org is focusing on:

+ Using innovative methods to quickly find threats wherever they occur
+ Confirming outbreaks and identifying their cause
+ Alerting key stakeholders, from villagers to global health authorities

See Google.org's Grants & Investments page for a list of current partners. For a closer look, please read our initiative brief.

While we are not accepting unsolicited proposals at this time, if you are working in the following specific issue areas and are interested in a partnership, please contact us.

+ Collection of specimens at the human/animal interface to identify and map hot spots
+ Innovative, event-based surveillance at the community level in the developing world
+ Integrated vulnerability mapping to the drivers of emerging infectious diseases


Inform and Empower to Improve Public Services

In rich countries we take it for granted that when we turn the tap clean water comes out, when our children go to school there will be a teacher present, and when we have health problems the medical provider will be attentive. Quality public services – clean water, health, and education – are vital for human welfare and a strong economy. But in many countries in the developing world, essential public services are failing, especially for the poorest members of society. Conventional approaches to tackling this challenge have focused on tracking money spent rather than results achieved. Accountability to citizens and communities has largely been absent.

While there are no quick fixes, Google.org believes that providing meaningful, easily accessible information to citizens and communities, service providers, and policymakers is a key part of creating home-grown solutions to improve the quality of public services. Better information can help governments and other providers spend scarce resources wisely. And, empowered by information, citizens and communities can demand better services from providers or develop new solutions to meet their own needs.

We will work with public, private, and civil society partners to address each side of this problem. This initiative will begin with a focus on education, health, and water and sanitation services in East Africa and India. Our work will support efforts that lead to empowered citizens and communities, responsive providers, and informed decision-makers. Success will depend on the presence of strong and effective leadership. We are committed to investing in the next generation of business, government, and civil society leaders to ensure the sustainability of this initiative.

Empowered Citizens and Communities

Google.org supports efforts to generate accountability and "bottom up" citizen engagement to influence the quality of public services. We will support efforts to provide easily accessible information to people so that they can choose the best strategy for themselves and their community. We will use multiple modes of communication (such as media, mobile, e-kiosks and other technologies) to allow a broader range of people to access information and we will seek innovative methods for disseminating information. We're focused on:

+ Informing individuals and communities of their rights, entitlements, choices, and quality of public services
+ Providing tools and information to increase access to and use of available services
+ Supporting civil society organizations that strengthen links between communities and policy makers.


Responsive Providers

We will enhance public and private providers' abilities to respond to the challenges of service delivery and increased demand. Access to new tools and better information will increase providers' autonomy and flexibility, shifting away from "business as usual" approaches to public services. Top-down accountability has too often failed because it is difficult to know what happens on the ground in an information-scarce environment. We envision providers that are responsive to citizen needs and committed to improving performance. We're focused on:

+ Increasing transparency in local budgeting and performance for improved resource allocation
+ Improving data quality to inform planning
+ Expanding service delivery with innovative information-based tools


Informed Decision-Makers

We will work to enhance the quality and quantity of data and evidence available for policymaking. To "unlock" existing data that is not publicly available, we are seeking innovations in the way data can be accessed, entered, stored, analyzed and communicated. Google.org believes that the transparency that comes with more public information increases checks and balances between citizens and communities, and policymakers. We're focused on:
+ Developing local capacity for data collection and analysis to inform decision making
+ Making existing information more public and useful for planning and advocacy
+ Generating evidence on "what works" and sharing this widely

Fuel the Growth of Small and Medium-Sized Enterprises

Small and medium sized enterprises (SMEs) are critical for creating more equitable economic growth. SMEs create opportunities for more people to participate in the formal economy and help reduce poverty by creating jobs. In many developing countries large businesses have access to formal, bank-based credit and capital markets while households and micro-entrepreneurs have access to micro-loans. This leaves a massive gap known as the “missing middle.”

While SMEs in rich countries represent half of GDP, they are largely absent from the formal economies of developing countries. Today, there are trillions of investment dollars chasing returns – and SMEs are a potentially high impact, high return investment. However, only a trickle of this capital currently reaches SMEs in developing countries. Our goal is to increase this flow.

We want to show that SMEs can be profitable investments. We will do this by focusing on lowering transaction costs, deepening capital markets to increase liquidity, and catalyzing capital for investment.

Lower Transaction Costs: Investing in SMEs in the developing world can be risky and expensive because of the difficulty in assessing entrepreneurs and the lack of standardized information. We will work on developing tools and systems to make it easier for growth capital to flow to these firms.

Deepen Capital Markets: Since there are few opportunities to exit successful SME investments to recoup the upside returns, as well as weak accounting systems and lack of transparency, investors are less likely to make equity investments in the first place. We will invest in information tools and investment mechanisms to increase liquidity in the market for risk capital.

Catalyze Capital: For the reasons listed above, investors are hesitant to invest in SMEs in the developing world. Google.org will invest in funds, partner with financial institutions, and directly support these firms to help make the business case for this sector and help make the market for new financial products and instruments.

Our geographic focus areas are India and East Africa.

While we are not accepting unsolicited proposals at this time, if you are working in the following specific issue areas and are interested in a partnership, please contact us.

+ Tools for better identifying high-potential entrepreneurs
+ Systems or methods for lowering financial transaction costs
+ Technology tools to standardize financial information

The Youngest Mother of the World

Pictured to the left, in 1940, is Lina Medina, her baby, and the doctor who delivered the baby. Her son was 11 months old in this photograhph

Born at full term at Lima's maternity clinic, her child was taken through a caesarian operation done by Dr. Lozada and Dr. Busalleu.

Her son, weighing 2,700 grams or 5.92 pounds, was well formed and in good health. Child and mother were able to leave the clinic after only a few days.

As a result of a disorder known as precocious puberty, Lina Medina, born September 27, 1933 in the small Peruvian village of Paurange, was 5 years 8 months old when she gave birth by cesarean section to her son on May 14, 1939 (Mother's Day of that year). The boy weighed 5 lbs and 9 ozs.

Lina is believed to be the youngest girl in the world to give birth to a healthy, full term baby.

Doctors found that Lina had a menstrual period at the young age of 8 months old. The reason for this disorder is not known. As it's not everyday a 5 year old girl gets pregnant, research on the disorder is hard. Dr. Gerardo Lozada the doctor who delivered her son was astonished.

When asked who the father was, Lina did not give an answer. Many believed her father had molested her and got her pregnant. He was arrested, but because of lack of evidence, the case was dropped.

When her son, Gerardo (named after the doctor who delivered him), was 10 years old he discovered something quite shocking: the girl he believed to be his 15 year old sister was actually his mother.



Gerardo died at the age of 40 in 1979 from bone marrow disease. There is no evidence of the disease having anything to do with the fact that his mother had been so young when she had him.

Lina got married to Raúl Jurado in 1972 and had a second child 33 years after she gave birth to Gerardo. To this day the father of Gerardo is a mystery. Lina's second son currently lives in Mexico.

She was one of nine children born to country folk in Ticrapo, an Andean village at an altitude of 7,400 feet in Peru’s poorest province

A book, written by obstetrician Joseph Sandoval in 2002, who had been interested in her case, brought fresh attention to Medina’s story, and raised the prospect that the Peruvian government may belatedly offer her financial and other assistance. “The government condemned them to live in poverty back in 1939.

Extreme degrees of precocious puberty in children under 5 are very uncommon but not unheard of. Pregnancy and delivery by a child this young remains extremely rare because extremely precocious puberty is treated to suppress fertility, preserve growth potential, and reduce the social consequences of full sexual development in childhood.

Microhoo Wave: Together, Yahoo and Microsoft, can compete Google?

Seattle: Yahoo Inc's purple T-shirt and jeans-clad employees could soon be shopping for dress-shirts and khaki pants.

If Microsoft Corp manages to buy the ailing Internet icon, it faces a clash between Yahoo's free-wheeling corporate culture and Microsoft's more button-down workplace, where even casual meetings often require PowerPoint slides.

That culture clash is just the beginning of the challenges ahead for Microsoft if its $45 billion offer is accepted.

First and foremost, Microsoft must convince Yahoo's best and brightest to bury years of Silicon Valley animosity toward its wealthier neighbor to the north and work together to fight a common enemy: Google Inc.

Meanwhile, Microsoft's top brass will have a Noah's Ark of a Web company -- with two of everything -- that needs to be molded into one cohesive brand.

"It's definitely going to be a long process," said Toan Tran, analyst at Morningstar, noting Yahoo's own restructuring adds another layer of complexity to what already would have been an arduous integration.

Microsoft Chief Executive Steve Ballmer launched his charm offensive on Friday, telling a conference call for analysts that Yahoo employees should be "very, very excited" about Microsoft's offer and that the two companies share a common vision on the Web and will be more competitive together.

The Redmond, Washington-based company tends to breed aggressive executives in the mode of Ballmer, who rarely shies away from a fight, while Yahoo advertises its "irreverence" to prospective employees on a job site, saying "We yodel."

Analysts worry about employees wary of Microsoft leading an exodus of Yahoo talent to Google and others because, unlike mergers of companies with fixed assets and valuable patents, Yahoo's prime asset may be its people and their Web expertise.

"If you are a brainiac engineer within search or any other division within Yahoo, do you want to get usurped into a Microsoft culture where maybe they don't care as much about the Internet?" Bear Stearns analyst Bob Peck said on a call with clients.

"Culture clash will be one of the big things." The two companies tend to view the world in fundamentally different ways. Sunnyvale, California-based Yahoo has always been a Web company, while Microsoft's roots are in selling software that runs on a computer's hard drive.

Microsoft Office and Windows are its core products, providing the bulk of the company's profits. By contrast, its online services division has not turned a profit in two years.

The biggest challenge of all may be how to integrate two companies with significant overlap in Web properties. Analysts questioned whether a joint MSN/Yahoo can maneuver fast enough and make the right decisions within the Microsoft bureaucracy to slice and dice overlapping products like Web e-mail and instant messaging. Yahoo Mail and Microsoft's Hotmail are the No. 1 and No. 3 US Web e-mail companies. Microsoft said it expects to be able to drive $1 billion in "synergies" from joining resources in engineering and research and development, reducing capital expenditures and reducing area of overlap. With so much money at stake, and a potentially long integration, analysts said Microsoft can not afford to repeat some of its past mistakes made in carrying out plans. In recent years, Microsoft's Web services business has undergone a series of management shake-ups and strategic shifts.

It has posted a loss in eight straight quarters and the company says the unit is still in an "investment phase." "What happens when you take a company with a fair to middling performance online and it is the acquirer of a company that has done pretty well historically. Are they going to be able to execute?" said Matt Rosoff, analyst at independent research firm Directions on Microsoft.

A criticism often lobbed against Microsoft is that it confuses consumers with too many Web services brands such as Windows Live, Hotmail and MSN.

Adding Yahoo to the mix would only complicates things. Yahoo, like most of the world's biggest Internet companies, runs many of its services on so-called "open-source" software created by volunteers in the industry. This software is a principal rival to Microsoft Windows and Exchange software.

And Yahoo paid $350 million last September to buy Zimbra, an open-source maker of Web-based e-mail, calendar and collaboration software, that is considered a major rival to Microsoft's Outlook franchise. Morningstar's Tran, who argues the two companies should spin out their Web assets into a separate company, said Microsoft will be pulled in too many directions with different parts of the company seemingly at odds with one another.

"Swallowing Yahoo whole into Microsoft is just not going to work," Tran said.